Journal of Multidisciplinary Healthcare最新文献

Erectile dysfunction (ED) is one of the most common sexual disorders in men, and its effective management requires a holistic approach involving the collaboration of healthcare professionals from various specialties. There is a reluctance to seek treatment despite the high prevalence. In the UAE, there are no region-specific guidelines to guide physicians about its management. To address this need, a panel comprising experts from urology, psychiatry, interventional cardiology, and clinical pharmacy convened in Dubai from 19 to 21 May 2023 to provide recommendations for the management of ED in the UAE. The panel reviewed the currently available data and international guidelines to formulate recommendations for managing the condition in the UAE. The panel recommended recognizing ED as an early sign of cardiovascular disease, addressing psychological concerns, and involving multidisciplinary collaboration for managing the condition. Patients with ED should be screened for other comorbidities. There is a need for a well-connected network of healthcare providers comprising psychologists, gynecologists, urologists, dieticians, physical therapists, pharmacists, yoga instructors, and nurses to treat patients with ED, and timely referrals within this network are necessary. Recognizing the psychological impact of the condition, providing counseling to couples and psychological support to the patient is critical. Shared decision-making about treatment, based on open and meaningful conversations is the need of the hour. Technology can be used for awareness and patient education. Understanding the burden of ED and developing a patient-centric collaborative framework involving various specialists is important for the early diagnosis and effective management of ED. These expert recommendations aim to standardize ED management in the UAE and enhance multidisciplinary collaboration.

Background: Physical restraint is commonly used in clinical settings to ensure patient safety, yet its application lacks standardization and may lead to adverse physical and psychological effects. There remains a significant gap in evidence-based guidelines tailored to nurses practices.

Objective: This study aimed to develop and validate clinical practice standards for physical restraint in hospitalized patients from a nurses staff perspective and to evaluate their impact on nurses knowledge, attitude, behaviors, and patient outcomes.

Methods: A multi-stage design was employed, including a cross-sectional survey, semi-structured interviews, a Delphi expert consultation, and a controlled trial. The study involved 202 nurses and 100 patients from a tertiary hospital in Chongqing, China. The intervention group received standardized training based on the newly developed restraint criteria, while the control group followed routine protocols.

Results: The expert consultation achieved high consensus (Cr = 0.85). Post-training, the intervention group showed significant improvements in knowledge, attitude, and practice scores (P < 0.05), and a reduction in restraint use and duration (P < 0.05). Although adverse event rates decreased in the intervention group, the differences were not statistically significant.

Conclusion: The developed standards effectively enhance nurses practice, reduce unnecessary restraint use, and maintain patient safety, supporting their integration into clinical nurses management.

Spinal disorders, such as intervertebral disc degeneration (IVDD) and spinal cord injury (SCI), pose substantial challenges in modern healthcare, exacerbated by an aging population and the limited effectiveness of current treatments. IVDD, characterized by extracellular matrix (ECM) degradation, dehydration of the nucleus pulposus, and inflammation, is a leading cause of chronic low back pain, affecting approximately 266 million people worldwide each year. Likewise, SCI, frequently resulting from traumatic incidents, can induce irreversible neurological impairment due to both primary mechanical injury and secondary inflammatory responses, encompassing glial scar formation and axonal disruption. Despite advancements in pain management, surgery, and cell therapies, these conditions remain difficult to treat effectively. This review examines recent developments in hydrogel materials for spinal surgery, with a focus on their applications in the treatment of IVDD and SCI. Hydrogels, due to their biocompatibility, tunable mechanical properties, and ability to mimic the native ECM, have shown enormous promise in spinal repair. Their high water content and porous structure enable the efficient delivery of drugs and cells, and their injectability makes them useful for minimally invasive procedures. Hydrogels offer potential in regenerating the nucleus pulposus, modulating inflammation, supporting axonal regrowth, and preventing fibrosis. Furthermore, their injectable and self-healing properties enable less invasive surgical interventions. While showing clear advantages, they continue to struggle with mechanical strength, controlled therapeutic delivery, and precise structural outcomes in 3D printing. Ongoing research is needed to optimize these properties for clinical applications. This review provides an overview of the biological mechanisms, material design, and fabrication techniques of hydrogels, aiming to support the future development of hydrogel-based therapies in spinal disorder treatment.

Objective: The spread of digital technologies has drawn attention to the health effects of problematic internet use (PIU). This study investigated whether PIU is associated with chronic low back pain, focusing on its neuropathic component and potential mediating factors.

Methods: A cross-sectional online survey was conducted among part-time university students aged 18-65 years. The questionnaire collected demographic, lifestyle, and health-related data, including depression, insomnia, and pain characteristics. Standardized instruments were used: the Problematic Internet Use Questionnaire (PIUQ), Beck Depression Inventory-Short Form (BDI-SF), Athens Insomnia Scale (AIS), and the painDETECT questionnaire. Statistical analyses included chi-square tests, correlations, hierarchical linear regression, and mediation modeling. Analyses were performed on the full sample (N = 550).

Results: The prevalence of chronic low back pain was 46.2%, with 12.2% reporting neuropathic pain. PIU was present in 8.4% of respondents, depression in 69.6%, and insomnia in 5.8%. Neuropathic pain correlated with PIU (r = 0.126, p < 0.05), depression (r = 0.44, p < 0.001), and insomnia (r = 0.33, p = 0.009). In regression analysis, depression (β = 0.256, p = 0.001), headache/migraine (β = 0.20, p = 0.002), smoking (β = 0.135, p = 0.030), and cardiovascular disease (β = 0.129, p = 0.045) were independent predictors of higher painDETECT scores. PIU was not a direct predictor but exerted significant indirect effects: mediation analyses confirmed indirect paths via depression (b = 0.08, p < 0.001) and insomnia (b = 0.05, p = 0.009).

Conclusion: Chronic low back pain is influenced by psychological, sleep, and lifestyle factors. Although PIU was not an independent predictor of neuropathic pain, it indirectly increased risk through depression and insomnia. Screening and management of these comorbidities should be incorporated into prevention and treatment strategies.

Purpose: Although artificial intelligence (AI) has garnered increasing attention in education and healthcare, examining the attitude and readiness of future nurses toward AI integration is crucial for creating successful curricula and promoting appropriate utilization of this technology.

Patients and methods: This cross-sectional study was conducted among 227 nursing students at King Saud University using two validated instruments: the General Attitudes toward Artificial Intelligence Scale and the Medical Artificial Intelligence Readiness Scale for Medical Students. Responses were recorded using a 5-point Likert scale. Descriptive and inferential statistics, including t-tests and correlation analyses, were employed to examine differences across study variables.

Results: Of the 227 participants, 48% (n = 109) were aged 18-24 years. Majority participants were women (60.4%, n = 137), and 39.6% (n = 90) were men. Nursing students generally demonstrated moderately positive attitudes toward AI. However, an independent-sample t-test indicated that women exhibited more negative attitudes toward AI than men (p = 0.013), and part-time students demonstrated a greater level of AI readiness than full-time students (p = 0.018). No significant differences were observed based on age, marital status, academic level, and/or training/experience. Significant positive correlations were identified between positive and negative attitudes and AI readiness.

Conclusion: The findings of this study may help nursing colleges to incorporate AI into their curricula. However, the study's cross-sectional design, single site setting, and short duration limit causal inference and generalizability.

Background: Non-alcoholic Fatty Liver Disease (NAFLD) is highly prevalent and increasingly recognized as a multisystem condition with bidirectional links to the brain-liver axis. While most prior work emphasized "liver-to-brain" effects, whether anxiety disorders increase the risk of Non-alcoholic Fatty Liver Disease remains unclear.

Methods: We employed Mendelian randomization (MR) analysis using Genome-wide association study (GWAS) data to investigate whether genetically predicted anxiety disorders play a causal role in NAFLD risk. We then validated our findings using a prospective cohort of 393,229 participants from the UK Biobank, with a median follow-up of 12.6 years.

Results: Our MR analysis provides suggestive evidence for a potential causal effect of genetically predicted anxiety disorders on NAFLD (odds ratio [OR] = 1.73, 95% confidence interval [CI]: 1.12-2.67, P = 0.013). This finding was further supported by the UK Biobank prospective study, which demonstrated that baseline anxiety was associated with increased incident NAFLD risk even after adjusting for potential confounding factors (hazard ratio [HR] = 1.630, 95% CI: 1.488-1.786, P < 0.001). Notably, participants with anxiety exhibited elevated liver fat content at follow-up magnetic resonance imaging, as assessed through follow-up magnetic resonance imaging, irrespective of gender (P < 0.001).

Conclusion: Our study provides converging evidence from genetic and observational data suggesting that anxiety disorders may be associated with an increased risk of NAFLD onset. This relationship necessitates a reconsideration of both NAFLD management and pharmacotherapy for anxiety disorders, advocating for a shift from a specialized clinical focus to a comprehensive community-level strategy for addressing non-communicable diseases (NCDs).

Purpose/objective: Chronic kidney disease (CKD), a complex and progressive condition, affects multiple organ systems, including the skin, where manifestations are common yet often underrecognized. This commentary aims to highlight these dermatologic signs as not only indicators of disease severity but also as opportunities for earlier intervention, improved patient comfort, and multidisciplinary collaboration. By examining the clinical relevance, educational importance, and research potential of CKD, we aim to promote a more comprehensive and proactive approach to its management.

Materials/methods – literature review: This expert commentary emphasizes the clinical significance of skin manifestations in chronic kidney disease and advocates for a comprehensive, multidisciplinary approach grounded in research, education, and patient-centered care.

Findings/results: Management of CKD should be integrated into standard nephrology care, with particular focus on symptoms such as pruritus, xerosis, and calciphylaxis, which not only cause discomfort but may also signal treatment deficiencies. Interdisciplinary collaboration among dermatologists, somatologists, and nephrologists is crucial to ensure timely diagnosis and comprehensive care. Additionally, educating patients about the potential skin-related complications of renal disease and encouraging them to report symptoms early can improve treatment adherence and lead to better outcomes.

Conclusion and recommendations: Cutaneous signs in CKD patients need more clinical focus, as they often signal early systemic problems and greatly affect quality of life. A comprehensive, patient-focused approach based on research, education, and policy change will be key to improving outcomes and enhancing the well-being of those with kidney disease.

Background: In traditional medicine, pulse palpation is a unique diagnostic technique focusing on identifying patterns of symptoms through subjective assessment of bio-signals. However, its reliability and objectivity have been questioned. We developed an artificial intelligence-based algorithm for clustering doctors' diagnostic results using unsupervised clustering techniques on pulse waveform signals.

Methods: Raw pulse signals were recorded from both wrists of healthy individuals and were then analyzed, with diagnoses provided by a Korean Medicine doctor. To measure pairwise pulse similarity, Dynamic Time Warping (DTW) was used, and Multidimensional Scaling (MDS) was applied for dimensionality reduction, enabling the clustering and validation of data-driven diagnostic patterns.

Results: Our findings revealed discrepancies between traditional pulse diagnosis and automated diagnoses, yet the clustering algorithm showed high alignment between data-driven groupings and expert diagnoses. Notably, pulse signals from the left wrist had better alignment in several categories than those from the right wrist (cosine similarity: left hand 0.56 ± 0.13; right hand 0.54 ± 0.15). The "Floating-Sinking" pattern was particularly identifiable, achieving the highest Cosine similarity (0.83).

Conclusion: The results suggest significant alignment between data-driven pattern identification and expert diagnoses, especially for the "Floating-Sinking" pattern. Further refinement with diverse populations is necessary, but data-driven diagnostic tools hold potential for standardizing and quantifying traditional pulse diagnosis, moving it toward a scientifically robust practice.

Trial registration: Clinical Research Information Service KCT0007655 (registered on 2024-02-29).

Purpose: This study aims to develop and validate the Breastfeeding and Family-Centered Care Assessment Scale (ScaleSc) utilizing the Delphi method and to examine its association with child psychological status.

Methods: Children aged 6-14 years were enrolled as study participants. Through multiple rounds of structured expert consultation, a comprehensive scale encompassing core elements of breastfeeding practices and family-centered care was systematically developed. Concurrently, support vector machine (SVM) and decision tree models were constructed utilizing ScaleSc scores alongside other relevant clinical characteristics of the participants.

Results: Multivariate modeling identified higher ScaleSc scores as a significant protective factor against poor psychological status, with the scale demonstrating substantial predictive importance within both computational models. Furthermore, exposure to school bullying (SchBull) emerged as a potent risk factor, exhibiting a markedly elevated odds ratio (OR) of 43.982 within the logistic regression analysis, highlighting its profound detrimental impact on child psychological well-being. The study robustly confirmed the significant influence of breastfeeding practices and family-centered care on child psychological development, demonstrating the ScaleSc's efficacy in quantitatively linking these critical early-life factors to psychological outcomes.

Conclusion: This research successfully developed and clinically validated the ScaleSc, establishing its significant utility for assessing child psychological status.

Background: The global opioid crisis has prompted healthcare systems to implement opioid stewardship programs (OSPs) aimed at optimizing prescribing practices and mitigating harm. Multidisciplinary teams (MDTs) are increasingly recognized as central to the success of these programs, yet their roles, structures, and implementation across clinical contexts remain poorly defined.

Objective: This scoping review explores the composition, functions, and contextual application of MDTs within OSPs. It aims to map the professional roles, describe the interventions deployed, examine reported outcomes, and identify implementation barriers and facilitators across healthcare settings.

Methods: Following the Joanna Briggs Institute framework and PRISMA-ScR guidelines, a systematic search of PubMed was conducted to identify studies involving MDT-led opioid stewardship interventions. Studies were eligible if they described multidisciplinary collaboration in opioid prescribing, pain management, or harm-reduction efforts. Data were extracted on team composition, interventions, outcomes, and contextual factors, and synthesized narratively.

Results: Thirteen studies published between 2017 and 2023 were included. Most were U.S.-based and employed descriptive or observational designs across varied settings, including hospitals, primary care, rural clinics, and telemedicine platforms. Core MDT members included physicians, pharmacists, and nurses, with frequent contributions from addiction specialists, psychologists, and social workers. Common interventions included opioid-sparing protocols, individualized tapering plans, naloxone co-prescribing, and interprofessional education. Reported outcomes included reductions in opioid prescribing, improved adherence to safety protocols, and enhanced provider confidence. Implementation challenges included limited staffing, fragmented communication, and patient resistance, while facilitators included standardized workflows, institutional support, and integrated electronic health systems.

Conclusion: MDTs play a critical role in operationalizing opioid stewardship across diverse clinical environments. Their effectiveness depends not only on professional composition but also on systemic support for collaboration, training, and workflow integration. Future research should evaluate the comparative impact of MDT configurations using standardized outcome measures and expand to non-US and resource-limited settings.