Objective To explore the significance of case managers using WeChat platform in the treatment process and extended care for patients with laryngeal cancer.Methods From November 2014 to May 2015, 30 patients with partial resection or total resection of laryngeal cancer in the department of head and neck surgery were selected as a research subjects.Case managers provided fully supports,such as establishing WeChat group,replying online consultations,popularizing health education knowledge,providing psychological counselings.Psychological assessment of the patients was conducted by social support scale(SSRS)and anxiety scale(SAS)in the beginning of case management.Results comparison was performed before and after three months intervention.Results The score of subjective support of patients before intervention was (25.13 ±4.81)points,which after intervention was (28.33 ± 4.41)points.The score of support availability before intervention was (7.20 ±1.99)points,which after intervention was (35.27 ±5.90)points.The differences were statistically significant(t =-2.685,-5.280,2.917,all P <0.05).Conclusion The WeChat platform mediated by the case management is effective in the management of the psychological health of patients with laryngeal cancer,which can effectively promote the rehabilitation of patients.

Stigma is common in patients with head and neck cancer, which greatly affects their physical and mental health and the quality of life. This article summarizes the research progress of stigma in patients with head and neck cancer from the aspects of research status, measurement tools, influencing factors and intervention strategies, in order to provide a reference for carrying out the research on stigma in patients with head and neck cancer in China.

Objective To explore the effects of collective neck and shoulder exercise in early function exercise rehabilitation of patients with thyroid cancer after surgery. Methods According to the patient′s admission time order, the first 76 cases were regarded as the control group, and last 80 cases as the observation group. Patients in the control group adopted routine early postoperative functional rehabilitation, while patients in the observation group adopted self-designed collective neck and shoulder exercise to realize early functional rehabilitation. Cervical wound drainage, neck scar and neck movement degree were compared in two groups before and after the intervention.Results The volume of wound drainage of patients in the observation group was (8.41±2.2) ml, and in the control group was (8.35±2.3) ml (P>0.05);1 month after surgery, the score of wound scar in the observation group was (6.80±2.86) points, and was (7.00±2.24) points in the control group ( P>0.05) . After surgery, the neck movement degree of bending to healthy side in the observation group was (36.2±11.0)°;the degree of rotation to healthy side was (52.3±12.2)°;they were all greater than that in the control group (P<0.05).Conclusions Collective neck shoulder exercise can improve the early rehabilitation of neck function in postoperative patients.

Objective To evaluate the risks of malnutrition and nutritional status of patients with esophageal cancer during radiotherapy , so as to explore nursing countermeasures to improve their nutritional status.Methods 60 inpatients with esophageal cancer receiving routine radiotherapy from June 2012 to April 2013 were investigated with anthropometric indicators and laboratory data for weekly nutritional evaluation on admission, during radiotherapy, and after radiotherapy.Meanwhile, the patients were conducted with Nutritional Risk Screening ( NRS2002 ) per week .Results NRS2002 score showed that the malnutrition risk values of patients with esophageal cancer gradually increased after radiotherapy .The score was (2.06 ±1.22) after 2 weeks of radiotherapy, suggesting that the difference was statistically significant (t=-2.457, P<0.05). After the radiotherapy , the scores of body mass index ( BMI ) , triceps skinfold ( TSF ) , arm circumference (AC), total protein (TP), albumin (ALB) and total lymphocyte count (TLC) were (20.21 ±2.69)kg/m2, (7.27 ±3.20)mm, (24.71 ±2.68)cm, (65.50 ±5.25)g/L, (38.48 ±5.00)g/L and (6.55 ±3.42) × 109/L, respectively, compared with those of admission , they decreased gradually in the subsequent weekly examinations and had statistical significance ( t=3.204,2.777, 3.053,7.174,5.685,12.508, respectively;P<0.05).After 2 weeks of radiotherapy, the incidence of malnutrition increased compared to that of admission, and the scores of TSF, TP and TLC were 95.00%, 11.67% and 98.33% respectively, which showed the statistically significant difference (χ2 =11.800, 7.792, 73.024, respectively; P <0.05 ). Conclusions Patients with esophageal cancer gradually have higher risk of malnutrition and worse nutritional status during radiotherapy and their incidence of malnutrition increased after 2 weeks of radiotherapy .

Objective To investigate the teaching effects of flipped class model on the Surgery Intensive Care Unit (SICU) nurses' ability of autonomic learning. Methods From July to December 2015, a total of 38 nurses who worked in SICU of Zhejiang Cancer Hospital were selected as the research objects by convenience sampling method. The nurses were trained in postoperative pain management knowledge by flipped class model, and were evaluated before and after the training by rating scale of self-directed learning competence for nurses. Results The total score of rating scale of self-directed learning competence for nurses, self motivation belief, task analysis, self monitoring and regulation, self evaluation were (128.26±18.69), (54.50±7.65), (22.05±3.66), (37.57±5.82) and (14.13±2.67) after the training, which all improved than (108.89±15.71), (47.18±6.61), (18.03±3.33), (31.37±5.24) and (12.32±2.14) respectively before training. The differences were statistically significant (t=-4.889, -4.460, -5.013, -4.883, -3.266; P<0.05). Conclusions Flipped class teaching model improves nurses' autonomous learning ability comprehensively and provide a new teaching mode for nurses' training.

Objective To explore the reasons and influencing factors of unplanned removal of implantable venous access port (IVAP) in tumor patients, and analyze its influencing factors, so as to explore the corresponding clinical interventions. Methods A total of 1 029 cases of tumor patients who were implanted IVAP in Zhejiang Cancer Hospital from January 1st, 2009 to December 31st, 2016 were recruited by convenience sampling method. Univariate analysis and Logistic regression analysis were applied to analyze the influencing factors of unplanned port-taking. Results Finally 1 002 tumor patients were recruited excluding patients who died or lost follow-up. Excluding patient's subjective factors, catheter-related blood stream infection (CRBSI), catheter clamping syndrome, and pain around infusion seat were the main causes of unplanned removal of IVAP. Univariate analysis revealed that there were significant differences in unplanned port removal among patients with different catheterization veins, infection and coagulation function (χ2=15.691, 14.425, 16.732; P＜ 0.001). Logistic regression analysis showed that internal jugular vein catheterization (OR=8.272), infection (OR=2.592) and coagulation (OR=2.709) were the main factors. Conclusions Medical staff should strictly control the causes and influencing factors of unplanned removal of IVAP when implanting and maintaining the use of IVAP for patients, so as to prolong the use time of infusion port.

Objective? To construct the objective, scientific and practicable self-management assessment indicators for cancer patients with oral chemotherapy at home so as to provide a basis for medical staff to pertinently carry out self-management education and guarantee safety of patients with oral chemotherapy agents well. Methods? From July 2017 to June 2018, we preliminarily drew up the assessment indicators based on self-management theory by document analysis, semi-structured interviews and expert group discussion. And then, we determined the self-management assessment indicators for cancer patients with oral chemotherapy at home by two rounds of 18 experts enquiry with the method of Delphi. Results? Among two rounds of enquiry, the questionnaire recovery rate was 100% with high expert initiative. The expert authority coefficient and the coordination coefficient were 0.83 and 0.192 respectively (P＜ 0.05). Finally, a total of 5 primary indicators and 38 secondary indicators were determined. Conclusions? The self-management assessment indicators for cancer patients with oral chemotherapy at home are scientific and reliable which are convenient for medical staff to understand patients' self-management and to provide high quality of nursing for cancer patients with oral chemotherapy at home.

Objective:To explore the incidence and risk factors of peripherally inserted central catheter (PICC) related upper extremity venous thrombosis (UEVT) in patients with head and neck neoplasm so as to provide a basis for preventing thrombosis.Methods:This study used the design of prospective cohort study. From January 2016 to March 2018, UEVT follow-up examination by B ultrasound was carried out for 1 137 head and neck neoplasm patients with PICC selected by convenience sampling. Single factor and multivariate Cox regression were used to determine the risk factors of PICC related UEVT.Results:There were 3.6% (41/1 137) of patients with PICC related UEVT. Multivariate Cox regression showed that the independent risk factors of PICC related UEVT included the older patients ( RR=1.04, 95% CI: 1.01-1.07, P=0.013) , being with a history of PICC catheterization ( RR=3.22, 95% CI: 1.53-6.77, P=0.002) and high frequency of catheter delivery ( RR=1.98, 95% CI: 1.30-3.00, P=0.001) . Conclusions:Patients with head and neck neoplasm have the low incidence of PICC related UEVT. The independent risk factors of PICC related UEVT in patients with head and neck neoplasm include the older ages, history of PICC catheterization and high frequency of catheter delivery. Positive intervention should be carried out for those patients which may reduce the incidence of PICC related thrombosis.

Objective:To construct a risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors, so as to provide an effective reference for clinical implementation of flap necrosis risk screening.Methods:The overall study period was from December 2020 to June 2021. Based on evidence, the item pool of the risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors was preliminarily established. Using the Delphi method, 16 experts engaged in flap transplantation were selected for three rounds of consultation, and the risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors was initially established. The weights were given to all indicators through the paired comparison.Results:In the first round, 16 questionnaires were distributed, and 15 valid questionnaires were recovered. In the second and third rounds, 15 questionnaires were distributed, and 15 valid questionnaires were recovered. Expert authority coefficients of the three rounds of expert consultation were 0.851, 0.853 and 0.853, respectively. The Kendall coordination coefficients of the three rounds of expert consultation were 0.377, 0.302 and 0.302 ( P<0.05) . The final constructed risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors included 3 first-level indicators, 8 second-level indicators, and 32 third-level indicators. The weights were assigned to each indicator by paired comparison, and the weights of the first-level indicator patient factor, treatment factor, and nursing factor were 0.36, 0.38, and 0.26, respectively. Conclusions:The risk assessment scale for flap necrosis after flap transplantation in patients with head and neck tumors constructed by combining evidence-based and Delphi method is highly scientific and reliable. Its clinical applicability and effectiveness can be further verified in the future clinical flap evaluation process.