论著

眼科急诊预检分诊标准体系构建及初步验证

Construction and preliminary verification of the ophthalmic emergency pre-examination and triage standard system

:91-98
 
目的:基于我国国情构建科学、简便且高效的眼科急诊预检分诊标准,为眼科医护人员提供高效的眼科急诊预检分诊工具。方法:基于文献查询法、半结构访谈法、德尔菲法及层次分析法确定眼科急诊预检分诊标准内容。通过提取2023年8月1日-2023年8月10日急诊分诊系统及HIMSS电子病历系统数据,分析初次分诊的级别与接诊医生最终诊断的所属级别符合率,对眼科急诊预检分诊标准体系的应用效果进行初步验证。结果:对18名专家进行2轮专家咨询,有效问卷回收率均为100%,专家权威系数均为0.95,肯德尔和谐系数分别为0.5640.117(均P<0.05)。最终构建的眼科急诊预检分诊标准体系包括3个一级指标、11个二级指标。初步验证显示,该预检分诊标准体系具有92.7%的分诊准确率。结论:本研究构建的眼科急诊预检分诊标准体系结构合理、内容全面,具有科学性及实用性,可为眼科临床急诊预检分诊工作提供准确、有效的分诊工具,有助于提高临床工作效率及预检分诊质量。
Objective: To establish a scientific, simple, and efficient ophthalmic emergency pre-examination triage standard, and provide efficient ophthalmic emergency pre-examination triage tools for ophthalmic staffs, based on national conditions. Methods: With literature search, semi-structured interview, Delphi Method, and Analytic Hierarchy Process, the content of ophthalmic emergency pre-examination and triage standard are confirmed. By extracting data from the emergency triage system and HIMSS electronic medical record system from August 1st, 2023 to August 10th, 2023, the consistency rate between the initial triage level and the final diagnosis level of the attending doctor was analyzed, and the application effect of the ophthalmic emergency pre-examination and triage standard system was preliminarily verified. Results: Two rounds of expert consultation were conducted among 18 experts, all with a 100% effective questionnaire response rate. The expert authority coefficients were 0.95, and the Kendall harmony coefficients were 0.564 and 0.117, respectively (all P<0.05). The final constructed ophthalmic emergency pre-examination triage standard system includes 3 primary indicators and 11 secondary indicators. Through verification, the pre screening triage standard system has a good triage accuracy rate of up to 92.7%. Conclusions: The structure of the ophthalmic emergency pre-examination triage standard system constructed in this study is reasonable, comprehensive, scientific, and practical. It can provide accurate and effective triage tools for ophthalmic clinical emergency pre-examination triage work efficiency, and preexamination triage quality.
教学专栏

眼科住院医师规范化培训前医师职业认同感调查

A survey on professional identity of ophthalmology residents before standardized resident training

:394-401
 

目的:了解目前眼科住院医师规范化培训前职业认同感现状,并探讨相关影响因素。方法:于2024年7—8月,通过问卷调查法调查64名临床医学眼科住培医师,了解其住院医师规范化培训前的职业认同感现状和影响因素,同时探讨规范化培训对于其职业认同感的影响及作用,通过描述性分析、t检验、单因素方差分析、Pearson相关性分析、多元线性回归分析等方法对相关数据进行分析。结果:规范化培训前,职业认同感评分、职业认知、职业情感、职业承诺、职业行为、职业期望、职业价值观等评分分别为(143.16±12.25)(3.60 ± 0.94)(3.98 ± 0.71)(3.61 ± 1.01)(3.89 ± 0.653.84 ± 0.78)(3.71 ± 0.86)分。规范化培训后,眼科住培医师职业期望评分略有降低,与规范化培训前比较差异有统计学意义 (均P  < 0.01), 其他职业认同度部分条目评分在规范化培训前后比较差异无统计学意义(均P > 0.05)。女生对于眼科医学的职业情感(P = 0.01)及职业价值观高于男生(P = 0.03)。本科时担任学生干部的眼科住培医师职业情感高于非学生干部的学生(P < 0.01)。第一选择为眼科的眼科住培医师的医学职业期望(P  < 0.01)和职业价值观更高((P = 0.02)。而学历、临床医学志愿选择与职业认同感差异均统计学意义(均P > 0.05)。此外,规范化培训一定程度增强了眼科住培医师的显微操作能力和职业信心。结论:住院医师规范化培训前眼科住培医师的职业认同感较高,但仍有待进一步提高。眼科住培医师的职业认同感与职业看法、培训内容、教学资源等因素密切相关。

Objective: To investigate the current status of professional identity among ophthalmology residents before standardized resident training and to explore the influencing factors. Methods: A survey was conducted from July to August 2024 involving 64 clinical ophthalmology residents. The survey assessed their professional identity before standardized resident training and examined the impact and role of pre-residency training on their professional identity. Descriptive analysis, t-tests, univariate analysis, Pearson correlation analysis, and multiple linear regression were used to analyze the data. Results: Before pre-residency training, the scores for overall professional identity, professional cognition, professional emotion, professional commitment, professional behavior, professional expectations, and professional values were (143.16 ± 12.25), (3.60 ± 0.94), (3.98 ± 0.71), (3.61 ± 1.01), (3.89 ± 0.65), (3.84 ± 0.78), and (3.71 ± 0.86), respectively. However, after pre-residency training, the score for professional expectations among ophthalmology residents decreased slightly (P < 0.01), while no significant statistical differences were observed in other items related to professional identity (all P > 0.05). Female residents had higher scores in professional emotion (P = 0.01) and professional values (P = 0.03) than male residents. Ophthalmology residents who had served as student leaders during undergraduate studies had higher scores in professional emotion (P < 0.01). Residents who chose ophthalmology as their first preference had higher scores in professional expectations (P  < 0.01) and professional values (P = 0.02). However, no significant differences were found among educational levels, clinical medicine preferencesand professional identity. In addition, pre-residency training enhanced the residents micro-surgical skills and professional confidence. Conclusions: The professional identity of clinical ophthalmology medical students before standardized resident training is relatively high but still needs improvement. Professional identity is closely related to factors such as professional views, training content, and teaching resources.

教学专栏

眼科住院医师规范化培训中人文素养培育的实践与探索

Practice and exploration of cultivating humanistic qualities in standardized training of ophthalmology residents

:402-407
 
在眼科住院医师规范化培训中,医学人文素质的培养对医患沟通能力与职业素养的塑造具有重要价值。医学人文不仅关乎医生的执业能力,更直接影响医疗服务的质量与患者满意度。文章分析了当前眼科住培医师人文素养教育现状及其重要性。在此基础上,提出了培养住培医师的人文素质的方法和途径:1)通过入培前的人文素养专题培训,强化住培医师的医患沟通意识,使其在进入临床实践前就树立正确的人文理念;2)借助医院服务中心的实践活动,让住培医师亲身参与患者服务,从而培养他们的同理心,更好地理解患者的需求与感受;3)开展医学人文读书活动,引导住培医师阅读经典人文著作,深化他们的人文情怀,提升职业素养;4)组织科室人文析议会,针对临床实践中常见的伦理困境进行研讨,帮助住培医师学会在复杂情境中做出合理决策;5)实施思政与医学人文融合的实践,拓展住培医师的人文视野,使其在专业技能提升的同时,不忘人文初心。该文旨在为眼科住培医师的人文素质培养提供理论支持和实践指导。通过这些方法的实施,期望培养出更多具备高人文素养的眼科医疗专业人才。
Strengthening medical humanities education is of vital significance in the standardized training of ophthalmology residents, as it contributes to enhancing their doctor-patient communication skills and professional ethics. This paper examines the current situation and significance of humanities education for ophthalmology residents. On this basis, the paper suggests five concrete methods and approaches for fostering residents' humanistic qualities, such as: (1) strengthening doctor-patient communication awareness through pre-training humanities courses to establish a proper humanistic mindset before clinical practice; (2) developing empathy by participating in hospital service center activities through hands-on patient service experiences; (3) deepening humanistic sentiment and enhancing professional ethics through medical humanities reading activities featuring classical works; (4) discussing clinical ethical dilemmas via departmental humanities analysis meetings to help residents develop decision-making skills in complex scenarios; (5) expanding humanistic horizons through the integration of ideological and political education with medical humanities practice, ensuring professional skill development aligns with humanistic principles. This paper aims to offer theoretical support and practical guidance for the humanities education of ophthalmology residents, with the objective of cultivating more ophthalmology professionals with both clinical excellence and high humanistic caliber.
论著

开角型青光眼患者眼部用药规范化护理管理的最佳证据总结

Summary of the best evidence on standardized ocular medication management among open-angle glaucoma patients

:17-24
 
目的:检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据,为临床实践提供参考。方法:通过护理循证方法提出实践问题,按照循证证据检索数据库的“6S”分类模型,检索有关开角型青光眼患者眼部用药管理的所有证据资源类型,包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果:最终纳入12篇文献,包括4篇指南、3篇证据总结和5篇系统评价;汇总了19条有关开角型青光眼眼部用药管理的最佳证据,包括滴眼技术指导、依从性管理和信息提供3个方面。结论:总结开角型青光眼眼部用药管理的最佳证据,可为临床医务人员管理患者提供参考和借鉴,以达到患者规范用药、控制眼压和延缓疾病进展的目的。
Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.
论著

督导式教学门诊在眼科住院医师规范化培训中的实践

Application of supervised teaching clinic in standardized training of ophthalmology residents

:477-481
 
目的:探讨督导式教学门诊在眼科住院医师规范化培训中的具体实践和教学效果。方法:通过合理排班、限制号源等措施设立每周固定的督导式教学门诊时间,安排老师和学员出诊;在教学门诊开展4个月后,通过问卷调查和临床技能考核的形式采集反馈意见并评估教学效果。 结果:共有16名老师和8名学员参加了督导式教学门诊,调查问卷结果显示100%的带教老师和学员认可该教学模式,参加过教学门诊的学员临床技能考核得分显著高于对照组(t =3.631, P<0.05)。结论:督导式教学门诊应用于眼科住院医师规范化培训具有实际可行性,并可以提高学员的临床技能水平。
Objective: To explore the application and effects of supervised teaching clinic in standardized training of ophthalmology residents. Methods: A weekly supervised teaching clinic was set through reasonable scheduling and limiting the registration numbers. After 4 months of application, feedbacks were collected through questionnaire survey from both the teachers and residents. Clinical skills assessments were also taken to evaluate the teaching effect. Results: A total of 16 teachers and 8 residents participated in the supervised teaching clinic. The results of the questionnaire showed that 100% of the teachers and residents agreed with the teaching mode. The clinical skill assessment scores of the residents who participated in the teaching clinic were significantly higher than those of the control group (t=3.631, P<0.05). Conclusion: The application of supervised teaching clinic in standardized training of ophthalmology residents is feasible and can improve the clinical skills of the residents. 
论著

眼解剖整合课程在眼科住院医师规范化培训教学中的应用

The application of the integrated course on ocular anatomy in the standardized training teaching of ophthalmology residents

:483-490
 
目的:探索和评价“线上教学-理论小课-Wetlab实操”眼解剖整合课程在眼科住院医师培范化培训(住培)教学中的应用和效果。方法:纳入中山大学中山眼科中心2023年新入培的住培学员93名,在岗前培训时进行眼解剖整合课程教学。在课程前后分别进行测试,评价课程教学效果,并在课程结束后采用匿名线下测试考核和满意度问卷调查的形式对课程的满意度进行调查。结果:培训前(T1)和培训后(T2)总分中位数分别是60分和70分,T1最低分、25%、75%和最高分分别是10、40、62.5和90,T2最低分、25%、75%和最高分分别是30、60、80和100,T2得分显著高于T1得分,差异具有统计学意义(P<0.000 1);T1和T2的自信度平均值分别为26.53±5.08、31.83±4.02,差异有统计学意义(P<0.001)。学员普遍表示对整合课程满意。结论:学员们接受整合课程培训后,对眼解剖学知识的掌握程度有明显提高,对整合课程满意度高。眼解剖整合课程有效性显著,是具有推广意义的教学改革。
Objective: To explore and evaluate the application and effect of an integrated   ocular anatomy course comprising three main components: ‘online preview,’ ‘lecture,’ and ‘Wetlab dissection training’in the standardized training teaching of ophthalmology residents (hereinafter referred to as "resident training"). Methods: A total of 93 new resident trainees from Zhongshan Ophthalmic Center of Sun Yat-sen University in 2023 were included in the integrated course on ocular anatomy during pre-job training. Tests were carried out before and after the course to evaluate the teaching effect of the course, and questionnaires were issued after the course to investigate the satisfaction of the course. It adopts the form of anonymous offline test and satisfaction questionnaire. Results: The median total scores before (T1) and after (T2) training were 60 and 70, respectively; the lowest scores, 25%, 75% and highest scores of T1 were 10, 40, 62.5 and 90, respectively; the lowest scores, 25%, 75% and highest scores of T2 were 30, 60, 80 and 100, respectively, and the scores of T2 were significantly higher than those of T1. The difference was statistically significant (P<0.000 1). The mean confidence of T1 and T2 were 26.53±5.08 and 31.83±4.02, respectively, and the difference was statistically significant (P<0.001). Participants generally expressed satisfaction with the integrated programme. Conclusions: After receiving the training of the integrated course, the students' mastery of the knowledge of ocular anatomy has been significantly improved, and the satisfaction of the integrated course is high. The integrated course on ocular anatomy is effective, and it is a teaching reform with popularization significance.
团体标准

广东省年龄相关性白内障手术操作及质量控制规范

Standard operating procedure and quality control standards for age-related cataract in Guangdong Province

:429-436
 
年龄相关性白内障是全球首位致盲性眼病,手术是治疗白内障唯一有效的手段。白内障手术后视力的良好恢复,除了患者自身的眼部条件外,还有赖于医疗机构的手术技术和质量管理水平。白内障摘除手术的规范操作、人工晶状体屈光力的精准测算和专业的围术期管理是白内障患者复明的关键。国家卫生健康委员会在《加强县医院白内障手术能力建设工作方案(2025—2027年)》中提出,通过加强设备设施建设、帮扶县级医院开展人员培训、建立标准化手术制度等方式,进一步提高县级医院开展白内障手术的能力,就近就便满足人民群众白内障复明需求。因此,为了规范化白内障手术操作、确保手术安全和减少手术并发症,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构35名权威专家共同起草,在参考国内外白内障手术标准的基础上,结合我省白内障手术的现状,共同讨论并最终确定了本团体标准。本标准系统地描述了年龄相关性白内障手术软件、硬件的基本要求、手术的适应证与禁忌证,制定了白内障手术的标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构开展白内障手术以及质量评估提供指导。
Age-related cataract is the leading blinding eye disease in the world, and surgery is the only effective treatment. The good recovery of vision after cataract surgery depends not only on the patients’ ocular conditions but also on the surgical technique and quality management level of medical institutions. Standard surgical procedures, the accurate measurement and calculation of intraocular lens (IOL) power, and professional perioperative management are the keys to restoring the sight of patients. In addition, the National Health Commission proposed in the "Work Plan for Strengthening the Cataract Surgery Capacity Building of County-level Hospitals (2025-2027)" that the ability of county-level hospitals to perform cataract surgery should be further improved by strengthening the construction of equipment and facilities, assisting county-level hospitals in carrying out personnel training, and establishing standardized surgical system. Therefore, in order to standardize cataract surgery procedures, ensure the safety of the surgery and reduce surgical complications, under the leadership of the Guangdong Medical Association, the Zhongshan Ophthalmic Center of Sun Yat-sen University, in conjunction with 21 other medical institutions in Guangdong Province and 35 authoritative experts, jointly drafted this group standard. On the basis of referring to the domestic and international standards for cataract surgery and combining with the current situation of cataract surgery in Guangdong Province, they jointly determined this group standard. This group standard systematically describes the basic requirements for the software and hardware conditions of age-related cataract surgery, the indications and contraindications of the surgery, formulates the standard surgical procedures and quality control standards for cataract surgery, and introduces the prevention and treatment of complications or adverse reactions, providing guidance for all qualified medical institutions at different levels to carry out cataract surgery and quality assessment.
封面简介

广东省玻璃体腔注药操作及质量控制规范

Standard operating procedure and quality control standards for intravitreal injection in Guangdong Province

:-
 
玻璃体腔注药是年龄相关性黄斑变性、糖尿病视网膜病变、视网膜静脉阻塞等常见慢性眼底病的主要治疗方式,凭借其治疗量大、操作流程化、实施简便,已成为眼科临床常规诊疗项目。基于《“十四五”全国眼健康规划(2021-2025年)》要求,秉承以患者为中心的服务理念,在确保医疗安全的基础上,优化治疗流程,提升患者接受玻璃体腔注药治疗的就诊体验和治疗效果。同时,广东省将有望承接越来越多港澳的眼病患者,需要建立融合粤港澳大湾区的广东省注药标准。因此,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构共同起草,通过函审、专家论证会等形式,共邀广东省内35名权威专家进行多轮会审,在参考国内外玻璃体腔注药标准的基础上,结合粤港澳大湾区眼科现状,共同讨论最终确定了本标准。本团体标准系统地描述了玻璃体腔注药的基本要求、适应证与禁忌证,制定了全新的玻璃体腔注药标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构所开展的玻璃体腔注药的临床应用以及质量评估提供指导。
玻璃体腔注药是年龄相关性黄斑变性、糖尿病视网膜病变、视网膜静脉阻塞等常见慢性眼底病的主要治疗方式,凭借其治疗量大、操作流程化、实施简便,已成为眼科临床常规诊疗项目。基于《“十四五”全国眼健康规划(2021-2025年)》要求,秉承以患者为中心的服务理念,在确保医疗安全的基础上,优化治疗流程,提升患者接受玻璃体腔注药治疗的就诊体验和治疗效果。同时,广东省将有望承接越来越多港澳的眼病患者,需要建立融合粤港澳大湾区的广东省注药标准。因此,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构共同起草,通过函审、专家论证会等形式,共邀广东省内35名权威专家进行多轮会审,在参考国内外玻璃体腔注药标准的基础上,结合粤港澳大湾区眼科现状,共同讨论最终确定了本标准。本团体标准系统地描述了玻璃体腔注药的基本要求、适应证与禁忌证,制定了全新的玻璃体腔注药标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构所开展的玻璃体腔注药的临床应用以及质量评估提供指导。
团体标准解读

《睑板腺按摩操作流程》团体标准解读

Interpretation of the group standard for operation procedure of meibomian gland massage

:236-240
 
睑板腺功能障碍可导致眼表微环境失衡,眼部不适及视功能障碍,深刻影响着患者的视觉生活质量。睑板腺按摩作为一种通过机械挤压睑板腺疏通睑板腺开口,排出异常睑酯的治疗手段,目前已被广泛应用于临床干眼患者,成为睑板腺功能障碍最常见的物理治疗方法。但由于睑板腺按摩的操作手法多样,不同医疗机构所积累的操作经验也不尽相同,导致在治疗过程中存在较多潜在风险,若操作不当,可造成眼部感染、眼睑红肿、结膜水肿出血,甚至角膜损伤。因此,制定标准化的操作流程,规范睑板腺按摩治疗非常重要。然而,目前尚缺乏全面、系统化且规范化的睑板腺按摩操作的临床实践指导。鉴于此,中山大学中山眼科中心联合全国19所医疗机构进行反复修订,于2023年12月17日在全国团体标准信息平台发布《睑板腺按摩操作流程》的团体标准。文章对该团体标准进行深度解读,以更好指导临床工作。
Meibomian gland dysfunction (MGD) can lead to an imbalance in the ocular surface microenvironment, eye discomfortable, and visual impairment, thereby profoundly affecting the visual quality of life of patients. Meibomian gland massage is now widely used in clinical patients, serving as the most prevalent physical therapy for MGD. The mechanism of meibomian gland massage is to open the meibomian gland opening by squeezing the meibomian gland and expel abnormal eyelid esters. However, due to the diverse techniques used in meibomian gland massage and the varying levels of operational experience accumulated by different medical institutions, there are many potential risks in treatment process. If medical staff operate improperly, it can cause eye infections, eyelid redness and swelling, conjunctival edema and bleeding, and even corneal damage. Therefore, it is crucial to establish the standardized procedure of meibomian gland massage therapy. Yet, there is currently lack of comprehensive, systematic, and standardized clinical practice guidance. Thus, the Zhongshan Ophthalmic Center, Sun Yat-sen University, in collaboration with 19 medical institutions across the country, has released the group standard for Operation Procedure of Meibomian Gland Massage on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group standard to guide clinical work better.
专家共识

荧光素眼底血管造影操作规范专家共识

Expert consensus on standardized practice for fundus fluorescein angiography

:96-102
 
荧光素眼底血管造影(fundus fluorescein angiography, FFA)是眼底疾病诊疗不可或缺的检查技术。虽然开展已有半个世纪,但临床工作者在FFA操作的规范性、科学性、安全性和结果同质性仍有不少顾虑和问题,同时缺乏相关指南和共识可供参考。中国微循环学会眼微循环专业委员会眼影像学组专家就FFA操作规范达成本共识,就开展FFA的条件和配置、适应证和禁忌证、检查前准备、检查操作程序、不良反应及处理、造影后患者告知和处理、造影报告等方面为FFA临床操作工作者提供建议和指导,以期在临床实践中获取良好眼底影像、减少不良反应、提高检查质量效率。
Fundus fluorescein angiography (FFA) is an indispensable examination for the diagnosis and treatment of ocular fundus diseases. Although FFA has been carried out for half a century, clinicians still have many concerns and problems in the standardization, scientificity, safety and result homogeneity of FFA practice, and there is a lack of relevant guidelines and consensus for reference. The experts of the Ophthalmic Imaging Group of the Ocular Microcirculation Division of the Chinese Society of Microcirculation reached a consensus on the standardized practice of FFA, providing suggestions and guidance for FFA operators about the clinical conditions and configurations, indications and contraindications, pre-examination preparation, examination procedures, adverse reactions and treatment, patient notification, and angiography reports, in order to obtain good fundus images, reduce adverse reactions, and improve the quality and efficiency of FFA examinations in clinical practice.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览