Journal of Multidisciplinary Healthcare最新文献

Objective: This study aimed to examine the integration of artificial intelligence (AI) into nursing clinical education, with particular emphasis on enhancing the Mini-Clinical Evaluation Exercise (Mini-CEX). The study focused on the role of AI in improving the objectivity of clinical performance assessment and the quality of feedback provided.

Methods: A mixed-methods approach was used, involving 140 undergraduate nursing students randomly assigned to a control or intervention group. The intervention group received conventional clinical instruction supplemented by an AI-assisted Mini-CEX. The AI was integrated during the assessment process to provide automated performance analysis of video-recorded clinical skills and transcripts of patient interactions. This analysis generated structured, individualized feedback reports for learners, which were then used by instructors to guide the dissemination of results in post-assessment debriefing sessions.

Results: The AI-supported Mini-CEX demonstrated a significant enhancement in the consistency and objectivity of clinical evaluations. In this study, artificial intelligence was specifically applied through automated performance analysis, real-time feedback delivery, and its integration into Mini-CEX assessments, thereby clarifying the role of AI within the instructional process. Learners in the intervention group achieved more rapid acquisition of technical skills and exhibited increased engagement, which was attributed to the provision of immediate and personalized feedback.

Conclusion: The incorporation of AI into the Mini-CEX framework, specifically for automating aspects of performance analysis and feedback generation, contributed to real-time, standardized, and learner-centered assessments. This approach improved the objectivity of evaluations while maintaining the integral role of human mentorship for interpretive guidance.

Introduction: Community-based palliative care implementation faces challenges in terms of providing services to people living with terminal illness in remote and underserved areas. Integrating telehealth into palliative care has the potential to improve access to and effectiveness of palliative care by enabling remote interactions between people living with terminal illness, their caregivers, and healthcare providers. However, the models and outcomes of telehealth in the context of community palliative care remain poorly understood.

Objective: The aim of this systematic review was to investigate the benefits of integrating telehealth into community-based palliative care for people living with terminal illness and their caregivers.

Methods: A systematic search of studies was conducted using MEDLINE, PubMed, EBSCO, Cochrane Controlled Register of Trials (CENTRAL), Scopus, and Google Scholar. The inclusion criteria were primary quantitative studies on integrating telehealth into palliative care in community for adults living with terminal illness, published in between 2014 and 2024. The risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa scale for cohort studies. The data were analyzed using content analysis.

Results: Seven studies met the inclusion criteria. Telehealth interventions most commonly involve telephone or video consultations and phone calls. Evidence has shown consistent improvements in functional status, reduction in hospitalization rate, and reductions in psychological distress (anxiety, depression) among people living with terminal illness. For caregivers, the benefits included reduced psychological distress (stress, depressive symptoms) and care burden. Additionally, improvements in quality of life among caregivers has been inconsistent.

Conclusion: Integrating telehealth into community-based palliative care is associated with improved outcomes for people living with terminal illness and their caregivers. However, the lack of studies based in low- and middle-income countries limits the generalizability of the results and prevents conclusions as to whether similar interventions will have the same outcome outside high-income countries.

Background: Mechanically ventilated patients are at significant risk of malnutrition, a condition that not only prolongs ICU length of stay but also dramatically increases mortality risk. While existing studies have focused on clinical protocols, the global research landscape and knowledge gaps remain underexplored in terms of systematic synthesis. This study employs systematic bibliometric analysis to quantitatively trace publication trajectories, identify dominant research clusters, and propose evidence-based pathways for enhancing global research prioritization and improving clinical nutrition practices.

Methods: Studies published between January 1, 2000, and November 6, 2024, on enteral nutrition in mechanically ventilated patients were identified using the Web of Science platform. A comprehensive analysis of these studies was performed using VOSviewer, CiteSpace, and an online analysis tool(R-bibliometrix), assessing publication trends, contributions from countries/regions and institutions, institutional productivity, major funding agencies, journals and their co-citation networks, authors and their co-citation patterns, and keywords and emerging trends in the field.

Results: A total of 1164 studies were included in the analysis, which showed a general upward trend in publication volume over the 24 years. The USA, supported by robust financial resources and well-established research institutions, ranked first in terms of publication count, citation number, and h-index. The top three institutions in terms of publication volume were Harvard University, the University of Toronto, and Queen's University of Canada. The journals with the highest numbers of publications were the Journal of Parenteral and Enteral Nutrition, Critical Care Medicine, and Clinical Nutrition. The most prolific author was Dr. Daren K. Heyland. The top keywords were "nutrition", "malnutrition", and "prevalence".

Conclusion: Research in the field of enteral nutrition for mechanically ventilated patients continues to thrive, increasing the number of investigations. The present bibliometric analysis provides a summary of current research frontiers and hotspots in the field, offering a robust reference framework for researchers investigating enteral nutrition in mechanically ventilated critically ill patients.

Background: Visceral leishmaniasis (VL) is a severe, life-threatening public health concern in Ethiopia. Since early 2022, the outbreak of VL in the South Omo Zone, particularly among pastoralist communities, has resulted in multiple deaths.

Objective: To assess the risk factors contributing to the VL outbreak in South Omo Zone, southern Ethiopia.

Methods: A mixed-method study was conducted in Hammer, Nyangatom, and Selamago districts (areas with the highest case load). The study included a stakeholder consultative workshop and qualitative interviews with health workers, community leaders, and caregivers. A matched case-control study was also performed, and conditional logistic regression was used to analyze quantitative data.

Findings: The stakeholder consultation revealed 64 challenges linked to the outbreak. The top-ranked challenge was the high non-medical cost of VL diagnosis and treatment, followed by limited government and stakeholder commitment. Notably, the absence of governmental structure in the Mursi area (Selamago district) was identified as a significant barrier despite being ranked 11th. Qualitative data highlighted additional challenges: poor transportation, distant treatment services, low awareness, cultural treatment practices, and lengthy therapy duration. Quantitatively, family history of VL was a significant risk factor (AOR = 2.91, 95% CI: 1.73-4.87), while VL cases were more likely to have good knowledge of the disease than controls (AOR = 6.6, 95% CI: 2.34-18.42).

Conclusion: The findings highlight significant challenges in the control and management of visceral leishmaniasis (VL) in South Omo Zone, including high non-medical costs of care, limited government commitment, inadequate outbreak preparedness, and shortages of trained providers. Prioritized strategies emphasized strengthening health systems, mobilizing resources, and engaging political and community leaders. Addressing systemic gaps and strengthening community-based interventions are essential for effective VL outbreak control and timely treatment.

Purpose: Platinum-based chemotherapy and radiotherapy are cornerstone treatments for many cancers but carry a high risk of ototoxicity, leading to hearing loss, tinnitus, and balance dysfunction. Despite the benefits of monitoring in reducing long-term consequences, global uptake remains poor. This study provides the first national-level insight into ototoxicity monitoring for cancer patients in Saudi Arabia, aiming to identify service gaps and propose solutions to guide healthcare planning.

Methods: Twenty-five oncology centers were evaluated. Data were collected via phone interviews with oncologists and audiologists, providing a comprehensive understanding of monitoring in clinical practice.

Results: Findings highlight a concerning reality: institutions often fail to support even the most basic elements of ototoxicity monitoring. Practices varied considerably in the absence of formal policies, even within the same institution, depending on audiology service availability and oncologists' referral approaches. Adult referrals were rare, pediatric monitoring was inconsistent, and long-term follow-up was limited. Barriers included inadequate audiological resources, staff shortages, insufficient multidisciplinary coordination, limited audiologists' knowledge, and lack of guidelines.

Conclusion: As decision-makers seek reliable national data to guide policies aligned with Vision 2030 health transformation goals, this study proposes policy-based solutions to strengthen ototoxicity monitoring and expand access to hearing rehabilitation services in Saudi Arabia. The study has inspired a collaborative initiative-currently being explored by the author with audiologists and oncologists across health sectors-to promote internal monitoring protocols in capable institutions and lay the groundwork for a future national ototoxicity monitoring program.

Background: The psychosocial impact of cancer, particularly social isolation, has gained increasing recognition in oncology research. This bibliometric analysis maps the global research landscape and evolving trends in social isolation among cancer patients over two decades.

Methods: We retrieved original research articles and review papers on cancer research associated with social isolation from Web of Science database between 2005 and 2024. Utilizing bibliometric platforms such as CiteSpace, VOSviewer, and bibliometric websites, we analyzed the annual publication trends, leading journals, countries, institutions, and authors in this field. Additionally, by analyzing keyword visualizations and keyword bursts, we identified the emerging and popular research areas related to social isolation in cancer research.

Results: We systematically analyzed 1219 publications from 2005 to 2024. Globally, the United States accounted for the highest proportion of research output (34.78%), ahead of England (16.57%) and China (7.71%). In terms of institutional contributions, the top three positions were held by the University of London (58 publications), the University of California System (54 publications) and French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM; 52 publications). Supportive Care in Cancer was the journal with the highest number of publications (52 papers). Keyword co-occurrence analysis revealed six major research clusters: social deprivation, palliative care, social isolation, social support, physical activity, and cognitive function. The research focus is transitioning from "risk factors" (2005-2014) to "psychosocial interventions" (2015-2024), with emerging focus on disparities, social determinants of health, and symptom management.

Conclusion: This study reveals accelerating global interest in cancer-related social isolation and highlights the need for multidisciplinary approaches that integrate biological and psychosocial perspectives in cancer survivorship care, particularly through targeted interventions for vulnerable populations.

Background: Chronic insomnia is a prevalent health concern. Treatment methods for chronic insomnia encompass medication therapy, psychotherapy, physical therapy, and sympathetic nerve regulation therapy. The synergistic effects of these various therapeutic approaches warrant further investigation.

Objective: This study aims to evaluate the impact of cognitive behavioral therapy for insomnia (CBT-I) in conjunction with stellate ganglion block (SGB) treatment on patients suffering from chronic insomnia.

Patients and methods: Patients diagnosed with chronic insomnia who were admitted to the anesthesia outpatient department between January 2023 and September 2024 were selected for this study. They were divided into two groups: the SGB group (Group S) and the CBT-I combined with SGB group (Group CS). Group S received ultrasound-guided SGB using 0.375% ropivacaine at a volume of 4 mL alternately on both sides, administered twice weekly over a period of 6 weeks. Group CS underwent CBT-I concurrently with SGB following the same protocol as Group S for 6 weeks. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and hypnotic medication were recorded before treatment as well as at 6 weeks and 12 weeks after treatment.

Results: The ISI and ESS scores were significantly decreased than before treatment at 6 weeks after treatment in group S (P < 0.05), and the ISI and ESS scores were significantly decreased than before treatment at 6 and 12 weeks after treatment in group CS (P < 0.05). The ISI and ESS scores were significantly lower in group CS than in group S at 6 and 12 weeks after treatment (P < 0.05). The hypnotic medication was also significantly lower in group CS than in group S at 12 weeks after treatment (P < 0.05).

Conclusion: CBT-I substantially enhances the efficacy of stellate ganglion block treatment for chronic insomnia, reducing reliance on hypnotic medications; furthermore, sustains stable long-term outcomes.

Objective: To identify distinct sleep quality profiles among patients undergoing maintenance hemodialysis (MHD) using latent profile analysis (LPA), and examine differences in perceived stigma across these sleep quality subtypes.

Methods: From December 2024 to March 2025, a total of 334 MHD patients were recruited via convenience sampling from the nephrology departments of two tertiary hospitals in Xinjiang, China. Data were collected using structured questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale (SDS), and the Social Impact Scale (SIS), along with sociodemographic and clinical information. LPA was employed to identify latent subgroups of sleep quality based on PSQI components. Multinomial logistic regression was used to determine predictors of sleep profile membership. Differences in stigma scores across sleep profiles were analyzed using non-parametric equivalents.

Results: Three distinct sleep profiles were identified: Class 1 - "overall better sleep", Class 2 - "short sleep duration and low efficiency", and Class 3 - "poor sleep quality with high medication use". Multinomial logistic regression identified comorbid heart failure (OR=2.867, P=0.001 for Class 2), pruritus (OR=2.715, P<0.001 for Class 2), depressive symptoms (OR=2.568, P=0.001 for Class 2; OR=4.823, P<0.001 for Class 3), and elevated C-reactive protein (OR=1.044, P<0.001 for Class 2; OR=1.035, P=0.008 for Class 3) as significant predictors of poorer sleep profiles. Stigma scores differed significantly across all sleep profiles (Class 1 vs 2: P=0.039; Class 1 vs 3: P<0.001; Class 2 vs 3: P=0.005), with Class 3 exhibiting the highest median SIS score.

Conclusion: Patients with MHD exhibit heterogeneous patterns of sleep disturbance, which are associated with varying levels of perceived stigma. Those with the poorest sleep quality and highest reliance on medication experience the most pronounced stigma. Tailored interventions addressing sleep-related issues and psychosocial factors may help reduce stigma and improve patient well-being.

Objective: The high prevalence of anxiety disorders among heart failure (HF) patients significantly impacts clinical outcomes, yet a comprehensive analysis of the global research landscape is lacking. This study explores research trends, knowledge structure, and emerging hotspots in the field of HF and anxiety comorbidity over the past decade.

Methods: A bibliometric analysis was conducted on 1,475 publications from the Web of Science Core Collection (2015-2024). A total of 1,475 English-language publications, including articles and reviews, were analyzed. CiteSpace and VOSviewer were used to analyze collaboration networks, references, and keywords. The search tool for the retrieval of interacting genes database was applied to construct a protein-protein interaction (PPI) network of HF and anxiety comorbidity. R with clusterProfiler was applied to perform kyoto encyclopedia of genes and genomes pathway enrichment analysis. Cytoscape was applied to visualize both the PPI network and the significant pathways.

Results: Annual publications increased steadily, peaking in 2021. The United States of America and China emerged as the most productive countries. Key contributors included Linkoping University and Harvard Medical School. Keyword analysis revealed evolving focuses from mortality and depression to self-care, cardiac rehabilitation, and psychological assessment tools. Gene intersection analysis identified 124 shared genes, with hub genes such as AKT1, TP53, and IL6 implicated in MAPK, FoxO, and JAK-STAT signaling pathways. These results suggest neuroendocrine and inflammatory mechanisms linking HF and anxiety.

Conclusion: This study offers the bibliometric and molecular insight into the HF and anxiety comorbidity landscape. While research output and mechanistic understanding have grown, gaps remain in standardized assessment and clinical translation. Future studies should focus on translating these mechanistic insights into strategies that improve integrated care and quality of life for patients living with the dual burden of heart failure and anxiety.

Pharmacogenetics is a concept designed to tailor medication based on genetic profile to improve efficacy and reduce adverse effects. This personalized strategy shows considerable potential for populations facing complicated therapeutic challenges, such as the coinfected Tuberculosis (TB)-HIV population. This systematic review analyses pharmacogenes related to antiretroviral and anti-tuberculosis medications in the TB-HIV population. An analysis of 39 included studies indicated that efavirenz and CYP2B6*6 are the most extensively researched antiretroviral therapy (ART) and gene, respectively. Isoniazid and N-acetyltransferase 2 (NAT2) are the most extensively researched anti-TB drug and gene, respectively. Nevertheless, many studies relied solely on observational research and the investigation of pharmacokinetic characteristics. Research evaluated both the drug concentration of individual gene-drug interactions and the interactions between medications based on their genotypes. The NAT2 slow acetylator genotype is associated with elevated isoniazid levels, consequently increasing efavirenz plasma concentrations. Arylacetamide deacetylase (AADAC) polymorphisms that increased rifapentine plasma levels could also reduce dolutegravir plasma concentrations. Specific genes linked to significant outcomes in TB-HIV populations, such as pregnane X receptor (PXR) g.24087C>T, which increased the mortality rate. Consequently, a holistic approach to pharmacogenetics in TB-HIV populations is essential, considering all drug-gene-disease interactions. High-quality research, including randomized controlled trials (RCTs), is necessary for the implementation of pharmacogenetic testing in TB-HIV populations before it can be widely adopted in clinical practice, which is currently lacking.