Background Postoperative endophthalmitis (POE) is a severe complication of intraocular surgery. This study aimed to evaluate the impact of a surgical safety intervention on the POE rate. Methods In late 2019, a multifaceted surgical safety intervention was established and implemented at the study hospital, targeting all staff involved in ophthalmic surgery. The intervention comprised five components: surgical safety visual cues, periodic training and educational meetings, regulation of surgical instruments, surface microbial sampling, and video-based performance review. We included all patients who underwent inpatient ophthalmic surgery between January 1, 2017 and December 31, 2023, and compared the POE incidence before (2017–2019) and after (2020–2023) implementation. Results A total of 191,657 patients were included. The POE incidence decreased by 64.4% after intervention (pre-intervention: 0.038% [27/71,978], 95% confidence interval [CI]: 0.025–0.055%; post-intervention: 0.013% [16/119,679], 95% CI: 0.008–0.022%; P < 0.001). Poisson regression confirmed a significant downward trend in annual POE incidence with continued implementation (incidence rate ratio [IRR] = 0.619, 95% CI: 0.523–0.733, P < 0.001). The highest POE incidence across the study period occurred in patients undergoing cataract and crystalline lens surgery (0.055% [15/27,098], 95% CI: 0.031–0.091%), and this subspecialty showed a more than six-fold reduction after intervention (pre: 0.132% [11/8344], 95% CI: 0.066–0.236%; post: 0.021% [4/18,754], 95% CI: 0.006–0.055%; P < 0.001). Conclusions Promoting surgical safety through a multifaceted approach is effective and sustainable in reducing the POE rate. This study offers a highly accessible intervention framework to improve the safety of ophthalmic surgeries.

目的 通过在三级专科医院搭建非计划再次手术智能识别系统,形成医疗质量监管"抓手",以降低医院非计划再次手术的漏报率,提高主动上报率.方法 使用头脑风暴、专家访谈等方法总结非计划再次手术的判断逻辑,输入医院信息系统中进行若干轮试运行,不断优化系统判断逻辑,最终使系统能够较为准确地识别出医院所有二次手术中的非计划再次手术.结果 智能识别系统实施后4个月的总识别率达到82.35%.非计划再次手术的主动上报率提升至82.59%,相比系统使用前的同期数据提高56.72个百分点.结论 系统智能识别准确度较高,能够提高医疗质量管理工作效率,减轻管理者筛选非计划再次手术的工作负担,并且形成监管"抓手"机制,有效降低非计划再次手术漏报率,提高主动上报率,进而提高医疗质量.

目的 探讨应用PDCA提高头颈部肿瘤治疗前临床TNM分期评估率.方法 建立改进目标工作小组,了解头颈部肿瘤治疗前临床TNM分期评估率现状,分析影响因素,制定并执行改进措施,检查改进措施执行效果.比较改进措施实施前后在医院住院治疗的头颈部恶性肿瘤患者临床TNM分期评估率.结果 对照组1720份病历的TNM分期评估率为40.87％,观察组1422份病历的TNM分期评估率为93.67％,两组TNM分期评估率的差异具有统计学意义(p＜0.01);不同头颈部恶性肿瘤改进措施实施前后TNM分期评估率的差异均具有统计学意义(p＜0.01).结论 运用PDCA,加强临床培训,结合信息技术,进行监测、督查与反馈,可以显著提高头颈部肿瘤治疗前临床TNM分期评估率.

目的 调查周围性眩晕患者疾病不确定感的现况,并探讨其与社会支持的相关性.方法 采用便利抽样法,选取2021年12月～2022年2月于复旦大学附属眼耳鼻喉科医院就诊的167例周围性眩晕患者为研究对象,采用一般资料调查表、Mishel疾病不确定感量表(MUIS)、社会支持评定量表(SSRS)进行问卷调查.结果 周围性眩晕患者的MUIS总分为(74.24±11.11)分,处于中等偏高水平,SSRS总分为(41.07±7.46)分.周围性眩晕患者MUIS总分及复杂性、不明确性维度得分与SSRS总分及3个子维度得分均呈负相关(P值均<0.05).结论 周围性眩晕患者的疾病不确定感与社会支持密切相关,临床工作者应引导患者主动寻求有力的社会支持,以改善患者的疾病不确定感.

Objective To determine the causes and influencing factors of unplanned reoperation,and put forward countermeasures to reduce the incidence of unplanned reoperation. Methods Based on the information of inpatients undergoing surgery in 2021,a questionnaire was designed. Assign values to the influencing factors of doctor ranking,calculate the average score and rank them by importance. Univariate and bivariate logistic regression analysis of unplanned reoperation in hospitalized patients. Results In terms of the direct causes of unplanned reoperation,postoperative bleeding and infection are the main reason for otorhinolaryngology;Other complications after the first operation,Unsatisfied operation and postoperative infection are for ophthalmology;The direct cause of Plastic surgery unplanned reoperation is unsatisfaction and needs to be operated again. The top influencing factors are the level and difficulty of the first operation（Level 3 and 4 operations）,the first operation is a complex operation,the patient has basic diseases,preoperative evaluation is flawed and the age of the patient. Male patients,elderly patients （≥65 years old） and patients whose first operation is a third or fourth grade operation are more likely to have unplanned reoperation. Conclusion Strengthening perioperative management,establishing an intelligent management system for unplanned reoperation,co-management beneath hospital and department,improving medical personnels’ attention are important strategies to reduce unplanned reoperation.

Objective:To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods:Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory （DHI） at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results:There was no significant difference in baseline data between the two groups （P>0.05）. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores（d₁=-30.22±3.78, d₂=-13.09±4.85, t=-2.799, P<0.05; d₁=-12.43±1.46, d₂=-4.55±2.17, t=-3.043, P<0.05）, while no significant difference was showed in the difference values of DHI-P and DHI-E scores（P>0.05）. There was no significant difference in incidence of fall between two groups（P>0.05）, but the incidence of experimental group decreased significantly compared with that before treatment（4.35% vs 34.78%, χ²=4.973, P<0.05）. No serious adverse event was reported in the two groups. Conclusion:Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.

近年来在多项政策支持及医院管理创新浪潮的带动下,医院医保管理正逐步向精细化迈进,但这些精细化管理手段尚未形成一套有机体系.本文在阐述了体系的优势及构建医保精细化管理体系必要性的前提下,着眼于三级医院,围绕医保精细化管理体系的构建原则、构建意义及体系大致框架几个方面展开讨论,并构建了初步的医保精细化管理体系,力求为医院医保管理领域的相关研究打下基础及提供参考.

Objective:To cross-culturally adapt the Meniere's Disease Outcomes Questionnaire（MDOQ） into Chinese language, to evaluate its reliability and validity, and to apply in clinical. Methods:The MDOQ was translated according to the Brislin model. Cross-cultural adaption was done by expert discussion and pilot study. The MDOQ was applied to 101 patients to test its reliability and validity. The quality of life（QOL） of 272 patients was measured by MDOQ-C, analyzing the influence factors of QOL of patients with Meniere's disease. Results:The CR value of each item of MDOQ-C exceeded 3.00, the Cronbach's α coefficient was 0.88, and the Spearman Brown coefficient was 0.90. The Pearson correlation coefficient of MDOQ-C and the DHI was 0.803（P<0.01）. Three factors were extracted by factor analysis, which could explain 60.503% of the total variance. The dimension composition was different from the original scale. The average QOL score of Meniere's disease patients was 52.94±13.87. The main influence factors were age, marital status, work status, with tinnitus and the number of vertigo attacks. Conclusion:The MDOQ-C is reliable and valid. After dimension reconstruction, MDOQ-C can be used to evaluate the QOL of patients with Meniere's disease. Through the preliminary clinical application, the influence factors of quality of life of patients with Meniere's disease were identified, thus providing reference for optimizing clinical management strategies.

目的 引进、汉化喉切除术后吞咽结局(Swallowing Outcome After Total Laryngectomy,SOAL)量表,并检验其信效度.方法 根据Brislin翻译模型对SOAL量表进行翻译和回译,通过专家咨询和预调查对中文版SOAL量表进行文化调试和修订.2019年12月—2020年8月对上海市4所三级甲等医院耳鼻喉科门诊复诊的180例全喉切除患者进行调查,验证中文版SOAL量表的信效度.结果 中文版SOAL量表各条目水平的内容效度指数为0.80～1.00,量表平均内容效度指数为0.99.以中文版安德森吞咽困难量表为校标,校标关联效度为-0.785(P<0.001);已知组群效度分析,不同治疗方式的患者SOAL量表得分差异有统计学意义(Z=-7.533,P<0.001),不同进食性状的患者SOAL量表得分差异有统计学意义(Z=-5.453,P<0.001).总量表的Cronbach'sα系数为0.867;重测信度为0.847.结论 中文版SOAL量表具有良好的信效度,适用于全喉切除患者吞咽状况的自我报告,为个性化康复护理方案的制订提供依据.

目的 探讨全喉切除术后患者吞咽障碍的影响因素及其与体质量变化的相关性,为全喉切除患者的吞咽康复及营养支持提供参考依据.方法 2019年12月-2020年8月,采用便利抽样法,选取于我院耳鼻喉科门诊复诊的114例全喉切除患者为研究对象,采用一般资料调查表,中文版安德森吞咽困难量表(MDADI)对全喉切除术后患者进行调查,同时测量患者复诊当日的体质量.结果 全喉切除术后患者安德森吞咽困难量表总分得分为(72.98±6.51)分;多元回归分析结果显示,有无辅助放疗、术后时间及肿瘤分期是全喉切除术后患者吞咽障碍的主要影响因素;全喉切除术后患者安德森吞咽困难量表总分与体质量变化差值呈显著正相关(r=0.302,P＜0.01);多元回归分析结果显示,吞咽困难状况、术后时间、术前BMI及高血压是全喉切除术后患者体质量恢复的主要影响因素.结论 全喉切除术后患者吞咽困难状况越严重,患者的体质量恢复情况越差.因此,临床医护人员需要及时评估全喉切除术后患者的吞咽状况,特别关注有辅助放疗的全喉切除患者,并在术后早期及时采取具有针对性的吞咽康复措施,旨在提高患者的吞咽相关生活质量,进而促进术后患者体质量的恢复,以改善全喉切除术后患者的临床结局.

目的 建立一套由护士主导的前庭康复训练护理策略,明确其对前庭失代偿症状的治疗效果.方法 本研究为前瞻性,选择2018年1—12月在复旦大学附属眼耳鼻喉科医院就诊的前庭失代偿患者48名,随机等分成对照组(常规康复训练组)和实验组(护士主导的前庭康复训练组).所有患者在入组时及治疗后2、4、8周各进行一次前庭功能检查,填写眩晕残障程度评定量表(Dizziness Handicap Inventory,DHI)、特异性活动平衡信心量表(Activities-specific Balance Confidence Scale,ABC)和焦虑自评量表(Self-Rating Anxiety Scale,SAS),并比较8周内两组患者自主进行前庭康复训练的总次数.结果 两组患者前庭失代偿症状治疗后较治疗前均有所改善.同组不同时间点前后对比显示:实验组的前庭平衡功能不良率于治疗后2周、眼震电图异常率在治疗后8周出现明显下降(P<0.05).实验组3种量表评分在治疗后2周均出现明显好转(P<0.05).对照组DHI和SAS量表评分在治疗后4周出现明显好转(P<0.05).依从性方面,实验组患者居家自主练习次数显著高于对照组(P<0.05).结论由护士主导的前庭康复训练能更早地改善患者的前庭失代偿症状,缓解患者焦虑抑郁情绪,提升患者平衡信心.

目的 翻译前庭活动与参与量表(Vestibular Activities and Participation,VAP)并评价其信效度.方法 采用Brislin模式对量表进行翻译,形成中文版VAP量表.对422例良性阵发性位置性眩晕患者和40例前庭康复患者施测,基于Rasch模型分析量表的信效度.结果 中文版VAP量表由活动维度(8个条目)和参与维度(4个条目)构成,维度构成与原量表不同(原量表两个维度各含6个条目);中文版VAP量表两个维度信度均>0.8,分离指数>2;两维度条目难度分布相对集中(均值Logit 0.00±0.19、Logit 0.00±0.30),个体能力相对较广(均值Logit-0.43±1.99、Logit-0.17±2.30);前庭康复前后量表得分差值为5.49分,效应量为0.87(P<0.01),标准化反应均数为0.85.结论 中文版前庭活动与参与量表维度构成与原量表不同,经重构后信效度良好,难度适宜,且具有较好的反应度,可作为评价前庭疾病患者活动与参与功能的有效工具.

自20世纪以来，听力损失逐渐受到人们的关注，相关的评价量表大量问世，种类繁多，但临床应用上存在较大困扰。本文基于ICF框架，对目前应用较广的听力损失患者报告结局测量工具的主要内容、心理测量学属性和特点进行了综述，为临床快速选择、规范化使用这些工具提供参考依据。.

Background: Patients who had total laryngectomy not only have a pressure from the possible diagnosis of laryngeal cancer, but also suffer from unspeakable misery. To relieve the suffering, some patients choose esophageal speech training. However, most of the current researches focus solely on the results of the training with the negligence of the patients’ mental health and their life experience during the training. A qualitative research is highly sensitive to patients’ subjective feelings, and thus able to capture their subtle emotional changes. Objective: To explore deeply patients’ real experiences of esophageal speech training after total laryngectomy and reveal the public their training experience of the unique and special group. Methods: In May 2018, researchers conducted a two-month field observation on and in-depth interviews with 15 patients who were on esophageal speech training after total laryngectomy in the esophageal speech training room of the Eye and ENT Hospital of Fudan University. The research applied phenomenological research method and Colaizzi Data Analysis. Results: The data analysis indicated four main themes: changes of mindset; showing positive attitudes and behaviors in training; shift in social relations; and arduous training process. Conclusion: The study has the finding that patients on esophageal speech training had negative emotions in the early stage of the training and dissatisfaction with its teaching. The repercussion of the surgery brought them changes of social relations, social bias and prejudice ensued. It is, therefore, urgent and crucial to give the speech trainees psychological counseling in the early stage to improve their qualities of life, to mobilize social support to incentivize their training, to optimize esophageal speech training teaching, and to regulate the management of the esophageal speech training environment.

Introduction Dizziness is one of the most common symptoms seen in chronic vestibular syndrome, which has been linked to an increased risk of falls, substantial disability and negative psychological consequences. Recent evidence demonstrated that vestibular rehabilitation therapy (VRT) is effective for treating chronic vestibular symptoms. However, the delivery of VRT remains challenging because of lack of facility, insufficient qualified physiotherapist resources, as well as being in the actual situation of the pandemic. WeChat, the most widely used mobile app in China, offers a more viable way of delivering VRT than traditional office-based approaches do. This study aimed to evaluate the effectiveness of the WeChat-VRT programme for patients with chronic vestibular syndrome. Methods and analysis This is a parallel-group, assessor-blinded randomised controlled trial. Fifty patients who experienced chronic vestibular symptoms longer than 3 months will be randomised into either the WeChat-VRT group or the usual care (UC) group. Participants in the WeChat-VRT group will receive 8-week VRT mainly through the WeChat app. Participants in the UC group will receive once-weekly VRT in the clinic for 8 weeks and remaining time home-based exercise. Outcome assessments will take place at baseline and at the 8th, 12th and 24th weeks after randomisation. The primary outcome will be the change from baseline to the eighth week on the patients’ functional improvements quantified by the Functional Gait Assessment (FGA). The secondary outcomes will include dynamic balance function, emotional well-being, and vestibular activity and participation level. Intention-to-treat analysis will be performed using generalised estimation equation modelling. Ethics and dissemination The trial has been reviewed and approved by the Institutional Review Board of Eye and Ear Nose Throat Hospital of Fudan University (reference number 2017047/1). The study findings will be disseminated via peer-reviewed journals and conferences. Trial registration number ChiCTR2000029457; Pre-results.

Objective To systematically review the influencing factors of nutritional status in patients with head and neck cancer(HNC). Methods Researches on influencing factors of nutritional status in HNC patients were retrieved in databases,such as PubMed,EBSCO,Web of Science,CNKI,WanFang Data and Chinese Biological Medicine(CBM)by computer from January 2010 to July 2018. Quality assessment, content extract and analysis was carried out for literatures met inclusive criteria. Results Finally,a total of 19 researches were included.Qualitative analysis and simple correlation showed that those researches involved 47 factors,the influencing factors of nutritional status included the reduced ingestion,high levels of weight and body mass index(BMI)before treatment,low levels of hemoglobin and serum albumin,swallowing problem,thirst,sense problem,constipation and oral mucositis;23 factors of them were with varying degrees of influence,such as the ages,males,education levels and drinking. Multivariate analysis showed that those researches involved 35 factors;the influencing factors of nutritional status of HNC patients included the radiotherapy types/technology and swallowing problem;17 factors of them were with varying degrees of influence,such as the ages,habitation and smoking. In simple correlation and multivariate analysis,swallowing problem was the only factor with statistical differences in two kinds of analysis;the ages,tumor stage,tumor location/kinds of disease,grades of T and N,complications after radiotherapy and adverse reactions were only with statistical differences in simple correlation but without statistical differences in multivariate analysis. Conclusions Nutritional status of HNC patients is influenced by many factors and influence of most factors is uncertain with great individual differences. Influencing factors of nutritional status of HNC patients and mechanisms need to be explored and expounded respectively by further studies,especially pay attention to swallowing problem of HNC patients.

目的 探讨我国言语和吞咽康复临床护理专家的培养框架,包括角色定义、准入标准、培养内容和具体岗位职能等.方法 采用文献回顾法结合Delphi法对19位耳鼻喉科专家、临床护理管理者、耳鼻喉科资深护士进行函询,直至专家意见达到基本统一,最终将三轮专家函询意见汇总后构建言语和吞咽康复临床护理专家的培养框架.结果 三轮专家函询问卷回复率分别为79.17％、100.00％、100.00％,专家权威系数均为0.88.确定了耳鼻喉科言语和吞咽康复临床护理专家的定义、准入条件、15项专科课程及18个基于Hamric核心能力的角色职能.结论 函询专家积极性和权威程度均较高,函询结果可靠,研究构建的言语康复临床护理专家的角色定义、准入标准、培养内容和岗位职能符合我国国情和高级护理实践本质.

目的:探讨多学科营养管理团队在头颈癌住院手术病人的应用效果. 方法:238例头颈癌病人按住院时间分为对照组125例和观察组113例.对照组进行常规营养指导,观察组在住院期间多学科营养管理团队对其进行营养管理及干预.术后每周使用人体成分分析仪对病人进行营养指标监测.比较两组病人在术后1周、术后2周营养指标的变化. 结果:通过实施多学科营养管理团队,观察者组病人术后1周的体质量、去脂体质量、骨骼肌含量和蛋白质含量变化均较对照组有明显改善(P＜0.05);术后2周的体质量、去脂体质量和蛋白质含量变化均较对照组有明显改善(P＜ 0.05). 结论:实施多学科营养管理团队能有效改善头颈癌手术病人住院期间的营养状态.

Objective:To translate the English version of vestibular rehabilitation benefit questionnaire （VRBQ） into Chinese, and to test its reliability and validity. Method:The VRBQ was forward and backward-translated according to the Brislin model. Cultural adaption was done by expert discussion and pilot study. The scale was applied to 158 patients to test its reliability and validity. Result:The Cronbach's α coefficient was 0.90, and the test-retest reliability was 0.98, the total scale responsiveness is 2.066. Chinese version of VRBQ consisted of 22 items. Four factors were extracted by factor analysis, which could explain 73.341% of the total variance. Conclusion:The Chinese version of VRBQ is reliable and valid, therefore can be used to evaluate the quality of life and rehabilitation efficacy of patients with vestibular dysfunction in Chinese cultural background.

This article introduced National Database of Nursing Quality Indicators(NDNQI)from following aspects,such as establishment background,basic structure and application progress in nursing quality evaluation.And it was put forward that China′s national health department or national nursing association should take leads in the research, development and construction of national nursing quality index database platform.In addition, the data collection and feedback analysis of each indicator should be completed,thus to achieve continuous improvement of care quality under the background of big data platform.