本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

      目的 探讨智能病案质控系统对病案质量及质控效率的影响，为优化病案管理模式提供依据。方法 选取2024年4月—9月传统人工质控病案2 000份（对照组）与2024年10月—2025年6月智能病案质控系统辅助质控病案2 000份（研究组），对比两组缺陷检出率、编码准确率、内涵质量达标率等病案指标，以及人均日均处理量、质控耗时、漏检率等效率指标。结果 研究组缺陷检出率（15.20%）高于对照组（8.30%）；编码准确率（95.70%）、内涵质量达标率（93.50%）高于对照组（86.50%、82.30%）（均P＜0.05）；研究组人均日均处理量较对照组提升；单份病案质控耗时（4.80 min）缩短；漏检率（3.00%）降低62.50%（均P＜0.05）。结论 智能病案质控系统可提升病案质量与质控效率，优化医疗资源配置，为DRG/DIP支付改革提供支持。

      Objective To explore the influence of intelligent medical record quality control system on medical record quality and quality control efficiency，so as to provide a basis for optimizing medical record management mode．Methods A total of 2 000 traditional manual quality control medical records（control group）from April to September 2024 and 2 000 intelligent medical record quality control system-assisted cases（experimental group）from October 2024 to June 2025 were selected．The study compared key indicators including defect detection rates，coding accuracy，and connotation quality compliance rates，along with efficiency metrics such as daily per capita processing volume，quality control time consumption，and missed detection rate between the two groups．Results The experimental group showed a significantly higher defect detection rate（15.20%）compared to the control group（8.30%）．The coding accuracy（95.70%）and connotation quality compliance rate（93.50%）were notably higher than the those of control group（86.50% and 82.30%，P＜0.05）．The experimental group demonstrated improved daily processing capacity per capita，with a significant reduction in quality control time for individual medical records（4.80 minutes）and a 62.50% decrease in missed detection rate（3.00%，P＜0.05）．Conclusions Intelligent medical record quality control system can significantly improve the quality and quality control efficiency of medical records，optimize the allocation of medical resources，and provide support for DRG/DIP payment reform．

      目的 调查住院老年患者因经外周静脉置入中心静脉导管（PICC）而引发的血栓情况，并分析其影响因素，为老年患者置入PICC产生的相关性血栓（PICC-CRT）和症状性血栓的评估与干预提供借鉴。方法 在2023年1月—2023年12月期间，选取广州市第一人民医院接受PICC置管的317例住院老年患者。采用包括患者一般情况调查表、运动功能评定、肌力检测、 Barthel指数评定、Padua评分等多种工具进行综合评估。采用多因素 Logistic 回归构建 PICC-CRT 及症状性血栓的预测模型，并应用逐步回归法优化变量筛选过程。模型性能通过 ROC 曲线进行评估。结果 去除临床资料不完整的患者40例，最终纳入277例患者的完整资料，其中123例患者出现了PICC-CRT，发生率为44.40%（123/277）。血栓分级中，I级78例，Ⅱ级37例，Ⅲ级8例。无症状血栓83例，占67.48%，发生率29.96%（83/277）；症状性血栓40例，占32.52 %，发生率14.44%（40/277）。单因素分析联合多因素Logistic回归显示，卒中史、凝血酶原时间（PT）、导管留置时间是住院老年患者PICC-CRT的关键因素（P＜0.05），预测模型ROC曲线下面积为0.719；置管史、恶性肿瘤史、导管留置时间、置管后并发症数量是住院老年患者PICC症状性血栓的独立影响因素（P＜0.05），预测模型ROC曲线下面积为0.812。结论 文章总结了PICC-CRT和症状性血栓独特的影响因素，基于关键因素构建了预测模型预测其发生，为护理人员预防PICC-CRT和症状性血栓的发生提供了参考。

   Objective To explore the incidence of thrombosis associated with peripherally inserted central catheter（PICC）placement in hospitalized elderly patients and to analyze its influencing factors，in order to provide a reference for the assessment and prevention of PICC-catheter related thrombosis（PICC-CRT）and symptomatic thrombosis in this population．Methods A total of 317 elderly inpatients who underwent PICC placement at a tertiary hospital in Guangzhou between January and December 2023 were enrolled．Comprehensive assessments were conducted using general patient information forms，motor function evaluation，muscle strength testing，Barthel Index，and Padua score．Multivariate Logistic regression analysis was used to construct predictive models for PICC-CRT and symptomatic thrombosis，with variable selection optimized via stepwise regression．Model performance was evaluated using receiver operating characteristic（ROC）curve analysis．Results After excluding 40 patients with incomplete clinical data，277 cases were included in the final analysis．Among them，123 patients developed PICC-CRT，with an incidence rate of 44.40%（123/277）．Thrombosis was graded as Grade I in 78 cases，Grade II in 37 cases，and Grade III in 8 cases．Asymptomatic thrombosis occurred in 83 cases（29.96%），accounting for 67.48% of PICC-CRT；symptomatic thrombosis occurred in 40 cases（14.44%），accounting for 32.52%．Univariate and multivariate Logistic regression analyses identified history of stroke，prothrombin time（PT），and catheter dwell time as key risk factors for PICC-CRT（P＜0.05），with the area under the curve（AUC）of 0.719．History of catheterization，malignancy，catheter dwell time，and number of post-catheterization complications were independent predictors of symptomatic thrombosis（P＜0.05），with an AUC of 0.812．Conclusions This study identified distinct risk factors for PICC-CRT and symptomatic thrombosis in elderly inpatients．Predictive models based on key variables may provide useful references for clinical staff in preventing the occurrence of PICC-related and symptomatic thrombosis．

       目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料，按照7︰3比例随机化分为训练列（293例）和验证队列（126例）。统计基于开发队列数据，采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素，并构建风险预测模型。基于开发队列和验证队列数据，采用校准曲线、受试者操作特征（ROC）曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎，发生率为26.97%。美国国立卫生研究院卒中量表（NIHSS）评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞计数与淋巴细胞计数比值（NLR）、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素（P＜0.05）。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型，校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近；ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906（95%CI：0.867~0.937）、0.884（95%CI：0.815~0.934）；决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage（ICH）and validate the predictive performance of the model．Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022．They were randomly divided into a development cohort（293 cases）and a validation cohort（126 cases）according to a 7∶3 ratio．The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data，and a risk prediction model was constructed．Based on the development cohort data and validation cohort data，the predictive performance of the model was analyzed using calibration curves，receiver operating characteristic（ROC）curve，and decision curve analysis．Results Among 419 patients，113 developed stroke associated pneumonia，with a rate of 26.97%．The National Institutes of Health Stroke Scale（NIHSS）score，swallowing difficulties，initial hematoma volume，neutrophil percentage to albumin ratio（NPAR），neutrophil count to lymphocyte count ratio（NLR），surgical treatment，endotracheal intubation，and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH（P＜0.05）．Based on the above influencing factors，a risk prediction model for stroke associated pneumonia in patients with ICH was constructed．The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence．The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906（95%CI：0.867-0.937）and 0.884（95%CI：0.815-0.934），respectively．The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%，and the threshold probability of the validation cohort was between 2%-76%，the intervention using this model was more clinically valuable than all/no intervention．

Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score，swallowing difficulties，initial hematoma volume，NPAR，NLR，surgical treatment，tracheal intubation，and indwelling gastric tube has good predictive performance and clinical application value．

       目的 构建与验证回肠造口术后造口周围皮炎发生的列线图预测模型。方法 回顾性分析广州市中山大学附属第六医院2022年7月—2023年7月收治的441例回肠造口术患者资料。通过单因素Logistic回归确定影响因素，基于训练队列建立列线图模型，并采用受试者操作特征（ROC）曲线和校准曲线分别评估模型的区分度与校准能力，同时通过决策曲线分析（DCA）评估临床实用性。在内部验证队列进行模型性能验证。结果 单因素Logistic回归确定6个危险因素，最终选取其中5个（是否糖尿病、造口定位、是否接受造口护理宣教、造口皮肤凹陷、性别）构建预测模型。训练队列中，模型校准曲线显示良好拟合优度（Hosmer and Lemeshow检验P = 0.976），ROC曲线下面积为0.672；决策曲线证实模型具有临床应用价值，预测模型在验证集上有类似结果。结论 本研究建立的5参数列线图模型具有良好的区分度、校准能力和临床实用价值，可为造口周围皮炎的预测提供量化工具。

       Objective To establish a predictive nomogram for peristomal dermatitis after ileostomy．Methods This study analyzed 441 patients who underwent ileostomy at a third-class premium hospital．The risk factors of peristomal dermatitis were determined by univariate binary Logistics regression．Then a predictive nomogram was established with the risk factors in the training cohort．The discrimination and calibration ability of the nomogram was demonstrated by receiver operating characteristic curves and calibration curves，respectively．Besides，a testing cohort was utilized to validate the nomogram model．To reflect the clinical utility of the model，we also performed decision curve analysis．Results A total of six parameters was determined as the risk factors of peristomal dermatitis．Finally，five of them（whether diabetes，stoma location，whether to receive stoma care education，stoma skin depression，gender）were chosen to establish the nomogram．The calibration curve showed favorable calibration ability in the training cohort with a Hosmer and Lemeshow goodness of fit test P-value of 0.976 and the area under the curve of the nomogram is 0.672．The decision curve showed nomogram had potential clinical utility．These results were consistent with the testing cohort．Conclusions The nomogram established by five parameters was capable of predicting the occurrence of peristomal dermatitis with favorable discrimination and calibration ability and shows potential clinical utility．

      目的 调查消化系统恶性肿瘤患者营养风险、营养知识-态度-行为（知信行）水平的现状，探究各因素是否对患者的营养风险、营养知信行水平具有影响，并分析两者之间的相关性。方法 选取中山大学附属第八医院（深圳福田）2024年2月—10月的244例消化系统恶性肿瘤患者为研究对象，采用一般资料调查表、营养风险筛查NRS2002量表以及消化系统肿瘤患者营养知信行问卷进行调查，数据收集后进行统计分析，从而研究消化系统恶性肿瘤患者营养筛查风险与营养知信行水平的现状、影响因素及两者间的相关性。结果 69.3%的消化系统恶性肿瘤患者存在营养风险，营养风险评分为（2.72±1.42）分。消化系统恶性肿瘤患者营养知识水平得分为（12.30±5.26）分、营养态度水平得分为（14.80±2.68）分、营养行为水平得分为（22.82±4.55）分、营养知信行水平总分为（49.96±9.50）分。家庭经济收入是患者营养风险水平的核心影响因素（P＜0.05），学历水平是患者营养知信行水平的核心影响因素（P＜0.05）。消化系统恶性肿瘤患者营养风险水平与营养知信行的总体水平呈负相关（r=-0.143，P＜0.05）。结论 消化系统恶性肿瘤患者的营养知信行水平总体处于中等水平，但普遍存在营养风险较高的情况。在患者治疗期间实施个性化营养健康宣教至关重要，这将有助于提升患者的营养知识水平，从而整体性改善其营养知信行素养并降低其营养风险，但在进行营养宣教和制定个性化营养方案时应充分考虑患者的家庭经济收入及学历水平。

    Objective To explore the nutritional risk and nutritional knowledge-attitude-behavior status of patients with digestive system malignant tumors，to analyze the influencing factors of nutritional risk，nutritional knowledge-attitude-behavior，and explore the correlation between them．Methods From February 2024 to October 2024，244 patients with digestive system malignant tumors at the Eighth Affiliated Hospital of Sun Yat-sen University were selected as the research subjects．A general information questionnaire，Nutritional Risk Screening 2002，and digestive system tumor patient nutrition knowledge-attitude-behavior questionnaire were used to study the influencing factors and correlations between the nutritional screening risk and nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．Results There were 69.3% of the patients with digestive system malignant tumors had nutritional risk score ≥3，and the overall score was（2.72±1.42）．The scores of nutritional knowledge，attitude，behavior and total score of digestive system malignant tumors patients were（12.30±5.26），（14.80±2.68），（22.82±4.55）and（49.96±9.50），respectively．Family economic income was the core influencing factors of nutritional risk in patients with digestive system malignant tumors，while educational level was the core influencing factor of nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．The nutritional risk level of patients with malignant tumors of the digestive system was significantly negatively correlated with the overall level of nutritional knowledge-attitude-behavior．Conclusions The nutritional knowledge-attitude-behavior level of patients with malignant tumors of the digestive system is generally at a medium level，but there is a widespread situation of relatively high nutritional risk．It is extremely important and necessary to conduct personalized nutrition knowledge education for patients during their treatment period，which will help enhance patients’ nutritional knowledge level，thereby comprehensively improving their nutritional knowledge-attitude-behavior literacy and reducing their nutritional risks．However，when conducting nutrition education and formulating personalized nutrition plans，the patient’s family economic income，medical payment methods and educational level should be fully considered．

       目的 分析药品集中带量采购（集采）政策下医院药品供应保障实况，提出优化政策及保障的对策建议。方法 通过提取重庆市渝北区人民医院2023年1月—2024年12月集采药品供应采购数据，描述性统计分析集采药品供应情况。结果 采购的416个中标药品中，69个在购销合同期内短缺，短缺率16.59%。短缺原因与企业生产能力、季节性需求波动相关，季节性强，以慢性病药和抗感染药为主。结论 建议建立监测平台、完善报告制度、制定应急预案、评估供货能力，保障供应。

   Objective To analyzes the current situation of hospital drug supply guarantee under the policy of centralized and volume-based procurement（hereinafter referred to as “central procurement”），and proposes optimization strategies and suggestions for the policy and guarantee．Methods By extracting the procurement data of drugs supplied through centralized procurement at Yubei District People’s Hospital in Chongqing from January 2023 to December 2024，descriptive statistical analysis of the drug supply situation through centralized procurement was conducted．Results Among the 416 selected drugs purchased，69 were in short supply during the contract period，with a shortage rate of 16.59%．The reasons for the shortage were related to the production capacity of the enterprise，seasonal demand fluctuations，strong seasonality，and mainly chronic diseases and anti-infective．Conclusions It is suggested to build a monitoring platform，improve the reporting system，formulate emergency plans，and evaluate the supply capacity to ensure supply．

癫痫是一种由多种病因引起的慢性脑部疾病，其患者死亡风险为一般人群的2~3倍。我国农村地区，受多种因素的影响，约2/3的癫痫患者未得到合理的治疗，给患者及其家庭和社会带来沉重负担。顺德区积极响应“中国农村地区癫痫防治管理项目”，成立癫痫专科医联体，构建三级诊疗体系，开展了一系列实践探索。本文旨在总结顺德区专科医联体管理模式下的癫痫综合管理实践，分析管理现状，并提出改进路径，以期为癫痫患者提供更优质的服务，改善患者生活质量。

Epilepsy is a chronic brain disorder caused by various etiologies，the mortality risk of epilepsy patients is 2 to 3 times higher than that of the general population．In rural areas of China，due to multiple influencing factors，approximately two-thirds of epilepsy patients receive inadequate or no proper treatment，imposing a heavy burden on patients，their families，and the society．Shunde District has actively responded to the “China Rural Epilepsy Prevention and Management Project” by establishing an epilepsy specialty medical consortium and building a three-tiered diagnostic and treatment system，conducting a series of practical explorations．This article aims to summarize the comprehensive epilepsy management practices under the specialty medical consortium model in Shunde District，analyze the current management status，and propose improvement strategies to provide better services for epilepsy patients and enhance their quality of life．

医疗质量管理是医院的核心任务，医疗质量管理在医院内具体落实到各个专科的管理，口腔门诊（不含住院部）作为一个特殊的专科，广泛存在于一、二级医疗机构，也存在于部分三级医疗机构，普通住院科室或门诊专科的医疗质量管理模式均不适用于口腔门诊，需要专属的医疗质量管理方式。医疗质量管理常以质控检查与指标监测为抓手，本文综合目前关于口腔门诊质控的研究，系统梳理口腔门诊的质控检查项目与指标，为口腔门诊医疗质量管理模式提供科学依据。

Medical quality management is the fundamental task of hospitals，and it is specifically implemented in the management of various specialties within hospitals．As a special specialty，dental outpatient clinics（excluding inpatient departments） exist in most primary and secondary medical institutions，as well as some tertiary medical institutions．The medical quality management methods of general inpatient departments or outpatient specialties are not applicable to dental outpatient clinics，which require a dedicated medical quality management approach．Quality control inspections and monitoring of quality control indicators are focuses of medical quality management．This article synthesizes current research on quality control in dental outpatient clinics，systematically sorts out quality control inspection items and quality control indicators for dental outpatient clinics，and provides a scientific basis for medical quality management model in dental outpatient clinics．

       目的 探讨基于德尔菲法构建专科护士能力分层管理模式。方法 通过查阅文献，并结合半结构式访谈，初步梳理出评价指标的条目集合。随机抽取20名权威护理临床实践专家，运用德尔菲专家函询法，依据专家反馈，确定评价指标体系。结果 共进行2轮专家函询，积极系数均为100%。专家权威系数分别为 0.83、 0.85。专家意见肯德尔系数分别为0.350、0.340。最终构建专科护士临床实践能力的分层级评价管理模式包括3项一级指标，8项二级指标，23项三级指标。结论 基于德尔菲法构建的专科护士能力分层管理模式，对于提升护理服务质量、推动护理学科发展具有积极的指导意义。

      Objective To explore the construction of a hierarchical management model for the clinical practice ability of specialist nurses based on the Delphi method．Methods By reviewing literature and conducting semi-structured interviews，we initially sorted out a collection of evaluation indicator items．Twenty authoritative nursing clinical practice experts were randomly selected．The Delphi expert consultation method was employed，and based on the experts’ feedback，the evaluation indicator system was determined．Results A total of two rounds of expert consultations were conducted，with a 100% positive response rate in both rounds．The expert authority coefficients were 0.83 and 0.85，respectively．The Kendall’s coefficient of concordance for expert opinions was 0.350 and 0.340，respectively．The final hierarchical evaluation and management model for the clinical practice ability of specialist nurses included 3 first-level indicators，8 second-level indicators，and 23 third-level indicators．Conclusions The hierarchical management model for the ability of specialist nurses constructed based on the Delphi method has positive guiding significance for improving nursing service quality and promoting the development of the nursing discipline．