Journal of Multidisciplinary Healthcare最新文献

Objective: The incidence of postoperative dysphagia in oral cancer patients is high, significantly impacting their quality of life. This study aimed to investigate the efficacy of a PDCA cycle in reducing the incidence of postoperative dysphagia in oral cancer patients.

Methods: A non-synchronous pre-post control design was employed. From January to June 2024, 120 patients undergoing radical surgery for oral cancer were assigned to the control group, receiving routine care. While 120 patients admitted between July and December 2024 formed the observation group, receiving multidisciplinary swallowing rehabilitation management based on the Plan-Do-Check-Act (PDCA) cycle. Primary outcomes comprised the incidence of moderate-to-severe dysphagia at 1, 2, and 4 weeks post-surgery. Secondary outcomes included length of hospital stay, hospital costs, and nasogastric tube retention duration.

Results: There were no statistically significant differences between the two groups in terms of demographic and clinical characteristics. The proportions of patients with moderate to severe dysphagia 12.5% and 10%, preoperatively (P > 0.05). The observation group exhibited significantly lower rates of moderate-to-severe dysphagia at 2 weeks (50% vs.72.5%) and 4 weeks (27.5% vs 60%) postoperatively compared to the control group (p < 0.05). The observation group exhibited significantly reduced hospital stays (15.73 ± 6.217 vs 20.63 ± 2.713), lower hospital costs (4.30± 1.930 vs 5.16 ± 1.889), and shorter nasogastric tube retention times (13.07 ± 1.465 vs 15.08 ± 1.612) (p < 0.05).

Conclusion: The PDCA cycle management model, through systematic and standardized multidisciplinary collaboration, effectively reduces the incidence of moderate-to-severe dysphagia in oral cancer patients postoperatively. It promotes recovery of swallowing function, shortens hospital stays, and reduces medical costs, thereby serving as an effective method for improving the quality of dysphagia management following oral cancer surgery.

Background: Inflammatory bowel disease (IBD) patients often exhibit low adherence to physical activity, potentially influenced by kinesiophobia. While kinesiophobia has been extensively studied in musculoskeletal and cardiovascular populations, its prevalence and patterns in IBD patients remain underexplored. This study aimed to explore the prevalence and distribution patterns of kinesiophobia in patients with IBD and identify factors associated with different kinesiophobia profiles.

Methods: This cross-sectional study recruited 222 IBD patients from a tertiary care hospital in China between January 2023 and September 2024. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11). Latent profile analysis was conducted to identify kinesiophobia subgroups, with additional assessments of disease activity, self-management behavior, self-efficacy, and fatigue. Multinomial logistic regression identified factors associated with profile membership.

Results: Among 222 IBD patients, 27.5% exhibited moderate-to-high kinesiophobia (TSK-11 ≥29). Latent profile analysis identified three distinct groups: Low-level Kinesiophobia-Cognitive Adaptation (51.4%), Medium-level Kinesiophobia-Somatic Symptom (28.8%), and High-level Kinesiophobia-Comprehensive Distress (19.8%). Complication presence was associated with both medium-level (OR=6.22, 95% CI: 2.63-14.69) and high-level profile membership (OR=4.82, 95% CI: 1.37-16.98), while disease remission showed protective effects against elevated kinesiophobia (OR=0.15 and 0.06 for medium- and high-level profiles, respectively). Fatigue severity emerged as a strong predictor of both medium- (OR=1.45, 95% CI: 1.21-1.73) and high-level profiles (OR=2.40, 95% CI: 1.81-3.18). Enhanced self-management capacity demonstrated protective effects against high-level profile (OR=0.92, 95% CI: 0.86-0.98).

Conclusion: This study revealed that 27.5% of IBD patients exhibited moderate-to-high kinesiophobia and identified three distinct profiles. Disease remission was a protective factor, while complications and fatigue severity were associated with elevated kinesiophobia. Routine kinesiophobia screening and profile-based interventions should be integrated into IBD care to improve physical activity engagement.

Objective: To develop a contextually tailored walking rehabilitation protocol for Chinese patients with lower extremity arteriosclerosis obliterans (ASO), providing evidence-based theoretical and practical guidance for clinical nursing.

Background: Lower extremity ASO is a prevalent chronic vascular disease with rising incidence, high morbidity, and mortality. Exercise interventions effectively improve patients' walking ability, and supervised walking programs are promising, yet standardized clinical guidelines remain lacking.

Methods: An evidence-based protocol was developed via systematic review of domestic and international literature. A preliminary draft was refined through two rounds of Delphi consultations with 20 multidisciplinary experts (vascular surgery, nursing, rehabilitation). Statistical analysis of expert agreement finalized the standardized protocol.

Results: Both rounds achieved a 100% response rate. Expert authority coefficients were 0.918 (Round 1) and 0.945 (Round 2). Coefficients of variation ranged 0.00-0.21 (Round 1) and 0.00-0.10 (Round 2). Kendall's concordance coefficients were 0.131 and 0.339 (p<0.05), indicating significant consensus. The final protocol includes 5 primary, 13 secondary, and 40 tertiary indicators.

Conclusion: This Delphi-derived standardized walking rehabilitation protocol addresses gaps in current guidelines and provides an evidence-based foundation for standardized Lower extremity ASO interventions.

Background: Bloodborne occupational exposure poses a significant risk to acupuncture physicians and medical students, yet evidence regarding their knowledge, attitudes, and practices (KAP) remains limited.

Methods: This multicenter cross-sectional study analyzed data from 224 participants recruited from hospitals in Guangzhou, Dongguan, and Shenzhen. Structural equation modeling (SEM) and logistic regression were applied to examine the associations among training, attitudes, and practice behaviors related to bloodborne occupational exposure.

Results: More than half of participants (51.4%) were healthcare providers, and most (78.6%) had received relevant training. The average scores indicated generally adequate knowledge, positive attitudes, and proactive practices. SEM demonstrated that training exerted both direct effects on practice and indirect effects mediated through attitudes, highlighting the central role of attitudes and training rather than knowledge alone in shaping safe behaviors. Gender and training were significantly associated with practice outcomes, with male participants demonstrating higher practice scores than female participants.

Conclusion: Acupuncture physicians and medical students exhibited adequate knowledge and positive attitudes toward bloodborne occupational exposure, while attitudes and training were strongly associated with proactive practice behaviors. Knowledge alone, without adequate training, was insufficient to promote safe practices. These findings underscore the importance of targeted and structured training programs to enhance proactive practices by fostering favorable attitudes and safe behaviors in clinical settings.

Breast cancer-related lymphedema (BCRL) is a prevalent and chronic complication that significantly impairs the quality of life of breast cancer survivors. As survivorship increases, the role of nursing in BCRL management has become increasingly critical. This review synthesizes current evidence on nursing-led strategies across the continuum of care, including early symptom recognition, risk stratification, perioperative prevention, conservative and surgical interventions, psychosocial support, patient education, and interdisciplinary collaboration. Special attention is given to the integration of novel technologies such as bioimpedance spectroscopy and wearable devices. Despite progress, gaps remain in standardized protocols, high-quality randomized controlled trials (RCTs), and patient-reported outcome research. In summary, nursing plays a central role in the management of BCRL, encompassing risk assessment, intervention implementation, and patient support. It is a key force in improving treatment outcomes and enhancing patients' quality of life.

Intestinal stoma surgery is a prevalent treatment for conditions such as colorectal cancer; however, postoperative complications such as intestinal stoma odor and pouch ballooning are frequent, contributing to anxiety, depression, social limitations, and reduced quality of life for patients. In this article, the impact of intestinal stoma odor and pouch ballooning problems on patients' quality of life and related intervention strategies are reviewed. Relevant literature from the past decade was collected through searches in databases, including PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI), and analyzed. It can be inferred from the review findings that intestinal stoma odor problems primarily result from the release of intestinal gas and feces, while pouch ballooning is influenced by factors such as dietary habits and intestinal dysbiosis. Identified interventions include dietary modifications, appropriate selection of ostomy products, and psychological support, as well as novel approaches such as improved ostomy pouch designs. The aim of this review is to serve as a clinical reference for optimizing the management of intestinal stoma odor and pouch ballooning to better improve the quality of life for patients with intestinal stoma.

Background: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms in Parkinson's disease (PD), but optimal programming strategies for non-motor symptom management remain unclear. This study compared the effects of high-frequency versus low-frequency stimulation on sleep disorders, cognitive function, and mood disturbances.

Methods: We conducted a retrospective controlled study of 80 PD patients who underwent bilateral STN-DBS between September 2023 and May 2025. Patients were divided into high-frequency (130-185 Hz, n=40) and low-frequency (60-80 Hz, n=40) groups based on their programming parameters. Sleep quality (Parkinson's Disease Sleep Scale, PDSS), cognitive function (Montreal Cognitive Assessment, MoCA), anxiety (Hamilton Anxiety Scale, HAMA), and depression (Hamilton Depression Scale, HAMD) were assessed at baseline and at 3, 6, and 12 months post-surgery. Linear mixed-effects models analyzed longitudinal changes.

Results: Both groups showed significant motor improvement (UPDRS-III reduction >50%, p<0.001). The low-frequency group demonstrated superior improvements in PDSS scores compared to high-frequency stimulation (mean difference at 12 months: 4.82 points, 95% CI: 2.15-7.49, p<0.001). HAMA scores improved more in the low-frequency group (mean difference: 2.34 points, 95% CI: 0.87-3.81, p=0.002). MoCA scores remained stable in both groups with no significant between-group differences (p=0.421). HAMD improvements were comparable between groups (p=0.156).

Conclusion: Low-frequency STN-DBS (60-80 Hz) provided superior benefits for sleep quality and anxiety compared to conventional high-frequency stimulation while maintaining equivalent motor and cognitive outcomes. These findings support personalized programming strategies targeting specific non-motor symptoms in PD patients.

Immune checkpoint inhibitors (ICIs) have reshaped oncology, yet overall response rates remain modest and resistance is common, driven by tumor heterogeneity and evolving tumor-immune crosstalk. Established biomarkers (PD-L1, tumor mutational burden, microsatellite instability) provide incomplete prediction. Multi-omics profiling across genomic, transcriptomic, proteomic, epigenomic, metabolomic and microbiomic layers offers a systems-level view of malignant and immune states, uncovering determinants of ICI efficacy such as lineage plasticity, stromal remodeling, immunometabolic reprogramming and microbiome-associated immune modulation. Artificial intelligence (AI) is uniquely positioned to fuse these heterogeneous data, learn non-linear cross-layer signatures, and enable interpretable predictions using approaches such as SHAP and Grad-CAM. Representative models link routine histology or imaging to molecular phenotypes, stratify patients beyond single biomarkers, and may nominate rational combinations that target oncogenic pathways, lactate-driven immune suppression, or the gut microbiome. In this narrative review, we synthesize recent AI-multi-omics advances for response modeling, immune-relevant tumor subtyping, and clinical translation, including radiomics/pathomics integration and liquid-biopsy-based monitoring, as well as emerging applications in toxicity risk prediction. We also discuss barriers to implementation-platform heterogeneity, limited prospective validation, bias, interpretability and cost-and outline future directions, including single-cell and spatial multi-omics integration, federated learning and generative modeling to improve robustness and equity of precision immunotherapy.

Purpose: Postoperative nausea and vomiting (PONV) remains one of the most common adverse effects associated with anesthesia care. This study aimed to explore the feasibility of applying machine learning models trained exclusively on routinely available non-invasive clinical indicators to predict early PONV risk. Explainable artificial intelligence techniques were also employed to identify the most influential predictors of early PONV.

Patients and methods: A retrospective dataset from Cathay General Hospital, including 927 patient cases and 16 non-invasive clinical indicators, was used to investigate early PONV risk prediction. This study evaluated the predictive performance of several traditional machine learning models, deep learning architectures, and ensemble learning methods to compare their classification capabilities.

Results: Overall, the models demonstrated moderate discriminative performance. The random forest model achieved an accuracy of 83.5% with balanced precision (80.81%) and recall (83.5%), while the logistic regression model attained an AUC of 0.6905. Analysis of positive SHAP values identified the top 7 most influential predictors of early PONV. These included pharmacologic interventions (eg, neostigmine), pre-existing comorbidities (eg, history of nausea and vomiting, history of cardiovascular disease), demographic characteristics (eg, gender), postoperative pain, and anesthetic and surgical factors (eg, type of surgery and duration of anesthesia). Moreover, SHAP analysis revealed that the use of dexamethasone was negatively associated with the predicted risk in the model, suggesting its potential protective role in the prevention of early PONV.

Conclusion: By generating explainable outputs, this study bridges the gap between algorithmic prediction and clinical decision-making, allowing anesthesiologists to better recognize underlying risk factors and make informed, evidence-based decisions in perioperative management.

Objective: A scoping review was conducted to explore the connotation and mechanism of action of family support for patients with chronic diseases under the perspective of health promotion.

Methods: English databases of PubMed, Medline, Embase, Web of Science, and Google Scholar were searched, as well as China Knowledge Network (CNKI), Wan Fang Database, and Wipu (China Science and technology Journal). Database). The literature search timeframe was from the time of database construction to May 2024, and the literature was screened according to the inclusion and exclusion criteria to extract the information of the included studies.

Results: A total of 34 papers were included. Key findings from these reviews indicate that family support-encompassing specific, emotional, counseling, and esteem support-exerts a significant positive impact on chronic disease patients' health promotion via family dynamics and psychological-behavioral mechanisms, with its effectiveness shaped by ecological, psychological, and methodological factors.

Conclusion: This study constructed the connotation and mechanism of action of family support for chronic disease patients under the perspective of health promotion. It provides a basis for the future development of family chronic disease management, family support intervention, and family health promotion.