Journal of Multidisciplinary Healthcare最新文献

Purpose: The palliative phase of a patient's life is often characterized by disease complexity, increasing the need for holistic care, support for the patient's relatives, and the up-to-date knowledge of a multidisciplinary healthcare team. Physicians in nursing homes have the main responsibility for providing palliative care to vulnerable and fragile patients. There is limited research uncovering physicians' experience and perceptions of what is important in this phase of patients' lives. The aim of the study was thus to investigate physicians' perceptions of factors that influence the quality of palliative care in Norwegian nursing homes and their descriptions of the importance of the team's collaboration.

Materials and methods: The study has a qualitative research design based on interviews with twelve nursing home physicians in Eastern Norway. Interviews were conducted between February 2023 to May 2023, analyzed using qualitative content analysis.

Results: Three themes describe the content of the findings: i) Comprehensive care plans enhance the quality of palliative care, ii) A collaborative team provides higher-quality care than the sum of its parts, iii) Systemic and environmental factors affect the ability to ensure continuity of care.

Conclusion: The physicians in this study expressed that the quality of palliative care in nursing homes depended on comprehensive care plans, including up-to-date knowledge of medical treatment options, partnership with the patient and relatives, and a consistent holistic approach to the patient. The quality also depended on the interdisciplinary team's collaboration in assessing the patient, observing symptoms, and planning further care and treatment in accordance with patients' and their relatives' preferences and wishes. Finally, systemic and environmental factors affected the ability to ensure continuity of care. Further work is needed to ensure that systemic factors enable physicians to deliver high-quality palliative care and that a comfortable physical environment is created in nursing homes.

Introduction: Motor learning, in addition to influencing the practice of physical activity, affects cognitive skills related to prediction and decision. One key principle in sports training is designing exercise programs that optimize cognitive-motor performance, based on the Challenge Point Framework (CPF). The aim of this study is to investigate the effect of different levels of work difficulty on cognitive-perceptual indicators in table tennis beginners.

Methods: Forty-two female beginners in table tennis (ages 20-35) were divided into high, moderate, low task difficulty, and control groups based on pre-test scores of attention networks. The intervention consisted of 8 daily training sessions, each lasting 30 minutes. Pre- and post-test comparisons were made to evaluate changes in cognitive-perceptual performance.

Results: Post-test results showed improvements in executive control of attention and cognitive effort across all groups. But there was no significant difference between the groups.

Discussion: These findings suggest that cognitive task difficulty, much like functional difficulty, aligns with predictions from the CPF, enhancing executive control and cognitive effort, and thereby supporting motor learning.

Conclusion: Cognitive difficulty, like functional difficulty, takes advantage of the challenge point framework and improves cognitive-cognitive indicators.

Objective: This study aimed to explore the value of a radiomic nomogram based on contrast-enhanced computed tomography (CECT) for differentiating benign and malignant solid-containing renal masses.

Materials and methods: A total of 122 patients with pathologically confirmed benign (n=47) or malignant (n=75) solid-containing renal masses were enrolled in this study. Radiomic features were extracted from the arterial, venous and delayed phases and further analysed by dimensionality reduction and selection. Four mainstream machine learning algorithm training models, namely, support vector machine (SVM), k-nearest neighbour (kNN), light gradient boosting (LightGBM) and logistic regression (LR), were constructed to determine the best classifier model. Univariate and multivariate analyses were used to determine the best clinical characteristics for constructing a clinical model. The radiomic and clinical signatures were integrated to construct a combined radiomic nomogram model. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to evaluate the performance of the radiomic nomogram, radiomic signature, and clinical model.

Results: Thirteen radiomic features were selected for the development of the radiomic signature. Among the various radiomic models, the LR model demonstrated superior predictive efficiency and robustness, yielding an AUC of 0.952 in the training cohort and 0.887 in the test cohort. The AUC for the clinical model was 0.854 in the training cohort and 0.747 in the test cohort. Furthermore, the radiomic nomogram, which incorporated sex, age, alcohol consumption history, and the radiomic signature, exhibited excellent discriminative performance, yielding an AUC of 0.973 in the training cohort and 0.900 in the test cohort.

Conclusion: The radiomic nomogram based on CECT offers a promising and noninvasive approach for distinguishing malignant from benign solid renal masses. This tool can be used to guide treatment strategies effectively and can provide valuable insights for clinicians.

Objective: Common examinations for diagnosing obstructive sleep apnea (OSA) are polysomnography (PSG) and home sleep apnea testing (HSAT). However, both PSG and HSAT require that sensors be attached to a subject, which may disturb their sleep and affect the results. Hence, in this study, we aimed to verify a wireless radar framework combined with deep learning techniques to screen for the risk of OSA in home-based environments.

Methods: This study prospectively collected home-based sleep parameters from 80 participants over 147 nights using both HSAT and a 24-GHz wireless radar framework. The proposed framework, using hybrid models (ie, deep neural decision trees), identified respiratory events by analyzing continuous-wave signals indicative of breathing patterns. Analyses were performed to examine correlations and agreement of the apnea-hypopnea index (AHI) with results obtained through HSAT and the radar-based respiratory disturbance index based on the time in bed from HSAT (bRDI_TIB). Additionally, Youden's index was used to establish cutoff thresholds for the bRDI_TIB, followed by multiclass classification and outcome comparisons.

Results: A strong correlation (ρ = 0.87) and high agreement (93.88% within the 95% confidence interval; 138/147) between the AHI and bRDI_TIB were identified. The moderate-to-severe OSA model achieved 83.67% accuracy (with a bRDI_TIB cutoff of 21.19 events/h), and the severe OSA model demonstrated 93.21% accuracy (with a bRDI_TIB cutoff of 28.14 events/h). The average accuracy of multiclass classification using these thresholds was 78.23%.

Conclusion: The proposed framework, with its cutoff thresholds, has the potential to be applied in home settings as a surrogate for HSAT, offering acceptable accuracy in screening for OSA without the interference of attached sensors. However, further optimization and verification of the radar-based total sleep time function are necessary for independent application.

Background: Community integration (CI) is the ultimate goal of rehabilitation for individuals with disabilities. It plays a significant role in restoring their social functioning and facilitating their reintegration into community and family life. However, no studies have utilized bibliometric methods to explore community integration.

Objective: To conduct a review about community integration of disabilities and to clarify the knowledge, hotspots, and trends through the bibliometric method.

Methods: Studies on community integration from 1990 to 2023 were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace 6.2.R4 and Microsoft Office Excel 2019 were applied. The CiteSpace node types involved in this study include keyword, reference, cited author, cited Journal, and the dual-map overlay of journals. CiteSpace presented the keyword cluster map, keywords timeline view map, keywords bursts map, and overlay map of journals. Microsoft Office Excel 2019 was used to present the trend of annual publications and draw up related tables and figures.

Results: A total of 2239 hits were included. The number of publications related to community integration is increasing gradually. The three most frequent keywords is Brain Injury (571, 13%), Individuals (488, 11%), Quality of Life (434, 10%). Keyword cluster map and timeline map with eight clusters were obtained, and the current strongest citation burst keywords are social participation, substance use, experiences, interventions, and Afghanistan. Willer is the author with the most citations. McColl has the largest centrality in the first ten cited authors. The most cited reference is published by the World Health Organization (WHO). Archives of Physical Medicine and Rehabilitation is the journal with the highest co-citation frequency. The overlay map of journals presented four distinct paths: the journals in "psychology education, health" and "neurology, sports, ophthalmology" often cite journals in "health, nursing, medicine" and "psychology, education, social".

Conclusion: Community integration for individuals with disabilities is gradually becoming a hot topic. Research on community integration related to traumatic brain injury (TBI), stroke, children, and spinal cord injuries is current focus of community integration. Future research should explore the experiences and feelings of different groups of disabilities regarding community integration and develop more effective interventions for their community integration. Community integration is complex, and future research on community integration for individuals with disabilities needs to be explored more specifically.

Background: This study evaluates a simulation-based interprofessional education (IPE) program implemented at the National Cheng Kung University Hospital between 2018 and 2023. The program aimed to improve teamwork, communication, and collaboration among healthcare professionals in high-acuity environments such as emergency departments and intensive care units (ICUs).

Methods: A prospective, mixed-methods approach was used to assess the program's effectiveness. The study enrolled 237 participants, including postgraduate medical trainees, nurses, respiratory therapists, and administrative staff. Two high-fidelity clinical scenarios-multiple trauma and respiratory distress with shock-were designed to simulate real-world emergencies. Participants' teamwork performance was evaluated using the Team Emergency Assessment Measure (TEAM), while qualitative feedback was collected via structured questionnaires and thematically analyzed.

Results: Quantitative analysis revealed significant improvement in leadership communication (p = 0.0328) and positive trends in teamwork dimensions such as completion and effective communication. However, global team performance showed only modest numerical gains. (p=0.5201) Qualitative feedback highlighted recurring themes such as unclear task delegation, delayed recognition of patient condition changes, and inconsistent use of communication techniques like call-outs and check-backs.

Conclusion: The simulation-based IPE program significantly enhanced interprofessional collaboration and clinical competencies among participants. However, specific areas, particularly communication, leadership, and situational awareness, require further attention in future training sessions. These findings underscore the importance of continuous refinement of simulation programs to prepare healthcare teams for high-stakes clinical scenarios effectively.

Background: Patients who incur an anterior cruciate ligament (ACL) injury and undergo ACL reconstruction (ACLR) have the intention of returning to sports at their pre-injury level; however, many do not return to the pre-injury level. This study aims to investigate the common factors that hinder patients from resuming sports activities following ACLR and to assess how these barriers impact their ability to return to sports. We hypothesized that patients' psychological factors, including fear of reinjury, would significantly influence their decision to return to sport after ACL reconstruction.

Methods: In this cross-sectional study, 138 patients who had undergone ACL reconstruction surgery were examined. The research methodology involved conducting interviews to gather comprehensive data on demographic, psychological, and physical factors that impact the resumption of sports activities following ACLR. The factors considered encompassed knee-related symptoms, life-related reasons, and choice-related reasons, such as fear of reinjury.

Results: Among the 138 participants who were included, the mean age was 33.49 ± 9.19 years, with only 39 (28.3%) patients indicated a successful return to their pre-injury activity levels. The obstacles preventing the resumption of sports activities were more commonly attributed to reasons such as fear of reinjury (79.8%) and persistent knee symptoms (78.8%), rather than choice-related reasons (excluding fear of reinjury) (23.2%), such as lack of time or interest, and life-related reasons (18.2%), including work, family, and education. In addition, patients who completed the rehabilitations were 6.277 times more likely to return to the previous level of activity (95% CI 1.801-21.880; P = 0.001).

Conclusion: This research places emphasis on the impact of psychological factors, particularly the fear of reinjury, more commonly in male, on the decision to resume sports activities. In addition, persistent knee symptoms and completion of rehabilitation after ACLR is another factors contributing in returning to sport. Psychological evaluation and counseling may identify those less likely to return to sport, allowing for more targeted interventions to further improve ACLR outcomes.

Objective: This study aimed to assess the determinants of demoralization syndrome among patients with breast cancer (BC) in the southwestern region of China.

Methods: This investigation constituted a single-center cross-sectional study in which 176 patients with BC were surveyed through a questionnaire covering the current status of demoralization syndrome and social support.

Results: Majority of patients with BC developed moderate-to-severe levels of demoralization. The degree of demoralization among patients with BC was complex and influenced by a variety of factors. Among patients with BC, demographic variables such as age, education level, residential address, monthly income, occupation, and receipt of chemotherapy were the main influencing factors (P < 0.05), whereas factors such as current status of children, and surgical methods were not the main influencing factors (P < 0.05). Additionally, all patients with BC reported receiving social support exceeding moderate levels, with no statistically significant difference in demographic data observed among those reporting heightened levels of social support (P > 0.05).

Conclusion: There are many factors influencing the degree of demoralization among patients with BC. Nursing interventions play a pivotal role in minimizing demoralization among patients with BC. We should pay more attention to patients with determinants of commitment level. Positive communication with patients, involving attentive listening, guidance and encouragement, is essential for providing effective psychological care and social support, fostering trust between healthcare providers and patients.

Triple-negative breast cancer (TNBC) is a unique breast cancer subtype characterized by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression in tumor cells. TNBC represents about 15% to 20% of all breast cancers and is aggressive and highly malignant. Currently, TNBC diagnosis primarily depends on pathological examination, while treatment efficacy is assessed through imaging, biomarker detection, pathological evaluation, and clinical symptom improvement. Among these, biomarker detection and pathological assessments are invasive, time-intensive procedures that may be difficult for patients with severe comorbidities and high complication risks. Thus, there is an urgent need for new, supportive tools in TNBC diagnosis and treatment. Deep learning and radiomics techniques represent advanced machine learning methodologies and are also emerging outcomes in the medical-engineering field in recent years. They are extensions of conventional imaging diagnostic methods and have demonstrated tremendous potential in image segmentation, reconstruction, recognition, and classification. These techniques hold certain application prospects for the diagnosis of TNBC, assessment of treatment response, and long-term prognosis prediction. This article reviews recent progress in the application of deep learning, ultrasound, MRI, and radiomics for TNBC diagnosis and treatment, based on research from both domestic and international scholars.

Background: Enteral Nutrition (EN) is the preferred method for providing nutritional support in intensive care units (ICUs) compared to parenteral nutrition (PN) due to its physiological advantages, safety profile, and cost-effectiveness compared to parenteral nutrition (PN). However, evidence suggests that EN might be associated with some complications. In this study, we aimed to identify the most common EN complications, as reported by healthcare professionals (HCPs) working in adult and paediatric ICUs (PICUs) in Saudi Arabia. We also investigated the factors influenced the HCPs' perception in reporting these EN complications.

Methods: In this cross-sectional pilot study, data was collected through an online survey from 25 December 2022 to the end of February 2023. All dietitians, physicians and nurses working in adult and PICUs in Saudi-Arabia were eligible to participate. The survey collected information about the demographic data of the participants, some of the EN related practice in intensive care settings as well as the frequency of the reported EN complications.

Results: A total of 173 respondents were included in the study. The most frequently reported complications were diarrhoea [3.06 ±1.197], aspiration [2.88 ±1.261], and constipation [2.85 ±1.11]. A statistical difference was recorded in the frequency of some of the reported EN complications between HCPs working in adults and paediatric ICUs (p<0.05). The participant's profession (r=-2.84, p<0.05) and years of experience (r=-0.5, p<0.05) appeared to statistically influence the perception of HCPs regarding EN complications.

Conclusion: This study highlighted the commonly reported complications associated with EN, with differences observed between adult and paediatric settings. The variation in reported complications may be attributed to differences in practitioner characteristics. These findings may emphasize the importance of targeted training, standardized reporting, and evidence-based practices to optimize EN management and improve patient outcomes in ICU settings.