Objective To identify the effect of specialized language training on the speech rehabilitation of total laryngectomy (TL)patients.Methods Twenty-seven TL patients were trained for esophageal speech by specialized speech-language pathologists from October 2005 to December 2006.Then the participants were followed and evaluated their esophageal speech level after one cycle of training program,1 month,3 months,6 months and 12 months after training program.Results The score of participants' esophageal speech was steadily improved during the 12 months after participating the training program.The score of esophageal speech greatly increased in the third month,and this significant improvement was kept until 12 months after the training program.The esophageal speech quality was negatively correlated with age and surgery area of patients.Conclusions Specialized speech-language training showed positive effect on esophageal speech rehabilitation,and esophageal speech training by specialists is worthy of wide application.

Objective To evaluate the status of self-efficacy and its influencing factors in adult patients with low vision,then explore an effective approach to improve their self-efficacy levels.Methods Seventy adult patients with low vision were sampled by random number table method.General social-demographic questionnaire and self-efficacy questionnaire were used to investigate these patients' general information and self-efficacy.Seventy pieces of questionnaires were issued and returned with the valid rate of 100％.Results The total score of self-efficacy in seventy adult patients with low vision was(16.25:±:1.93) points,92％ of patients had a low level of self-efficacy.The influencing factors of self-efficacy in adult patients with low vision were the attitude toward disease,mental status and gender.Conclusions The selfefficacy in patients with low vision was affected by many factors at different levels,so we should focus on main influencing factors to adopt corresponding nursing measures in order to improve self-efficacy of adult patients with low vision.

Objective To evaluate the diagnostic value of low-dose volume perfusion imaging with 320-detector CT in differentia-ting solitary pulmonary nodules (SPNs).Methods 130 patients with 130 SPNs (79 malignant tumors,1 6 active inflammations,1 6 benign nodules and 1 9 chronic inflammations)underwent contrast-enhanced dynamic volume perfusion CT prospectively.50ml of contrast medium with iodine concentration of 370 mg I/mL was injected at a flow rate of 5 mL/s,and the scan began at 0 second or 4 seconds after the bolus injection.20 or 21 intermittent low-dose volume acquisitions were made with 2 s intervals,and the total ac-quisition time was 38 s or 40 s.Post-procession was performed using a perfusion software on the CT (Body Perfusion,Dual-input single compartment mode).The perfusion parameters (PF,BF,PPI),T-DC and TPF were measured or calculated,and then as-sessed.Results PF and PPI of active inflammation nodules showed significant higher value than those of the other three kinds of nodules,and there were significant differences in PF and PPI between active inflammation nodules and other kinds of nodules.The value of BF in malignant nodules was higher than that in the other three kinds of nodules,however no statistic significant difference in PPI was found between malignant and chronic inflammation nodules.The value of TPF in malignant and active inflammation nod-ules was higher than that in benign and chronic nodules,and there were statistic significant differences between malignant and active nodules and chronic ones.Six types of T-DC were displayed on SPNs:malignant,benign and chronic nodules showed a variety of T-DC types,and active inflammatory nodules showed only one type-typeⅠ.Conclusion Low-dose volume perfusion technique with 320-detector row CT can provide abundant information about blood flow of SPNs,and it may be regarded as an important technique in the differential diagnosis of SPNs.

Objective:To introduce a novel ridge preservation technique with micro-titanium plate avoiding the use of bone grafting materials,and evaluate the potential horizontal bone preservation effect of this new technique,applied on single maxillary central incisors after tooth extraction for future implant restoration.Methods:Nine patients (six women and three men),mean age (26.0 ±5.7)years(from 1 8 to 34 years)referred to the Department of Oral Implantology,Peking University School and Hospital of Stomotology,were selected and diagnosed with unsalvageable single middle incisor with fine general con-ditions,no signs of acute local inflammation,no ongoing or previous periodontitis,healthy neighboring teeth and intact buccal bone walls.Tooth extraction,delayed implant placement and implant-supported single crown restoration were selected as treatment plan.The teeth were extracted atraumatically with lo-cal anesthesia,followed by a reflection of a minor flap to exposed 2-3 mm of the buccal bone plate.Af-ter that,a micro-titanium plate was trimmed and bended to fit the convexity of the labial bone and fixed by two mini pins with intent to support the labial soft tissue.The flap was then repositioned over the micro titanium plate and secured with two single sutures.No bone grafting materials or releasing incisions were needed.The sockets were left to heal without any intention of primary wound closure.Cone-beam compu-ted tomographic (CBCT)scans were obtained before and four months after tooth extraction.Horizontal ridge widths were measured with CBCT software,and the preservation effects were calculated and recor-ded by the percentage of horizontal ridge alteration.Results:The nine extraction sockets were healed un-eventfully.The average socket width before extraction was (7.51 ±0.48)mm (6.92-7.82 mm).The average alveolar ridge labial-palatal width at the control point of the edentulous area was (6.81 ±0.44) mm (6.04-7.38 mm)4 months after tooth extraction,the mean percentage of ridge width preserved was 90.87%±2.91%(87.28%-95.60%).Conclusion:This novel ridge preservation method by the usage of a micro-titanium plate did not interfere with the natural socket healing process,and at the same time,largely preserved the width of alveolar ridge without any bone grafting procedures.Long term results remain to be seen.

Objective: To explore the role of bioelectrical impedance analysis (BIA) and laboratory tests for nutrition related indicators in preoperative nutritional risk screening of patients with head and neck cancer. Methods: Totally 131 patients with head and neck cancer were selected by convenient sampling method. The nutritional risk was screened by NRS 2002 nutritional risk screening scale. The bioelectrical impedance indexes were collected by human body component analysis instrument and the nutritional related laboratory indicators were collected by electronic medical records. Results: The incidence of nutritional risk in patients with head and neck cancer before operation was 18.6% (22/131). Correlation analysis showed that nutrition-related laboratory indicators were not related to nutritional risk, while bioelectrical impedance indicators such as fat-free mass, skeletal muscle mass, bodi mass index (BMI), inorganic salt content, water content and protein content were significantly correlated with NRS 2002 screening results(r=-0.228- -0.183, P<0.05 or 0.01). Univariate analysis showed that BMI, fat-free mass, protein content, skeletal muscle mass, water content, pharyngeal cancer, lymphatic metastasis, and diabetes mellitus were risk factors for nutritional risk (t=-4.121-2.918, χ²=4.167, 6.353, 4.032, P<0.01 or 0.05). Multivariate analysis showed that lymphatic metastasis was the independent risk factors of nutritional risk. Conclusions Preoperative nutritional risk screening is required for patients with head and neck cancer, especially those with tumor located in the pharynx, lymphatic metastasis and diabetes mellitus. Bioelectrical impedance analysis can be used as a reference for preoperative nutritional risk screening of patients with head and neck cancer, and can provide specific questions about human body composition for patients with nutritional risk, so as to provide a clear direction for nutritional risk intervention and can be used as an evaluation method of intervention. It is recommended that bioelectrical impedance analysis can be used as an auxiliary tool for nutritional risk screening.

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.

Objective To integrate the best available evidence of preoperative care for ophthalmic patients undergoing day surgery into clinical practice,so as to improve the quality of nursing.Methods This project was performed in an ophthalmic day surgery ward,guided by the Joanna Briggs Institute(JBI)Practice Application of Clinical Evidence System (PACES) program which includes 3 procedures:baseline audit,evidence implementation,and re-audit.Eight audit criteria were made based on evidences from JBI.Twelve nurses and 267 patients were enrolled in baseline audit,and 12 nurses and 234 patients were recruited for re-audit after evidence implementation.Results Six of the audit criteria that nurses showed poor compliance in the baseline audit(0％～28.5％),such as providing preoperative telephone screening and reducing preoperative waiting time through better preparation and planning,were significantly improved in the re-audit(71.43％～100％).The preoperative waiting time was shortened from 109.70±18.34 minutes to 88.22±9.91 minutes;the correct rates of operation-related knowledge in patients increased from 63.0％ to 85.09％;the patients' satisfaction scored 84.23±17.01 in baseline audit and 95.02±7.32 in the re-audit(P＜0.001).Conclusion Application of evidence-based preoperative care of ophthalmic patients undergoing day surgery can improve nurse's behavior and compliance with the implementation of evidence into clinical practice,and increase patient satisfaction.Continuous audits are needed to continuously improve clinical nursing quality.

Objective The purpose of this study was to acquire a deeper understanding for the short-term psychological experience after discharge for male patients after laryngectomy. Methods Phenomenological method and in-depth interviews were used. Eleven patients were recruited. The data were analyzed by Giorgi′s phenomenological procedures. Results After analyzing the data, five main themes were extracted: rejecting tracheal tube, desiring to speak early, sense of uncertainty about the future, emerging various negative emotions, heavy pressure caused by disease treatment, facing reality and living in the moment. Conclusions Patients with laryngectomy discharged in short term faced major problems, so clinical staff should give timely support and care to help them return to society in a better condition.

Objective To develop audio-visual materials and confirm their effect in patients with nasopharyngeal carcinoma receiving radiotherapy. Methods Audio-visual development were produced based on relevant literature, professional demonstration, and digital video. A total of 84 patients with nasopharyngeal carcinoma were selected from Jinhua Hospital of Zhejiang University and divided into control group (n=42) and intervention group (n=42) according to admission time. The patients of control group received usual one-to-one healthcare education. The patients of intervention group received audio-visual materials systematically for imitation excise with professional guidance. The compliance of rehabilitation exercise and patients′ satisfaction on nursing service were compared between two groups. Results The scores of compliance in the intervention group at 1 month after discharge and at 3 months after discharge ware higher than those of the control group (P<0. 05). There was significant difference between the intervention group and the control group in patients′satisfaction (P<0. 01). Conclusions Self-made audio-visual materials are intuitionistic, iconic, straightaway, imitable, receivable, and they can improve patients′ compliance on rehabilitation exercise and satisfaction on nursing service effectively.

Objective To promote the application of the best evidence for supportive care in the management of depression in patients with head and neck cancer, and to improve the quality of clinical care.Methods Follow the three stages of clinical evidence practice of Joanna Briggs Institute (JBI): baseline review, practice change and effect evaluation, the best evidence of supportive nursing in depression management for head and neck cancer patients were retrieved, and 4 quality review indicators were developed. A total of 50 hospitalized head and neck cancer patients and 12 nurses were selected to collect data by means of field observation, interviews and nursing records. The obstacles to the application of evidence were analyzed and a practical scheme was worked out.Results The nurse's implementation rate of the four review indicators increased from 0-90％ at the baseline review to 90％-100％ after the evidence was applied. Except for Indicator 3 "Indicators nurses introduced the pressure on patients and their families to face cancer", the implementation rates of the other three indicators were significantly improved (P<0.01). After the application of evidence, the incidence of depression was decreased (P<0.05). The score of Relaxation, Sleep and Fatigue Management Knowledge Questionnaire was (18.20±14.09) before the application of evidence, which was lower than that after the application of evidence (80.60±12.84), and the difference was statistically significant (t=-23.14, P<0.01). The nurses' score of Supportive Nursing Knowledge Questionnaire before the application of evidence was (63.83±10.78), which was lower than that after the application of evidence (95.5±3.18), and the difference was statistically significant (t=-9.76,P<0.01).Conclusions The evidence-based application program can standardize nurses' supportive nursing behaviors for patients with depressive symptoms, reduce the severity of depression, improve the self-support knowledge level, and improve the quality of depression management in hospitalized patients with head and neck cancer.