Complementary and alternative medicine

补充和替代医学
  • 文章类型: Journal Article
    许多功能失调性子宫出血(DUB)患者寻求传统医学咨询。本研究旨在调查台湾DUB患者的补充中草药(CHM)与手术率的关系。
    我们在1997年至2010年期间从台湾的国家健康保险研究数据库中招募了43,027名新诊断的DUB患者(ICD-9-CM代码626.8)。其中,38,324是CHM用户,4703没有接受CHM治疗。在根据患者年龄(每5岁)进行1:1的倾向评分匹配后,合并症,常规药物,分娩状态,从DUB的诊断年和指标年开始的持续时间,CHM队列和非CHM队列中的患者数量相等(n=4642).结果测量是手术事件发生率的比较,包括子宫切除术和子宫内膜切除术,在2013年底之前的两个队列中。
    CHM使用者的手术发生率低于非CHM使用者(调整后的HR0.27,95%CI:0.22-0.33)。在随访期间,CHM队列中手术的累积发生率显着降低(Log秩检验,p<0.001)。CHM队列中的146例患者(4.99/1000人年)和非CHM队列中的485例患者(20.19/1000人年)接受了手术(调整后的HR0.27,95%CI:0.22-0.33)。CHM还降低了有或没有合并症的DUB患者的手术风险。无论分娩状态或患者是否服用NSAIDs,氨甲环酸或孕酮,CHM队列中接受手术的患者少于非CHM队列.最常用的单一草药和配方是Yi-Mu-Cao(HerbaLeonuri)和Jia-Wei-Xiao-Yao-San,分别。
    真实世界数据显示,CHM与DUB患者手术率降低相关。这些信息可用于进一步的临床研究和政策制定。
    UNASSIGNED: Many patients with dysfunctional uterine bleeding (DUB) seek traditional medicine consultations. This study intended to investigate the association of complementary Chinese herbal medicine (CHM) with the surgery rate in patients with DUB in Taiwan.
    UNASSIGNED: We enrolled 43,027 patients with newly diagnosed DUB (ICD-9-CM codes 626.8) from the National Health Insurance Research Database in Taiwan during the period of 1997 to 2010. Among them, 38,324 were CHM users, and 4703 did not receive CHM treatment. After performing a 1:1 propensity-score match based on patients\' age (per 5 years), comorbidities, conventional drugs, childbirth status, duration from the diagnosis year of DUB and index year, there were an equal number (n=4642) of patients in the CHM cohort and non-CHM cohort. The outcome measurement was the comparison of incidences of surgical events, including hysterectomy and endometrial ablation, in the two cohorts before the end of 2013.
    UNASSIGNED: CHM users had a lower incidence of surgery than non-CHM users (adjusted HR 0.27, 95% CI: 0.22-0.33). The cumulative incidence of surgery was significantly lower in the CHM cohort during the follow-up period (Log rank test, p < 0.001). A total of 146 patients in the CHM cohort (4.99 per 1000 person-years) and 485 patients in the non-CHM cohort (20.19 per 1000 person-years) received surgery (adjusted HR 0.27, 95% CI: 0.22-0.33). CHM also reduced the risk of surgery in DUB patients with or without comorbidities. Regardless of childbirth status or whether patients took NSAIDs, tranexamic acid or progesterone, fewer patients in the CHM cohort underwent surgery than in the non-CHM cohort. The most commonly prescribed single herb and formula were Yi-Mu-Cao (Herba Leonuri) and Jia-Wei-Xiao-Yao-San, respectively.
    UNASSIGNED: The real-world data revealed that CHM is associated with a reduced surgery rate in DUB patients. This information may be provided for further clinical investigations and policy-making.
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  • 文章类型: Journal Article
    癌症通常会导致复原力下降,生活质量(QoL)和总体幸福感较差。为了缓解这些问题,补充和替代医学(CAM)在癌症患者中广泛使用。这项研究旨在评估跨学科综合肿瘤学小组计划(IO-GP)对癌症患者CAM的弹性和使用的长期影响。
    这是一个前景,观察,单中心研究。弹性(RS-13),CAM用法(I-CAM-G),QoL(SF-12)和健康相关的生活方式因素(营养,吸烟,饮酒和体育锻炼)的数据收集了70例因癌症在2019年1月至2022年6月期间参加了为期10周的IO-GP的患者。IO-GP在大学医院的环境中提供,对成年癌症患者开放。它包含心身医学和积极心理学的元素,以及关于健康饮食的建议,锻炼和CAM方法。本研究包括至少12个月前(1-4.5年前)完成IO-GP的患者。统计学分析包括描述性分析以及参数和非参数检验,以确定显着差异(P<0.05)。
    参加IO-GP后≥12个月,弹性显着增加(n=44,P=.006,F=8.274),并且具有中等效应大小(r=.410)。自IO-GP完成以来的时间(“12-24个月,\"\"24-36个月,\"和\">36个月\")与弹性变化无统计学意义的相互作用(P=.226,F=1.544)。在过去的12个月中,最常用的CAM模式是维生素/矿物质(85.7%),松弛技术(54.3%),草药和植物药(41.1%),瑜伽(41.4%)和冥想(41.4%)。IO-GP是告知研究参与者放松技术的最常见来源(n=24,64.9%),冥想(n=21,72.4%)和服用维生素D(n=16,40.0%)。与非从业者相比,练习冥想(P=.010,d=-.642)或可视化(P=.003,d=-.805)的弹性水平明显更高。
    IO-GP有可能使癌症患者能够继续使用CAM实践-特别是从身心医学-甚至在完成该计划后的1至4.5年。此外,韧性水平提高。这些发现为综合肿瘤学干预对弹性和CAM使用的长期影响提供了显着见解。尤其是乳腺癌患者。
    UNASSIGNED: Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, complementary and alternative medicine (CAM) is widely used among patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of CAM in patients with cancer.
    UNASSIGNED: This was a prospective, observational, single-center study. Resilience (RS-13), CAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP is offered at the setting of a university hospital and is open to adult patients with cancer. It contains elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and CAM approaches. Patients who completed the IO-GP at least 12 months prior (1-4.5 years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences (P < .05).
    UNASSIGNED: Resilience increased significantly ≥12 months after participation in the IO-GP (n = 44, P = .006, F = 8.274) and had a medium effect size (r = .410). The time since the IO-GP was completed (\"12-24 months,\" \"24-36 months,\" and \">36 months\") showed no statistically significant interaction with changes in resilience (P = .226, F = 1.544). The most frequently used CAM modalities within the past 12 months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n = 24, 64.9%), meditation (n = 21, 72.4%) and taking vitamin D (n = 16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation (P = .010, d = -.642) or visualization (P = .003, d = -.805) compared to non-practitioners.
    UNASSIGNED: IO-GPs have the potential to empower patients with cancer to continue using CAM practices-especially from mind-body medicine-even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of CAM, especially in patients with breast cancer.
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  • 文章类型: Journal Article
    尽管最近在牛皮癣治疗方面取得了进展,管理方面的挑战依然存在。最近,患者对补充和替代药物(CAM)的兴趣越来越高,在对更自然的渴望的驱使下,整体方法和对常规治疗的不满。高达41%的银屑病患者报告使用替代疗法,39.5%使用补充疗法(MurphyEC,努斯鲍姆D,PrussickR,弗里德曼·AJ(2019)银屑病患者使用补充和替代药物。JAmAcadDermatol81:280-283)。尽管它们的患病率迅速增长,缺乏CAM治疗牛皮癣的文献,使他们的推荐困难。自2018年发表关于这一主题的最后一次系统综述以来,已经出现了新的替代疗法的证据。促进对其功效的进一步调查(GamretAC,价格A,FertigRM,Lev-TovH,NicholsAJ(2018)银屑病的补充和替代医学治疗:系统评价。JAMADermatol154:1330-1337)。本系统综述旨在收集有关研究最多的牛皮癣替代疗法的最新文献,并进一步讨论其有效性,以建议临床医生指导患者使用这些非标准方法。在PubMed进行了文献检索,EMBASE,Cochrane中央控制试验登记册,和Clinicaltrials.gov数据库,用于2018年3月至2024年4月期间银屑病辅助和替代疗法的随机对照试验(RCT),导致12项研究纳入本综述.许多治疗如姜黄素的初步结果,饮食调整和添加,天然靛蓝,冥想,针灸,和护理疗法显示出积极的临床效果。然而,我们还需要更多精心设计的随机试验来确认潜在的有益效果,并确定使用的安全性.
    Despite recent advancements in psoriasis treatment, challenges in management persist. Recently, there has been a rising interest amongst patients in complementary and alternative medicines (CAM), driven by the desire for more natural, holistic approaches and dissatisfaction with conventional treatments. Up to 41% of patients with psoriasis reported using alternative therapies and 39.5% use complementary therapies (Murphy EC, Nussbaum D, Prussick R, Friedman AJ (2019) Use of complementary and alternative medicine by patients with psoriasis. J Am Acad Dermatol 81:280-283). Despite their rapidly growing prevalence, literature on CAM therapies for psoriasis is lacking, making their recommendation difficult. Since the last systematic review on this topic published in 2018, evidence for new alternative therapies has emerged, promoting a further investigation of their efficacy (Gamret AC, Price A, Fertig RM, Lev-Tov H, Nichols AJ (2018) Complementary and Alternative Medicine Therapies for Psoriasis: A Systematic Review. JAMA Dermatol 154:1330-1337). This systematic review aims to compile recent literature on the most studied alternative therapies for psoriasis and further discuss their effectiveness in order to counsel clinicians in guiding patients on the use of these non-standard approaches. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases for randomized controlled trials (RCT) on complementary and alternative therapies in psoriasis from March 2018 through April 2024, resulting in 12 studies being included in this review. The preliminary results for many treatments such as curcumin, dietary modification and additions, indigo naturalis, meditation, acupuncture, and balneotherapy showed positive clinical effects. However, additional well-designed randomized trials are needed to confirm the potential beneficial effects and to establish safety of use.
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  • 文章类型: Journal Article
    背景:预言医学,在穆斯林占多数的地区,医疗保健不可或缺,特别是中东和北非,在现有文献中经常被挖掘不足。目的:本概念分析试图通过界定先知医学的属性来探索其概念,前身,和后果,以增加医疗保健提供者对先知医学的理解。它还寻求加强跨学科对话,从而丰富了传统治疗方式在现代医学实践中的整合。方法:采用Walker和Avant方法,通过查阅已发表的有关概念的文献进行概念分析。结果:分析确定了预兆医学的核心属性,如黑色种子,日期,Miswak,湿拔罐,和Zamzam水,探索文化,精神,以及这些实践的实际基础。文化背景等因素,精神信仰,基础知识,更低的成本,感知的安全性,功效,简单的技术,并确定了对同种疗法的不满。这些做法的后果包括先知医学的多方面影响,强调这些传统习俗与健康结果之间的关系。对实践的影响:此概念分析强调了认识到先知医学的这些方面对于医疗保健提供者有效地将先知医学融入实践的重要性。旨在获得有利的患者结果,并培养更具包容性的,文化敏感的医疗环境。
    Background: Prophetic Medicine, integral to healthcare in Muslim-majority regions, particularly the Middle East and North Africa, is often underexplored in existing literature. Purpose: This concept analysis sought to explore the concept of Prophetic Medicine by delineating its attributes, antecedents, and consequences in order to augment healthcare providers\' comprehension of Prophetic Medicine. It also seeks to enhance interdisciplinary dialogue, thereby enriching the integration of traditional healing modalities in modern medical practices. Methods: Walker and Avant\'s method was used to conduct the concept analysis by reviewing published literature on the concept. Results: The analysis identified the core attributes of Prophetic Medicine, such as Black Seeds, Dates, Miswak, Wet cupping, and Zamzam water, and explored cultural, spiritual, and practical underpinnings of these practices. Antecedents such as cultural background, spiritual beliefs, basic knowledge, lower cost, perceived safety, efficacy, simple techniques, and dissatisfaction with allopathic therapy were identified. The consequences of these practices include the multifaceted impact of Prophetic Medicine, highlighting the relationship between these traditional practices and health outcomes. Implications for Practice: This concept analysis underscores the significance of recognizing these aspects of Prophetic Medicine for healthcare providers to effectively integrate Prophetic Medicine into practice, aiming for favorable patient outcomes and fostering a more inclusive, culturally sensitive healthcare environment.
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  • 文章类型: Journal Article
    尽管针对普通人群的补充和替代医学(CAM)的研究正在扩大,仍然缺乏研究CAM实践的有效性和利用率的研究,特别是在儿科人群中。根据世界卫生组织(WHO),父母在其家属中使用CAM的患病率估计高达80%。这篇文献综述确定了广泛的,异质,以及关于CAM的应用和有效性的不确定证据,主要归因于社会人口因素的差异和国家医疗保健系统的差异。此外,审查发现主流专业人员在行动机制方面缺乏共识和两极分化的立场,应用程序,CAM的有效性。这篇叙述性综述提出了关于大多数CAM疗法及其应用的疗效的不同结果;然而,一些证据表明针灸的潜在益处,瑜伽,太极,和按摩改善身心健康。此外,现有证据表明冥想可以增强心理健康,而灵气可能只会影响患者的舒适度。鉴于草药的复杂性和多面性,必须逐案评估其功效,考虑到所涉及的具体化合物和程序。这项全面的审查是卫生专业人员的宝贵资源,为考虑患者价值观和信念的个性化医疗保健方法提供指导,从而促进一体化,旨在提高医疗服务质量和患者满意度的循证实践。
    While research on complementary and alternative medicine (CAM) for the general population is expanding, there remains a scarcity of studies investigating the efficacy and utilisation of CAM practices, specifically in the paediatric population. In accordance with the World Health Organization (WHO), the prevalence of the parental utilisation of CAM in their dependents is estimated to reach up to 80%. This literature review identified broad, heterogeneous, and inconclusive evidence regarding CAM\'s applications and effectiveness, primarily attributed to variance in sociodemographic factors and differences in national healthcare systems. Additionally, the review identified a lack of consensus and polarised positions among mainstream professionals regarding the mechanisms of action, applications, and effectiveness of CAM. This narrative review presents varied results concerning the efficacy of most CAM therapies and their applications; however, some evidence suggests potential benefits for acupuncture, yoga, tai chi, and massage in improving physical and mental health. Moreover, the available evidence indicates that meditation may enhance mental health, while reiki may only influence patients\' perceptions of comfort. In light of the intricate and multifaceted nature of herbal medicine, it is imperative to assess its efficacy on a case-by-case basis, taking into account the specific compounds and procedures involved. This comprehensive review serves as a valuable resource for health professionals, offering guidance for personalised healthcare approaches that consider the values and beliefs of patients, thereby facilitating integrated, evidence-based practices aimed at enhancing the quality of healthcare services and patient satisfaction.
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  • 文章类型: Journal Article
    建议成年人平均睡眠7-8小时。然而,睡眠不足(定义为每晚<7小时)与心血管疾病(CVD)和2型糖尿病(T2DM)等慢性疾病的风险增加有关。传统,互补,和综合医学(TCIM),一个新兴的研究和实践领域,利用现代和传统方法来改善健康。尽管TCIM被认为是改善睡眠和相关结果的工具,文学在解决黑人个体中的影响方面存在差距,他们经历了不成比例的IS和慢性病负担。这项定性研究旨在增加对TCIM实践的理解,以克服黑人社区的IS和整体健康状况。
    使用photovoice方法,一个定性工具,应用社区参与的原则,通过采访和数字媒体产生文化上知情的结果,同意的参与者是从迈阿密招募的,佛罗里达州和(1)指示在一周内捕获图像,这些图像传达了他们的TCIM,以改善他们的移动设备上的睡眠和整体健康状况;(2)使用个人采访,半结构化程序,将“语音”添加到他们捕获的“照片”约20分钟;(3)邀请参加后续焦点小组,以进行精细讨论和数据三角测量约1.5小时。个人和焦点小组访谈均在Zoom上进行,并使用Nvivo软件转录记录以进行正式内容分析。
    样本包括N=25个不同的美国黑人个体(M=37,SD=13,范围21-57)。大约四分之一的样本失业(N=7),大多数是妇女(N=21)。结果强调了五个主题,包括:(1)自然健康(睡眠补充剂,舒适饮料,芳香疗法,草药,户外);(2)自我护理(自我维护,身体活动,空间舒适度);(3)休闲(宠物支持,玩耍);(4)精神刺激(正念,阅读);和(5)精神健康(基于信仰的实践)。研究结果阐明了不同的美国黑人个体在社会文化知识方面的异质性,信仰,和行为。
    解决黑人社区中的IS问题需要一种综合文化敏感性的综合策略,家庭和社区动态,教育,心理健康支持,知情决策。未来的研究应该考虑睡眠健康素养,压力评估,和应对策略可能因种族/族裔而异,以进行量身定制的干预。
    UNASSIGNED: Average adults are recommended to have 7-8 h of sleep. However insufficient sleep (IS defined as <7 h/nightly) is associated with increased risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Traditional, complementary, and integrative medicine (TCIM), a burgeoning area of research and practice, leverages both modern and traditional approaches to improve health. Despite TCIM\'s recognition as a tool to improve sleep and related outcomes, there is a gap in literature in addressing its impact among black individuals, who experience a disproportionate burden of IS and chronic disease. This qualitative study aimed to increase understanding of TCIM practices to overcome IS and overall health in black communities.
    UNASSIGNED: Using photovoice methodology, a qualitative tool which applies community-engaged principles to produce culturally informed results through interviews and digital media, consented participants were recruited from Miami, Florida and (1) instructed to capture images over one week that communicated their TCIM to improve sleep and overall health on their mobile device; (2) interviewed using individual, semi-structured procedures to add \"voice\" to the \"photos\" they captured for ~20 min; and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for ~1.5 h. Both individual and focus group interviews were conducted over Zoom with recordings transcribed for formal content analysis using Nvivo software.
    UNASSIGNED: The sample included N = 25 diverse US black individuals (M = 37, SD = 13, range 21-57). Approximately a quarter of the sample were unemployed (N = 7) and majority were women (N = 21). Results highlighted five themes including: (1) natural wellness (sleep supplements, comfort beverages, aromatherapy, herbalism, outdoors); (2) self-care (self-maintenance, physical activity, spatial comfort); (3) leisure (pet support, play); (4) mental stimulation (mindfulness, reading); and (5) spiritual wellness (faith-based practices). Study results elucidate the heterogeneity of diverse US black individuals regarding sociocultural knowledge, beliefs, and behaviors.
    UNASSIGNED: Addressing IS in black communities requires a comprehensive strategy that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Future studies should consider how sleep health literacy, stress appraisal, and coping strategies may vary by race/ethnicity for tailored intervention.
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  • 文章类型: Journal Article
    目的:抑郁症是一个主要的公共卫生问题。许多补充和替代医学(CAM)干预措施已被建议作为潜在的治疗方法。
    方法:我们在PubMed中全面搜索相关的系统综述和荟萃分析,EMBASE,WebofScience,和Cochrane图书馆数据库。我们根据抑郁评估量表评分的效率和变化评估有效性,并根据不良事件评估安全性。
    结果:这篇综述包括22篇符合条件的文章。月菊抗抑郁药和电针(EA)改善抑郁症状优于抗抑郁药。此外,ω-3脂肪酸(n-3PUFA),锻炼,手动针灸(MA),金丝桃单制剂,放松,维生素D的疗效优于安慰剂和对照组。GPD作为辅助治疗比抗抑郁药具有更高的疗效,MA和月菊抗抑郁药比抗抑郁药具有更好的安全性。
    结论:我们的研究表明,10种CAM可以有效改善临床抑郁症患者的病情。
    OBJECTIVE: Depression is a major public health problem. Many complementary and alternative medicine (CAM) interventions have been suggested as potential treatments.
    METHODS: We comprehensively searched for relevant systematic reviews and meta-analyses in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. We assessed effectiveness based on efficiency and changes in Depression Assessment Scale scores and safety based on adverse events.
    RESULTS: This umbrella review included twenty-two eligible articles. Yueju antidepressant and Electro-acupuncture (EA) improved depression symptoms better than antidepressants. In addition, omega-3 fatty acids (n-3PUFAs), exercise, manual acupuncture (MA), Hypericum mono-preparations, relaxation, and Vitamin D showed better efficacy than placebo and control. GPD as adjunctive therapies have higher efficacy rates than antidepressant, and MA and Yueju antidepressants have a better safety profile than antidepressants.
    CONCLUSIONS: Our study demonstrated that 10 CAMs can effectively improve the condition of patients with clinical depression.
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  • 文章类型: Journal Article
    补充和替代医学(CAM)作为针对各种医疗状况的常规医学之外的治疗方法而受到欢迎。这项研究旨在评估患病率,模式,以及伊朗甲状腺疾病患者CAM使用情况的披露。
    这项描述性分析的横断面研究涉及在设拉子内科诊所就诊的甲状腺疾病患者。CAM的使用通过使用波斯版的I-CAM-Q(I-CAM-IR)问卷进行评估。
    共有343人参加了这项研究,85.4%的患者报告在过去12个月内使用CAM。草药是最常用的CAM模式(63%)。CAM的使用主要是为了增强整体健康。在自我保健CAM实践中,祈祷是最常用的(70%)。与男性相比(p<0.001),女性的CAM利用率明显更高(高四倍)。草药更常用于女性(p<0.001)。相当比例的参与者没有告知他们的医生他们使用CAM,46%的人从使用CAM中获得了显著的好处。
    这项研究强调了CAM使用的高患病率,特别是草药,在伊朗甲状腺疾病患者中。
    UNASSIGNED: Complementary and alternative medicine (CAM) has gained popularity as a therapeutic approach outside conventional medicine for various medical conditions. This study aimed to assess the prevalence, patterns, and disclosure of CAM use among patients with thyroid diseases in Iran.
    UNASSIGNED: This descriptive-analytic cross-sectional study involved patients with thyroid diseases who were visiting Internal Medicine Clinics in Shiraz. The use of CAM was assessed by employing the Persian edition of the I-CAM-Q (I-CAM-IR) questionnaire.
    UNASSIGNED: A total of 343 individuals took part in the study, and 85.4 % of them reported using CAM within the previous 12 months. Medicinal herbs were the most commonly used CAM modality (63 %). CAM use was primarily for enhancing overall well-being. Among self-care CAM practices, praying was the most frequently employed (70 %). Women exhibited a significantly higher CAM utilization rate (four times greater) compared to men (p < 0.001), with herbs being more commonly used by women (p < 0.001). A significant proportion of participants did not inform their physicians about their CAM use, and 46 % experienced significant benefits from using CAM.
    UNASSIGNED: This study highlights a high prevalence of CAM use, particularly herbal remedies, among Iranian patients with thyroid diseases.
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  • 文章类型: Journal Article
    背景和目的:尽管缺乏经证实的疗效,阿片类药物历来被用于治疗非癌性背痛.随着时间的推移,用于疼痛管理的各种其他有效治疗选择变得越来越可用。2016年,俄勒冈州实施了一项独特而新颖的政策,以改善基于证据的背痛护理,并通过该州的医疗补助计划促进更安全,更有效的阿片类药物处方。俄勒冈州的健康计划。本文探讨了提供者在COVID-19背景下适应为背痛患者提供护理的方式,并更好地了解提供者面临的挑战和所做的适应。方法:我们与临床医生和身体疼痛治疗模式从业者(PPTMPs)进行了焦点小组。总的来说,129个提供者参加了六个焦点小组之一,包括74名临床医生(54%)和55名PPTMP(42%)。自反性主题分析用于构建跨数据的主题或意义单位。结果:焦点小组对PPE短缺表示担忧,远程医疗挑战,沟通障碍,以及行业对COVID-19的特定反应,这阻碍了患者护理和转诊。焦点小组还强调了与提高对患者生活的洞察力有关的一些优势,加强治疗。COVID-19期间的护理导致患者对远程医疗和远程医疗的持续兴趣。结论:针对健康状况优化这些技术的使用,如背痛,增加了患者的治疗选择,并使提供者对患者的生活有更全面的了解,他们可能面临的挑战,以及如何影响他们的治疗。
    Background and Purpose: Despite the lack of proven efficacy, opioids historically have been used for the treatment of noncancer back pain. A variety of other effective therapeutic options for pain management are becoming more available over time. In 2016, Oregon implemented a unique and novel policy to improve evidence-based back pain care and promote safer and more effective opioid prescribing through the state\'s Medicaid program, the Oregon Health Plan. This article examines the ways providers adapted to providing care for patients with back pain in the context of COVID-19 and to better understand the challenges faced by and adaptations made by providers. Methods: We conducted focus groups with clinicians and physical pain treatment modality practitioners (PPTMPs). In total, 129 providers participated in one of six focus groups, including 74 clinicians (54%) and 55 PPTMPs (42%). Reflexive thematic analysis was used to construct themes or units of meaning across data. Results: Focus groups revealed concerns about PPE shortages, telemedicine challenges, communication barriers, and profession-specific responses to COVID-19, which hindered patient care and referrals. Focus groups also highlighted some advantages related to increased insight into patients\' lives, which enhanced treatment. Care during COVID-19 has resulted in continued patient interest in telehealth and telemedicine. Conclusion: Optimizing use of these technologies for health conditions, such as back pain, adds to treatment options for patients and gives providers a more holistic understanding of patients\' lives, the challenges they may face, and how that impacts their treatment.
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  • 文章类型: Journal Article
    背景:补充和替代医学(CAM)的医学研究最近有所增加,引发了对CAM道德地位的伦理关注。医学学术期刊负责对手稿进行伦理审查(ER),以保护人类受试者的利益,并在决定发表之前提供伦理结果。然而,没有对CAM期刊中的ER进行系统分析。本研究旨在评估CAM期刊中道德要求和合规性的现状。
    方法:这是一项横断面研究。我们审查了期刊引文报告(2021)(https://jcr)中包含的CAM期刊作者(IFA)的说明。clarivate.com)获取ER的一般信息和要求。我们还浏览了CAM期刊在1月至6月Q1和Q2部分发表的随机对照试验的手稿,2023年,检查道德要求的实际情况。使用描述性统计和Fisher精确检验进行统计分析。
    结果:最终纳入了27种期刊和68份手稿。92.6%(25/27)的IFA包含ER的关键字,表明存在道德考虑。然而,CAM不需要特定的ER(n=0)。我们按地理来源对期刊进行分类,JCR部分,电子JCR年,研究的类型,%OAGold探讨可能影响CAM期刊制定一定伦理审查政策的因素。结果表明,在任何分类的期刊中,某些伦理审查政策均无统计学意义(p>0.05)。研究中包含的所有RCT手稿通常符合已发表期刊的伦理审查要求。
    结论:所有IFAs讨论的ER,但是内容是分散的,注意力不集中,并且没有关于CAM的特定ER要求。尽管手稿基本上符合期刊的要求,在手稿中不可能更接近ER的过程。为了确保这些政策在未来得到充分执行,CAM期刊应要求作者提供更多详细信息,或形成CAM伦理审查所需的项目清单。
    BACKGROUND: Medical research in complementary and alternative medicine (CAM) has increased recently, raising ethical concerns about the moral status of CAM. Medical academic journals are responsible for conducting ethical review (ER) of manuscripts to protect the interests of human subjects and to make ethical results available before deciding to publish. However, there has been no systematic analysis of the ER in CAM journals. This study is aim to evaluate the current status of ethical requirements and compliance in CAM journals.
    METHODS: This is a cross-sectional study. We reviewed instructions for authors (IFAs) of CAM journals included in the Journal Citation Reports (2021) ( https://jcr.clarivate.com ) for general information and requirements for ER. We also browsed the manuscripts regarding randomized controlled trials published by CAM journals in Q1 and Q2 section from January to June, 2023, to check the actual situation of ethical requirement. Descriptive statistics and Fisher\'s exact test were used for statistical analysis.
    RESULTS: 27 journals and 68 manuscripts were ultimately included. 92.6% (25/27) IFAs included keywords of ER, indicating the presence of ethical considerations. However, no specific ER was required for CAM (n = 0). We categorized journals by Geographic origin, JCR section, Year of electronic JCR, Types of studies, % of OA Gold to explore the factors that could influence CAM journals to have certain ethical review policies. The results showed there was no statistical significance in certain ethical review policy in any classification of journals (p > 0.05). All RCT manuscripts included in the study generally met the requirements of the published journals for ethical review.
    CONCLUSIONS: All IFAs discussed ER, but the content was scattered, unfocused, and there were no specific ER requirements regarding CAM. Although the manuscripts basically met the requirements of the journal, it was not possible to get closer to the process of ER in the manuscript. To ensure full implementation of these policies in the future, CAM journals should require authors to provide more details, or to form a list of items necessary for CAM ethical review.
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