目的:调强放疗(IMRT)是肿瘤学中最常用的放疗技术,这使得能够将辐射剂量精确地构造到目标体积,并且降低对邻近的正常结构的辐射损伤的风险。然而,头颈部肿瘤的IMRT仍然不可避免地引起与辐射相关的毒副作用,比如口干,粘膜炎,口腔构音障碍,味觉障碍,骨坏死,和刺耳.三联症是鼻咽癌(NPC)放疗引起的最常见的晚期副作用之一,严重影响鼻咽癌患者的生活质量。然而,目前鼻咽癌放疗后的临床评估和治疗还不完善。该最佳实践实施项目旨在实施基于证据的实践,以评估和管理接受放疗的NPC患者的牙关。从而提高最佳证据的临床实践依从性和NPC患者的生活质量。
方法:这个基于证据的审计和反馈项目是在中国的一家三甲医院采用三阶段方法实施的,遵循JBI的临床证据系统(PACES)和GRiP证据应用的实际应用。第一阶段包括基线审计,其中有六个基于证据的审计标准,这些标准来自现有的最佳证据。第二阶段包括分析基线审计的结果,确定遵守最佳实践原则的障碍,并制定和实施战略,以解决基线审计中发现的障碍。第三阶段涉及后续审计,以评估为改善实践而实施的干预措施的结果。
结果:申请证据后,审计标准1的合规率从基线审计时的0%增加到后续审计时的70%。审计准则2的符合率从0%提高到100%。审核标准3的符合率从22%增加到62%。审核标准4的符合率从88%提高到100%。在基线审计和后续审计中,审计准则5的合规率为100%。审计准则6的符合率从0提高到55%。
结论:实施最佳证据,对鼻咽癌放疗后患者的主食进行评估和管理,有利于提高临床实践对最佳证据的依从性,规范临床护理实践,提高临床护理质量,和更好地预防鼻咽癌患者放疗后严重的三端肌。
OBJECTIVE: Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis, and
trismus.
Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously affects the quality of life for patients with NPC. However, the current clinical assessment and management of
trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC.
METHODS: This evidence-based audit and feedback project was implemented using a three-phase approach at a third-class hospital in
China, following JBI\'s Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria derived from the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit to assess the results of the interventions implemented to improve practice.
RESULTS: After evidence application, the compliance rate for audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate for audit criterion 2 increased from 0% to 100%. The compliance rate for audit criterion 3 increased from 22 to 62%. The compliance rate for audit criterion 4 increased from 88 to 100%. The compliance rate for audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate for audit criterion 6 increased from 0 to 55%.
CONCLUSIONS: Implementation of the best evidence for the assessment and management of
trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.