基于社交媒体的公众和医务人员对护士处方权态度的文本挖掘研究

目的通过文本挖掘方法对社交媒体信息进行分析,揭示公众和医务人员对护士处方权的关注点和态度。方法使用Python工具自动挖掘2017年1月1日至2022年11月1日在4个中文互联网平台上发布的与关键词“护士开处方”“处方”相关的文本。这4个互联网平台包括知乎、微博.爱爱医医学论坛、丁香园医学论:坛。通过Snow自然语言处理、贝叶斯隐含狄利克雷分布和Boson自然语言处理方法对数据进行人员类别分析、主题分析和情感分析。在主题和情感分析结果的基础上,使用Nvivo11进行内容分析。结果在4个互联网平台.上共获得2 823条评论,计92 859字。分析结果显示,公众和医务人员对护士开处方持否定态度的较多,少数持谨慎的积极态度。公众关注护士处方对医务人员的影响以及对护士能力的要求;医务人员关注护士处方在中国的现状和未来,以及实施护士处方的困难。结论护士应通过努力提高专业能力和自我管理能力,逐步获得公众和医生群体对其专业水平和能力的认可。护士管理者和教育者需要认识到护士处方权的优势,并通过推动立法、教育和提高对护士处方权的认识来应对实施过程中的挑战和问题。

Competing Risk Model for Time to Development of Tuberculosis among Adults on Combination Antiretroviral Treatment

The purpose of this study was to identify factors affecting the time to development of tuberculosis in the presence of competing risks. In this case death before developing tuberculosis was deemed a competing risk because it altered the occurrence of the outcome of interest being time to development of tuberculosis from baseline. We used data from a randomized longitudinal clinical trial study called the “Tshepo” study. The “Tshepo” study was a 3-year randomized clinical study following 650 ART-naïve adults (69.4% female) from Botswana who initiated first-line NNRTI-based ART. Participants were assigned in equal proportions (in an open-label, unblinded fashion) to one of 6 initial treatment arms and one of two adherence arms using permuted block randomization. Randomization was stratified by CD4+ cell count (less than 200 cells/mm3, 201 - 350 cells/mm3) and by whether the participants had an adherence assistant. Classical methods such as the Kaplan-Meier method and standard Cox proportional hazards regression were used to analyze survival data ignoring the competing event(s) which may have been inappropriate in the presence of competing risks. The idea was to use competing risk models to investigate how different treatment regimens affect the time to the development of TB and compare the results to those obtained using the classical survival analysis model which does not account for competing risks. Amongst 38 patients who died 15.8% of them developed tuberculosis whilst 84.2% of those who died did not develop the outcome of interest. The hazard ratio of treatment C was 1.069 implying that the risk of developing TB in patients taking treatment C is about 6.9% higher compared to those taking treatment A having adjusted for baseline age, baseline BMI, baseline CD4, Hemoglobin and gender. Similarly, after accounting for competing risks the hazard ratio for treatment C was about 1.89 implying that the risk of developing TB amongst those taking treatment C was about 89% higher as compared to those taking treatment A. From the obtained results it was thus concluded that the standard Cox model of time to event data in the presence of competing risks underestimated the hazard ratios hence when dealing with data with multiple failure events it is important to account for competing events.

Effects of Religious vs. Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial

Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70), anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and 24 weeks. Differential effects of baseline religiosity on treatment response were also examined, along with effects of religiosity on changes in biomarkers over time independent of treatment group. Biomarker levels were log transformed where possible to normalize distributions. Mixed models were used to examine trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine decreased over time, mostly in the opposite direction expected (except epinephrine). No significant difference between RCBT and CCBT was found on average trajectory of change in any biomarkers. Religiosity interacted with treatment group in effects on IL-6, such that CCBT was more effective than RCBT in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more effective than CCBT in those with high religiosity. Higher baseline religiosity also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers. CCBT was more effective in reducing IL-6 levels in those with low religiosity, whereas RCBT tended to be more effective in those with high religiosity. Unexpectedly, higher baseline religiosity was associated with an increase in several stress biomarkers.

Yoga and Qigong in the Psychological Prevention of Mental Health Disorders:A Conceptual Synthesis

The study proposes to explore two alternative medicine therapies--qigong and yoga for balanc- ing the essential duo of holistic mind-body and consequently offer a solution for stress, uncertainty, anxiety and depression. Qualitative research methods have been used to create a conceptual synthesis of yoga and qigong. It is suggested that an increased sense of control is the interface between these two modalitieso This conceptual congruence of qigong and yoga is thought to be a selective, curative method, a prescription for ideal living and a ground of human essence existence. Furthermore, this essence is thought to enhance the mind＇s self-regulatory processes and prevent mental health disorders. The two alternative therapies can prevent mental health disorders such as anxiety, depression and, minimize mental health disruptions such as stress and poor quality of life. It is suggested that patients and/or clients can benefit from this fusion.

Religious Involvement, Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness

Background: Religious practices/experiences (RPE) may produce positive physiological changes in patients with major depressive disorder (MDD) and chronic medical illness. Here, we report cross-sectional relationships between depressive symptoms, RPE and stress biomarkers (pro-/anti-inflammatory measures and stress hormones), hypothesizing positive associations between depressive symptoms and stress biomarkers and inverse associations between RPE and stress biomarkers. Methods: We recruited 132 individuals with both MDD and chronic illness into a randomized clinical trial. First, stress biomarkers in the baseline sample were compared to biomarker levels from a community sample. Second, relationships between depressive symptoms and biomarkers were examined, and, finally, relationships between RPE and biomarkers were analyzed, controlling for demographics, depressive symptoms, and physical functioning. Results: As expected, inflammatory markers and stress hormones were higher in our sample with MDD compared to community participants. In the current sample, however, depressive symptoms were largely unrelated to stress biomarkers, and were unexpectedly inversely related to proinflammatory cytokine levels (TNF-α, IL-1β). Likewise, while RPE were largely unrelated to stress biomarkers, they were related to the anti-inflammatory cytokine IL-1RA and the stress hormone norepinephrine in expected directions. Unexpectedly, RPE were also positively related to the proinflammatory cytokine IFN-γ and to IFN-γ/IL-4 and IFN-γ/IL-10 ratios. Conclusions: Little evidence was found for a consistent pattern of relationships between depressive symptoms or religiosity and stress biomarkers. Of the few significant relationships, unexpected findings predominated. Future research is needed to determine whether religious interventions can alter stress biomarkers over time in MDD.

Incorporation of Massage into Psychotherapy:An Integrative and Conjoint Approach

This article presents the potential integration of psychotherapy and massage when considering the essence of their beneficial effects.The essence of this model of practice is multifaceted,combining principles from anatomy,physiology and neuroscience with psychotherapy to benefit patient care.It has been advocated that possessing multidisciplinary knowledge from these areas of science enhances psychotherapists＇ holistic care of their depressive patients.A narrative review of the literatures and a qualitative,conceptual synthesis has been performed to create a new theoretical-pragmatic construct.This article introduces the concept of massage practice as a part of psychotherapy practice and presents the potential integration of psychotherapeutic knowledge with clinical decision-making and the management of depressive symptoms.The authors emphasize the usefulness of multi- and interdisciplinary knowledge in the psychotherapeutic process and explain how this knowledge might be extrapolated and incorporated into theoretical and practical settings to benefit depressive patients.The justification for this concept is also presented.The principles set out in this article may be a useful source of information for psychotherapists concerned about their patients＇ holistic well-being in addition to the psychopathology for which they have sought treatment.Researchers and psychotherapists can obtain valuable and additional knowledge through cross-fertilization of ideas across the arguments presented here.

Yoga and Physiotherapy:A Speculative Review and Conceptual Synthesis

This article presents the potential integration of yoga and physiotherapy when considering the essence of their underlying concepts.Within the scope of this article the existence of several similarities between these two‘concepts has been suggested.Researchers,physiotherapists and their patients as well as yoga practitioners can obtain valuable and additional arguments through the cross-fertilization of ideas across presented studies united by shared,underlying concepts.The practice of yoga is based on the...