Sexual violence has increased quite rapidly. Sexual violence can be in the form of physical or verbal violence. The impact of sexual violence causes a traumatic experience that causes physical problems, psychological problems, loss of the future, and causes the risk of death. Nurses have an important role in reducing the impact of sexual violence on victims. The purpose of this study is to describe nursing interventions to reduce the impact of traumatic experiences experienced by victims of sexual violence. This study used a scoping review method. The literature used in this study is from CINAHL, PubMed, and Scopus. Keywords in this study are sexual violence, traumatic experience, impact, and victims. Search strategy used PRISMA Extension for Scoping Reviews to select articles for this study. The inclusion criteria were that the sample was female victims of sexual violence, studies employed a randomized control trial or quasi-experimental research design, and the publication period was of the last 10 years (2013–2022). We found 10 articles that matched the inclusion and exclusion criteria. The findings from this scoping review show that nursing interventions can reduce the impact of traumatic experiences on victims of sexual violence. There are three methods of nursing intervention, namely cognitive behavior, counseling, and web-based intervention. The samples are from developing and developed countries. The range of the samples are from 35–1250 respondents. Nursing interventions focus on victims in order to improve mental health and reduce the traumatic impact experienced by victims of sexual violence. The activities carried out were psychoeducation, keeping a daily journal, and discussions related to the traumatic experiences experienced. Nurses as health workers have a role to provide comprehensive nursing care to victims of sexual violence by taking into account the characteristics and impact of trauma experienced by victims of sexual violence. Cases of sexual violence are now increasing every year. Physical and/or sexual violence against women in 2021 is 26.1%. According to a report by the United Nations Emergency Children’s Fund (UNICEF), in 28 European countries, there are 2.5 million young women who reported having experienced sexual harassment, either through physical contact or not before the age of 15 years . The preSexual violence is any act that appears in the form of coercion or threatening to have sexual intercourse , performs torture or acts sadistically, and leaves someone, including those who are classified as children, after having sexual relations . All behThe negative effect of sexual violence are physical problems and psychological problems. The results of previous research explain that the impact of violence experienced by children who are victims of sexual violence, among others, are that they do not want to go to school and have feelings of low self-esteem, they withdraw from society, and are easily offended and aggressive ,11,12. OPsychological reactions that appear immediately after individuals’ experience with sexual violence include shock, disbelief, denial, feeling afraid, confused, anxious, and withdrawn ,16. AnotBased on the description above, it can be seen that trauma is one of the psychological impacts that is quite serious for victims, not only in the short term but can also last for a long time and cannot be predicted. Treatment of trauma to victims of sexual violence can be done by nurses through several methods ,22. SomeThe impact of sexual violence on the victim can have a traumatic effect that can cause major impacts such as a loss of the future and the risk of suicide. Nurses as health workers need to deal seriously with the impact experienced by victims. However, not all nurses understand the methods that can be used in dealing with victims of sexual violence that have a traumatic impact. So, a study is needed that discusses nursing intervention methods that can be done to reduce the impact of traumatic experience, experienced by victims of sexual violence.This study used the design scoping review. Scoping review is a method that can discuss hot topics that are currently developing. The authors chose this design study because it can cover a wide conceptual range based on the objectives of this study. The steps taken in this study were designing research questions, creating an article search strategy by determining keywords, selecting articles for review, analyzing and describing the results of the scoping review, and preparing a report on the results of this study. The article search strategy in this study used PRISMA Extension for Scoping Reviews (PRISMA-ScR) to select and identify various topics that discuss nursing interventions to reduce the impact of traumatic experiences, experienced by victims of sexual violence.This study conducted an article search through three databases, namely CINAHL, Pubmed, and Scopus. These databases were the largest and most extensive databases of abstracts and citations of peer-reviewed literature: scientific journals, books, and conference proceedings. The keywords used in English were: “nursing care OR nursing intervention” AND “traumatic experience effect OR traumatic effect” AND “victim” AND “sexual violence OR sexual aggression”. The research questions are: What types and how can nursing interventions reduce the impact of traumatic experience on victims of sexual violence?The search strategy and article selection used PRISMA Extension for Scoping Review (PRISM -ScR) to identify types of nursing interventions that can reduce the impact of traumatic experiences on victims of sexual violence . The incData extraction in this study uses manual tables. Manual tables can contain various information needed to describe the results of studies that have been carried out. This table can also be material for writers in making discussion points to make them more comprehensive and focused and make it easier for writers to classify data. The contents of the articles written in the extraction table are the author, year, country, research design, population and sample, procedures, interventions, and results of the study.Quality appraisal is needed in this study to assess the quality of the articles. The quality of the articles was seen by the authors using The Joanna Brigs Institute (JBI) tools. JBI contains statements based on research design to assess the quality of articles. The statement is given a score consisting of yes, no, unclear, and not applicable. Score 1 is for the yes score and score 0 is for the other scores. The author determines the standard quality of articles based on the JBI assessment, which is above 75% for use in this study. All authors double checked to ensure that the articles obtained are relevant to the purpose of this study.The data analysis used a descriptive approach. Data analysis begins with classifying the data obtained based on the study results, then the author describes the study results based on the articles reviewed. All authors reviewed the articles obtained twice to ensure the data obtained were correct. Data analysis is seen from the manual tables that have been made by the authors to see nursing intervention methods for victims of sexual violence and how the effectiveness of interventions is to reduce the impact of traumatic experience. After obtaining the data, all authors analyzed and explained them based on the results of the study.The number of articles obtained from the search database is 299 articles. After duplicating the collected articles, 259 articles were obtained. Furthermore, after elimination based on the inclusion criteria and checking the title and abstract, 21 articles were found. We read the full text, and we found 10 articles to be analyzed. We used the JBI Critical Appraisal Tool assessment method to analyze the quality of articles, and all authors gave a standard score of JBI to the articles to be analyzed as above 75% based on criteria and topic relevance .There were 10 articles that discussed nursing interventions to reduce the effects of traumatic experiences on victims of sexual violence. The research locations in this scoping review range from developed and developing countries. The sample in this study is in the range of 35–1250 respondents. Respondents mostly include women and are still teenagers. We have read and analyzed 10 articles, and we classified the intervention with three programs; these were cognitive behavior, counseling, and web-based intervention. Trauma-Based Cognitive Therapy is a cognitive behavior intervention that utilizes modules in its intervention. The module contains guidance on interactivity, didactic activities, trauma recovery, and problem solving. This module runs over 14 sessions over a period of 14 weeks. Imagery Rehearsal Therapy is one of the cognitive behavior interventions carried out for 12 weeks. The intervention consisted of accepting the traumatic event, health education, role playing, and keeping a daily journal to make the time more productive. The results of the study show that both interventions can reduce the impact of sexual violence.The other two interventions are narrative exposure therapy and Cognitive Behavior Therapy. Both of these interventions were carried out for 8–10 weeks with the intervention having 8–12 sessions. These two interventions are part of cognitive behavior therapy that utilizes psychoeducation, relaxation skills, affective attention, and cognitive coping. The results of the intervention showed that there was a decrease in the negative impact of victims who experienced sexual violence.This study found four counseling programs in reducing the impact of traumatic events on victims of sexual violence. The four interventions are psychosocial interventions, Trauma Recovery Program, Common Elements Treatment Approach, and Trauma-Informed Support, Skills, and Psychoeducation Intervention. Of the four interventions, all were carried out in a time span of 15–18 weeks and 8–12 sessions. Each intervention was carried out in groups and individually. In the group intervention, general information about sexual violence was discussed so that participants have the same perception related to sexual violence. Then, the intervention carried out individually is an intervention that focuses on accepting and solving the problems encountered.Counseling intervention has the aim of building adaptive coping in dealing with stressors in the form of traumatic events due to sexual violence. Participants were also trained on self-confidence about their condition so that they can be productive again in carrying out their lives. The results of the intervention showed that there was a significant improvement in the quality of life for victims of sexual violence.Web-Based Sexual Violence Bystander Intervention and web-based weWomen/ourCircle intervention are two types of nursing interventions in reducing the impact of online sexual violence. This intervention consists of psychoeducation, meditation, problem recognition, and problem solving. Participants are also given space to tell the facilitator stories outside of the predetermined agenda. This intervention was carried out for 12–15 weeks. Any material provided via video can be played repeatedly. Providing Zoom services for asynchronous discussions can also increase the enthusiasm and motivation of participants in carrying out interventions. The results of this intervention study show that there is an increase in the quality of life and a decrease in depressive symptoms in victims of sexual violence.The results of the analysis of the articles are presented in manual form from all authors presented as follow :The results of this scoping review show that nursing interventions can reduce the negative impact of traumatic experiences due to sexual violence. The author classified the results of the study into three nursing intervention methods, namely cognitive behavior, counseling, and web-based intervention. Each intervention is carried out by facilitators, namely nurses and other health workers such as psychologists. The interventions taken in this study are from the last 10 years to obtain the latest types of interventions in reducing the impact of traumatic experiences due to sexual violence.Based on study results, sexual violence often occurs among women. Previous studies have shown that 80% of incidents of sexual violence occur among women . The cauThe interventions in this study were carried out in developed and developing countries. Incidents of sexual violence can occur anywhere, including developed and developing countries. This is in line with previous studies which show that sexual violence often occurs in developing countries . MeanwhiThe intervention in this study was carried out over a period of 8–15 weeks. This long time is used to recover from the trauma experienced by victims of sexual violence. Traumatic disorders make it difficult for victims of sexual violence to concentrate, have difficulty communicating, and have cognitive impairments. Psychological problems occurred for a long time 2 months) ,42. So,  months ,The method of nursing intervention that can be done is cognitive behavior. Cognitive behavior is a form of psychotherapy that aims to improve your thought process (cognitive) and behavior. The results of previous studies show that cognitive behavioral therapy is a form of psychotherapy that has been shown to be effective for a variety of problems, including depression, anxiety disorders, alcohol and substance abuse problems , family Another method that can be used to reduce the negative impact of traumatic experience on victims of sexual violence is counseling. Counseling is carried out by a psychologist or psychiatric nurse as a facilitator. Counseling has an important role in accepting traumatic events experienced by previous victims . The facWeb-based intervention is an intervention that can be done online for victims of sexual violence. This intervention utilizes technology to provide education, training, and discussion to victims of sexual violence. Web-based interventions can reach every individual without being limited by distance and time. So, this intervention process is more affordable and more efficient ; this isThe impact of sexual violence can lead to a decrease in the victim’s mental health. Health workers have a role to play in reducing the negative events and impacts resulting from traumatic experiences, experienced by victims of sexual violence. In addition to the role of health workers, the government also needs to make policies to provide a safe space for every individual and avoid sexual violence.The limitation in this study is that the literature reviewed is limited to the last 10 years (2013–2022), so it cannot discuss literature beyond that period; thus, this study cannot comprehensively discuss interventions. In addition, this study also has further limitations as the design is limited to randomized control trials and quasi-experiments; thus, this study cannot discuss interventions carried out without using this design. These limitations are carried out by the author in order to obtain relevant and up-to-date data sources so that they can be carried out in the present.This study showed that there are 10 articles from three databases that discuss nursing interventions in reducing the impact of traumatic experiences on victims of sexual violence. The methods used in the nursing interventions are cognitive behavior, counseling, and web-based intervention. Activities carried out in the form of psychoeducation, physical activity, meditation for relaxation, daily journals, and problem solving discussions. Nurses have an important role to be facilitators, educators, and counselors in every activity carried out. The implication of this study is that there is a basis for nurses to intervene in victims of sexual violence to reduce the impact of the traumatic experience they experience. In addition, this intervention can also be used as material in making policies on sexual violence by the government and health services. Suggestion for future research are the need for research on the impact of sexual violence experienced by women and the effect of the nursing interventions by women nurses to reduce the negative effect of sexual violence on women with victims of sexual violence.


Chronic obstructive pulmonary disease (COPD) is a respiratory disease that can be treated and prevented. The purpose of this paper is to conduct a meta-analysis of clinical rehabilitation nursing of COPD patients based on intelligent medical care by constructing a suitable model so as to make the research on clinical nursing of COPD patients more effective. This paper first introduced the intelligent medical system, analyzed the clinical rehabilitation nursing of COPD patients, established the SCNet model suitable for this paper, and then used statistical algorithms to carry out the meta dynamic analysis of the clinical rehabilitation nursing for COPD patients. Through the analysis of the current situation of medical equipment and the comparison of models and statistical analysis, the experimental results showed that the pulmonary function indexes of the pulmonary rehabilitation treatment group and the conventional treatment group were improved after treatment compared with before treatment. Although on specificity metrics SCNet did not perform the best, it was about 1% lower than the best baseline model. However, the comprehensive performance of the SCNet model on Acc, Sen, F1-Score, and AP indicators showed that the model SCNet proposed in this paper had certain advantages, which was helpful for the clinical rehabilitation care of patients with COPD and could better assist doctors in treatment. With the development of medical technology, the term intelligent medical care appears in front of the public. In the meantime, China's medical care has developed. Most medical bachelors will also invest a lot of energy in clinical rehabilitation care in order to provide more comprehensive treatment to patients. Smart healthcare is to build a regional medical information platform for health records and use the most advanced Internet of Things technology to realize the interaction between patients and medical staff, medical institutions, and medical equipment, and gradually achieve informatization. At present, intelligent medical treatment has been widely used in the medical field, such as remote consultation, remote surgery, and AI-assisted treatment, and has successfully solved the problem of interaction between patients and multiple parties, and it achieved good results.With the rapid development of domestic medical level today, more attention has been paid to the clinical rehabilitation of patients. COPD is a chronic bronchitis and/or emphysema with characteristics of airflow obstruction, which can further develop into lung common chronic diseases of heart disease and respiratory failure. The application of intelligent medicine to meta-analysis of clinical rehabilitation nursing of patients with COPD also has far-reaching significance for the development and expansion of clinical rehabilitation nursing of patients with COPD. The application range of intelligent medicine is very wide. In recent years, scholars have conducted research on intelligent medicine, but there are relatively few studies on the meta-analysis of intelligent medicine in clinical rehabilitation nursing of COPD patients. Therefore, this paper applied intelligent medical method to the meta-analysis research of clinical nursing of COPD patients, which had both theoretical and practical significance.As the society pays more attention to domestic medical care, more and more scholars have done research on the meta-analysis of clinical rehabilitation nursing of COPD patients. In recent years, Fu C comprehensively analyzed the available evidence on the efficacy of HFNC on exercise capacity, lung function, and other factors related to pulmonary rehabilitation in COPD patients in the article . But theThe innovations of this paper are as follows. (1) In the clinical rehabilitation of COPD patients, intelligent medicine can be used to conduct its meta-analysis research to make the research results more comprehensive and specific. (2) By analyzing the performance of different benchmark models, it is concluded that the SCNet benchmark model is suitable for the study of this paper, and then it is analyzed for the research topic of this paper. Statistics are also used to analyze the two groups of rehabilitation nursing patients.The concept of artificial intelligence was first proposed in 1956. After continuous development and evolution, artificial intelligence has been applied in various fields. It is a new technical science about the study of human intelligence. Among them, medical treatment is one of the fields where artificial intelligence and practice are most closely integrated. The smart healthcare assistant diacrisis system is the product after the combination of the two, which first appeared in 1972 (AAPHELP system). Its main purpose is to improve the work efficiency and clinical competence of doctors. Its core is to accomplish the processing of iatrical data and the extraction of iatrical knowledge through artificial intelligence technology. Smart healthcare mainly covers online and offline systems , as showcheck item, the model will wait for the data input by the user and continue the interaction process with the user; if the recommended action is diagnosis disease results, the model thinks that the current interaction process can end and give the diagnosis results [The overall structure of the interactive intelligent auxiliary diagnosis model and the detailed implementation details of each part are shown in  results .Among them, the smart healthcare based on iatrical images has become a hot topic, and it is the most intelligent auxiliary diagnosis system in the current practical application . This isThis system is composed of peripheral medical equipment, intelligent medical management and service intelligent terminals, communication access network, and health service platform. The system can be used in the following aspects: reading peripheral medical equipment data information, reading patient identity information, entering doctor follow-up information, calling and viewing health files, medical management and service business operations, active push of service information, etc. , specifiCY and obtain key text feature information CYattϵTM. Because the neural attention mechanism can give a neural network the ability to focus on a subset of its inputs (or features). Its specific calculation formula is as follows:E ∈ TM is the training parameter, CYY is the transpose of CY, N is the bias, and R ∈ TK represents the score of K sequence steps in the sequence CY.Aiming at the extraction of various modal information by the intelligent medical system, this paper used the attention mechanism to realize the key feature extraction of text features VATT is used as the weighted feature map, in which XCIT is the multimodal feature representation of the fusion image and text. The formula obtained is:Then, CIT of each modality. However, considering that different feature channels focus on different image information, this model obtains the corresponding weight of each feature channel in the image through the constructed feature channel screening network, in order to focus on the feature channel that is more relevant to the target information [The feature map weight function is calculated through the fusion features ormation . Its strEIT, where E1 and E2 are the training parameters in the fully connected layer. Finally, the learned weights are normalized to obtain the final weights CG ∈ TL2 represents the multi-modal fusion vector of 2L dimensions, and finally get:Then, YO represents the cancer samples correctly classified by the model. YM represents the cancer-free samples correctly classified by the model. GM stands for cancer-free samples misclassified by the model [GO represents cancerous samples misclassified by the model. he model . GO reprThe main clinical symptom of COPD is chronic bronchitis with persistent airflow limitation, and even more severe patients may develop emphysema. In addition, the treatment period of COPD is long, and current moderate exercise, smoking cessation, and pulmonary rehabilitation training can improve the lung function of patients .P > 0.05, after nursing, the lung function was obviously improved, P < 0.05. The details are shown in How important is rehabilitation care for COPD patients? Two sets of data were taken out for comparison. Before nursing, P < 0.05, as shown in The following is a comparison of the nursing satisfaction of the two groups of patients. The nursing satisfaction of the research group was 92%, which was significantly better than that of the control group, which was 68%, In addition, a cognitive questionnaire survey was conducted on patients with COPD in a hospital. The scale was orthogonally rotated by the maximum variance method to extract two common factors, namely, the cognition of self-disease management (F1) and the perception of COPD disease cognition (F2). The eigenvalues of the two common factors were greater than 1, and the cumulative contribution rate was 55.28%, indicating that the validity of the questionnaire was good, and the data collected through the questionnaire could accurately reflect the real status of the respondents' cognition of their own diseases, as shown in Tables The question setting is based on the severity of the disease, the treatment method of the disease and the current disease situation.Most patients do not understand their own conditions and treatment, and lack understanding of their own management .Pulmonary rehabilitation is an individualized comprehensive intervention after a comprehensive assessment of the patient's condition, which mainly includes exercise training, health education, psychological intervention and nutritional support. It aims to improve the physical and psychological status of patients with chronic respiratory diseases. At present, pulmonary rehabilitation is mainly used for chronic obstructive pulmonary disease . StudiesIt mainly writes about the calculation method of entity and attribute distribution. If there are more web pages of two entities, the more they are related .θ before the statistical test is carried out. The resulting distribution. In the absence of any superfluous knowledge, the simplest prior distribution is the mean distribution. If the variable value is generated L times in advance, and then combined with the sample, this is the estimation of the distribution [GDI is the number of diseases with serial number O, and the value of L is 10. When estimating variable distribution, it is judged by the distribution of variable samples. To solve this problem, a prior distribution needs to be added. It is not related to the test results; it reflects the knowledge of other parameters ribution . TherefoThe symptom is similar to diseases, which is calculated as:In the case of statistical disease K, the probability of symptom O occurring is:GH0FK means having a disease K and gender O. The value of L3 is 2.0. The probability of knowing the gender according to the above is the Formula , which GFor age, this paper divided it into 7 intervals. According to different standards, there are different ways to divide age, and the main reference here is the classification method of Google Health. For example, a newborn baby was more important for a few days and a few months. If there was enough data, the statistics of age could be made to a very precise level. But because the current data volume was not much, it could only be divided into 7 intervals . They arGAI represents the figure of emergence of age team O, there is:If O1(DO|FO) represents the distribution obtained from structured data, and O2(DO|FK)represents the distribution obtained from the statistical data of the cases.After determining the respective distributions of the two parts, their results are weighted and combined. The relationship between disease and symptoms, which is the most complex relationship, is used as an example to illustrate. The following formula is obtained:YG refers to the frequency of diseased words. ofg refers to inverse document frequency. For word Y and document F, the word frequency is calculated as:The final assumption is that At present, the research and development of domestic medical service terminal equipment is in a stage of rapid development, but the terminal equipment is generally less intelligent in patients with different diseases, and it has some defects in system interaction and function. Such as fewer self-service terminals, outdated or idle terminal functions, etc. .In 2018, the number of domestic hospitals reached 30,000. Currently, some hospitals in developed eastern coastal cities use self-service terminals more, while in some third- and fourth-tier cities, the penetration rate of self-service terminal equipment is very low. As shown in In order to make a better meta-analysis of clinical rehabilitation care of COPD patients, this paper proposes a benchmark model SCNet and compares it with other models, fully demonstrating its superiority. First, in order to prove that the model proposed in this paper (SCNet) has superior performance compared with single-modal models based on text or image data, in this paper the SCNet model is experimentally compared and analyzed with the single-modal benchmark models for images and text . The resIn the comparison experiment between the SCNet model and the text classification benchmark model, this paper selects the CNN-based text classification model (Text_Cnn), the bidirectional LSTM model and the GRU + attention model as the comparison objects. It can be seen from In order to further prove the superiority of the SCNet model, this paper conducts an experimental comparative analysis between SCNet and the multimodal benchmark model. First, it can be seen from the figure that the accuracy of the SCNet model is better than that of the benchmark model. On the sensitivity metrics in In order to conduct a statistical meta-analysis of various aspects of clinical ConocoPhillips care for patients with COPD, we compared the patients as two groups.Pulmonary rehabilitation treatment group: this group had completed various scales and scores upon admission, and they were tested pulmonary function and given basic treatment according to the guidelines. Conventional drug treatment included respiratory support, oxygen inhalation, anti-infection, expectorant, anti-inflammatory, antispasmodic, and antiasthmatic. From the second day of admission, pulmonary rehabilitation treatment, health education, sputum excretion guidance, etc. were carried out according to the pulmonary rehabilitation treatment plan until discharge. The pulmonary rehabilitation treatment was completed under the guidance and supervision of medical staff. Upon discharge, various scales and scores were completed again to test lung function .Routine treatment group: This group has completed various scales and scores, and they were tested lung function and given basic treatment according to the guidelines on admission. Patients in this group could not undergo any form of pulmonary rehabilitation training during hospitalization. Upon discharge, various scales and scores were completed again to test lung function .Pulmonary rehabilitation regimens were as follows. From the second day of hospitalization, Zheng's recumbent position rehabilitation exercises were performed under the direct supervision of medical staff. Before the training, full-time medical staff distributed pictures and video materials to the patients. The lying position rehabilitation exercises consisted of four movements: stretching. Sit-ups, bridge exercises, air pedaling, and abdominal pursed lip breathing.Patients without carbon dioxide retention and those with percutaneous fingertip oxygen saturation<92% could be kept under nasal cannula oxygen inhalation, while those with carbon dioxide retention could be kept under non-invasive ventilator-assisted ventilation.They were instructed to perform cough, expectoration, and expectoration training. It was advisable to sit or stand upright, with the upper body leaning forward slightly, while slowly pursing the lips and exhaling. After taking a deep inhalation, they should return to the upper body, contract the abdominal muscles, and use abdominal strength to actively cough. They also should cough out the air in the lungs, and stop coughing after 3–5 times in a row. If there was secretion, it should be discharged through the mouth in time and handled properly. Then the pursed-lip breathing method was used to breathe calmly for several times, or they could rest for a while. Next, the above steps were repeated. Small auxiliary instruments also can be used, such as respiratory expectoration valves, to guide effective coughing and promote the discharge of respiratory secretions.Health education is also an essential part of pulmonary rehabilitation. Patient health education is usually carried out by a pulmonary rehabilitation specialist team. The main content is to educate and guide patients and their family members to urge and encourage patients to adhere to pulmonary rehabilitation exercises, and regularly follow up on their health and well-being. The implementation of the exercise program should also be supervised. Patients should be helped to change their unhealthy lifestyles and establish healthy behaviors to promote behavioral changes. At the same time, the patient's family members should be educated about the disease so that they can correctly understand the disease, treat the disease, and maintain a healthy mood. Specifically, it can be divided into the following aspects:Precautions during exercise: transcutaneous oxygen saturation and heart rate should be monitored in real time, and pulmonary rehabilitation training should be stopped immediately. The following situations should be dealt with: first, the heart rate is greater than the target heart rate (target heart rate = (220 − age − resting heart rate) × 50% + resting heart rate). If the patient did not relieve after rest or the patient's heart rate could not fall to the normal range, it was necessary to stop exercising and find the cause of the increased heart rate of the patient. The second was refractory hypoxia, which was still lower than 88% after high-flow oxygen inhalation. Third, the patient had obvious increased shortness of breath, increased dyspnea, chest tightness, chest pain, palpitations, severe headache, abdominal pain, nausea, and vomiting, or they complained of intolerance. Fourth, if the patient's blood pressure dropped significantly below 90/40 mmHg, or the blood pressure rose significantly, exceeding 180/110 mmHg, it is necessary to suspend exercise and be observed. Fifth, the patient fainted and lost consciousness. Firstly, disease education: the knowledge of chronic obstructive pulmonary disease related diseases needs to be explained in order to make the subjects understand the concept of disease and understand their own condition. The patients also should be guided to know the basic drugs and common side effects related to chronic obstructive pulmonary disease, especially the correct use and precautions of inhaled preparations that require long-term use. Knowledge of home oxygen therapy and mechanical ventilation, knowledge about pulmonary rehabilitation can be educated through audio-visual materials, bedside demonstrations, real-life demonstrations, etc., especially the explanation and guidance of exercise therapy, also needs to be popularized. In addition, compliance and satisfaction of patients should be satisfied and they need to be instructed to pay attention to weather changes and changing clothes in a timely manner, avoiding getting cold and preventing colds. It is also important for these patients to avoid going to crowded places to prevent respiratory infections. Moreover, they need to understand the indications for hospitalization for acute exacerbations.Secondly, life education: the subjects should be persuaded to quit smoking and drinking, and avoid second-hand smoke to get rid of irritating gas or polluted gas environment. The connection among smoking, drinking and COPD should also be explained to them so as to help patients develop good living habits. The first point is to stay away from tobacco. Smoking can cause a variety of diseases and accelerate our aging. It can be said that there are no harms and no benefits, so smoking cessation is necessary. It not only to ensure that the patients themselves do not smoke, but also to persuade the people around them to quit smoking, jointly creating a smoke-free and harmless environment. The second point is to avoid contact with the polluted environment. If the occupation requires protection, the inhalation of harmful substances and allergens should be minimized. When cooking at home, it is necessary to try to choose healthy and nutritious methods such as cooking, and avoid deep-frying, barbecue and other methods. They need to reduce travel in hazy days and use air purifiers indoors. They must wear effective filtering masks when going out.Thirdly, diet guide: chronic obstructive pulmonary disease patients are in a state of chronic consumption for a long time, coupled with the decline of digestion and absorption function, long-term insufficient energy intake, abnormal metabolism and so on, resulting in different degrees of malnutrition. In patients with acute exacerbation of COPD will increase consumption due to infection and stress on the one hand, and they may be led to severe negative nitrogen balance because of insufficient nutrient intake and absorption disorder due to impaired gastrointestinal function on the other hand. Therefore, reasonable nutritional support can improve lung function in patients with acute exacerbation of COPD, delay disease progression, and improve prognosis. The prevalence of malnutrition in COPD patients ranges from 20% to 60%. Malnutrition and cachexia may increase the risk of death in patients with chronic obstructive pulmonary disease. Therefore, reasonable dietary advice is of great significance.Fourthly, psychological counseling: Others needs to establish a good relationship with patients. It is necessary to timely understand and master the patients' adverse emotional changes. Timely communication with them is significant in order to effectively ease their moods, avoiding further development of depression. These patients also should be provided with positively social and psychological support in order to help them build confidence in overcoming the disease and correctly understand diseases. In addition, to eliminate anxiety and tension in the face of illness, yoga, meditation and other training to regulate emotions can be carried out appropriately, so as to ensure high-quality and effective sleep. Therefore, a harmonious state of physical and mental balance can be achieved, improving treatment compliance and speeding up the progress of pulmonary rehabilitation.p < 0.05. The normal distribution test showed that the difference between the experimental group and the control group did not meet the normal distribution, the statistical analysis method was paired rank sum test, and the comparison of the therapeutic effect between the laboratorial team and the control team was performed by two independent samples rank sum test.Then all the data were analyzed by SPSS22.0 statistical software, and the data in each group was tested for normality, which were expressed as mean ± standard deviation (mean ± SD). The rank sum test was used to compare the differences between the two groups. The difference was statistically significant with Finally, it was found that the pulmonary function indexes of the pulmonary rehabilitation treatment group and the conventional treatment group were improved after treatment compared with those before treatment, and the differences in the degree of improvement before and after treatment were further analyzed. Among them, FEV1/FVC was the most commonly used parameter to judge whether there was expiratory airflow obstruction. There was no disparate in the degree of change in this value between the pulmonary rehabilitation treatment group and the conventional treatment group, indicating that pulmonary rehabilitation treatment could not significantly improve airflow degree of blocking in COPD patients in the short term. However, FEV1 had the best repeatability in the pulmonary function test and was also the most commonly used parameter for judging the degree of damage. The change of this index in the pulmonary rehabilitation treatment group was more obvious than that in the conventional treatment team, and the disparity was statistically valid, suggesting that short-term pulmonary rehabilitation treatment had a certain effect on delaying the damage of lung function.This article is devoted to the study and design of a meta-analysis of clinical rehabilitation care for COPD patients based on intelligent medicine, and applies it to the analysis of clinical rehabilitation nursing of patients with COPD. This not only expands the scope of intelligent medical applications, but it is also a new attempt to research the complexity of clinical rehabilitation and nursing care for patients with COPD. By comparing the performance of multiple models, it is determined that the model used in this paper is the most suitable for this study. It also shows that intelligent medicine is also a vital tool to study the complexity of the system and has certain potential in the study of the complexity of clinical rehabilitation nursing of patients with COPD. In addition, based on the current situation of the existing medical equipment, the analysis is carried out and the model comparison is added. Finally, the clinical rehabilitation nursing of patients with COPD is analyzed by statistical calculation. For the research of intelligent medical treatment, this paper starts with the introduction of the most basic intelligent medical system and analyzes the structure of intelligent medical treatment. At last, intelligent medicine is successfully applied in the meta-analysis of rehabilitation nursing of COPD patients. This paper uses the benchmark model to find that the best model suitable for this study is SCNet, analyzes the performance of the model in all aspects, and then compares the rehabilitation conditions of the two groups of patients.It is shown that clinical rehabilitation care for COPD patients based on intelligent medical treatment is more effective than single rehabilitation care, and patients can interact better with medical equipment and doctors. This can greatly reduce the patient's unknown to the disease. In specific practical decision-making, hospitals can formulate different clinical rehabilitation care plans through intelligent medical care for patients with different symptoms, which makes rehabilitation treatment more effective and facilitates patients to know their own news.This paper takes the current situation of intelligent medical equipment in a hospital as a case study. First, through statistical and qualitative analysis to determine the current state of medical equipment and comparison of the SCNet model with other groups of models, it can be known that it is the most suitable model for this study. After analysis, it is concluded that the clinical rehabilitation nursing of COPD patients based on intelligent medical treatment is very effective in terms of the degree of recovery of the patients.Through the case study, important conclusions can be drawn: based on the blessing of the intelligent medical system, the clinical rehabilitation nursing of COPD patients will be more comprehensive and effective. The pulmonary function indicators of the pulmonary rehabilitation treatment group and the conventional treatment group are also better than those before treatment. But this is not absolute. For example, in the research on the current situation of medical equipment in this case, there are still many places where intelligent medical care has not been applied. This requires closer study of intelligent medical care in the future in order to conclude solution. The article is a meta-analysis research on clinical rehabilitation nursing of COPD patients based on intelligent medical treatment. The selection of this project is relatively limited, but in reality there are often more choices. In addition, the research application in reality should also be analyzed in combination with a variety of factors, which will have greater value and certainly greater difficulty. But it is undeniable that we always believe that there will be more and more research on intelligent medicine in the medical field, and the domestic medical level will also be higher and higher. The analysis of clinical rehabilitation care of patients with COPD will get better and better.


In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application.We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report.Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ.A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time , (2) layout , (3) questions , (4) pictures , and (5) motivation . Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret.The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. The Norwegian Food-Based Dietary Guidelines (Norwegian FBDG), published by the Norwegian health authorities, aim to reduce the risk of lifestyle-related chronic diseases and promote overall health in the general Norwegian population . There iDigital applications assessing diet and lifestyle behaviors for use in epidemiological and clinical studies are emerging ,6,8-12. To the best of our knowledge, no digital application has been developed to assess dietary intake according to the Norwegian FBDG with integrated personalized feedback reports. We developed the DIGIKOST-FFQ, a short, digital, semiquantitative food and lifestyle frequency questionnaire, designed to assess adherence to the Norwegian FBDG. The DIGIKOST-FFQ is applicable in a number of settings where information on diet and lifestyle is needed. Based on a respondent’s answers to the DIGIKOST-FFQ, a report, known as the DIGIKOST report, is automatically generated and immediately made available to the respondent after completion. It gives individual feedback on the respondent’s adherence to the Norwegian FBDG and on other lifestyle factors, as well as advice on how to fulfill the recommendations.The process of creating new digital dietary and lifestyle assessment tools involves several developmental stages, from defining the different constructs in the questionnaires to making it feasible for use. In addition, new research tools must be evaluated to explore their validity and reproducibility . To evalDuring a focus group interview, the participants are invited to share their views, comments, and perspectives, phrased in their own words and in synergy with the other participants in the group. A moderator ensures that the structure and framework of the interview follow the focus group interview guide ,20.Usability testing is also a key component in the development of digital applications ,22 and iAs part of the development of the DIGIKOST-FFQ, we performed several focus group interviews with healthy individuals and cancer survivors, because both of these groups are expected to be important study populations in future research studies using the DIGIKOST-FFQ. Furthermore, an independent group of healthy individuals was invited to the usability testing of both the DIGIKOST-FFQ and the DIGIKOST report. In the current paper, we present the results from the focus group interviews and the usability testing of the DIGIKOST-FFQ and the DIGIKOST report.The DIGIKOST-FFQ is derived from a paper-based, validated, short, semiquantitative food frequency questionnaire called the NORDIET-FFQ ,24, whicThe DIGIKOST report presents adherence to the Norwegian FBDG in different ways . First, Both healthy adult individuals and cancer survivors were recruited to the focus group interviews, while only healthy individuals were recruited to the usability testing. Healthy individuals were recruited using Facebook announcements, with separate recruitment processes for focus group interviews and the usability testing. Cancer survivors were recruited from an ongoing randomized controlled trial, the CRC-NORDIET study, and from the Norwegian Cancer Society user group panel ,27. The A moderator and 2 researchers from the Department of Nutrition at the University of Oslo (UiO) led the focus group interviews. Recording of the interviews was done with both Zoom and the Dictaphone app for smartphones, which sent all data directly to a secure server, the Services for Sensitive Data , at the University Center for Information Technology (USIT) at UiO . In addiAll transcripts of the recorded focus group interviews were made with f4transkript software  . The traThe usability testing was completed individually and conducted on Zoom with each participant. At this time, the DIGIKOST report was ready for using and testing. A moderator from USIT at UiO led the usability testing, with 2 observers from the Department of Nutrition at UiO taking notes on how the participants completed the planned tasks. The purpose was to test the technical flow of the DIGIKOST-FFQ, from consent and completion of the DIGIKOST-FFQ to opening and printing the individual DIGIKOST reports .Furthermore, after printing the DIGIKOST report, the participants shared their understanding and views of the report  by answeThe current study was carried out in accordance with the Helsinki Declaration; informed consent was obtained from all participants. The Norwegian Centre for Research Data approved the focus group protocol, the usability testing, and the informed consent (277679). All participants signed the informed consent form before completing the DIGIKOST-FFQ, focus group interviews, and usability testing. After accepting the study invitation, the participants were asked to fill out the DIGIKOST-FFQ before the focus group interviews. For the usability testing, the participants did not have access to the DIGIKOST-FFQ or the DIGIKOST report before attending the testing.A total of 20 adults, including 11 women and 9 men, participated in 6 focus group interviews, with 3 to 4 participants in each group. Each interview lasted for 1 to 1.5 hours. The focus group discussions had a natural flow, but were guided by the motivator using the interview guide. Five main themes and subthemes were identified through analysis of the transcripts: (1) the time it took to complete the questionnaire, (2) the layout of the questionnaire, (3) the questions in the questionnaire, (4) the pictures of portion sizes in the questionnaire, and (5) motivations for the participant to fill out the questionnaire .In general, the responses from the 2 groups of participants were similar and addressed the same themes and topics. However, cancer survivors had a harder time reporting physical activity and time being sedentary than healthy individuals. Healthy individuals asked for more questions about plant-based food and a third gender option.All participants completed the DIGIKOST-FFQ within a scheduled time of about 15 to 20 minutes. However, many respondents stressed that the questionnaire should not take more time than this to fill out:I see that I got tired at the end...Healthy female participant; June 22, 2020I noticed that in the end it became more skim reading.Healthy male individual; June 22, 2020However, the participants also stated that the digital format was easier than a paper questionnaire:It is much simpler compared to the whole paper mill where you have to sit for hours to complete.Female cancer survivor; May 8, 2020Both groups agreed that the DIGIKOST-FFQ was easy to navigate and the questions were easy to understand:I think it was easy to navigate and there was a good progression and so, you were not surprised by any of the questions. The questions appeared clear and concise and easy to understand.Healthy male individual; June 22, 2020...and then the question and portion sizes are simple and straight forward. Period.Male cancer survivor; May 8, 2020The advantage of including different kinds of questions in the questionnaire to prevent it from becoming boring and tiring toward the end was also emphasized:I believe in general that it is good if you change the way you ask the questions, so you do keep yourself awake and not just “click” your way down.Healthy female individual; March 23, 2020A questionnaire to be completed with a lot of fun...Healthy male individual; June 23, 2020We observed 2 challenges with the questionnaire: reporting seasonal variation in dietary intake and registering time being sedentary:We are living in a society with big variation according to season. Especially in the north where the access to fruit and vegetables is determined by season.Healthy female individual; June 12, 2020I believe that it is very season dependent what we eat now and what we eat later. In the winter you eat paprika, whereas in the summer you eat strawberries, which has just started now.Healthy male individual; June 23, 2020I found it (sedentary time) seriously complicated to answer, I didn’t have a chance.Female cancer survivor; June 22, 2020I agree (sedentary time), I was very... I have no idea, however then I tried to picture an ordinary day, but I think there were a huge difference between what I pictured and what I noted for an ordinary day, to say it that way.Healthy male individual; June 22, 2020The introductory questions were well accepted by the participants:It worked very well.Female and male healthy individuals; June 12, 2020I think... for my part it fitted very well, you know... I can say “no” to things that I for sure never eat, and when I say “yes” to something, I pretty much found what I eat. However, I am probably more average when it comes to diet [laughter].Male cancer survivor; May 12, 2020It worked very well.Female cancer survivor; April 14, 2020I think it was okay to answer yes or no, I had no problems with that.Healthy female individual; June 22, 2020There were a few alternative answer options that the participants felt were missing from the questionnaire, such as categories for gender:I noticed that there were only two variables [for gender].Healthy male individual; June 22, 2020Yes, in modern society you probably should have a third alternative for gender. And I, working at a health clinic for rare diseases, know that this exists.Healthy female individual; June 12, 2020Moreover, the cancer survivors emphasized the importance of being able to include power naps and transportation time in the definition of sedentary time. It was suggested that a function for summing the different levels of physical activity  throughout a 24-hour period should be included to increase the feasibility of reporting those questions correctly. The cancer survivors also felt that questions were missing about intake of legumes, potatoes, and eggs. Reporting intakes of berries used in homemade jam was also challenging for some, because they were unsure whether to report homemade jam as jam in the questions about spreads or in the questions about berries.There was a request for more text and the addition of grams to each image with portion sizes to increase the accuracy of the reporting. In particular, for some participants, it was difficult to tell some portion illustrations apart, especially portion sizes A and B and portion sizes C and D, as illustrated in Some of the participant responses were as follows:Now we are closing in on where I really missed grams for references.Male cancer survivor; May 8, 2020Beautiful pictures, particularly the berries.Female cancer survivor; April 14, 2020A report about adherence to the Norwegian FBDG, along with a trending curve showing the change in intake over time (for studies where the participants would fill in the DIGIKOST-FFQ repeatedly over time), would have motivated participants in both groups to complete the DIGIKOST-FFQ:I would like to find out more about my diet and lifestyle out of curiosity.Healthy female individual; June 23, 2020I think that some kind of report about your lifestyle, would be great fun.Healthy female individual; June 22, 2020Yes, it is obvious, it is fun to get feedback. See how you are placed... What kind of actions should I take.Healthy female individual; June 22, 2020It would be nice with feedback and compare your current to how you did in previous rounds... see if you have improved or worsened, preferably in tables or figures.Male cancer survivor; May 12, 2020A total of 4 of 5 invited individuals, including 2 women and 2 men, participated in the usability testing. All attendees showed good technical skills. There was wide variation in their educational backgrounds, ages, and residential locations in Norway (data not shown). It took approximately 1 hour to conduct the usability testing for each attendee. All participants completed the 4 test tasks . HoweverThe 3 participants who completed the technical flow testing  of the DIGIKOST-FFQ performed well, but 1 of the participants had minor challenges completing and submitting the DIGIKOST-FFQ .The participants were, in general, positive about the DIGIKOST report . The colThe aim of the health index included in the report appeared to be unclear and difficult to understand for most participants. One participant asked whether the aim was to increase your BMI to achieve a full score by increasing dietary intake. Another participant found it difficult to see the difference between the 2 indices . Some found it difficult to understand the total sum score of 5 points when each component in the score reached only a maximum of 1 point. The participants suggested either improving the presentation of the health index by making it simpler or removing it from the report entirely. The participants liked the use of traffic-light coloring; however, it was pointed out that the colors used could be challenging for individuals who are color blind.All participants reacted positively to the immediate individual response with advice on how to improve adherence to the recommendations, and 1 pointed out that it was very helpful. Another participant suggested reorganizing the responses by presenting the advice on improving adherence to the recommendations first and presenting the recommendations that were fulfilled second.The DIGIKOST-FFQ, with the DIGIKOST report, is the first short digital FFQ and personal report that has been benchmarked against the Norwegian FBDG. The findings from both the focus group interviews and the usability testing showed that the DIGIKOST-FFQ and the DIGIKOST report were overall well accepted and easy to use. However, the study also revealed challenges for users and a need for some improvements. Particularly for the DIGIKOST-FFQ, there were challenges related to reporting seasonal variation in dietary intake over the last year, reporting physical activity, and differentiating images illustrating different portion sizes. FFQs rely on memory and a participant’s conceptualization of portion size and frequency of intake, and these are frequently mentioned as challenges in the literature -35. SeasTo understand the willingness to respond and the motivation to participate in surveys and thereby improve survey effectiveness, de Leeuw et al  used an All participants agreed that the questionnaire should be short and take no more than 15 to 20 minutes to complete to reduce the survey burden and maintain enjoyment and motivation to participate. Previous studies have found that the use of digital dietary assessment tools is perceived as more fun, more motivational to use, and preferable to paper-based dietary assessment tools ,39,40. TOverall, the results from the focus group interviews showed that there were no large differences in the feedback from the healthy individuals and the cancer survivors, indicating that completion of the DIGIKOST-FFQ was equally feasible for both groups. However, some differences in their feedback should be pointed out. The cancer survivors found it most challenging to report daily activities and intake of traditional foods, whereas the challenges identified by the healthy individuals were related more to social status and the lack of questions about novel food products available on the market today. We assume that the differences in the feedback from healthy individuals and cancer survivors might be due to age; however, we do not have information on the age of the participants.The results from the usability testing showed that the technical flow of the questionnaire was good. Most participants found the DIGIKOST reports easy to understand, and all enjoyed the individual advice and recommendations presented in the text at the end of the report. However, some preferred a more visual presentation of the results, such as percentage adherence, rather than the textual information in the table. We speculate that it would be difficult to please all individual preferences on how to visualize the results, and that the solution might therefore be to include both tables and graphics in the report to suit both preferences. The interpretation of the health index varied to a great extent, and most participants found it difficult to understand. Difficulties in perceiving health risk factors presented as percentages or other statistical terms have been documented in patients with low numeracy, whereas interactive graphics may be more easily perceived -43. ThusDIGIKOST-FFQ is accessible from multiple electronic devices, such as personal computers, phones, and tablets, allowing for high flexibility in future use of the tool, minimal respondent burden, and potentially reduced selection bias. Further advantages are a low demand for personnel and economic resources and easy implementation in research settings, including both observational and interventional studies; the literature has reported similar advantages for previous digital questionnaires . MoreoveA limitation of the current study could be that the focus group interviews were carried out by video call on Zoom due to the COVID-19 pandemic, which could have affected the group dynamics and the ability of the participants to freely discuss their ideas. Some participants found it difficult to participate on Zoom due to technical issues and low-quality sound or video, and we speculate that the study population may have been biased toward people with access to high-quality digital equipment and greater technological skills. Nevertheless, the video-call format made it possible to include individuals living across Norway.The focus group interviews contributed valuable knowledge about users’ challenges and led to suggestions for improvements. For instance, in the future, we will include more text about each food item and present food quantities by weight or volume, in addition to pictures representing different portion sizes. Moreover, as most of the participants found it challenging to report intake and activities over the previous year due to seasonal variations, the time frame of reporting will be revised and reduced to the previous 2 months.Several aspects of the DIGIKOST reports were challenging to understand for the participants. Therefore, we will remove the graphics showing achievements as percentages, the health index, and the Healthy Eating Plate recommendations. Moreover, we will add more lifestyle factors to the “individual advice for you” section, such as alcohol intake, smoking, physical activity, and body weight.The DIGIKOST-FFQ and the DIGIKOST report were well received by the participants, who found it easy to log in to and navigate the system and understand the questions. The completion time was acceptable. Changes in the questionnaire and report to address difficulties in recalling dietary intake over the previous year and due to seasonal variation will be implemented. Also, text with additional information on weight or volume will be added to the portion-size pictures. All participants found it motivational to receive personalized feedback reports with dietary advice. The usability testing showed that the log-in system worked well, but that some adjustments were needed to the reports in order to make the personalized feedback more understandable.


Building Information Modeling (BIM) has been increasingly used in coordinating the different mechanical, electrical, and plumbing (MEP) services in the construction industries. As the construction industries are slowly adapting to BIM, the use of 2D software may become obsolete in the future as MEP services are technically more complicated to coordinate, due to respective services’ codes of practice to follow and limit ceiling height. The 3D MEP designs are easy to visualize before installing the respective MEP services on the construction site to prevent delay in the construction process. The aid of current advanced technology has brought BIM to the next level to reduce manual work through automation. Combining both innovative technology and suitable management methods not only improves the workflow in design coordination, but also decreases conflict on the construction site and lowers labor costs. Therefore, this paper tries to explore possible advance technology in BIM and management strategies that could help MEP services to increase productivity, accuracy, and efficiency with a lower cost of finalizing the design of the building. This will assist the contractors to complete construction works before the targeted schedule and meet the client’s expectations. Buildings are constructed with various complicated structures, just like the methodological arrangement of components in humans . A buildAs the respective services have their codes of practice to follow, MEP services are technically more challenging to coordinate in Building Information Modeling (BIM), as compared to the other services such as architectural and structural services ,5. In adBIM is seen as a superior technology compared to traditional CAD, providing a higher level of capability to reduce conflicts in construction sites ,18,19. MThe objective of this paper is to review possible advanced technology solutions in BIM that can further improve the current BIM MEP coordination process and examine possible factors that can affect the BIM coordination process. We first present the research findings that are related to potential limitations in BIM MEP coordination faced by current construction industry sectors, followed by analyzing the solutions to identify the best practical solution. We then provide recommendations for future research in for the modern construction industry.We first provide a summary of important concepts of how BIM aids the modern construction industry. We reviewed a total of 85 publications ranging from 1981 to May 2022. As part of the literature review, we focus on the different technologies and/or software that can be used to enhance the BIM MEP coordination process, as well as automation in BIM—to speed up the clash detection process by removing irrelevant clashes—and strategies to enhance BIM MEP coordination management techniques.As there are different services in a building, it is essential to ensure that there are no clashes when the contractors install their respective services in the building. BIM software is widely used in the modern construction industry to coordinate the different services involved, such as architecture, structural, and MEP systems for energy efficiency calculations, project coordination, and operation and maintenance.BIM is a technique that allows architects and civil, mechanical, and electrical engineers and/or drafters to design, collaborate, consolidate, and show all details on the building/project . BIM canBIM 3D (Design Modeling)This involves all services, such as architecture, structure, and MEP services collaborating on one platform. BIM 3D provides visualization to check for clashes and better communication between all services.2.BIM 4D (Time)BIM 4D helps to plan and schedule data on the amount of time needed to complete the project and provide additional information on time variable schedules, such as contracts, project duration, procurement, and cost of contract. This will provide more details on the sequence of the construction and installation process to make site planning manageable. As the information is shared with everyone who is involved in the project, the contractors will be more prepared when it is their turn according to the schedule. This will improve safety and productivity and minimize buffer and lead time on-site if everything goes according to schedule .3.BIM 5D (Construction Management)BIM 5D can provide a prediction on budget evaluation and cost at the beginning of the project. The cost will also be automatically amended when there are changes to the project. This allows the clients and/or owners to evaluate and track the actual cost used for the project.4.BIM 6D (Sustainability)BIM 6D provides an estimate of energy consumption analysis of the building at the initial design stage. The client and/or owner will know the total cost of their building, which includes the construction cost and estimated cost of energy consumption after the building has started operating. They will then have an idea on how to achieve sustainability to further minimize costs on energy consumption. Therefore, BIM 6D can assist in improving sustainability in terms of minimizing energy usage and enhancing operational management when the project is completed.5.BIM 7D (Facilities Management)BIM 7D helps building owners track vital asset data, such as information on warranty and technical specifications for future usage in facility operations and management. The building owners will be updated on which areas of the building require maintenance. The relevant information in the BIM 7D model can assist the contractors to improve the maintenance process.With these progressions, it will be easier to collaborate with other services, e.g., architectural, structural, and MEP services, and integrate the design together to identify and solve clashes before the start of construction stage  to avoidThe use of BIM has increased by 75% between 2009 and 2014. In 2014, nearly three-quarters of the North American building industry used BIM because it allows relevant personnel who are working on the same project to exchange information within a short period of time, improving project quality and completing construction of a building on time . HoweverThe virtual representation in BIM could be different from how components, such as pipe connectors, are installed on site. This could be due to the pipes/ducts installed on site being different from those shown in the BIM model in terms of dimensions, shapes, and sizes ,32. ThisThe job scope of BIM coordinators includes checking for clashes in the models and bringing them up to the drafters during meetings ,34. The Other than the coordination process, the cost of full-functionality BIM software can be costly for a small designing company. It is more economical to outsource the drawings to a company that has skillful drafters and software to save costs, rather than buying the software and hiring drafters.Revit’s built-in functionsIt is known that at least 60% of organizations execute their coordination operations using a BIM-based strategy . New tecFirst stageFocuses on automated ceiling space that is specially designed to aid MEP engineers in the analysis of available and congested ceiling space for MEP components.Second stageMEP engineers develop rule-based routing with the Autoroute Add-In function to automate and enhance the productivity of the MEP coordination process. The Autoroute Add-In function will send an error to the designer immediately if pipes/ducts that flout the standard code of practice are being drawn. Clearly, the Revit API can aid in the design process becoming more systematic and less laborious, with fewer reported clashes and coordination meetings. Next, BIM MEP models can be built automatically in using transfer laser scanning data through Dynamo, a Revit visual programming plug-in, to auto-detect and auto-recognize the building’s installations . This teA combination of BIM technology and cloud computing interfaceBIM MEP coordination is an essential step in the design stage, as BIM could detect clashes before the contractors install their respective services on the construction site ,6,41,42.Clash detection technologiesOne of the current practices in BIM coordination is using Naviswork software to integrate models created by all services and detect clashes based on the user’s settings ,46. ClasOther than improving technologies, project success also depends on the coordinating methodologies used ,31, typeLee et al.  did a coApart from the BIM coordination process, Tillmann  suggesteBIM can help all services in the construction industry speed up the process of MEP coordination and replace the process of drawing in 2D software. For instance, Park et al.  made a cThe presented methodologies of several case studies in The construction process will be faster when there are fewer parties engaged in a project, when MEP coordination tasks are prioritized and completed in a sequential manner, and when 3D BIM models are created to generate 2D coordinated drawings for submission. In this way, the BIM design coordination management will be more organized, and the respective services will have a better understanding of the project’s requirements. This would lead to a smoother and faster flow of constructing and installing the respective components in the construction site, with minimized conflicts and clashes on site. However, it is not possible to have a small number of people working on a big commercial project. Therefore, technologies and/or other software are required to speed up the BIM design coordination process when there is limited manpower working on the project. A summary of the management strategies that are suitable for both small and large projects is shown in There are numerous papers that explore ways to speed up the design process of architecture and/or structure of the building ,67,68,69With the aid of advanced technology, automation in the BIM coordination process could reduce manual work in modeling, as BIM design coordination is the most complicated process, which can lead to time and cost overruns and construction delays. Lin and Huang  conducteThere are various studies that use machine learning with a hybrid approach in civil engineering ,75,76,77BIM is also a versatile software that may be used in conjunction with a variety of technologies, for example, with the Blockchain technology (BCT) to optimize productivity. BCT maintains a database that keeps information methodically and delivers a copy to all parties involved in the project with legality and safety . The intWhen sophisticated technologies are introduced into BIM, it is beneficial to make recommendations on coordination techniques to further improve the productivity process in the building sector, as illustrated in Furthermore, BIM usage can be extended to facility management (FM). For instance, Cheng et al.  presenteAlthough BIM is a powerful and well-established international tool for those working in the construction-related industry, the physical site condition may differ from the BIM model due to differences in concrete quality and fabrication of ducts and pipes. Therefore, Zhang et al.  stated tIn conclusion, we have reviewed relevant technology advances and management strategies related to BIM design coordination that can help MEP services to increase productivity, accuracy, and efficiency in finalizing the design of building and construction work. Relying solely on advanced technology is insufficient if management tactics in the BIM design coordination process are poor. We have also summarized possible solutions and the different practices found in other countries that can help to save time and minimize problems that delay the construction process. With the aid of advanced technology, BIM has further improved with visual programming that provides future research directions for a machine learning hybrid method to be incorporated into the BIM design coordination process, to further explore the possibilities of enhancing the workflow and coordination of MEP services on BIM. BIM modeling is projected to be 10% faster and 80% more accurate with the help of Autodesk Revit software, as compared to 2D software . However


Fidelity assessment tools can assess whether a program embraces a core set of principles and performs well. A quality fidelity tool with valid scales can be a feedback loop to identify areas that need further work to improve the program. Using data collected from 1816 correctional and reentry programs in the United States in the construction sample and 761 programs in the confirmation sample, this study examined the internal consistency of the Risk-Need-Responsivity (RNR) Program Tool, an online resource to capture information about structural features of a program.The study reports on reliability statistics and factor analyses to highlight individual subscales. Six scales emerged and had acceptable to excellent levels of internal consistency. These scales are staffing, reward-and-sanction, clinical standards for programs, coaching, program duration, and risk-need assessment.This article discusses fidelity scales from the RNR Program Tool and provides guidance on the importance of tool development processes to ensure accurate, valid, and reliable scales. The purpose of the RNR Program Tool is to create a modern, online tool integrating both the empirical (research) literature on effective practices and clinical standards on quality programming. This process minimizes the need for consultants by giving program administrators the ability to gather information on their programs, score them, and receive instant and targeted feedback with recommendations for improvement to assess their programs against empirical standards in the field. Furthermore, it provides a standardized tool that administrators can use to examine what type of individuals fare better in their programs. The provided targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program. Higher quality programs deliver better client-level outcomes  the Correctional Program Assessment Inventory (CPAI), (2) the Correctional Program Checklist (CPC), and (3) the Standardized Program Evaluation Protocol (SPEP). Each tool assesses the quality of the programs but the tools vary in terms of the number and type of item, and sources of information. This section will describe the similarities and differences among the three tools.The CPAI was developed using Canadian programs to measure how well programs were adhering to Gendreau and Andrews’  principlThe CPC was developed on a sample of halfway house programs in Ohio by researchers at the University of Cincinnati  has been previously established for consultants . The goals are to use the diagnostic information to improve resource allocation, reduce inconsistencies in decision-making, structure intake interviews to capture similar important information, and improve the matching of individuals to programs  have been shown to reduce recidivism, and are the preferred style of providing therapeutic services  to psychometrically evaluate the scales of a new fidelity tool, the RNR Program Tool, (2) to utilize psychometric scale development to design the existing scales and improve their internal consistency, and (3) to provide guidance on the importance of psychometrics in tool and scale development. In addition, we report the findings on two sample sets of programs data to illustrate how the scores vary across types of programs. This study is intended to provide program administrators with knowledge about fidelity of their programs. Using data collected from 1816 correctional and reentry programs in the United States in the construction sample and 761 programs in the confirmation sample, this study examined the internal consistency of the RNR Program Tool. Exploratory factor analysis (EFA) and reliability analyses were performed on the construction sample to let the data determine underlying constructs for the measured variables. Then, confirmatory factor analysis (CFA) was performed on a different sample to test and confirm the structure of the identified factors. More details are explained below.The RNR Program Tool was developed in 2009–2011 to provide a self-administered instrument for a broader array of programming that is typically used for justice-involved individuals including cognitive behavioral groups, restorative justice, educational groups, and community services; the tool was designed to assess the fidelity of program components depending on the goal, purpose, and whether the program had a therapeutic orientation(s). The RNR Program Tool includes a number of built-in reliability checks. It does not require consultants to administer it but instead allows agencies and systems to use the tool to broadly examine the quality of their programs and services. Training and certification for the tool are provided by the Center for Advancing Correctional Excellence (ACE!) . Many of the programs were newly awarded grants from the Center for Substance Abuse Treatment  and/or Bureau of Justice Assistance (U.S. Department of Justice). Both granting agencies encouraged their grantees to use the tool to assess the quality of the program. Others are from select jurisdictions that requested the assistance of the ACE! to improve program fidelity. Program staffers completed the tool and agreed to allow the information to be used for research purposes. The data included a construction sample of 1816 correctional and reentry treatment programs in the construction sample and 761 programs in the confirmation sample. The tool involves a self-administered online survey that is stored in a secure database.Data were collected from programs across the United States that agreed to use the Program Tool as part of the RNR Simulation Tool package  estimator. The data were examined based on correlations among variables, parameter estimates, and the model’s fit to the observable data. Model fit was assessed by examining the relative chi-square (chi-square/degrees of freedom), root mean square error of approximation (RMSEA), probability RMSEA, standardized root mean square residual (SRMR), and comparative fit index (CFI) and Tucker Lewis index (TLI). Factor loadings of each item were expected to be 0.40 or greater  is recommended. KR-20 formula is equivalent to performing the split half methodology on all combinations of questions and is applicable when each question is either right or wrong (dichotomous). KR-20 coefficient was measured and reported below.The reliability of an instrument or questionnaire is concerned with the consistency, stability, and dependability of the scores  Program Tool scales established construct validity using EFA and CFA, and had good reliability, with KR-20 reliability coefficients of 0.60 to 0.90. All items were dichotomized to ensure the consistency of the items. The reliability measures can be found in Table Table Internal consistency across almost all factors was high. With the KR-20 coefficient, a score above .5 is usually considered reasonable. Good internal consistency means that the survey items tend to pull together. In other words, a participant who answers a survey item positively is more likely to answer other items in the survey positively Blunch, .The staffing factor consists of 8 items with a high reliability KR-20 coefficient of .90. The reward-and-sanction factor consists of 9 items with a high reliability KR-20 coefficient of .85. Four items loaded into factor 3, clinical standards for programs, with a reliability KR-20 coefficient of .71. Four items loaded together to create a coaching factor (4) with a reliability KR-20 coefficient at .60. Factor 5 has four items representing the program duration with a reliability coefficient of .63. Five items loaded together to create the use of risk-need tools factor with a reliability measure of .86 (factor 6). Total score has a reliability of .91 for the main sample of 1816 individuals and a comparable reliability of .90 for the test sample of 761, which was used for the CFA. Originally, we had expected to have 3 more factors , but they had low reliability, very few items with cross-factor loadings, and the CFA confirmed excluding them. Therefore, number of factors was reconsidered because very few items are insufficient to measure a construct Norton,  and itemCFA was conducted on the items on a different sample of 761 programs to test the hypotheses about the six theorized constructs achieved by EFA, which concurred with expert opinions and theoretical concerns. WLSMV estimator was used within CFA, which is specifically designed for binary, categorical, and ordinal data. As Li  shows, WModel fit was assessed and the results were satisfactory; the collective goodness-of-fit indices pointed to a good fit. Chi-Square Test of Model Fit was 1463.094 with 512 degrees of freedom. Just like the EFA, a large Chi-square value is expected for large sample sizes Brown, ; therefop-value) for the loadings of all six latent variables of the RNR scales. Figure Table Program fidelity is associated with better outcomes, and it is important to assist correctional and treatment organizations – either institutional or community-based – with the tools to understand the degree to which they are implementing quality programs to achieve key client benchmarks , five items for risk-need assessment, eight items for staffing, to nine items for reward and sanctions. Psychometric methods aid researchers to assess if the construct is unidimensional (measuring only one construct) or multidimensional (measuring more than one construct). Collectively, the advancement of rigous scales is an important contribution to the field.Future research is needed to examine the predictive validity for different program outcomes  for each domain and the overall tool score. Predictive validity will examine which of the domains are needed to deliver a high-quality program that contributes to positive client outcomes. We could not perform concurrent validity for this study because there are no other validated instruments that are related to the constructs measured in this study, and we are unaware of any tools that have such items. In another study, we explored how program- and individual-level factors impact the success of 848 drug court clients in nine courts in terms of: 1) graduation rates; and 2) not being arrested while participating in the court program. In this study, we found that three program level factors  predicted recidivism   literature on effective practices and clinical standards on quality programming. Administrators can gather information on their programs, score them, and receive instant and targeted feedback with recommendations for improvement. The targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program. The tool provides an opportunity for administrators to learn aobut their operations and work on specific areas. While the tool has utility for administrators, consultants can also use the tool to provide a solid process for assessing program features. Facilitators or consultants are frequently needed for an agency to critically analyze operations, and in fact external facilitators typically help organizations achieve greater gains (Berta et al., Second, RNR Program Tool scales essentially describe core functions that are important to the program quality in terms of the clinical, management, and/or empirical literatures. And, these core features derive from a myriad of literature in correctional programs, substance use disorders, mental health disorders, educational programs, and social work services. This means that the tool and the resulting scale are valuable to different audiences including programs and services that are operated by other agencies outside of the correctional system. These include practices related to staffing, clinical standards, and use of rewards and sanctions. The scales disentangle the messiness of implementation fidelity into more manageable and targeted components given the goal is to provide administrators with feedback on how to improve their current program. That is, the feedback report will generate scores in each domain and then administrators can use this report to identify program features that need to be strengthened. Targeted feedback reports can be directive and point programs into specific directions for improving their fidelity. This self-administered approaches uses feedback reports as a means of helping administrators identify the aspect of the program that needs improvement.This study illustrates the importance of using accepted psychometrics in developing instruments for justice settings and/or programs that service justice clients. During the development of the RNR Program Tool, EFA and CFA assisted in clarifying the scales. It raised issues regarding the measurement of core variables, which resulted in harmonizing the underlying data to use dichotomous variables. This drove the selection of the KR-20 over the Cronbach’s alpha for measuring reliability. Developers of scales can learn lessons about creating subscales or domains that are empirically and theoretically sound through the use of better psychometric methods. This is important to both the science behind the instrument as well as its utility in the field. More emphasis should be placed on ensuring that instruments are reliable and valid.This study is motivated by the dearth of studies on scales for fidelity tools. Fidelity assessment tools can assess whether a program embraces a core set of principles and performs well. After covering the literature on what we know about fidelity in programming and program impact on client level outcomes, this article discusses the construction of scales for one fidelity tool, the RNR Program Tool, which integrates both research on effective practices and clinical standards on quality programming. This online process gives administrators and consultants the ability to collect information on their programs, score them, and receive instant and targeted feedback with suggestions for improvement in their programs and to evaluate them against empirical standards in the field.The importance of developing accurate, valid, and reliable scales while developing tools is highlighted in this study. A valid fidelity tool is invaluable since it ensures that the underlying scales represent objective items that are useful in assessing the process of a program. Good quality scales can provide a feedback loop to administrators on how to strengthen the program. Consequently, a quality fidelity tool with valid scales can offer an accurate picture of the functionality of a program with guidance on how to improve practice. Furthermore, it provides a standardized tool that administrators can use to examine what type of individuals fare better in their programs. The provided targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program.