Journal of Multidisciplinary Healthcare最新文献

Purpose: To investigate the relationship between choroidal thickness and postural stability in healthy young adults, focusing on the influence of refractive error and choroidal thickness distribution across quadrants.

Patients and methods: A cross-sectional study was conducted with 24 young adults (19 men, 5 women; mean age, 22 ± 2.06 years). Refractive error was measured using an autorefractor, and choroidal thickness was assessed with optical coherence tomography. Postural stability was evaluated using a force platform under quiet stance and one-legged stance conditions. Choroidal thickness was analyzed across quadrants and rings, and its correlation with postural sway parameters was determined using univariate analyses.

Results: The mean choroidal thickness was 280 ± 77.51 μm, with the nasal quadrant being the thinnest and the inferior quadrant the thickest. Myopic participants had thinner choroids (mean, 273 ± 77.25 μm) compared to non-myopes (mean, 288 ± 77.08 μm). A positive correlation (r = 0.279, P < 0.001) was found between choroidal thickness and refractive error. In quiet stance, increased choroidal thickness was negatively correlated with anterior-posterior sway but positively correlated with medial-lateral sway. During one-legged stance, choroidal thickness was negatively correlated with most postural sway measures, except for maximum medial-lateral sway.

Conclusion: Choroidal thickness is associated with refractive error and postural stability. Regional differences in choroidal thickness may play a role in balance control, highlighting the potential relevance of ocular structural health to mechanisms underlying balance control and fall risk. Further research is needed to explore the mechanisms linking choroidal dynamics and postural control.

Background: The Enhanced Recovery After Surgery (ERAS) protocol has shown promise in improving postoperative outcomes, but its specific impact on pulmonary nodule resection has not been well explored. In this retrospective cohort study with propensity score matching, we evaluated the association between ERAS-guided care and postoperative outcomes after pulmonary nodule resection.

Methods: Patients undergoing pulmonary nodule resection were retrospectively enrolled, and 168 propensity score-matched patients were analyzed. The included patients were divided into the control group receiving conventional nursing care and the ERAS group receiving care guided by the ERAS protocol. Postoperative complications, stress response indicators, including C-reactive protein (CRP) and interleukin-6 (IL-6), as well as pulmonary function parameters, were evaluated.

Results: A significantly lower overall complication rate was observed in the ERAS group (5.9% vs 20.5%, p = 0.006) compared to the control group. Additionally, the ERAS group demonstrated a shorter postoperative drainage duration, shorter tracheal extubation time, and a decreased length of stay. Postoperative pulmonary function, as assessed by Forced Vital Capacity (FVC%), Forced Expiratory Volume in 1 second (FEV1%), and the FEV1/FVC ratio, was significantly improved in the ERAS group (FVC%: 76.92 ± 11.68 vs 70.57 ± 11.92, p < 0.001; FEV1%: 68.97 ± 9.44 vs 63.53 ± 9.66, p < 0.001), indicating superior recovery. Furthermore, serum CRP and IL-6 levels were significantly lower in the ERAS group at 48 h postoperatively (p < 0.001 for both), suggesting a reduced inflammatory response.

Conclusion: ERAS protocols are associated with significantly improved postoperative recovery following pulmonary nodule resection, including reduced complications, enhanced pulmonary function recovery and decreased inflammatory markers.

Purpose: This study aimed to explore intervention strategies for fluid and electrolyte regulation in patients with high-output stomas, to optimize their clinical outcomes and quality of life.

Results: Fifteen experimental and semi-experimental studies were systematically reviewed. Interventions were categorized into five types by therapeutic purpose and route: gastrointestinal motility/anti-secretory agents, Glucagon-like Peptide-1/2 (GLP-1/2) analogs, rehydration/electrolyte supplements, micronutrient supplements, and dietary restriction. Key HOS complications included hyponatremia, hypomagnesemia, metabolic acidosis, hypokalemia, hypocalcemia, and kidney injury.

Conclusion: Hydro-electrolyte management in patients with HOS requires a multidisciplinary approach that integrates fluid management, pharmacotherapy, nutritional support, and surgical intervention. This framework may reduce dehydration-related readmission and improve outcomes. Future large-scale prospective studies are warranted to verify the efficacy, safety, and novel therapies, explore new therapeutic targets/drugs, and develop standardized guidelines, with an emphasis on individualized management for complex cases and prioritizing patient quality of life.

Purpose: Type 2 diabetes mellitus (T2DM) and diabetes-related complications can pose serious challenges to pilots by affecting their flight performance and professional careers. This study aims to investigate the emergence of complications in commercial pilots with T2DM through a retrospective evaluation of their aeromedical examination records.

Patients and methods: The retrospective cohort study included 59 commercial pilots who had a confirmed diagnosis of T2DM in year 2012, whereas pilots without such diagnosis within that year were excluded from the study. Their examination records involving the first diagnosis of T2DM prior to 2012 and all subsequent records from 2013 to 2021 were comprehensively analyzed. Data included demographic information, smoking status, age of diabetes and complication onset, certain biochemical markers, complications, and aeromedical certification processes. Estimated glomerular filtration rate (eGFR) values were calculated in each record using the CKD- EPI equation, with chronic kidney disease determined as two consecutive eGFR measurements being <60 mL/min/1.73 m². Examination intervals varied from 6 to 12 months based on aeromedical regulations. Statistical analyses were performed using proper comparative tests, and multivariate logistic regression was employed to identify factors linked to complications.

Results: Of the 59 pilots, 28 (47.5%) had at least one complication, such as coronary artery disease (CAD), retinopathy, stroke, or diabetic kidney disease (DKD), with 14 of them diagnosed retrospectively by eGFR measurements. The prevalence of smoking was 30.5%, with 77.78% of them developing complications, indicating a significant relationship (p=0.004). The mean age at the diagnosis of T2DM was 50.16±6.62, while complications occurred at 58.64±5.69 years. No significant difference was found in the age of T2DM onset between pilots with complications and those without.

Conclusion: This study identified a strong association between smoking and diabetes-related complications, demonstrated a high rate of complications -primarily CAD and DKD- in pilots with T2DM, and underscored the importance of periodical examinations in detecting subclinical conditions. Routine eGFR measurement was also shown to be essential for the early detection of DKD diagnosis.

Purpose: Medication disposal knowledge is a key component of safe pharmaceutical management, while medication adherence remains essential for achieving optimal treatment outcomes among patients with chronic conditions. However, poor adherence may contribute to medication accumulation and waste, which, if not disposed of properly, can pose risks to environmental and public health. Therefore, this study aimed to assess medication disposal knowledge, policy awareness and satisfaction, as well as medication adherence among chronic disease patients, and to examine how these outcomes differed across demographic and clinical subgroups.

Patients and methods: A cross-sectional design was employed, collecting data from 273 chronic disease patients with long term medication usages at a hospital in Taipei, Taiwan. The questionnaire covered knowledge of medication disposal, medication adherence, clarity of the disposal policy and satisfaction with the disposal policy promotional strategies, and socio-demographics. Independent samples t-tests were used to assess the influence of demographic characteristics on knowledge and adherence. Pearson correlation coefficients were applied to evaluate the relationship between knowledge of medication disposal and medication adherence.

Results: Younger age and higher education were associated with better medication disposal knowledge. Medication adherence was significantly higher among patients over 65, lower education, who lived alone and those taking five or more medications. The medication disposal knowledge was not significantly different between good or poor adherence. Although most respondents were unaware of the recycling label on medication bags, those who knew the location of disposal stations scored higher knowledge of medication disposal, clarity in the disposal policy and satisfaction with the disposal policy promotional strategies.

Conclusion: Medication disposal competency plays an important role in reducing environmental harm, especially in people with poor adherence. Improving knowledge of medication disposal and adherence remains a key objective for medication safety and health issues.

Background: Diabetes mellitus (DM) is a chronic disease that significantly affects patients' quality of life and mental health. Psychoeducational approaches have been recognized as an effective strategy to improve knowledge and self-care skills and to reduce psychological burden. However, scoping reviews focusing on psychoeducational interventions and their outcomes in patients with type 2 diabetes mellitus in Asian contexts remain limited.

Purpose: This scoping review aimed to identify, map, and synthesize existing evidence on psychoeducational interventions for adults with type 2 diabetes mellitus in Asian countries.

Methods: A scoping review was conducted in accordance with the Arksey and O'Malley framework and reported in accordance with PRISMA guidelines. Literature searches were conducted across CINAHL, PubMed, Scopus, and Taylor & Francis databases through July 28, 2025, complemented by manual searches in Google Scholar. Eligible studies were randomised controlled trials (RCTs) published in English that involved patients with diabetes types 2 in Asian countries. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist, and data were synthesised through thematic analysis.

Results: There were 13 RCT articles analyzed in this review. The psychoeducational interventions identified could be classified into three main models: cognitive-behavioral and acceptance-based interventions, mindfulness and stress-reduction interventions, and educational and coaching-based interventions. The reported outcomes also clustered into three domains: psychological, behavioral/self-management, and clinical. The most consistent improvements were observed in psychological and behavioural outcomes, while clinical outcomes, such as reduced HbA1c, cortisol levels, and PAI-1, also improved.

Conclusion: Psychoeducational interventions are diverse and effective in improving psychological well-being and self-management among patients with diabetes in Asia. Culturally-based adaptation and integration into primary healthcare systems are essential to ensure sustainability and long-term effectiveness.

Introduction: Family caregivers of persons with schizophrenia often face significant challenges, including stress and negative caregiving experiences. Psychoeducation is an effective nursing intervention to support caregivers, yet the specific needs of Sundanese family caregivers in Indonesia remain unexplored.

Purpose: This study aimed to explore the psychoeducational needs of Sundanese Indonesian family caregivers caring for Persons with schizophrenia during the maintenance phase.

Patients and methods: A descriptive qualitative design was employed. Participants were purposively sampled from family caregivers in Soreang District, Bandung Regency, until data saturation was reached (n=20). Semi-structured interviews were conducted, and data were analyzed using inductive content analysis.

Results: Seven key main categories emerged: 1) the required psychoeducational content; 2) psychoeducation delivered by healthcare professionals in collaboration with community leaders; 3) the recipients of psychoeducation involve the primary decision-makers within the family; 4) psychoeducation is administered directly; 5) books as a medium for psychoeducation; 6) appropriate timing for implementing psychoeducation; and 7) accessible locations for carrying out the psychoeducation.

Conclusion: The findings highlight culturally tailored psychoeducational needs for Sundanese caregivers, emphasizing the importance of involving community leaders and family structures. These insights can inform mental health programs to reduce caregiver burden and improve outcomes for persons with schizophrenia.

Objective: This study aimed to explore the barriers and facilitators of the linkage to care in Bandung, Indonesia.

Methods: This study used a descriptive qualitative design with in-depth interviews with 17 purposively selected participants, including people living with HIV (PLHIV), healthcare providers, case managers, and community health volunteers. Data were collected from September 2024 to December 2024 in three key service settings in Bandung. A socio-ecological framework guided data collection and deductive content analysis, allowing thematic categorization at the individual, interpersonal, healthcare system/policy, and community levels.

Results: The analysis identified 10 main categories and 22 subcategories of facilitators and barriers linked to HIV care across socio-ecological levels. At the individual level, psychological readiness, HIV-related knowledge and perceptions, clinical conditions, and socioeconomic status shaped the linkage to care. Interpersonal support from family members, peers, and healthcare providers affected the decisions linked to care. At the healthcare system and community levels, service accessibility, stigma, and community engagement under the ongoing implementation of Universal Health Coverage (UHC) influenced the linkage to care in Bandung. A unique aspect of the present study lies in its emphasis on community engagement in the context of the ongoing implementation of UHC as a key facilitator, and service gaps at the primary care level and persistent stigma remains a key barriers in Bandung.

Conclusion: Multi-level factors shaped the linkage to HIV care in Bandung. Strengthening nurse- and peer-led navigation, expanding primary care services, promoting community participation, and scaling up structured professional guidance are key to reducing stigma and improving early engagement.

Background: Self-Injurious Behavior (SIB) is a behavior that can lead to mental health problems and may become a contributing factor to future suicide. Intervention and strategy have been reported to be effective in reducing and preventing SIB. However, there are no existing reviews that report it from the nursing perspective even though nurses play a crucial role in caring for individuals with SIB.

Purpose: This scoping review aims to identify nursing care interventions that can be used to reduce SIB.

Methods: The study was based on the five-stage methodological framework and was guided by the PRISMA-ScR. We searched from 2 to 9 June 2025 records identified from database Pubmed (n = 12105); CINAHL (n = 145807); Scopus (n = 99); Garuda (n = 46) and a total of 158057 literature screened, 4 studies published between 2015 and 2025 were included in the review. The key words in English were nursing care OR therapy AND adolescents AND adults, young AND non suicidal self-injury OR self-harm OR self-injurious behavior. While in Bahasa Indonesian were Intervensi Keperawatan OR Terapi Keperawatan AND Remaja AND Dewasa AND Self-Harm OR non-suicidal self-injury.

Result: We found 4 articles showing therapeutic interventions by nurses to reduce SIB in both clinical and non-clinical settings. Four types of interventions were used to reduce SIB, and recommended therapeutic nursing intervention in groups is group psychological nursing. Meanwhile, in hospital settings, Dialectical Behavior Therapy (DBT) is the recommended method, and in communities, a combination of psychoeducation and MBCT is recommended. Dhikr is recommended as a culturally practice.

Conclusion: Our findings highlight that four methods are effective in reducing SIB and provide valuable references for both clinical and non-clinical applications in children, adolescents, and adults. Our study indicates that the potential of four intervention can be used as a strategy in the mental health nursing and psychiatric area.