Journal of Multidisciplinary Healthcare最新文献

Background: Emerging evidence suggests that air pollution, particularly fine particulate matter (PM2.5), may exacerbate migraine. Northern Thailand experiences severe seasonal air pollution, offering a unique context to investigate this association. This study aimed to evaluate the impact of seasonal PM2.5 exposure on migraine frequency, severity, emergency room (ER) visits, and medication use.

Methods: This retrospective observational study included 42 adult migraine patients attending a university hospital's headache clinic from 2021 to 2023 who completed monthly headache diaries. PM2.5 data were obtained from national monitoring networks. "Polluted months" (January-May) were compared with "non-polluted months" (June-December). Study outcomes included headache frequency (days/month), pain severity (mild/moderate/severe), ER visits, and medication use.

Results: Among 42 patients (mean age: 39.2 years; 57.1% female), headache frequency was higher during polluted months (6.4 vs 4.3 days/month, P < 0.001). All pain severity levels increased significantly during polluted periods. ER visits rose markedly (3.37 vs 0.65 visits/patient, P < 0.001). Use of both migraine-specific and non-specific medications per patient was significantly greater in polluted months.

Conclusion: PM2.5 exposure is associated with increased migraine burden. Seasonal air pollution may worsen headache frequency, severity, and healthcare utilization. Air quality should be considered in migraine management and environmental policy planning.

Background: Breast cancer is the leading cause of death among women. Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis through treatment. However, knowledge of the levels of heterogeneity in psychosocial adaptation and its influencing factors in breast cancer patients is limited.

Objective: To examine the psychosocial adaptation trajectories of breast cancer patients from diagnosis to the chemotherapy phase and to explore the facilitators and barriers influencing their psychosocial adaptation.

Methods: Latent class growth modeling was used to analyze the latent classes of psychosocial adaptation trajectories. Colaizzi's seven-step method was used to analyze the qualitative data.

Results: Three distinct psychosocial adaptation trajectories were identified in breast cancer patients: high-stable, moderate-declining, and low-increasing adaptation groups.The individuals within the three psychosocial adaptation categories share identical growth trajectories but exhibit different growth patterns. Category 1, the "High-stable adaptation group", comprised 51 individuals (30.9% of the total sample), with an average intercept of 176.85 (P<0.001) and a slope of -0.032 (P=0.977). Category 2, the "Moderate-declining adaptation group", included 54 individuals (32.7% of the total sample), with an average intercept of 142.77 (P<0.001) and a slope of -1.78 (P=0.381). Category 3, the "Low-increasing adaptation group" consisted of 60 individuals (36.4% of the total sample), with an average intercept of 105.04 (P<0.001) and a slope of 13.13 (P<0.001). Predictive factors for different trajectory groups included monthly income, type of surgery, and pathological stage. Through semi-structured interviews, three themes were identified for facilitators and barriers. Facilitators included personal resources, social resources, and family resources, while barriers included complications and adverse drug reactions, heavy economic burden, and cognitive changes.

Conclusion: Breast cancer patients experience dynamic and heterogeneous psychosocial adaptation from diagnosis to chemotherapy. The trajectory predictors and barriers identified in this study can assist healthcare providers in offering personalized, targeted interventions and plans to promote psychosocial adaptation in breast cancer patients.

Background: Acinetobacter baumannii (A. baumannii) is one of the most common pathogens in pneumonia patients with cerebral hemorrhage. Exploring objective predictors of pneumonia due to multidrug-resistant (MDR) A. baumannii is of great significance for infection prevention and control.

Objective: To construct a risk prediction model for MDR A. baumannii pneumonia in cerebral hemorrhage patients based on inflammatory markers from peripheral blood cell counts.

Methods: A retrospective study was carried out in cases with pneumonia due to A. baumannii among patients with cerebral hemorrhage from January 2021 to December 2024. The baseline data and peripheral blood cell counts were used for analysis. The risk factors for pneumonia due to MDR A. baumannii were obtained through univariate and multivariate analyses.

Results: Among the 182 patients included, there were 79 cases with pneumonia due to MDR A. baumannii and 103 cases with pneumonia due to sensitive A. baumannii. The level of systemic immune-inflammation index (SII) at admission in patients with pneumonia due to MDR A. baumannii was significantly higher than sensitive A. baumannii. The result of multivariate logistic regression analysis showed that SII level (≥1851.91 × 10⁹/L), tracheotomy duration (≥6 days) and Glasgow coma scale score (<11) were risk factors for pneumonia due to MDR A. baumannii. The Area Under Curve (AUC) of the multivariate logistic regression model was 0.755, the sensitivity and specificity were 86.1% and 55.3%, respectively.

Conclusion: Longer duration of tracheotomy, lower GCS score and higher SII at admission were possibly associated with pneumonia due to MDR A. baumannii in cerebral hemorrhage patients. For high-risk patients, taking timely preventive and control measures against MDR A. baumannii pneumonia infections is crucial.

Objective: To evaluate the effectiveness of a multidisciplinary collaborative nursing management model in patients with diabetes mellitus and coronary heart disease, focusing on blood glucose control, cardiac function, psychological adjustment, and health-promoting behaviors.

Methods: A retrospective controlled study was conducted including 150 patients admitted from April 2022 to April 2025. Patients were divided into a control group (n=75, routine nursing) and an observation group (n=75, multidisciplinary collaborative nursing). Outcomes included blood glucose [fasting plasma glucose (FPG), 2-hour postprandial glucose (2 h PG), HbA1c], cardiac function [LVEF, LVESD, LVEDD], psychological status [SAS, SDS], health behaviors [HPLP-II], and nursing satisfaction [NSNS].

Results: After intervention, both groups showed improvements in all outcomes, with the observation group achieving significantly greater improvements (P<0.05). Specifically, blood glucose levels decreased, LVEF increased while LVESD and LVEDD decreased, SAS and SDS scores improved, health behavior scores increased, and nursing satisfaction was higher in the observation group (93.3% vs 81.3%, P<0.05).

Conclusion: Multidisciplinary collaborative nursing management effectively improves clinical and psychological outcomes, enhances health behaviors, and increases nursing satisfaction in patients with diabetes mellitus and coronary heart disease.

Introduction: Patient safety is a critical priority in high-risk environments like operating rooms, interventional radiology rooms, and hybrid operating rooms, where complex procedures and multidisciplinary teams are involved.

Purpose: This study explores healthcare staff perceptions of safety climate across the operating, interventional, and hybrid operating rooms, aiming to identify areas for improvement to promote a safer, more collaborative environment.

Patients and methods: A cross-sectional study was conducted using a modified Swedish version of the Safety Attitudes Questionnaire - Operating Room. Participants included physicians, nurses, and nurse assistants from the Operating, Interventional Radiology, and Hybrid Operating Room at a Swedish university hospital. Differences in safety climate perceptions were analyzed across professional groups and based on demographics including age and length of experience.

Results: Among 180 healthcare staff members (44.8% response rate), no significant differences in safety attitudes were found between professional groups or multidisciplinary teams. Significant differences were observed across age groups in the domains of teamwork climate (p = 0.035), job satisfaction (p = 0.015), and perception of management (p = 0.021). Differences were also found across experience groups for working conditions (p = 0.029), stress recognition (p = 0.041), and perception of management (p = 0.046). Qualitative analysis highlighted the importance of staff retention, effective communication, and continuous professional development in improving patient safety.

Conclusion: Safety climate perceptions vary significantly with age and experience rather than professional role. These findings highlight the importance of fostering inclusive team dynamics that integrate diverse experience levels and implementing targeted strategies focused on staff retention, communication, and education to strengthen the overall safety climate.

Background: Insufficient early dietary fiber (DF) supplement may be closely associated with adverse clinical outcomes in critically ill patients.

Objective: We evaluated the association between the early intake of dietary fiber (DF) and the development of acute gastrointestinal injury (AGI) in ICU patients.

Methods: A prospective observational study was conducted at the First Affiliated Hospital of Soochow University from April 2021 to March 2023. DF intake was quantified using dietary records, and AGI severity was assessed on day 3 (D3) and day 5 (D5) after ICU admission based on the 2012 ESICM recommendations.

Results: A total of 184 ICU patients were enrolled. The mean daily DF intake over the first five days was 5.44 ± 4.33 g/day. The cumulative intake reached 11.07 ± 11.60 g by day 3 and 27.21 ± 21.65 g by day 5. The incidence of AGI was 95.6%, 77.7%, and 51.1% on days 1, 3, and 5, respectively. Ordered logistic regression revealed that higher average DF intake in the first three days was independently associated with reduced AGI severity on D3 (OR 0.863, 95% CI: 0.771-0.967, P < 0.05) and D5 (OR 0.823, 95% CI: 0.712-0.952, P < 0.05).

Conclusion: Higher average DF intake during the first three days following ICU admission may be associated with reduced AGI severity on D3 and D5. Future multi-center, large-sample, randomized controlled studies are needed to confirm the relationship between early DF intake and the severity of AGI.

Purpose: To timely tackle malnutrition in hospital patients, the implementation of a new malnutrition practice is needed. We aimed to determine the readiness of nutrition support hospital staff for implementing a new malnutrition practice, using the Patient-Generated Subjective Global Assessment (PG-SGA) instrument.

Participants and methods: A cross-sectional assessment of readiness among nutrition support hospital staff was conducted using semi-structured interviews. Interviews were scored across five dimensions of the community readiness model: Knowledge of efforts, Leadership, Community climate, Knowledge of the issue, and Resources for efforts. A general score and a dimension score (mean and standard deviation) were calculated. Scores could range from 1 (no awareness) to 9 (community ownership).

Results: In total, 11 respondents, including physicians (n=2), dietitian (n=1), physiotherapists (n=3), speech therapists (n=2), nutritional assistants (n=2), and a manager (n=1) were interviewed. The general community readiness score was 4.0±0.3, indicating the preplanning stage for the implementation of the PG-SGA. All five dimensions were in the preplanning range (3.5-4.5). Resources was lowest (3.5 ± 0.9; range 3.0-4.0), and Knowledge of efforts was highest (4.5 ± 1.9; range 2.0-7.0); the scores of the remaining dimensions clustered around ~4.0. No dimension score exceeded the preplanning stage.

Conclusion: Readiness to implement the PG-SGA was uniformly low (ie, at preplanning stage) across CRM dimensions, with resources most limited and awareness of existing efforts highest, yet still in the preplanning stage. Recommendations are directed to hospital leadership/clinical leaders and to interprofessional nutrition teams, with targeted training for all professionals involved in nutritional care to enable progression toward implementation.

Context: Herpes zoster-associated neuralgia (ZAN), the most common symptom across all stages of herpes zoster, significantly impacts patients' quality of life and emotional well-being. Traditional Chinese Medicine (TCM) treatments have demonstrated unique efficacy in treating ZAN. However, non-standardized outcome reporting remains a significant challenge. Therefore, establishing a core outcome set (COS) is essential for standardizing TCM clinical research on ZAN.

Objective: This study aims to develop a COS for future clinical trials of TCM for ZAN (COS-TCM-ZAN).

Methods: This study determined the list of outcomes measures by systematically searching databases and clinical trial registeres. Subsequently, multiple stakeholder groups from various fields were selected to conduct two rounds of Delphi surveys to assess the importance of each outcome measure. Finally, we will hold a face-to-face consensus conference to approve the final COS-TCM-ZAN.

Timeline: The study will start in April 2025, aiming to finalize the outcomes list by June 2025. Then having stakeholder screening, a Delphi survey (July-Dec 2025), and a consensus conference in early 2026. In line with the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines, the COS findings will be reported and exchanged at national and international conference.

Conclusion: The standardized COS will enhance the identification of effective evaluation indicators for TCM treatment of ZAN, thereby enhancing the comparability and reproducibility in research and clinical practice for TCM in the field of ZAN treatment.

Trial registration: This COS has been prospectively registered in the COMET database (registration #3370, available at https://www.comet-initiative.org/studies/details/3370). Clinical trial number: not applicable.

Objective: In the Chinese medical context, there is a large variation in patient health literacy levels and an imbalance of power between doctors and patients. The mechanism by which communicative health literacy (CHL) influences patient loyalty (PL) remains unclear. This study aims to explore how CHL in the medical context improves PL by promoting enhancement of perceived health literacy (EPHL) and strengthening decision-making involvement satisfaction (DMIS) based on the Social Exchange Theory (SET).

Methods: This study employs a questionnaire survey to collect data from five representative cities in China (Beijing, Shanghai, Guangzhou, Wuhan, and Chengdu), with a total of 4018 questionnaires collected, yielding 3264 valid questionnaires after quality control (valid rate: 81.23%). A structural equation model is used to examine the relationships between CHL, EPHL, DMIS, and PL, and to test the relevant hypotheses. Additionally, data from three cities in Jiangsu Province, China, are collected, with 2393 questionnaires collected and 1942 valid questionnaires obtained (valid rate: 81.15%), to conduct a robustness test of the model.

Results: CHL was significantly positively correlated with EPHL (β=0.516), DMIS (β=0.329), and PL (β=0.192). EPHL was also significantly positively correlated with DMIS (β=0.301) and PL (β=0.355). DMIS was significantly positively correlated with PL (β=0.316). EPHL partially mediated the relationship between CHL and DMIS (32.02%), and between CHL and PL (48.80%). DMIS partially mediated the relationship between CHL and PL (35.02%). EPHL and DMIS played a chain-mediated role between CHL and PL (20.33%). DMIS partially mediated the relationship between EPHL and PL (21.11%).

Conclusion: This study extends the application of SET to the realm of doctor-patient communication, and is the first to confirm the sequential process of "cognitive reserve - capability construction - emotional identification - relational return" within a Chinese context. It provides a new perspective for understanding the formation mechanism of PL and offers theoretical support for the construction of health literacy-oriented medical institutions. Future research could expand the sample scope to cover different cultural backgrounds and various types of medical institutions, thereby enhancing the model's generalizability and further exploring its mechanisms of action.

Introduction: Physical education (PE) is a key school-based strategy for improving physical fitness (PF) among children and adolescents. However, a systematic synthesis of the most influential literature linking PE to PF development remains limited. Understanding publishing patterns and research hotspots can inform future directions in PE- and PF-related scholarship.

Objective: To conduct a bibliometric analysis of the 50 most-cited articles examining the relationship between PE and PF in school-aged children and adolescents, and to identify major contributors, thematic clusters, and evidence gaps.

Methods: A comprehensive search was performed using the Web of Science Core Collection. The 50 most-cited articles meeting the inclusion criteria were analyzed. Citation patterns, journal productivity, country contributions, co-authorship networks, and keyword co-occurrence were examined using Microsoft Excel and VOSviewer. Quantitative indicators-including total citations, citations per paper (CPP), and cluster mapping-were summarized.

Results: The included articles received 52-687 citations. The United States produced the highest number of publications (n = 19; CPP = 100.3), followed by Australia and Spain (each n = 6). The most active journals were BMC Public Health (5 articles, 481 citations) and PLOS ONE (4 articles, 582 citations). Keyword analyses identified three major thematic clusters: (1) PE-based interventions, (2) health-related fitness components (aerobic capacity, muscular strength, body composition), and (3) cognitive and psychological outcomes linked to PE participation. Across studies, PE consistently improved multiple PF dimensions among children and adolescents.

Conclusion: High-impact evidence shows that well-designed school-based PE programs significantly enhance aerobic fitness, muscular strength, body composition, and overall health-related PF in youth-while also providing emerging cognitive and psychosocial benefits. However, research output remains heavily concentrated in high-income countries, indicating a need for more diverse and equitable global investigations. This bibliometric synthesis clarifies current research patterns and highlights opportunities for advancing evidence-based PE to support youth fitness development.