Journal of Multidisciplinary Healthcare最新文献

Background: Resting-state functional magnetic resonance imaging (rs-fMRI) is a noninvasive way to evaluate brain physiological activity by detecting blood oxygen level fluctuations. Diminished ovarian reserve (DOR) indicates ovarian aging. Before 40, patients may have menstrual abnormalities, poor reproduction, and poor assisted reproductive results. Without treatment, it can cause early ovarian failure. Studies have shown that acupuncture can ameliorate sex hormones and antral follicle count (AFC) in DOR patients.

Objective: Despite limited studies on its mechanism, acupuncture have been shown to treat DOR. There is no relevant research on brain functional magnetic resonance and brain functional connectivity of acupuncture in treating DOR. We design this clinical trial to preliminarily elucidate the neuroimaging method of controlling the brain functional network and acupuncture impact in DOR patients using rs-fMRI.

Methods: This study will involve 30 DOR patients and 30 healthy individuals. DOR patients will have rs-fMRI before and after 3 menstrual cycles of acupuncture, whereas healthy individuals will need one rs-fMRI scan. The primary end measures will be follicle-stimulating hormone (FSH) and AFC. In contrast, the secondary outcomes will be luteinizing hormone(LH), estradiol (E2), anti-Müllerian hormone (AMH), modified Kupperman scale, self-rating anxiety scale (SAS), self-rating depression scale (SDS), and rs-fMRI alterations.

Results: This study uses rs-fMRI technology to identify the brain regions that differ between DOR patients and healthy people before and after acupuncture treatment. This study will connect brain regions, examine the effects of acupuncture on menstruation and pregnancy on DOR patients' brain function networks, and discuss neuroimaging methods.

Conclusion: Acupuncture may have the potential to regulate menstruation and increase the chances of pregnancy promotion in patients with DOR.

Objective: The employment of the no-touch technique in harvesting the great saphenous vein (GSV) for coronary artery bypass grafting has been associated with a significant improvement in clinical patency rates. Despite these advantages, such grafts may predispose patients to complications in the lower limbs. This study endeavors to evaluate the incidence of complications in the lower extremities by deploying an enhanced protocol for the no-touch harvesting technique.

Methods: The historical control group in this study included patients who underwent coronary artery bypass grafting (CABG) with the no-touch technique for GSV harvesting at our institution from August 2018 to April 2020, in compliance with ethical standards. The intervention group consisted of patients who received CABG and were subjected to an optimized no-touch technique for GSV harvesting from May 2020 to June 2022. Technical modifications were applied to reduce lower limb complications, including limited use of electrocautery, minimization of extravascular tissue preservation, relaxation of postoperative elastic compression bandages, and elevation of the lower extremities. These measures aimed to decrease the incidence of postoperative lower limb complications, such as pain, numbness, edema, exudation, and delayed healing. The occurrences of postoperative complications were meticulously documented, compared, and analyzed between the two groups.

Results: The adoption of the optimized no-touch technique resulted in a significant decrease in the incidence of postoperative lower extremity incisional complications among patients subjected to off-pump CABG (p < 0.05).

Conclusion: The results of this study substantiate that the application of an optimized no-touch technique to harvest the GSV significantly diminishes the incidence of postoperative lower limb complications in patients receiving CABG. These results highlight the importance of adopting and integrating this optimized technique into clinical protocols, emphasizing its critical role in advancing patient care outcomes.

Objective: To investigate the impact of surgical intervention on hemodynamic parameters and postoperative delirium in Stanford Type A aortic dissection patients.

Methods: A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling.

Results: ① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6 hours, cardiopulmonary bypass time >3 hours, and deep hypothermic circulatory arrest time >40 minutes (OR > 1, P < 0.05).

Conclusion: Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.

Objective: This study evaluates the therapeutic effects of the Yangxin Huoxue Formula in the management of stable angina pectoris associated with Qi deficiency and blood stasis syndrome, co-occurring with anxiety and depressive disorders. The primary objective is to determine its efficacy in enhancing cardiac function and reducing emotional symptoms.

Methods: A randomized, single-blind, placebo-controlled clinical trial was conducted with 94 individuals with stable angina pectoris. Participants were randomly allocated to either a treatment group receiving Yangxin Huoxue Formula granules or a placebo group receiving placebo granules, administered twice daily over a 12-week period. Primary outcome measures included assessments of cardiac function, angina frequency, PHQ-9 and GAD-7 scores, traditional Chinese medicine (TCM) syndrome improvements, and inflammatory markers.

Results: The treatment group exhibited significantly greater improvements in cardiac output and reductions in peripheral vascular resistance compared to the placebo group. Additionally, a significant decrease in the frequency and duration of angina episodes was observed in the treatment group. Improvements in TCM syndrome scores and GAD-7 scores were also notably superior in the treatment group. No significant adverse reactions were recorded during the safety assessment of the treatment group.

Conclusion: The Yangxin Huoxue Formula demonstrates efficacy in improving cardiac function, alleviating symptoms of anxiety and depression, reducing inflammatory mediator release, and enhancing quality of life in individuals with stable angina pectoris. The treatment was well-tolerated, confirming both its safety and therapeutic effectiveness.

Hospital manpower management (HRM) is vital for effective healthcare delivery. Unique challenges, such as managing diverse staff, ensuring clear communication, and optimizing resources, complicate HRM. Rising operational costs, workforce shortages, and employee burnout necessitate strategic approaches to manpower management. This review aims to provide a comprehensive understanding of manpower management in hospitals, focusing on identifying core components and discussing innovative strategies to address current challenges, particularly those related to workforce shortages. A literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key terms included "hospital manpower management", "HRM challenges in healthcare", and "workforce shortages", selected for their relevance to the core focus of this review. Relevant articles published from 2019 to 2023 were selected for analysis. The review identified core components of manpower management: recruitment and staffing, workforce planning, training and development, performance management, and compensation and benefits. Strategies to address workforce shortages included strategic hiring and enhancing employee engagement. The integration of technology and ongoing training emerged as critical for maintaining high-quality patient care. Effective manpower management is essential for the sustainability of healthcare systems. This review highlighted the importance of innovative HRM strategies to tackle workforce shortages and improve employee satisfaction. By focusing on comprehensive HRM practices, healthcare organizations could enhance workforce efficiency and provide better patient care. Future research should explore the long-term impacts of these strategies on healthcare.

Lymphoma, a heterogeneous group of blood cancers, presents significant diagnostic and therapeutic challenges due to its complex subtypes and variable clinical outcomes. Artificial intelligence (AI) has emerged as a promising tool to enhance the accuracy and efficiency of lymphoma pathology. This review explores the potential of AI in lymphoma diagnosis, classification, prognosis prediction, and treatment planning, as well as addressing the challenges and future directions in this rapidly evolving field.

Purpose: An association between the use of chlorhexidine in mechanically ventilated patients for the purpose of oral hygiene and the prevention of ventilator-associated pneumonia (VAP) lacks conclusive evidence in the literature. Therefore, this study aims to assess the clinical impact of such practice. This evaluation will consider that retention factors, infection foci, and oral biofilm will be regularly removed by a dentist.

Patients and methods: In this retrospective cohort study, a comparison was made between two groups, one using chlorhexidine and the other using saline solution. Patients from both groups included in this study were admitted between January 2016 to March 2018. Data such as the incidence of VAP, duration of mechanical ventilation (DMV), length of stay (LOS), and mortality rate (MR) were collected and compared between the groups. Only patients aged 18 or older, under mechanical ventilation for more than 48 consecutive hours were included. Were excluded from this study patients with a diagnosis of VAP or other pulmonary infection upon admission or within the first 48 hours of hospitalization. Also not included were those who stayed in the ICU for less than 48 hours. Dental treatment was carried out addressing the regular removal of retention factors, potential oral infection foci, and oral biofilm by a dentist. Additionally, at each appointment, the visible biofilm was removed by the dentist themselves, and the maintenance of oral hygiene was performed daily by the nursing staff. For the statistical analysis the non-parametric Mann-Whitney test was used for comparisons between groups regarding LOS and DMV. Additionally, the associations between groups and VAP, outcomes (discharge or death), and diseases were analyzed using the chi-square test and Fisher's exact test. A significance level of 5% was assumed.

Results: In both evaluated groups, each consisting of 36 patients, the incidence of VAP was identical at 2.8%. Specifically, the chlorhexidine group had an incidence of 2.105 VAP cases per 1000 days of mechanical ventilation (MV), while the placebo group had 2.865 VAP cases per 1000 days of MV (p = 1.000). No significant difference between groups regarding LOS (p = 0.5694) and DMV (p = 0.1136) was found. There was also no significant association between the MR in the two groups (47.2% chlorhexidine, 36.1% placebo) (p=0.3390).

Conclusion: When intensive oral care is performed, the use of chlorhexidine shows no significant change in VAP incidence, MR, LOS, and DMV. Therefore, the dentist, as part of the multiprofessional team, should decide on its use.

Objective: Burnout is an increasingly prevalent phenomenon, which can be associated with a wide range of mental and physical illnesses. There is also a possible connection between burnout and neuropathic low back pain, but the association is poorly studied.

Methods: The aim of our cross-sectional study was to analyze the prevalence and risk factors of chronic neuropathic low back pain taking many co-variates into account, such as burnout and its main determinants among postal workers. Demographic data, risk factors and concomitant diseases were recorded. Burnout was measured with the Mini Oldenburg Questionnaire (MOLBI), neuropathic low back pain was assessed by the painDETECT questionnaire, insomnia was detected by the Athen's Insomnia Scale and depression was measured by the Beck Depression Inventory.

Results: Three hundred sixty-eight males (35.6%) and six hundred sixty-six females (64.4%) participated in our study. Low back pain occured in 182 workers (17.6%), among them 36 workers (19.4%) had neuropathic low back pain, 56 (30.9%) had mixed pain and 90 (49.7%) workers had nociceptive low back pain. In a hierarchical regression analysis strong predictors of neuropathic low back pain included having secondary employment, depression, sleep disturbance and emotional exhaustion (main component of burnout).

Conclusion: This is among the first studies showing a possible association between burnout and neuropathic low back pain, highlighting the importance of adequate burnout screening and the implementation of interventions to avoid significant disabilities.

Research-oriented hospitals represent the primary direction for the future development of large-scale, high-level hospitals in China. Research-oriented hospitals, increasingly highlighted in domestic policies, lacks a comprehensive analysis of existing research outcomes. Bibliometric evaluates scientific research endeavors and trends in disciplines by statistically analyzing literature data. Citespace is a widely used bibliometric software that helps researchers visualize research hotspots and trends in a specific field by measuring and modeling literature data from that area. This study employs CiteSpace software to conduct a bibliometric analysis and visualization analysis of the literature in the field of research-oriented hospitals, spanning publications from 2003 to 2023 and sourced from databases including the China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu (VIP). Findings indicate rapid publication growth from 2010 to 2016, followed by fluctuations characterized by alternating declines and increases. In terms of the distribution of authors and institutions, the study observes a relatively modest level of collaboration among highly productive researchers and research institutions, suggesting room for enhanced interdisciplinary and institutional partnerships. Moreover, research hotspots in the field of research-oriented hospitals can be categorized into hospital development strategy, hospital management, and technological innovation. Considering the limitations of current research and the evolution of social needs, this study suggests that future research should focus more on clarifying the essence of research-oriented hospitals, developing targeted development strategies, and addressing the numerous obstacles faced during the hospital innovation process. In conclusion, this bibliometric analysis provides a snapshot of the current research status and trend. The insights gained from this research not only aim to inform future studies but also to inspire relevant stakeholders such as policy makers, hospital managers, and scholars to strengthen practical actions, enhance the construction and operation of research-oriented hospitals, thereby improving healthcare outcomes for populations.

Objective: To explore the factors that lead to occupational burnout among nurses in pediatric infectious disease wards after two consecutive years of frontline anti-epidemic work since the admission of COVID-19 patients in January 2020, in order to lay a scientific basis for reducing nurse occupational burnout.

Methods: A total of 12 nurses who working in pediatric infection units were included in the study. Utilizing qualitative research methodologies, we used semi-structured interviews as the primary data collection method. The interview data underwent meticulous organization and were subjected to descriptive analysis.

Results: 12 nurses assigned to pediatric infection wards frequently encounter occupational burnout, primarily attributed to increased work intensity, nurse-patient relationships, occupational frustration, psychological pressure, hospital infections, and various other contributing factors.

Conclusion: We found that the severity of occupational burnout among nurses specializing in pediatric infectious diseases is noteworthy. Our recommendations include heightened consideration of this issue by government authorities and hospital administrators.