European Journal of Integrative Medicine

IFC - Editorial Board

2009-12-01

Editorial Board

2009-12-01

Stefan N. Willich — 2009-12-01

With the present issue of the European Journal of Integrative Medicine we are completing our first year of publication. The journal is devoted to fostering integrative medicine, considered not as mere addition of complementary and alternative medicine (CAM) to conventional medicine, but rather as combination of their mutual strengths (see ). On the one hand, CAM methods should be able to provide evidence regarding safety and effectiveness before being accepted as part of modern integrative medicine. On the other hand, conventional medicine may well be ‘fertilized’ by interaction and possible cooperation with CAM. Topics that have been discussed primarily in context of CAM, e.g. placebo aspects or issues of complex therapeutic intervention, could be pertinent also in further developing conventional approaches. We are grateful for the strong resonance among scientists, clinicians and health professionals within the last 12 months, confirming the need of a panel for integrative medicine.

Call for papers

2009-12-01

The Clinic for Integrative Medicine in Essen, Germany

Gustav J. Dobos — 2009-12-01

In integrative medicine (IM) the basic concept is the combination of mainstream with Complementary and Alternative Medicine (CAM) supposedly leading to synergistic therapeutic effects. In an extended version the methods of Mind/Body Medicine (MBM) are also added. A recent survey screening the German population concerning their preferences for cam, mainstream medicine or combining both of them (IM) showed that most Germans were in favour of integrative medicine. This shows the development of a new understanding of medicine in Germany.In 1999 the first hospital for Internal and Integrative Medicine with 54 beds was established at the Teaching Hospital Kliniken Essen-Mitte as a model institution of the county North Rhine-Westphalia, Germany. In October 2004, after a 5-year period of scientific evaluation by the university board, the first German Chair for Complementary and Integrative Medicine was founded by the Alfried Krupp von Bohlen and Halbach-Foundation at the University Clinic Duisburg-Essen. In this model institution Western trained doctors specialized in CAM as well as mind–body instructors offering Mind–Body Medicine (MBM) are working together. Besides the task of teaching students the Chair and institution is focussing on clinical and basic research on Traditional European and Chinese Medicine as well as Mind–Body Medicine. Besides that an intensive program evaluating the outcome of more than 2500 patients, who have been treated during the past 5 years has been established. The stay in the hospital is paid by all German insurance companies for patients.In the talk the concept of Integrative Medicine in a regular hospital setting combining Complementary Medicine and Mainstream Medicine will be introduced. Indications and expected benefits, for in-patients, day-care in-patients and out-patients will be discussed.

The Royal London Homoeopathic Hospital: Dimensions of integration

P. Fisher — 2009-12-01

Our definition of integrated medicine is pragmatic: offering patients the best of conventional and complementary therapies, combined in a way which meets their needs. Integration with a large academic medical centre opens many opportunities but realising these requires integration in several dimensions:

Educational initiatives in integrative medicine: The imperative for change

Aviad Haramati — 2009-12-01

: As the public's use of complementary and alternative medical (CAM) therapies has increased, and as research into the safety and efficacy of these modalities has intensified, medical schools are faced with the challenge of determining how best to integrate this information into the curriculum. Over the past decade, there has been increased interest and activity at many medical schools to incorporate complementary, alternative and integrative medicine (CAM) into the 4-year-undergraduate medical curriculum, as well as to graduate medical education programs. Beginning in 2000, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health in the US funded 15 institutions for multi-year grants (R25 awards) to foster these types of educational initiatives. The efforts of this group have been documented in a series of articles published in Academic Medicine and other key journals. Another important development has been the formation in 2002 of the Consortium of Academic Health Centers for Integrative Medicine, a group of now 43 medical schools in North America dedicated to helping transform healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine with the rich diversity of various therapeutic systems and modalities. The Consortium published a suggested list of core competencies in integrative medicine that all graduates of medical school should possess (Acad. Med. 79:521–531, 2004), and also compiled a series of modules for teaching elements of Integrative Medicine. In Canada, efforts are underway, through the CAM in UME (Undergraduate Medical Education) Project, to broaden the awareness of CAM practices, products and perspectives in an evidence-based manner across the various curricula. In this plenary presentation, Dr. Haramati will outline the imperative for moving medical education in this direction. A variety of approaches will be highlighted in which material from the thematic thread of Complementary and Integrative Medicine, that is the blending of conventional and non-conventional therapies, can be used to advance both scientific curricular objectives and also to help students attain proficiency in competencies related to professionalism, such as self-awareness, self-care and personal growth.

Systematic reviews—Benefits and pitfalls

Klaus Linde — 2009-12-01

Systematic reviews have considerable impact on the discussion of complementary therapies in the scientific community, the media and on health care decision making, as they are considered to be the most reliable tool to summarize and assess the available evidence on a defined question. This lecture will discuss strengths and limitations of systematic reviews, both in general and in relation to complementary and alternative medicine (CAM). Well-performed systematic reviews clearly define the questions addressed, use systematic methods and describe them carefully, assess the quality of the primary studies and summarize their findings in a transparent manner. However, review questions in CAM tend to be broad which often leads to results which leave wide room for subjective interpretation. For searching the literature comprehensively it is sometimes necessary to go far beyond conventional electronic databases, but the quality of the material identified in other sources seems often doubtful. Small changes in selection criteria can influence strongly which studies are actually included. Publication bias, insufficient reporting in primary studies and problems related to quality assessment apply to both conventional medicine and CAM. In conclusion, while systematic reviews are (at least currently) without alternative, they have to be read and interpreted with caution. And in many cases, particularly in the area of CAM, they will leave a lot of room for controversial discussions.

The development of patient centred and individualised outcome measures and their use in complementary medicine research in the field of cancer

Charlotte Paterson — 2009-12-01

In evaluating potentially curative treatments for cancer the primary outcome, or desired effect, is usually survival. Consequently, although patient's quality of life is increasingly being measured in trials of cancer treatments, it is usually considered to be of lesser importance. The complexity of balancing benefits in terms of increased survival against worse quality of life becomes increasingly important in palliative care. However, when people use complementary therapies after a diagnosis of cancer they nearly always do so as an adjunct to conventional care – with much wider and individualised aims of symptom relief, improved wellbeing, and as a way to take some control and re-integrate themselves. Knowledge of peoples’ experiences of these outcomes is the basis on which appropriate outcome measures can be developed.In addition to describing those quality of life questionnaires that have been developed for conventional treatments, I will discuss the development of an individualised tool Measure Yourself Concerns and Wellbeing, MYCaW. This allows patients to specify what their main concern is as well as measuring its severity and change over time. It is a questionnaire that collects both numerical data and data written in the patient's own words and a framework for analysing such data is also available. MyCaW has mainly been used in evaluating cancer support services and some results from these evaluations will be presented. In these settings, psychological and emotional concerns predominated and significant improvements were demonstrated. Patients also highlighted the importance of the supportive interaction they had with their therapists, other patients and the centre staff. Not only are patient-centred outcome measures vital if we are to carry out meaningful evaluations of interventions, but they may also have a role in helping clinicians to keep their focus on the patient as well as the disease.

Evidence based integrative medicine

F. Pfab, J. Huss-Marp, H. Behrendt, U. Darsow, J. Ring — 2009-12-01

Integrative approaches have played an essential role in the treatment of dermatological diseases since a long time. Many current standard treatments can be considered integrative such as phototherapy, climate therapy (such as staying at high altitude or at the sea), special training on how to handle a disease, special diets and psychological approaches. Furthermore the amount of well-controlled studies on complementary medicine in the treatment of dermatological disorders has increased within the last years. Besides different therapies derive from natural remedies, such as fumaric acid or psoralene (used e.g. in the treatment of psoriasis).An example reflecting the integrative approach in dermatology is the treatment of atopic eczema—an inflammatory, chronically relapsing, non-contagious and pruritic skin disease.Amongst others it consists in rehydration, anti-inflammation, antisepsis, avoidance of trigger factors and anti-pruritic strategies. The large number of emollients currently used includes many naturally derived topical agents. Anti-inflammatory standard treatment with corticosteroids and calcineurin-inhibitors is complemented by e.g. phototherapy or topical usage of e.g. soaked black tea pads as further treatment options. In case of antimicrobial treatment a variety of natural agents such as tea tree oil, lemongrass and cinnamon oil proved a strong anti-bacterial effect. Due to their potency to induce contact allergies they are, however, not recommended; neither are antibiotics. Non-irritating antiseptics are the agents of choice.Avoidance of triggering factors includes amongst others staying at high altitude or at the sea as well as special diets and avoidance of allergens. Antipruritic treatment includes topical therapies with anesthetics and corticosteroids as well as cold showers.Within the last years some promising new approaches have evolved, which have to further be evaluated regarding its clinical effect on atopic eczema: Recent experimental studies have e.g. shown an effect of acupuncture on histamine- and allergen-induced itch and an influence of allergen-induced basophil activation. Sangre de grado, an Amazonian medicinal, showed to be a potent antimicrobial, anti-inflammatory and inhibitor of sensory afferent nerve mechanisms.Future studies will have to further focus on the role of integrative medicine in dermatology.

Pain: Comparison of evidence for conventional western and alternative therapies

2009-12-01

Complementary and alternative medicine (CAM) is in widespread use among pain sufferers. Often CAM is used in parallel with conventional pain treatment by both patients and physicians. In addition, in pain medicine the border between conventional and alternative therapies is not well defined.Here, the evidence for both conventional western as well as CAM for chronic pain is reviewed. Since chronic pain conditions as well as therapies are heterogeneous, only for a few topics and therapies comparable studies exist. The literature search comprises only randomized controlled trials (RCTs) and systematic reviews or guideline publications in which the quality of the included studies is analysed according to predefined criteria. The following pain entities have been selected: cancer pain, neuropathic pain, low back pain, and fibromyalgia.For cancer pain, very efficient conventional treatment options exist. In comparison, evidence for CAM is limited due to the paucity of rigorous trials. Only one systematic review was found. Despite the scant evidence, CAM is widely used among cancer pain patients. Reasons may be the low rate of adverse effects compared to conventional (opioid) therapy and the combination with a CAM therapy of the malignant disease itself.For neuropathic pain, good evidence exists for conventional pharmacological treatment. However, conventional treatment options are not uniformly efficacious for all forms of neuropathic pain. For CAM, evidence is limited. For most forms of CAM therapy only single studies of often low quality exist.For chronic low back pain, only few forms of conventional therapy have proved consistently efficacious in multiple RCTs. Nevertheless many other forms of therapy, especially interventional, continue to be popular among both patients and physicians. The same is true for the diverse forms of CAM, where evidence is conflicting, too. In the treatment of fibromyalgia, the situation is similar.In summary for many pain conditions evidence is lacking for both conventional and alternative therapies, and conventional therapy is often not sufficiently efficacious. Risk–benefit ratios as well as cost-effectiveness analyses need to be taken into account when integrating all forms of therapy.

The children's clinic for integrative medicine in Amsterdam

2009-12-01

The outpatient integrative pediatric clinic was set up in 2007 with the goal to provide access to the best practices available in complementary and natural therapies in conjunction with conventional medicine in a culturally competent manner. The Slotervaart Hospital is the national leader in offering integrative medicine advice and treatment options in the Netherlands. The pediatric Integrative Medicine clinic offers a variety of treatment and consultative services to children and their families (holistic assessment and personalized information/resource consultation). Specific individual or multimodality treatment approaches at the Integrative medicine clinic include academic therapy, aroma diffusion therapy, integrative cancer care service, massage therapy, lifestyle management, mind–body skills, psychotherapy, relaxation and mental imagery and self regulation skills training. Next to the internal services an interprofessional collaboration with CAM health care practitioners was established in an integrative health care model. To ensure coordinated care CAM practitioners are selected by a set of specific criteria focusing on education and training, experience with children, shared medical records and licensing. Most external referrals are to naturopathic doctors, homeopathic doctors, chiropractors and acupuncturists. A preferred list based on the medical needs of the patient population for adjunctive treatment services was built. Patient referrals are either from primary care practitioners (family doctors) or from pediatric subspecialists in academic hospitals, asking for advice about CAM treatment in children with chronic illnesses.As there is an increasing amount of journal articles, books, websites and information databases on CAM therapies, a close co-operation with the librarian in the Slotervaart Hospital was established as a stepping stone in the ensurance of Evidence Based Medicine for the medical doctors running the Integrative Medicine Clinic. Momentarily the clinic creates a website for parents and children for information purposes on integrative medicine and a forum to share the CAM experiences of the children. A survey is being conducted among the patients attending the Integrative Medicine Clinic with data presentation on the 5th International Congress on complementary Medicine Research (Norway. ICCMR 2010) held in Tromsø, Norway.

Complex treatments—A challenge for clinical research

C.M. Witt — 2009-12-01

In complementary medicine, the so-called “whole medical systems” use a complex approach for the diagnosis and treatment, such as Chinese medicine or homeopathy. According to NCCAM whole medical systems are systems that are built upon complete systems of theory and practice and have evolved prior and separate from the conventional medical approach. Clinical research can focus on a variety of different questions, including efficacy and effectiveness. There is an ongoing discussion about the advantages and limitations of both efficacy and effectiveness research. ‘Efficacy’ refers to the extent to which a specific intervention is beneficial under ideal conditions, while ‘effectiveness’ is a measure of whether a specific intervention when applied in a usual care setting has the desired effect. For efficacy studies whole medical systems have to be broken down to single interventions to allow for comparison with a placebo. Furthermore, in these efficacy studies the interventions are mainly applied in a standardized manner, whereas in practice they are usually tailored to the individual patient. The advantage of effectiveness studies is that they allow for an evaluation of whole medical systems by comparing these, for example, with complex conventional standard treatments. When developing a study protocol for an effectiveness study, the theoretical basis of the medical system and the available health service data on the usage in routine care should be considered, to assure that this trial reflects usual care. The relevance for decision making from both efficacy and effectiveness studies is still open to discussion. This is not only a methodological discussion, but also an ethical and political discussion. The core question to be answered is whether the evidence for a specific effect or the evidence that a specific intervention is beneficial in usual care should have more impact, when deciding on the availability of a treatment.

The WHO perspective on integration of traditional medicine into health system

Xiaorui Zhang — 2009-12-01

The reality of health care systems is that there is a strong demand for traditional medicine (TM), as shown in the WHA 56.31 resolution on traditional medicine in 2003 the popular use of TM demonstrates that it is widely accessible, affordable, and culturally accepted in large parts of developing countries, especially in Africa, Asia and Latin America, where TM is often deeply rooted in the local culture. In Europe and North America, people are increasingly using TM as complementary to or as an alternative for western medicine (WM) treatments.TM has a distinct appeal to broad populations of people. TM systems often have specific theories, diagnoses and treatments which may be different than the methods and treatments of WM. Recognizing these differences, it is essential to understand that both systems of TM and WM have their advantages and weakness. The advantage of TM may be found in their utilization for chronic diseases, improving quality of life and health maintenance, as well as for some health conditions that could not be treated well with WM.There are significant challenges facing this integration. There is lack of appropriate standards and measures to control the quality of TM, especially herbal medicines. There is also a lack of appropriate accepted research methodology to evaluate TM based on TM characteristics. Therefore, the cooperation and collaboration between the experts of both TM and WM is necessary.WHO encourages countries to integrate TM into health systems so that patients will obtain the health benefits from both TM and WM. In support of integrating TM into their existing health systems, WHA 62.13 resolution on TM adopted in May 2009 urges the Member States to respect, preserve and communicate, as appropriate, the knowledge of traditional medicine, treatments and practices, appropriately based on the circumstances in each country, and on evidence of safety, efficacy and quality; to consider, where appropriate, including traditional medicine into their national health systems based on national capacities, priorities, relevant legislation and circumstances, and on evidence of safety, efficacy and quality; to further develop traditional medicine based on research and innovation, giving due consideration to the specific actions related to traditional medicine in the implementation of the Global strategy and plan of action on public health, innovation and intellectual property resolution which was adopted in 2008.This abstract can be surmised by a statement made by Dr. Margaret Chan, Director-General of WHO, during the WHO Congress on Traditional Medicine in 2008. “The two systems of traditional and western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each.”

Representation of complementary and alternative medicine (CAM) in German treatment guidelines — An appraisal

K. Kraft — 2009-12-01

Background: In the German medical care system CAM still seems to be more or less ignored.Objective: To evaluate the occurrence of CAM in German treatment guidelines and in the 4 national health care guidelines (NHCG).Design: The treatment guidelines and NHCG published by the Working Groups of the Scientific Medical Societies (www.AWMF.de) between 2004 and 2009 were searched for CAM with respect to occurrence and rating (recommendations: positive, negative, still unclear) in August 2009.Results: Eighty-eight scientific medical societies have published altogether 728 treatment guidelines. Only 75 guidelines and the NHCGs list any CAM; of these, 9 guidelines and 2 NHCGs mention kinesitherapy, dietetic treatment, relaxation techniques, physical therapy and physiotherapy mainly without supplying further details. In the guidelines and NHCGs altogether 168 CAM measures are validated as positive, 48 as negative and 88 as unclear. Main reasons for the rating “unclear” are low quality or missing clinical trials.In Germany, CAM methods are subsumed under the generic terms physical medicine and balneotherapy/climate therapy (measures of physical therapy, physiotherapy, balneotherapy and climate therapy) or naturopathy (which includes measures of physical medicine, balneotherapy and climate therapy and several other methods). From the measures of physical therapy, etc., mentioned in the guidelines, 95 are validated as positive, 12 as negative and 22 as unclear. If measures of physical medicine, etc. are excluded, of the remaining naturopathic methods 67 are rated as positive, 40 as negative and 43 as unclear. Alternative methods are rated as positive (n=9), negative (n=6) and unclear (n=13).Conclusion: The notification of CAM in German medical guidelines increased in the last few years. Also, some naturopathic methods beyond physical medicine are rated as positive. However, CAM is still far from being a substantial part of medical care in Germany.

Phytobalneotherapy (hay bath) with Graminis flos vs. hydrotherapy: A prospective cross-over study

B. Brinkhaus, R. Kohnen, E.G. Hahn — 2009-12-01

Background and aim: Phytobalneotherapy with Graminis flos (hay bath) is being used more frequently in the areas of prevention, clinical treatment and rehabilitation in Southern Germany and Austria. However, there are only a few studies investigating the effects of the hay bath.Methods: In a prospective cross-over study we randomized healthy subjects into two groups, each receiving one hour of treatment in either a traditional hay bath or a warm bath (hyperthermia). The two groups were then investigated for differences in cardiovascular parameters (blood pressure, heart rate, and sublingual temperature), subjective well-being, quality of sleep, and tolerability during the treatment.Results: Twelve male test subjects (age 25.2±3.3 years, BMI 23.4±2.3) years were included in the study. There were no significant differences between the two groups in terms of demographic data, nor did the objective or subjective parameters reveal any significant differences between the groups. Side effects (numbness, headache) were documented by two subjects receiving hay bath.Conclusion: When using the hay bath, potential side effects must be taken into account. In view of the increasing use of Graminis flos in phytobalneotherapy, investigations involving large groups of patients with defined illnesses are needed in order definitively to establish the effectiveness and risks of the hay bath.

Phytotherapy in inflammatory bowel diseases (IBD)

J. Langhorst — 2009-12-01

Phytotherapy is one of the major fields in “Klassischer Naturheilkunde” in Germany and it is the most frequented one. In 2003 more than 2 billion dollar was spent for over-the-counter herbal treatment.In Germany more than 300,000 patients suffer from IBD, mainly Crohn's disease and ulcerative colitis.In IBD every other patient has personal experience with CAM. Almost 44% of these patients had experience in the field of Herbal therapy, mainly as an adjunct to conventional therapy in an integrated medical treatment approach.One way to implement herbs in the treatment is self-help strategies such as tea. Moreover, there are various herbal preparations with promising results in the treatment of IBD. In Germany there is major interest in the herbs isphagula, frankinsence, myrrh and camomile for the treatment of IBD. Moreover, ginger, curcumin, tormentill, wormworth and green tea have shown first promising results.The different herbs will be introduced and existing data or ongoing research will be presented.

Potential confounders in studies of complementary alternative medicine: Which study design?

F. Porzsolt — 2009-12-01

The design of a scientific study should be appropriate to answer the study question but independent of the theory which generated the study question. Different study designs will be needed to answer questions related to diagnosis, therapy or prevention but may not be needed to investigate different treatments founded by different theories.Aim: Using the example of treatment-related questions we discuss the applicability of 12 questions [Usability of Scientific Publications (USP) Questionnaire; manuscript submitted] to studies of complementary alternative medicine.Methods: Q1 Was the aim of the study clearly stated? Q2 Was the design appropriate to answer study question? Q3 Can the design of the study be used in a confirmatory study? Q4 Were the risk profiles of the study populations similar? Q5 Was the allocation of patients to study groups concealed? Q6 Were doctors and patients continuously blinded? Q7 Was the follow up long enough to detect the defined endpoint? Q8 Were all patients included in reported results? Q9 Were adequate statistics applied? Q10 Were the results influenced by conflicting interests? Q11 Is the validity of report acceptable? Q12 Is the described effect clinically relevant?Result: The questions Q1, Q2, Q7–Q10 and Q12 can be answered without specific instruction. Possible answers to the other questions are: Q3 The designs of some studies are ambiguous and not clear enough to be used in a confirmatory study. Q4 The risks of harm may be imbalanced among the investigated groups. Imbalanced means that most of the risk factors indicate a marginally higher risk of harm in one of the investigated groups. Q5 The answer to this question is “no” if the allocation to a particular treatment group can be predicted. Q6 In some studies doctors and/or patients can identify rather fast to which treatment a particular patient is allocated. Q11 This question should be answered by a group of advocates and skeptics of the tested treatment.Conclusion: It is not possible to recommend a “one fits all” study design but the criteria can be specified which influence the validity of the study results. Two interesting aspects have to be discussed in more detail, the role of randomization and the threshold of validity. Increasing evidence indicates that both aspects may be more a societal than a scientific problem.

How should we take into consideration experimental data about the interaction of CAM and antitumoral medicacian therapeutics when planning an individual therapy or a study?

J. Hübner — 2009-12-01

How should we take into consideration experimental data about the interaction of CAM and antitumoral medication therapeutics when planning an individual therapy or a study?Decisions about therapy should be based on evidence derived from clinical studies preferentially from randomized blinded and controlled studies.Unfortunately regarding CAM high-ranking studies are mostly missing.As most of our patients use classical therapy and CAM in parallel we have to be very cautious about possible interactions.As part of the German Cancer Organisation (DKG) AKKOM takes part in the development of guidelines.In this process we are discussing whether we should take into consideration preclinical data for a substance that could be used as supportive agent (e.g. Ginseng against fatigue) if there are data revealing a negative potential of the substance.These thoughts are in contrast to the usual process of guidelines in which preclinical data are regarded as data of insufficient evidence.Yet I strongly recommend considering them because most CAM substances are tested as supportive therapy and most of the clinical studies on this field are not designed to tell us enough about possible negative impacts on therapy, long-term consequences and patient survival. Only in a minority of studies there are secondary endpoints like overall survived and mostly either the design of the study or the number of patient is insufficient to answer this question.In the case of an individual therapy decision the same considerations should be made for the safety of our patients.Whenever there are experimental data which show that the substance can diminish the effect of our chemo-, radio- or targeted therapy we have to be very careful to use it even if there is a high level of evidence for its usefulness as supportive agent.In most clinical studies any use of CAM is prohibited but we know that the compliance of patients at this point is not good. So it could be an idea to explicitly allow for the use of certain CAM substances that have been checked for their usefulness and interactions.AKKOM is in contact with study groups and the industry and first studies with a CAM substance as supportive agent in combination with new substances have been designed.To my opinion these considerations should also be made concerning classical supportive therapy. If we look at the potential interactions of most of these substances and at the design of the studies in which they have been approved I think we must admit that we do not know whether there could be a negative impact on long-term outcome.

Are asthma and allergies increasing in children and adolescents?

S. Lau — 2009-12-01

Asthma and allergies are the most common chronic diseases in childhood and adolescence with a tremendous impact on life quality and health systems. After the Second World War, an increasing prevalence of allergies and asthma could be observed in westernized countries, while infant mortality and severe infections like tuberculosis were decreasing. This observation turned out to be due to a real increase of diseases, although there was also increased awareness in terms of allergies and asthma. Genes play a major role in the development of the allergic inflammation; however, as genes do not change within a short period of time, the penetrance or expression of genes may have changed due to an altered environment. These factors are thought to be a lack of microbial burden, a decrease in family size, a lack of physical exercise and a change in nutrition. While the increase was very high during the period of 1960 and 1998, a certain plateau has been reached in Central Europe and the US. However, studies like ISAACIII show that in certain regions of the world like Thailand and Lithuania, allergies are still increasing, while low prevalence is observed in rural China.

Integrative concepts in asthma and allergy treatment in children: TCM

K. Stockert — 2009-12-01

Traditional Chinese medicine (TCM) has considered the lung to be connected to the large intestine for 2000 years. According to the principles of TCM and the theory of the Five Elements any treatment aimed at the lung, as a Yin-organ, also implicates treatment and regulation of the large intestine, as the linked Yang-organ.This interaction between lung and large intestine was recently re-detected by epidemiological studies carried out to generate hypothesis of plausible mechanisms for the increasing prevalence of asthma and atopic diseases in developed countries.The “Hygiene Hypothesis” postulates that improvements in public health, hygiene practices and smaller family sizes result in a reduced exposure to TH 1-trophic microbial stimuli from both commensals and pathogens. Observations of altered intestinal microflora in allergic children and clinical studies elucidated the role of non-pathogenic microbes of the gut and the GALT as a major factor essential for the maturation of the immune system to a nonatopic mode.A randomised, placebo-controlled pilot study of laser acupuncture and probiotics in school age children with asthma showed a beneficial clinical effect on bronchial hyperreactivity. Acupuncture treatment of patients with allergic asthma resulted in a significant decrease in Th2 cytokines IL-4, IL-6 and IL-10 serum levels.Acupuncture in allergic rhinitis leads to clinically relevant and persistent benefits. Tentatively, it appears that acupuncture and Chinese herbal medicine can be effective in allergic rhinitis and asthma, but for confirmatory evidence larger, multi-centre trials are necessary.Recently, use of paracetamol and antibiotics for common cold diseases in the first year of life and the later childhood were shown to be associated with the risk of inducing asthma, rhino-conjunctivitis and eczema. A low risk for asthma-related morbidity was also shown for ibuprofen use in febrile children.How can TCM counteract these mechanisms?Shang han lun, the oldest surviving Chinese medical text devoted to externally contracted (common) cold diseases, presents a systematized knowledge concerning the origin and development of such diseases and their treatment by highly sophisticated use of herbs combined in formulae that are skillfully modulated to deal with a vast variety of disease manifestations. Examples will be presented.Strict guidelines on diet and lifestyle are essential in TCM and will be explained.

Can body self development system (Body-sds) treatment prevent patients with chronic back pain from surgery?

M. Heidenberg — 2009-12-01

Objective: Chronic back pain (CBP) is the most prevalent, costly and disabling musculoskeletal problem in modern western societies. We want to study if the non-pharmacotherapy and non-invasive method of Body-sds could effectively reduce the symptoms of CBP. The complementary method, Body-sds, is a manual therapy, using chiropractic, lymph drainage and massage techniques.Methods: A pilot study will be conducted on 20 patients with indication for discusprothesis operation. The test persons will undergo 6 treatments of Body-sds, followed by an evaluation of their physical and psychological health, as well as ADL and VAS variables. There will be 3 points of evaluation: the first one, before the treatment starts and the other two, 3 and 12 months after the treatment has stopped. The patient will be asked to fill out a series of questionnaires including the Oswestry back pain scale, the SF-36, the Euro-QOL life quality scheme and the VAS scale.

Inhibition of glucose uptake by Silybin and Dehydrosilybin

T. Zhan, M. Digel, W. Stremmel, J. Füllekrug — 2009-12-01

Type 2 diabetes (T2D) is a common disease in industrialized countries. Pathological changes in cellular glucose and fatty acid uptake are hallmarks of T2D. Medical plants from traditional medical systems of China and India are considered as a promising source for new anti-diabetic drugs. Here, we screened a panel of plant extracts and single chemical compounds from traditional medical plants with reported anti-diabetic effects for their ability to modulate cellular glucose and fatty acid uptake rates.Cellular glucose uptake, but not cellular fatty acid uptake, was significantly reduced by several candidate drugs. Of those drugs, we chose Silybin (SIL) and its derivative Dehydrosilybin (DHS), two main flavonoids of Silybum marianum, for further investigations. SIL is reported to improve blood sugar control in several clinical trials and also possesses strong anti-cancer effects. We could show that SIL and DHS inhibit glucose transport in 3T3-L1 fibroblasts and adipocytes. Both flavonoids reduce basal glucose uptake in a dose-dependent manner (52% and 36% of basal uptake for 40μM SIL, 5% and 20% of basal uptake for 40μM DHS in fibroblasts and adipocytes). Insulin-stimulated glucose uptake is inhibited by SIL and DHS at concentrations of 20 and 10μM, respectively. Using time course experiments, immunofluorescence microscopy and subcellular fractionation/immunoblotting, we demonstrated that both substances do not interfere with insulin-triggered translocation of GLUT4 to the plasma membrane. Onward metabolism seems unaffected since there are no inhibitory effects of SIL and DHS on hexokinase activity in 3T3-L1 adipocytes. To determine whether SIL and DHS may affect intrinsic transport activity of GLUT4, we heterologously expressed this isoform in CHO-K1 cells. CHO-K1 expressing GLUT4 shows a 2-fold increase in basal glucose uptake compared to control cells. This increase in glucose transport is completely abolished by 40μM SIL or DHS. SIL and DHS therefore inhibit glucose uptake by interfering with glucose transporters including GLUT4. Stable expression of GLUT4 in CHO-K1 significantly reduces the cytotoxic effect of both SIL and DHS as determined by MTT assay, indicating that restriction of glucose uptake is an important mechanism for the anti-cancer effect of the flavonoids.Our results show that inhibition of glucose transporters is a potential mechanism by which anti-diabetics from medical plants could work.

Vertigo—The practitioner's view

J.-H. Wichert — 2009-12-01

Dizziness and vertigo (International Classification of Disease-R42) are listed under the top 10 symptoms in an outpatient setting seeking advice by a primary care physician. The lifetime prevalence of dizziness/vertigo is reported to be up to 30% with a female preponderance. The incidence of dizziness and vertigo increases with age. Common findings of comorbidities like hypertension, lipid disorders and others pointing to arteriosclerosis in the elderly are associated with dizziness symptoms; however, a causal relationship is not uniformly given. Therefore the role of concomitant disease for dizziness in the elderly is still under discussion.Epidemiological studies from specialised vertigo referral centers usually report specific diagnosis of vestibular vertigo. Their figures might well be different from an outpatient population. In line with these two reports (Neuhauser et al., 2005; Kruschinski et al., 2008) from different working groups investigating dizziness/vertigo in an outpatient population, we have come to the conclusion that 80% of all dizziness/vertigo (R42) cases present with unspecific symptoms. The symptoms might be feeling unsteady, a tendency to fall or feeling of staggering.To date, little data are available on how to proceed further with this large group of patients presenting with unspecific vertigo symptoms. Undoubtedly referral to a specialist is mandatory if warning symptoms like additional neurologic findings or the new onset of symptoms suggest emergency cases. However, in most elderly patients the symptoms prevail for a longer time and daily activities might be restricted because of that. Given the multifactorial origin in most of the cases (visual, vestibular and somatosensoric disturbances) the dizziness with unspecific symptoms is a therapeutic challenge not well included in treatment guidelines.Treatment strategies to date reach from ignorance from the physicians’ side over physiotherapeutic measures to complementary alternative medical approaches or drug-based therapies derived from experience with vestibular symptoms.However, as most drugs prescribed for vestibular symptoms will have anticholinergic side effects, current guidelines do not recommend this group of antivertiginosa in the dizzy patient. Therefore there is still the quest for a safe, effective therapy. A complementary alternative medical approach might be an option in this unsolved problem for the practitioner.

Positive influence of Vertigoheel on signalling pathways of smooth muscle cells and vertigo

A. Pries — 2009-12-01

The incidence of circulatory disorders is increasing against the background of increasing life expectancy. Cardiovascular, metabolic and inflammatory disorders are directly associated with endothelial dysfunction of the small blood vessels.It is possible to influence microcirculation disorders in various ways through the use of drugs. An experimental investigation at the University of Tübingen in cooperation with the Charité Berlin has recently shown that the complex homoeopathic preparation Vertigoheel in vitro influences the contraction of smooth muscle cells. The investigation was performed on sections of rats’ arteries, which were initially contracted and then treated with various concentrations of Vertigoheel. The concentrations used corresponded to the dosages used in clinical therapy. On the one hand the complex remedy induces – through its direct effect on beta-2 receptors and a partial rise in NO – an increase in the synthesis of the messenger substances, while at the same time inhibiting their degradation. The resulting effect is a higher concentration of the molecules, leading to the development of the protective effect of NO. The study showed that under the influence of Vertigoheel there was significant, concentration-dependent relaxation in the vascular wall.In a further fundamental investigation it was possible to show the influence of Vertigoheel on the activity of human adenylate cyclase and phosphodiesterases IV and V. From the combination of these data it is now possible to describe the signalling pathways of Vertigoheel in a scientifically established manner.However, Vertigoheel not only improves the signalling pathways of smooth muscle cells but also is an effective medication for the therapy of vertigo of varying genesis. Various clinical investigations and cohort studies have shown an equivalent effect to dimenhydrinate (n=774), betahistine (n=117) and ginkgo biloba (n=170). In each case the frequency, duration and intensity of the vertigo attacks were determined, as well as the tolerability of the medication. A meta-analysis of four studies also underlined the efficacy of Vertigoheel in cases of vertigo of varying genesis.

CAM-orientated therapy for age-related vertigo in cases of suspected arteriosclerosis

Elfi Seeger-Schellerhoff — 2009-12-01

Many elderly patients with comorbid conditions such as hypertension or lipid disorders suffer from vertigo and dizziness, one of the 10 symptoms that are most commonly seen in general medical practice. The prevalence of these symptoms increases with age. Patients reported feeling unsteady, to stagger, or to have tendencies to fall. Overall, these symptoms interfere with patients’ ability of coping with everyday tasks. In up to 80% of patients, no vestibular findings are apparent, meaning that the feeling of vertigo is likely to be related to circulatory problems, orthostatic disorders or psychological causes. Symptomatic treatment with customary allopathic vertigo medication may cause side effects and interaction with other prescribed medications. These interactions most often occur with sedatives, antidepressants, anaesthetics, diuretics, anticoagulants, barbiturates and alcohol. Given the high prevalence of symptoms of vertigo and dizziness (ICD-Classification R42) in non-hospitalised elderly people, and taking into account the clinically relevant side effects of allopathic medication, the effectiveness and tolerability of the homeopathic preparation Vertigoheel in the treatment of vertigo and dizziness in daily clinical practice (general medicine) were studied.In the context of outpatient treatment, patients suffering from vertigo (age>50, with suspected arteriosclerosis by history or with documented hypertension, lipid disorders and other risk factors) were enrolled in a non-interventional study design. The observational cohort study, with a maximum duration of nine months, was carried out in 183 practices with an initial group of 2141 participants, mainly between the ages of 70 and 80. The determination of dosage and daily monotherapy regime were the responsibility of the physician, mostly daily doses of 3×1 or 3×2 tablets were taken. The study shows a decrease in the daily duration of vertigo- and dizziness attacks, as well as an improvement of symptoms, which eased the coping with everyday tasks. Following the conclusion of the study, physicians and patients were both satisfied with the results, overall. Furthermore, the likelihood in both groups to prescribe or take this homeopathic complex preparation again was very high. Therefore, the prescription of the homeopathic complex preparation Vertigoheel can be seen as a safe and effective long-term treatment for patients diagnosed with unspecific symptoms of dizziness and vertigo in an outpatient setting.In summary, elderly patients who present with vertigo- and dizziness symptoms should be investigated with particular attention to possible neurootological causes of vertigo. If the symptoms – as is the case for most patients – do not belong to vestibular or neurological causes, treatment recommendations for allopathic drugs are limited, due to their side effects. The findings of the presented non-interventional study show the favourable long-term effect of a CAM-orientated approach. Given the high prevalence of vertigo and dizziness and the serious impact of orthopaedic trauma following falls, this warrants further studies in the management of unspecific symptoms of dizziness and vertigo in elderly people. CAM-orientated treatment approaches might be a welcome therapeutic option in these studies.

Homeopathic and conventional therapies for chronic skin diseases: A prospective study on effectiveness and safety

M. Jong — 2009-12-01

Objectives: To assess the effectiveness and safety of homeopathic and conventional therapies in the treatment of chronic skin diseases.Methods: Prospective multi-centre study. Patients were recruited at out patient care settings in Germany and Austria and given either homeopathic or conventional treatment. The main outcome criterion was the response rate, defined as the proportion of patients experiencing ‘complete recovery’ or ‘major improvement’ at 6, 12, 18 and 24 months. Secondary outcome criteria were quality of life (SF-12, EQ-5D, KINDL), patient satisfaction and safety.Results: A total of 204 patients with chronic skin diseases were evaluated in the full analysis set of which 125 received homeopathic (H) and 79 conventional (C) treatment. The majority of the patients in both groups suffered from either eczema (H: 32%; C: 39.2%), psoriasis (H: 21.6%; C: 48.1%) or neurodermitis (H: 20.0%; C: 8.9%). In the homeopathic group, patients were treated either with homeopathic topical ointments (such as a 10% berberis acquifolium or 10% cardiospermum halicacabum) or individual homeopathic treatment (such as sulphur, natrium chloratum or lycopodium). In the conventional treated group, topical creams containing corticosteroids and calcipotriene were most frequently prescribed.The % of responders (defined as ‘completely recovered’ or ‘major improvement’) increased from 54.4% (H) and 41.7% (C) after 6 months of treatment to 59.2% (H) and 43.1% (C) after 2 years of treatment, respectively. Quality of life and general health were improved in both groups after 2 years of treatment. Patient's satisfaction with treatment and health care provider after 2 years of treatment was higher in the homeopathic treated group (72.8% and 84.8%) compared with the conventional treated group (60.8% and 76.0%). Adverse drug reactions occurred less frequently in the homeopathic group than in the conventional treated group (H: 26.4%; C: 41.7%).Conclusions: The treatment of chronic skin diseases with homeopathic remedies appears to be more safe and satisfactory to the patient when compared with conventional medication, with improvement in quality of life and general health up to 2 years after start of the treatment.

Traditional Asian medicine and leprosy in Bangladesh

M.A.H. Mollik, M.F. Hossain, D. Sen, A.I. Hassan, M.S. Rahman — 2009-12-01

Bangladesh covers an area of 147,570km2, a little more than the size of Greece. It extends from 20°34N to 26°38N latitude and from 88°01E to 92°41E longitude. In Bangladesh, leprosy is among the major health challenges with 9% of the population estimated to be affected. This study focuses on the people affected by leprosy (e.g. patients, families, and tribal communities), and beliefs about its causes, prevention and treatment. In addition to the government supported allopathic health services and Bangladeshi Medicine System, people also consult a range of other traditional practitioners and religious healers. We conducted an ethnobotanical survey of medicinal plants used by traditional practitioners and religious healers of Bangladesh. A total of 36 plant species were collected, which were used to treat leprosy. These plant species (with parts used given in parenthesis) included Zingiber officinale (tuber or tuber root), Jatropha gossypifolia (seed, fruit), Pandanus odoratissimus (whole plant), Cajanus cajan (leaf, seed), Tinospora cordifolia (whole plant), Calotropis procera (leaf, gum, flower), Nigella sativa (seed, fruit), Costus speciosus (whole plant), Sonneratia apetala (leaf, fruit), Solanum surattense (whole plant), Derris indica (seed, leaf), Plumbago indica (whole plant), Ricinus communis (seed, fruit), Terminalia arjuna (bark, fruit), Cynodon dactylon (whole plant), Bombax ceiba (seed, root), Azadirachta indica (leaf, stem), Madhuca latifolia (whole plant), Hibiscus esculentus (seed, fruit), Centella asiatica (whole plant), Glycine max (seed, fruit), Terminalia catappa (fruit, seed), Piper nigrum (whole plant), Luffa acutangula (seed, fruit), Acalypha indica (whole plant), Terminalia belerica (seed, fruit), Senna alata (whole plant), Sesamum indicum (seed, fruit), Lantana camara (whole plant), Ruellia tuberosa (whole plant), Nerium indicum (seed, flower), Ficus racemosa (leaf, fruit), Ocimum tenuiflorum (whole plant), Curcuma longa (tuber or tuber root), Cereus grandiflorus (whole plant), and Diospyros peregrina (seed, fruit). The study of leprosy in Bangladesh is especially important because of the greater acceptance of people with leprosy than in surrounding Asian countries (e.g. Myanmar, Tibet, Nepal, India, Pakistan, Sri Lanka, China, and Bhutan) where leprosy remains among the most feared and stigmatized conditions. Project support received in part by the Peoples Integrated Alliance and SHACO—Health & Education Society.

Changes in self-management skills during inpatient treatment in an internal-naturopathic clinic: A pilot study

A. Paul, S. Lange, R. Lauche, K. Wagner, T. Esch, G. Dobos — 2009-12-01

The treatment of our chronically ill patients aims at the reduction of symptoms and the increase of their quality of life. Another major goal can be described as initiating sustainable lifestyle modifications utilizing the patient's salutogenetic resources. This paper investigates the influence of a 2-week inpatient treatment on the development of health-related resources and self-management skills with particular attention to gender differences.Methods: As part of a longitudinal prospective cohort study 116 patients were given the FERUS questionnaire (Fragebogen zur Erfassung von Ressourcen und Selbstmanagementfähigkeiten) prior and after their 2-week inpatient treatment. FERUS measures the motivation to change behaviour, coping, self-observation, self-efficacy, self-verbalisation, hope, and social support.Results: Pre- and post-treatment data of 73 patients, 55 women and 18 men were included. The average age of respondents was 51.5±13.5 years. With the exception of the motivation to change behaviour of the patients, all other parameters measured showed significant improvements in all measured dimensions. Increases in self-efficacy and hope were larger in women than in men.Discussion: During their inpatient treatment most of patients’ self-management skills improved significantly. It is currently being investigated whether this effect is influenced through participation in an outpatient program. Gender-specific aspects of the program are investigated as well.Conclusion for practice: A resource-oriented approach to the treatment of chronic disease can improve patients’ self-management skills. Further research in the context of integrative treatments is warranted.

Topical formulation containing natural oligomeric proanthocyanidins (OPCS) reduces UV-induced oxidative stress in skin as assessed by ultra-weak photon emission (UPE)

R. van Wijk, S. Bosman, G. Achanta, E. van Wijk — 2009-12-01

Background: OPCs are natural phytonutrients of the flavanol family. The dietary supplement ingredient MASQUELIER's® OPCs has been demonstrated to exhibit antioxidant, anti-inflammatory and vasculo-protective properties in humans, which suggested potential benefits as a topical formulation for skin health. Exposure of skin to UV triggers oxidative stress in skin tissue that can lead to erythema, skin aging or even cancer. Our previous studies have shown that a specific topical formulation (cream containing MASQUELIER's® OPCs) can significantly reduce UV-induced erythema in skin of human subjects and in animals, indicating it has antioxidant activity in skin.Objective: This study was undertaken to further establish antioxidant activity of the specific OPCs cream formulation in human skin by measuring ultra-weak photon emission (UPE) of skin. UPE measurement in skin is a non-invasive, fairly-sensitive and convenient technique for continuously monitoring oxidative stress (Sauermann, 1999).Methods: The study was an open-label study in 25 healthy volunteers. Measurement of skin UPE was performed on the dorsal surface of the subjects’ hands before (spontaneous UPE) and after exposure to UV (UV-induced UPE). The effects of the OPCs cream on spontaneous and UV-induced UPE were measured using a fractionated UV exposure protocol.Results: Within each subject, spontaneous UPE of the right and left hand were found to be significantly correlated (r=0.9; p=0.000). UV-induced UPE of the right and left hand were also significantly correlated (r=0.87; p=0.000). UV exposure resulted in a long-term (>80min) increase of spontaneous UPE. This is likely due to depletion of antioxidant capacity of skin, which is quantifiable by the fractionated UV-exposure protocol. Application of the OPCs cream immediately after UV exposure resulted in a significant (approx. 30%) decrease in UV-induced UPE. Topical OPCs application also reduced UV-induced long-term increase in spontaneous UPE, indicating prevention depletion of antioxidant capacity of skin by UV.Conclusions: This study indicates that the specific OPCs cream formulation significantly decreases UV-induced oxidative stress in human skin based on UPE measurement, thereby suggesting that regular use of this OPCs cream might protect skin from harmful effects of UV.

Homoeowiki—An interactive learning platform for homeopathic remedies

M. Haiderer — 2009-12-01

Aude sapere-Dare To Know (Samuel Hahnemann 1755–1843)Introduction: Collecting knowledge about homeopathic remedies is one of the first steps a student is challenged with, in order to enter the field of Homeopathy. A lot of research work is invested within Homeopathic study-groups. In the process of studying homeopathic remedies, students analyze literature of original authors as well as from modern homeopaths.The results are consolidated information about remedies with a high value because of the independency of one author. The main target for the master thesis is to analyze homeopathic information paths and replicate them within a modern information system. The system will be based on the Web2.0 standards in order to build a place for this matured information and enable an interactive discussion process.Method: The method is to analyze information paths of the target group and build upon this knowledge, a full functional prototype. This prototype-based modeling leads to an Information System with valid content. The authors of this prototype enrich the platform with structured information about substances in a template-based way. The common method within the Materia medica of considerable authors is the basement for the structure of such a global template.In other words the aim of such a plattform is to offer an information system that has the following attributes:Results: The result is a full functional prototype of an Online Materia medica that holds about 300 remedies as a base choice set which can be enhanced if necessary. The search engine within such a system will be delivered through the OpenSource plattform MediaWiki. The MediaWiki also enables discussion processes, which will help students to explain their consolidated findings. The important point of data security and logged protocols of changes is also a result of the right choice of the underlying platform.Conclusions: The platform has the potential to be an open and commercial free foundation for students and Homeopaths to create a modern and timely accurate Information System for Homeopathic remedies.

Artistic sculpture in anatomy: Training minds for holistic and integrative activity—A pilot study in medical education

P. Heusser, A.C. Grande, U. Wolf — 2009-12-01

Background: Increasing emphasis on integrative and holistic care also calls for a training of medical students in holistic and integrative mental activity. Intellectual learning can be complemented by holistic educational methods (such as arts) that make use of holistic gestalt perception and sensory-motor integration.Course, setting and subjects: A 20h credit-rewarded elective in artistic sculpture of anatomical forms was implemented as a pilot course to 1st- and 2nd-year medical students (n=21) parallel to anatomy at the University of Bern.Objectives: To facilitate the formation of three-dimensional (3D) holistic morphological representations through modelling anatomical structures in their morphological wholeness; to enhance remembrance of anatomical structures and motivation for learning anatomy. To evaluate global course satisfaction, course elements and instructor, and the transfer of course benefits.Outcome measures: At course end students filled in a questionnaire to assess the subjectively perceived outcome of course and learner objectives, with 5 free-text-answer questions and 22 questions with a pre-scaled answering format: a 10-point scale for the assessment of global course satisfaction, and a 4-point scale for the remaining questions.Results: Course evaluation: Satisfaction with the course, its singular elements and the instructor was “good” to “very good”, except for time management (1 question) and transfer (3 questions): “insufficient” to “sufficient”.Cognitive and affective learning objectives: The 5 questions received a moderately positive rating (to be answered by 4=yes, 3=rather yes; 2=rather no, or 1=no): facilitation of 3D representations (mean=3.0; range 1–4), of holistic representations (2.8/1–4), of remembrance of anatomical structures (3.0/1–4), and positive influence on attitude towards relation of art and anatomy (3.0/2–4), but moderately low influence on motivation for learning anatomy (2.3/1–4). The free-text answers revealed positive effects such as becoming aware of details in relation to the whole, improved comprehension of forms, metamorphoses and 3Ds, enhanced creativity, joy to use one's hands, and others.Conclusion: Our data suggest a subjectively perceived positive effect of artistic sculpture on the formation and remembrance of holistic 3D representations of anatomical forms and on their aesthetic appreciation.

DEGAM-Symposium

D. Jobst — 2009-12-01

Einführung: Am 16./17. Januar 2009 fand in Bonn auf dem Hintergrund der universitären Lehrverpflichtungen der erste akademische Seminarkongress Forschung und Lehre für Naturheilverfahren (NHV) und Komplementärmedizin (CAM) statt. Der Kongress war konzipiert als Arbeitstagung für deutschsprachige Hochschullehrer/Dozenten für NHV/CAM zusammen mit Forschern und interessierten Studierenden.Methoden: Plenarbeiträge beschränkten sich beim Kongress auf eine Impulsfunktion. In thematisch zugeordneten, fachlich moderierten und mitprotokollierten Arbeitsgruppen wurden die Impulse weiterbearbeitet. Die Arbeitsgruppen von 6–18 Personen bildeten den Kern der Tagung und erbrachten die Ergebnisse.Ergebnisse: In drei parallelen Arbeitsgruppen ging es um Kriterien für die Aufnahme von komplementärmedizinischen Verfahren in den akademischen Unterricht. Von diesen wurden u.a. mittels Ratingskala Akupunktur, Ausleitungsverfahren, Diätetik, Homöopathie, Neuraltherapie, Ordnungstherapie und Phytotherapie mit jeweils über 50 von 80 möglichen Punkten als wichtig für das Unterrichts-Curriculum bewertet.In zwei parallele Arbeitsgruppen „Didaktik des Lernens konnten Unterrichtsprobleme von den Dozenten angesprochen werden. Es wurden mehr Lösungsvorschläge unterbreitet bzw. lösungsorientierte Fragen gestellt und, als dass Probleme geklagt wurden.Die Arbeitsgruppe„ Faculty develpomen-Wege in die Fakultäten machte eine Reihe von Vorschlägen zur Etablierung von NHV/CAM an den medizinischen Fakultäten. Dabei wurde die wissenschaftliche Forschung als ein Kernstück akademischer Präsenz von NHV/CAM herausgestellt.Diskussion: Die Veranstalter und Initiatoren sahen etliche Kongress-Ziele realisiert. Die Fülle der Ergebnisse, Ideen, Arbeitsimpulse und kritischen Randbemerkungen wird im Vortrag auf dem ECIM komprimiert vorgestellt werden. Sie auszuführen bleibt einem Kongressband vorbehalten, der gerade erarbeitet wird.

CAM-education in the medical curriculum: Vision of medical students

E. Kolkman — 2009-12-01

Objective: Purpose of our study was to investigate the attitudes and knowledge of medical students towards complementary and alternative medicine (CAM) at all eight medical universities in the Netherlands.Design: Empirical quantitative research using a questionnaire survey.Methods: In total 10,532 student members of the Royal Dutch Medical Association (KNMG), at all eight universities in the Netherlands, were invited to complete a short questionnaire by email. The questions were divided into three parts. The questions in the first part were about self-reported use of CAM, scientific research skills to appraise the CAM literature and attitude, opinion and interests in CAM. The second part consisted of six questions asked about each of the nine most used CAM-therapies in the Netherlands. The six questions were about knowledge, effectiveness, existing and desired education, referral to CAM services and integration into the Dutch health care service. The third part were 30 statements about evidence-based-medicine, the side effects and safety of CAM, the place of CAM in the Dutch Health Care Service, CAM in the medical education, the position and visibility of CAM in professional education, reasons for using CAM, and the role and influence of the Royal Dutch Medical Association on the availability of CAM services.Results: A total of 2004 medical students responded to our questionnaire. The average age of respondents was 22.7 year (SD: 3.9) and 71.9% were female. The most students (83%) said that doctors should be able to give patients objective information about CAM. The opinion of 69.9% was that more research must be done to establish the effectiveness and safety of CAM. The majority (74.2%) responded that they do not have enough knowledge about CAM and more than three quarters (76.9%) responded that doctors should have such knowledge about CAM. Two-third felt it is important that knowledge about CAM therapies should be taught at medical school while one-third felt it should be in the core medical education.Conclusions: The result of this study shows that medical students in the Netherlands have a positive attitude towards CAM and think it should be part of their medical education.

Active student involvement in integrative clinical care—A qualitative and quantitative study on learning experiences, professional development and progress in competencies in integrative medicine

C. Scheffer, M. Bertram, M. Neumann, D. Tauschel, F. Edelhäuser — 2009-12-01

Introduction: Teaching and Learning Integrative Medicine (IM) faces the challenge to integrate different health concepts including those of biomedical care and of CAM. Students have to learn about specific powers and limits of different methods of IM and how to use these together to heal and preserve health of the patient's body, mind and spirit. The aim of our study was to see how learning and professional development of final-year medical students was affected by active student participation in integrative clinical care during their 16 weeks rotation in internal medicine.Method, setting and subjects: Based on the concept of legitimate peripheral participation by Lave and Wenger, a Clinical Education Ward for Integrative Medicine (CEWIM) was established. Final year medical students were integrated in a ward where conventional medicine is complemented by Anthroposophic Medicine including the use of conventional treatment, natural and anthroposophic remedies, physical and art therapies and biographic counseling. Students were participants of the program “Integrated Curriculum for Anthroposophic Medicine” (ICURAM), which is integrated into the medical curriculum of 6 year duration at the University of Witten/Herdecke in Germany. Twelve final year medical students who participated at CEWIM were interviewed (4 individual interviews, 2 focus groups) regarding their learning experiences and their professional development. Additionally, students rated their competencies in IM before and after their rotation.Results: A qualitative analysis of the interviews showed that being responsible for patients under structured supervision is seen to be a powerful motivation for active learning and professional development. Working and reflecting with peers as well as being mentored were essential aspects and gave important support for personal development. According to quantitative analysis of self-evaluation students made significant progress in diagnostic and therapeutic competencies in internal medicine as well as in practicing specific aspects of IM like using different healing methods and learning to assess their specific powers and limitations.Conclusion: Active participation in integrative clinical care for final year medical students seems to offer good opportunities for learning IM including personal and professional development of the learners.

Case-based conference in integrative medicine: A pilot project to enhance learning and exchange of different medical concepts

2009-12-01

Background: Since several years there is an ongoing discussion within the German medical community about understanding of and collaboration between the different medical concepts (Hibbeler 2006; Willich et al. 2004), aiming on the development of a patient-centered and effective integrative medical approach (Scheffer et al. 2007). A symposium in 2006 brought the different medical perspectives into a dialogue based on presented cases. The question arose how to transfer this dialogue into especially academic medical education.Aim: To develop a learning format that brings students and experts of different medical concepts together, allowing reflexion and discussion on approaches, methods and therapy from the different medical perspectives.Setting, subjects and methods: In 2008, four experts (conventional medicine, homoeopathy, Traditional Chinese Medicine, Anthroposophic Medicine) and voluntarily students (mainly year 3) took part in a case-based conference (CBC) at the University of Witten/Herdecke, Germany. It started with history taking of a real, present patient by all experts. The didactical course leads through several small group and plenary sessions focusing on methods and therapeutical approaches of the different medical concepts. Students could receive credits concerning the German approbation regulations. Students were given a questionnaire with 6-point Likert scale to rate the conference at the end.Results: Quantitative analysis showed that students felt motivated to more deeply engage in all of the presented medical concepts including conventional medicine. Over 90% reported having received a better impression of opportunities and limitations of the different medical concepts. In total 75% felt improvement by the CBC to counsel patients concerning the different medical concepts. More than 85% of the students clearly wished that CBC in Integrative medicine should be held regularly dealing with different diseases.Conclusion: A case-based conference in Integrative Medicine seems to be an adequate course to bring integrative medicine into the academic teaching and learning context. It offers students deeper insights in different medical concepts and seems to motivate further student's engagement.

Fifteen years of integrated academic complementary and alternative medicine—From public demand to a unique CAM chair in Bern, Switzerland

2009-12-01

Aim: To describe the implementation of general practitioners’ (GP) experience in complementary and alternative medicine (CAM) in an academic chair divided into four fields.Background: In Switzerland, 10% of GPs are certified in, 30% are practising, and 40% referring to any form of CAM due to a high public demand.History: In 1994, four GPs were offered a chair as part-time (25%) CAM professors at the University of Bern due to a referendum for academic CAM service, teaching, and research.Structure: The chair is divided into the four CAM methods most frequently practised by GPs in the Canton of Bern: anthroposophic medicine, classical homeopathy, neural therapy and traditional Chinese medicine/acupuncture. Four assistants or residents, 50% part-time each, were assigned. Further positions and research projects are financed by third parties. Two secretaries run the office.Service: Clinical consultations, and outpatient services, held separately or as colloquia, steadily increased from 100 to nearly 2000 annually. Public mandates for authorities, e.g. National Office of Public Health, CAM associations, and societies, health insurances and companies are further fields of work.Research: Interdisciplinary research groups were formed together with other institutes of the University hospital and other national and international teams. Research focus was methodologically suitable and problem-oriented investigations, clinical and basic research with modern physical, biochemical and biological tools was conducted. Results were presented as invited lectures, posters or scientific publications in chapters, books or peer-reviewed journals.Teaching: Lectures, seminars, workshops, and bedside teaching were held as electives or compulsory subjects in medical, pharmacy, and veterinary students’ curriculum throughout the year. Public lectures were given in winter. Continuous and further education were offered in co-ordination with the respective CAM societies.Summary: KIKOM is a successful example of both, GP practice and CAM implementation, into academic medicine.

Impact of eurythmy therapy on cardiorespiratory interaction

F. Edelhäuser, A. Minnerop, B. Trapp, D. Cysarz — 2009-12-01

Objectives: Mind–body therapies combine body movements and accompanying guided imagery. Eurythmy therapy (harmonious rhythm, EYT) is a mind–body therapy that is based on the principles of Anthroposophic Medicine. It uses harmonious body movements and guided imagery according to the state of movement. It has been shown that different EYT exercises show a distinct impact on heart rate variability. Here, we investigate whether two different EYT exercises (‘Migraine B’/MigB and ‘I Think The Saying’/ITTS) also affect coordination of heartbeat and respiration (cardiorespiratory interaction).Methods: A total of 20 healthy subjects (average age: 29.1±9.3 years, 13 female, 7 male) carried out the following sequence of exercises: rest–YET–rest–CE1–rest–CE2–rest. Each exercise and each resting period (sitting position) lasted 8min (total duration: approx. 60min). During control exercise 1 (CE1) the same movements as in EYT were carried out without guided imagery and during CE2 the subjects walked on the spot. An electrocardiogram and the nasal/oral airflow were recorded throughout the procedure. The respiratory rate was calculated using the airflow trace. Cardiorespiratory interaction was quantified by the ratio of heart rate and respiratory rate (HRR). The temporal relationship between heartbeat and respiration was quantified by the amount of phase coordinated heartbeats (PCH%) and its accompanying ratio of heart rate and respiratory rate (PCR).Results: During MigB the respiratory rate was 14.4 cycles per minute (cpm) on average. The respiratory rates increased during CE1 (16.7cpm) and CE2 (23.0cpm). During MigB HRR was 6.6 and decreased during CE1 (5.8) and CE2 (4.9). PCH% decreased from 6.9% during MigB to 2.4% during CE1 and increased to 8.3% during CE2. PCR was the same during MigB and CE1 (4.7) and decreased during CE2 (4.3). During ITTS the respiratory rate was 14.7cpm and it increased during CE1 and CE2 (16.6 and 19.2cpm). HRR was 6.6 during ITTS and decreased during CE1 (5.7) and CE2 (4.7). PCH% was 7.4% and increased during CE1 (8.4%) and CE2 (11.1%). PCR was the same during ITTS and CE1 (4.8).Conclusion: The respiratory rate, HRR and PCH% reflect differences between EYT, CE1 and CE2. However, only PCH% reflects differences between ‘Migraine B’ and ‘I Think The Saying’. In conclusion, we found that EYT de-coordinates rather than coordinates heartbeat and respiration because PCH% was lower during EYT compared to CE2.

Colchicum autumnale in the treatment of patients with subclinical hyperthyroidism: Results of a prospective pilot study

C. Scheffer, M. Kroetz, M. Debus, C. Heckmann, M. Girke — 2009-12-01

Background: Subclinical hyperthyroidism (sH) due to thyroid autonomy is very common, especially in iodine-deficient areas. In anthroposophic medicine, a form of complementary medicine, Colchicum autumnale (CAU) is used in the treatment of various thyroid disorders. The objective of this pilot study was to examine the effect of CAU in patients with sH.Patients and methods: We carried out an observational study (OS) on 18 patients (15 females, 3 males) with sH. After 3 months the clinical pathology based on the Hyperthyroid-Symptom-Scale (HSS) and the hormone status (thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3)) were investigated. Patients with immunogenic TSH-suppression were excluded.Results: A total of 16 patients took CAU over a 3-month period (2 dropouts). Within that time, there was a significant decrease in the HSS (from 7.9±6.0 to 2.9±2.9; p<0.01) and in the fT3 (from 3.98±0.71pg/ml to 3.61±0.48pg/ml; p<0.05). Direction and strength of changes in peripheral hormones depended on their initial values; linear regression was significant for fT3- (fT3-change against initial value: p<0,01) and fT4-change (p<0.05). Patients tolerated the treatment well and there were no serious adverse drug events.Conclusions: In this first OS on the effects of CAU, patients with sH showed positive changes on the clinical pathology and normalization of peripheral hormones that would not be expected in a natural course of sH. Controlled studies with larger collectives and comparison groups are required.

Homeopathic treatment of elderly patients—A prospective observational study with a follow-up over a two-year period

M. Teut, R. Luedtke, S.N. Willich, C. Witt — 2009-12-01

Background: Very little is known about the range of diagnoses, course of treatment and long-term outcome in elderly patients who choose to receive homeopathic medical treatment. We investigated homeopathic practice in an industrialised country under everyday conditions.Methods: In a prospective, multicentre cohort study involving 38 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data was analysed from all patients >70 years consulting the physician for the first time. The main outcome measures were: assessment of the severity of complaints (numeric rating scales 0–10) and quality of life (SF-36) at baseline, and after 3, 12, and 24 months.Results: A total of 83 patients were studied (41% men, mean age 73.2±3.1 years; 59% women, 74.3±3.8 years). 98.6 percent of all diagnoses were chronic with an average duration of 11.5±11.5 years. 82 percent of the patients were taking medication at baseline. The most frequent diagnoses were hypertension (20.5%, 11.1±7.5 years) and sleep disturbances (15.7%, 22.1±25.8 years). The severity of complaints decreased significantly between baseline and 24 months in both patients' (from 6.3 (95%CI: 5.7–6.8) to 4.6 (4.0–5.1), p<0.001) and physicians’ assessments (from 6.6 (6.0–7.1) to 3.7 (3.2–4.3), p<0.001); quality of life (SF 36) and number of medicines taken did not significantly change in this period.Conclusion: The severity of disease showed sustained improvements under homeopathic treatment, but this did not lead to an improvement of quality of life. Overall our findings indicate that homeopathic medical therapy may playa beneficial role in the long-term care of older adults with chronic diseases and therefore deserves further attention.

The benefit of ayurvedic diagnostics in treatment strategies for rheumatoid arthritis

2009-12-01

Question: Ayurveda gains greater attention worldwide, but investigations of ayurvedic treatments with participation of ayurvedic physicians are scarce in international literature presumably due to different conceptual frameworks of both medical systems.We examined which ayurvedic diagnosis corresponds to the diagnosis rheumatoid arthritis (RA) and how patients with RA respond to one line of herbal ayurvedic drug preparations.Methods: In an open observational study, a team of physicians from western and ayurvedic medicine diagnosed patients according to the ARA criteria (1987) as RA and thereafter according to ayurvedic criteria. One line of routinely used ayurvedic drug preparations based on Semicarpus anarcardium L., Commiphora mukul Hook ex Stocks, Withania somnifera Willd. and Asparagus racemosus Dunal. was given for 10 months in India. The Paulus and Ritchie indices, Steinbrocker classes, ESR, CRP, joint swelling score, morning stiffness, joint pain/tenderness scores and the functional status were monitored monthly.Results: Forty-four RA-patients were included and subgrouped according to ayurvedic diagnostic criteria as Sandhigatavata srotovarodha (SS) (n=33), Sandhigatavata dhatukseya (SD) (n=6) and Amavata (A) (n=5) with distinct clinical and biochemical features. The treatment course was completed by 26 patients. Eighteen patients left due to improvements (n=3), non-compliance (n=7), relocation (n=1), unknown reasons (n=4), adverse events (n=1) or inflammatory attacks (n=2). The 20% and the 50% Paulus response were achieved by 34% and 15.9% of all patients, respectively. The 50% Paulus response was achieved in 40% of A-, in 33% of SD-, but only in 9% of SS-patients.Conclusion: The Western diagnosis RA did not correspond to a uniform ayurvedic diagnosis. The treatment response differed between subgroups. Ayurvedic diagnostics may support the search for ayurvedic drugs for RA in India and may be developed to an additional tool for treatment strategies and response predictions to medication in RA in Western medicine.

Color therapy changes blood oxygenation in the brain and muscle

J. Weinzirl, M. Wolf, P. Heusser, U. Wolf — 2009-12-01

Introduction: In anthroposophic medicine art therapies such as color therapy (CT) are applied for various medical conditions. The aim of this pilot study was to investigate possible effects of CT hemodynamics and tissue oxygenation in the brain and skeletal leg muscle measured by near infrared spectrophotometry (NIRS).Materials and methods: Ten subjects (5 male, 5 female, age mean 27 range 23–44 years) were measured during CT. The measurement included 8min without color exposure (baseline), 10min color exposure to intensive red or blue light followed by 16min without exposure during recovery. Each subject was measured twice, once exposed to red, once to blue in a randomized crossover protocol. A Hamamatsu NIRO 300 NIRS instrument was used to non-invasively measure total hemoglobin concentration (tHb in μM) and tissue oxygen saturation (StO2 in %). By a paired t-test the last 5min of pre-baseline were compared to the first and last 5min of the color exposure, and three periods of 5min of recovery. Blue and red exposures were compared by a paired Wilcoxon signed rank test.Results: In the leg, the tHb concentration increased significantly and continuously during and after exposure by up to (mean±SEM) 1.08±0.19μM (p=0.0002) for blue and 1.52±0.33μM (p=0.0013) for red. Although StO2 did not change significantly compared to baseline, after exposure to blue StO2 was significantly (p=0.0371) higher than during red exposure.In the head tHb did not change significantly, while StO2 increased significantly during blue exposure by 0.51±0.21% (p=0.0367), with a maximum shortly after exposure 0.98±0.40% (p=0.0324). During red exposure StO2 changed little and not significantly. The increase in StO2 during exposure to blue was significantly different (p=0.0488) from red.The findings for the muscle can be interpreted as an increase in blood volume and a decrease in oxygen consumption for blue compared to red exposure. For the head blue specifically increases oxygenation without increasing blood flow.Conclusion: The results show that CT has effects on important physiological parameters and that these effects depend on the color that the subject is exposed to.

The treatment of children with anthroposophic medicine in daily primary care—Results of a network study

2009-12-01

Background: The treatment of children is a core domain of anthroposophic medicine (AM) since its beginnings almost 80 years ago. However, a systematic analysis of AM-therapies in paediatric primary care is still missing. This study aims to investigate this field of AM.Methods: A total of 38 primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions, diagnoses, and non-pharmacological therapies were reported for each consecutive patient. Multiple logistic regression was used to determine factors associated with anthroposophic prescriptions.Results: During the 1-year study period (year 2005), a total of 107,903 prescriptions for 18,440 children under 12 years (48.1% female) were included. The most frequent single diagnoses were acute upper respiratory tract infections (URTI) (22.7%), bronchitis (9.0%), and otitis media (6.6%). Anthroposophic medication accounted for 41.8% of all drugs prescribed and decreased with patient age (47.3% under 2 years, 41.1% 2–6 years, and 37.4% 6–11 years; p for trend <0.001). The Odds Ratio (OR) for receiving an anthroposophic remedy was significantly greater than 1 for the first consultation (OR=1.19; CI: 1.16–1.23), for disorders of conjunctiva (OR=2.47; CI: 2.27–2.70), otitis media (OR=1.50; CI: 1.43–1.59), URTI (OR=1.28; CI: 1.23–1.33), other diseases of the respiratory system (OR=1.15; CI: 1.07–1.24), symptoms involving the digestive system and abdomen (OR=1.39; CI: 1.28–1.51), and general symptoms and signs (OR=1.25; CI: 1.16–1.36). The chance for a prescription of an anthroposophic remedy decreased with patient age (OR=0.96; CI: 0.95–0.96), treatment by a paediatrician (OR=0.43; CI: 0.42–0.44), chronic lower respiratory diseases (OR=0.87; CI: 0.82–0.92), and noninfective enteritis and colitis (OR=0.82; CI: 0.75–0.89). Of the 2475 therapeutic procedures prescribed (26.7% anthroposophic), the most frequent were physiotherapy, speech therapy, logopaedics, and breathing therapy.Conclusion: This study is the first to provide a systematic overview of everyday anthroposophic practice for children in primary care. We found that AM in terms of an integrative medicine combines conventional and anthroposophical concepts. More detailed studies on indications and drug classes should be conducted in the future to complement and specify these findings.

Safety of anthroposophic supportive treatment in children with medulloblastoma receiving first-line therapy

2009-12-01

Background: The use of anthroposophic medicine (AM) is popular in Central Europe, especially in German-speaking countries. A survey regarding AM use in pediatric oncology in Germany estimates its prevalence among CAM users to be about 30%. Although these therapies are judged to be beneficial by many patients, there exist no data concerning safety and efficacy in this population. Several theoretical concerns have been published regarding tumor enhancement or promotion of metastatic dissemination. To test the safety of supportive anthroposophic treatment accompanying the first-line treatment in children with medulloblastoma, we performed a retrospective matched pair analysis of 17 patients with medulloblastoma treated concomitantly with a panel of anthroposophic medicines (AM) including mistletoe. All patients were treated according to the treatment protocols of the German HIT study group.Methods: There were 12 male patients and 5 female patients, with a median age of 6.2 years (interquartile 4.1–7.3, range 1.8–15.7). The supportive anthroposophic treatment was given by pediatricians with specialized training in anthroposophic medicine. All patients underwent tumor resection followed by postoperative radiation and chemotherapy. The patients with AM were matched in a 1:2 ratio with 34 patients from the database of the German HIT study group with regard to the criteria diagnosis, age, status of metastatic dissemination, resection status and first-line therapy.Results: The overall survival after 10 years was 58.33% for the AM group and 57.14% for the control group, i.e. showing only a marginal non-significant difference (stratified Cox regression, p=0.6023). Six medulloblastoma patients with AM had local tumor recurrences and 3 died due to tumor progression. In the control group 8 medulloblastoma patients had a local tumor recurrence and 7 patients died due to tumor progression. Event-free survival (including metastases) also did not differ between the groups (stratified Cox regression, p=0.4275).Conclusions: Anthroposophic medicine consisting of different combinations of specific pharmacological and non-pharmacological interventions appears to be safe with respect to the first-line therapy. There is no evidence regarding tumor enhancement. The effectiveness of the supportive AM cannot be assessed based on these data.

Perceived risks and benefits of the use of honey for infants

N. Robinson, A. Lorenc, R. Kumar, M. Blair — 2009-12-01

Question: Traditional and complementary healthcare approaches (TCA) are widely used for children. Honey is one such TCA used for upper respiratory tract symptoms. A recent Cochrane review suggests honey has potential benefit for acute cough in children . However, health officials advise limiting the use of honey due to the risk of contamination with Clostridium botulinum. As part of a larger study about TCA for children, parents’ and health professionals’ beliefs about the benefits and risks of honey were explored.Methods: The study was conducted in a multi-ethnic community (London Boroughs of Brent and Harrow). Eleven parent focus groups (n=92) and individual interviews with healthcare practitioners (n=30) explored beliefs about TCA. Qualitative data was analysed using the Framework approach and validated with inter-rater coding. Data on the use of honey were extracted for detailed thematic analysis.Results: Of the 92 parents interviewed, 27 (29%) reported use of honey for their children. Honey was believed to be culturally acceptable, easily accessible, natural and safe. Only 2 parents expressed concern over safety. Reported uses were for colds (11), coughs (10), sore throats (2), flu (2), fever (2) and loose motions (1). Modes of use included honey combined with lemon juice in hot water (19), or with ginger, lime, pepper, beetroot or hot milk, for its perceived healing properties and sometimes to improve taste.Almost half (40%) of practitioners mentioned the use of honey for children, but many believed that it ‘may not even be classed as healthcare’. One midwife and one GP cited honey and lemon as safe for infants. Only health visitors (9) stated the risk of infant botulism, 2 described a conflict with parents’ traditional beliefs. Some reported challenges in communicating risk to parents.Conclusion: Honey is frequently used as a treatment for respiratory tract symptoms, Parents and some health practitioners are unaware of/choose to ignore safety advice. Healthcare professionals need to be attentive to the use of honey, and other TCA, according to belief systems. They must appreciate parental perception of risk and benefit and continue to raise awareness of contamination danger. Further research on the efficacy of honey for acute cough is needed as honey has potential as an inexpensive alternative to pharmacological intervention.

Use of different medicinal systems of complementary and alternative medicine: A cross-sectional survey at a paediatric emergency department

A.P. Simões-Wüst, I. Zuzak-Siegrist, L. Rist, G. Staubli, T.J. Zuzak — 2009-12-01

Background: Although a considerable part of the population from the German-speaking Switzerland uses complementary and alternative medicine (CAM), little information is available on the experiences being done with these therapies.Patients and methods: A cross-sectional survey was performed on patients presenting to an urban, tertiary paediatric emergency department in Zurich; 68% (n=1143 questionnaires) of the distributed questionnaires could be used for data analysis. The respondents were asked on their experiences with CAM and with conventional medicine (CM).Results: The respondents perceived the efficacy of the CAM-therapies to be comparable to that of CM. Respondents described that compliance to, frequency of use and direct costs to the patient of CAM and CM were similar. The majority (93%) of the respondents experienced no side effects upon CAM-therapies, whereas only 52% of the respondents stated the same about CM-therapies. Ten percent of the respondents reported “strong side effects” upon using CM-therapies, whereas the same was mentioned by only 1% of the respondents with respect to CAM. Homeopathy was used very frequently (77% of all CAM users), followed by herbal medicine (64%), anthroposophic medicine (24%), traditional Chinese medicine (13%), Ayurveda (5%) and others (34%).Conclusions: The respondents perceived and behaved towards CAM- and CM-therapies in comparable ways. Only the reported frequency and intensity of side effects were markedly lower in the case of CAM.

The role of thyme in the treatment of pyodermia in newborn infants: A retrospective analysis

M. Thiel, F. Sitzmann, A. Längler — 2009-12-01

Background: A great amount of data on the antimicrobiotic effect of thyme is available. However, there are no clinical trials on the treatment with thyme in newborn infants present.Method: We analysed the treatment procedures in newborn infants diagnosed with pyodermia in our department between August 2003 and December 2008 retrospectively.Results: Of the 36 patients 14 fulfilled the study criteria. Ten (71%) of these patients received thyme alone or in combination with a systemic antibiotic or other local form of therapy. Three patients (21%) were treated locally with thyme only. Nine patients (64%) received either a combined systemic antibiotic therapy or systemic antibiotic treatment alone. There were no differences regarding the duration of treatment. Side effects or complications did not occur under either form of therapy.Discussion and conclusions: Inspite of being a department with focus on complementary and integrative medicine, patients often receive systemic antibiotic treatment. Thyme is an often preferred supplement, sometimes when under clinical control even the alternative treatment.The amount of data ascertained was not large enough in order to allow making statements on the role of thyme tea as alternative or supplementary treatment, especially not in the sense of making treatment recommendations.Whether a local treatment with thyme tea might be sufficient for a subgroup of patients would have to be examined prospectively with a larger patient collective. The same accounts for cost efficiency. Our study is the first to examine therapy concepts for the treatment of pyodermia, with a focus on the use of thyme tea in the treatment of newborn infants.

Unintended, accidental intakes of remedies from complementary and alternative medicine in children—Data analysis of Swiss Toxicological Information Centre

T. Zuzak, C. Rauber-Lüthy, A.P. Simões-Wüst — 2009-12-01

Introduction: The use of complementary and alternative medicine (CAM) in the German-speaking Switzerland is rather high. Therefore, the occurrence of unintended, accidental intakes of CAM-remedies by children and associated intoxications is likely.Patients and methods: The inquiries to the Swiss Toxicological Information Centre regarding accidental drug poisonings with CAM-remedies of children <16 years of age were analyzed from 1998 until 2007. Inquiries for information were performed by public, physicians, pharmacists and others in case of acute accidental intake of CAM-remedies; feedbacks from physicians about paediatric patients with acute intoxication possibly associated with the unintended ingestion of CAM-remedies were as well considered.Results: During the study period, a total number of 3436 cases (1081 herbal drugs and 2355 homeopathic drugs) of accidental intakes with remedies from CAM were reported, corresponding to 8.6% of all accidental intoxications with pharmaceutical products in children. No significant increase of the yearly number of accidental intakes of CAM-remedies was detected during the study period. Three cases of remedies-poisoning with herbal remedies were reported to be of moderate severity score and 28 cases of minor severity. Nine cases of intoxication with homeopathic remedies were reported, with minor symptoms only. There was no case of intoxication with any CAM-remedies associated with severe symptoms.Conclusion: Unintended, accidental intakes of CAM-remedies by children did happen, but developed mostly harmlessly. Comparing herbal with homeopathic remedies, accidental intakes of homeopathic remedies were more common, but intoxications associated with symptoms were observed more frequently in the case of herbal remedies.

The safety and effectiveness of pediatric chiropractic: A survey of chiropractors in a practice-based research network

J. Alcantara, J. Ohm, D. Kunz — 2009-12-01

Background and significance: Vohra and her colleagues recently performed a systematic review of the literature to document adverse events (AE) associated with pediatric spinal manipulative therapy (SMT). Over a period of 100 years and using 8 databases, they found 14 articles documenting AE with SMT. Ten of the 14 cases were associated with chiropractic SMT. Miller and Benfield performed a retrospective review of pediatric patient file at a chiropractic teaching clinic and reported an adverse event of 1 in 100 patients or 1 in 700 patient visits. To further contribute to evidence-based practice, we performed a practice-based research survey to examine the safety and effectiveness of chiropractic SMT on children.Materials and methods: This study was approved by the IRB of Life University, Atlanta, GA, USA.Chiropractors were asked to provide sociodemographic information, presenting complaints, and treatment-associated improvements, aggravations and complications.Results: The children consisted of 861 females and 872 males for a total of 1733. Their average age was 6.36 years. A majority (N=629) presented for “wellness care.” The indicated primary complaints are as follows: challenged child (N=106); digestion/elimination problems (N=158); ENT/respiratory problems (N=211); immune dysfunction (N=80); musculoskeletal problems (N=384); neuromuscular problems (N=134); spinal injury (N=52) and others (N=59).Only 16 patients reported aggravations as soreness or pain from 16,747 visits. No reported complications. Improvements were reported in 81% of the patients.Discussion: Our practice-based research observational study reports a rate of that <1% of the patient population or 1 in 1046 patient visits resulted in minor adverse events. All reported aggravations (from chiropractor and parent survey) were minor, self-limiting and did not require hospitalization or medical attention.Conclusion: This is the first study of its kind reporting on the safety and effectiveness of pediatric chiropractic SMT in a practice-based research setting. Prospective population-based studies are needed to further examine the safety and effectiveness of pediatric chiropractic.

Anthroposophic medicine in paediatric oncology in Germany: Results of a population-based retrospective parental survey

2009-12-01

Introduction: Anthroposophic medicine (AM) as a CAM treatment is used frequently in German-speaking countries. Based on a retrospective parental questionnaire, this study presents results of a comparison between AM-users and users of other complementary and alternative medical treatment methods (CAM) in paediatric oncology in Germany. The differences between these two groups are investigated with respect to CAM-use behaviour, surrounding circumstances and previous experience of CAM.Results: Of the 367 CAM-users 98 (27%) patients employed anthroposophic treatments or therapies. Treatment duration amounted to a median 619 days for AM and 225 days for other CAM treatments. All parents with previous experience of AM also used AM for treatment of their child's cancer disease. AM-users had a higher social status. Physicians of AM-users played a more relevant role both in procuring information (24% vs. 11%) and in prescribing medicines and therapies (73.5% vs. 34.9%). AM-users communicate more frequently with their physicians about the use of CAM treatments (89.8% vs. 63.9%) and recommend AM more often than other CAM-users recommend other CAM therapies (95.9% vs. 87%).Conclusions: AM plays a major role in paediatric oncology in Germany. Patients using anthroposophic medicine sustain treatment and therapies considerably longer than patients using other CAM treatments. Furthermore, all families who had used AM before their child was diagnosed with cancer also used AM for the treatment of their child's cancer disease. Therefore, compared to other CAM treatments, patient satisfaction with AM appears to be high for long-term treatment.

Parents’ and primary care practitioners’ differing perspectives on traditional and complementary approaches to health (TCA) for children in a multi-ethnic community

A. Lorenc, M. Blair, N. Robinson — 2009-12-01

Question: To compare parents’ and primary care practitioners’ attitudes, knowledge and beliefs regarding traditional and complementary approaches to health (TCA) for children.Methods: This exploratory qualitative study was conducted in community settings and primary care in Northwest London. Eleven focus groups with parents from multi-ethnic communities explored the use of TCA for their children, their decision-making process and whether they communicated with healthcare practitioners on the use of TCA. Crèches and translation were used when necessary. Semi-structured one-on-one interviews were conducted with 30 primary care practitioners (GPs, nurses, health visitors and midwives) to explore their attitudes and beliefs to TCA and professional behaviour. Sampling was purposive and iterative to capture the range of ethnic groups. All interviews and focus groups were analysed using Framework Analysis, inter-rater coding and Atlas.ti software.Results: Some practitioners were aware of the extent of TCA use in the community, but numerous areas of disparity between parents and practitioners regarding their knowledge, views and perceptions of TCA were identified. These included disparate definitions of the terms ‘traditional’ and ‘complementary’, practitioners’ underestimated the extent of TCA use, especially for routine day-to-day use of traditional home remedies and different beliefs about what types of TCA should be used. Practitioners’ perceived TCA users as affluent, ‘informed’ and in certain ethnic groups and placed greater importance on evidence and safety. In general health visitors’ views were closer to parents’, GPs’ were most disparate. These areas of disparity may have implications for patient care due to practitioners’ limited knowledge of the real-life use of TCA in the community. This may affect trust and communication within the practitioner–family relationship, limit patient-centred care and parent empowerment, and have potential safety implications.Conclusion: Many primary care practitioners, especially GPs, had a different perspective regarding TCA compared with parents. They underestimated the extent and range of TCA use and focussed on issues that are less important to parents. This may affect the practitioner–family relationship and child healthcare.

Changing didactics towards patient- and student-centered learning in an integrative paediatric clerkship—A quantitative pilot study on students’ judgement

D. Tauschel, C. Streibert, C. Scheffer, F. Edelhäuser, A. Längler — 2009-12-01

Background: Anthroposophic Medicine (AM) belongs to the holistic medical systems. It considers four layers of man in diagnosis and therapy: physical, vital, emotional and I(ego)-organization. Since 2004, an optional curriculum in Integrative Medicine was established at Witten/Herdecke University in Germany with the goal to complement conventional medicine with Anthroposophic Medicine. The Integrated Curriculum for Anthroposophic Medicine (ICURAM) is inserted in the regular curriculum over full length (6 years) including clinical clerkships in different specialities.Setting: Paediatrics are taught at UWH at year 4, mainly based on a 4-week clerkship. A clerkship in integrative paediatrics was implemented and fully integrated in the regular curriculum since 2006. In 2008 didactics were changed towards student- and patient-centeredness.Research questions: (a) How do students rate this integrative paediatric clerkship compared to the conventional ones? (b) Do more students get attracted to this clerkship if didactics change towards student- and patient-centeredness?Methods and outcome measures: Comparison of intervention group (IG) and 2 control groups (CG). CG were students of the same year in a paediatric clerkship at two different teaching hospitals. Quantitative analysis of:Results: (a) Of the 36 participants 26 answered (overall return rate 72.2%). Subgroup analysis: intervention/CG 1/CG 2: 75.0/73.3/69.2%(b) Number of applicants raised 53.8–61.5% from N=7–8 (2006–2008) to N=13 (in 2009).Conclusions: Changing the didactics towards more patient- and student-centeredness in an integrative paediatric clerkship was very well accepted and led to a high increase of applicants. Further research is necessary to see if effects are long-lasting, qualitative research might uncover specific experiences students gain in this new setting.

Peaceful Play Program: Yoga for hematology/oncology inpatient children and their parents

M. Thygeson, M.C. Hooke — 2009-12-01

Objective: Yoga is being used increasingly in the medical field as a healing modality for adult patients experiencing serious illness and for those undergoing chemotherapy and radiation treatment for cancer. The purpose of this study was to explore the effects of a single 45-min yoga intervention on pediatric hematology/oncology inpatients and their parents facing a life-threatening disease and hospitalization.Methods: The study included a cohort of 16 patients, ages 7–16, who were receiving inpatient treatment for cancer or blood disorders. There were 6 females and 10 males; 11 were ages 7–11, and 5 were ages 13–16. The parent cohort included 33 parents of children receiving inpatient treatment for cancer. There were 23 mothers and 10 fathers. The Spielberger State Trait Anxiety Inventory (STAI) was used to measure subjects’ anxiety and a general sense of well-being. Measurements were administered immediately before and after the yoga class. The adult version was used for the adolescents and the parents; and the child version was used for the children.Results: In the child group (n=11), a Wilcoxon Signed Rank Test showed that the pre-class STAI score (Md=31) evidenced little change. In the adolescent group (n=5), anxiety and sense of well-being significantly improved with the median STAI score decreasing from pre-class (Md=41) to post-class (Md=28), z=−2.03, p=0.042. In the parent cohort (n=33), STAI scores showed a decrease in anxiety and increase in well-being, with the median STAI score decreasing from pre-class (Md=45) to post-class (Md=30) z=−5.00, p<.001. An open-ended question administered at the end of class reflected a greatly improved sense of relaxation and ease.Conclusion: Yoga is a feasible intervention in a hospital setting. Children, adolescents and parents were enthusiastic about class participation. There was a significant improvement in the sense of well-being in adolescents and parents, while well-being in children remained constant. The majority of participants enjoyed yoga as a family activity. Parents reported how meaningful it was to engage in a healthy activity with their ill child. As a mind body experience, adolescent patients appeared to be more sensitive to the benefits of yoga than the younger patients. This may be due to developmental differences and merits further investigation. Yoga is a beneficial activity for parents, who are stressed by the hospitalization of their chronically ill child.

Pericardium 6 acupressure and acupuncture as additive antiemetic therapy during chemotherapy in children and adolescents—A randomized placebo-controlled pilot study

2009-12-01

Purpose: Children with cancer still experience chemotherapy-induced nausea and vomiting despite the use of modern antiemetic therapy, such as 5-hydroxytryptamine-3 (5-HT3) antagonists. In adult cancer patients, additional Pericardium 6 (P6) stimulation by acupressure or acupuncture has been shown to reduce these symptoms.Method: We conducted a randomised, placebo-controlled, crossover pilot study to evaluate bilateral P6-point acupressure (with elastic bands) and manual acupuncture during three cycles of high emetogenic chemotherapy. Each supplemental therapy was tested on a cohort of 18 children with cancer. All patients received standard antiemetic medication with a 5-HT3 antagonist. Verum (P6-point), sham (placebo) acupressure/acupuncture or no (control) acupressure/acupuncture was applied on each day during one chemotherapy cycle in the same patient. Acute nausea (4-point scale), acute emesis (metric scale), application of concomitant pharmacological antiemetics and outcome of a newly developed emesis score and failure of treatment score were the criteria analysed.Results: All criteria were assessed for each eligible chemotherapy cycle for the patient cohorts, which included 42/54 and 48/54 for acupressure and acupuncture, respectively. Nausea occurred in 67% and 69% of chemotherapy cycles in patients treated with acupressure or acupuncture, respectively. Emesis occurred in 26% and 31% of chemotherapy cycles and additional antiemetics were required in 43% and 54% of chemotherapy cycles in patients treated with acupressure or acupuncture, respectively. The emesis score was positive in 81% of the chemotherapy cycles in either treatment group, and the failure of treatment scores were positive in 71% and 79% for acupressure or acupuncture, respectively.Conclusion: No significant benefit was detected for children receiving verum acupressure or acupuncture in this pilot study; however, a trend was detected for a benefit to patients treated with verum acupuncture. A study of a larger number of patients is required to confirm whether verum acupuncture could truly benefit pediatric cancer patients.

Resistance in therapy of the functional shoulder impingement syndrome—Pathogenesis and possibilities of treatment in complementary medicine

M. Bernsdorf, U. Irlenbusch, S. Born — 2009-12-01

Background: The impingement syndrome of the shoulder is the most common pain syndrome of the upper extremities. The sensomotoric disorder and triggerpoints of muscles realizing shoulder/scapula movement play an important role in the pathogenesis of this disease. To normalize the dysfunction of these muscles is difficult and often frustrated and so a number of patients get renewed shoulder pain after the first or second orthopaedic treatment. Finally operative intervention/surgery is the further way of therapy.Question: What is the reason of the resistant muscle/shoulder dysfunction?Is the overloading of muscles the only reason or is there a connection with disturbance of inner organs?Methods: From 2004 to 2008 we examined 286 pretreated (pain therapy/physiotherapy) patients with resistant shoulder impingement syndrome. We carried out surface elektromyography (SEMG) of the following muscles: m. trapecius-pars descendens, m. infraspinatus, m. serratus ant., m. latissimus dorsi, m. trapecius-pars ascendens. These muscles are important not only in a regular movement of the shoulder but also in reflex zones because of diseases of inner organs. Furthermore we did clinical/osteopathic exam especially of the shoulder (constant score), spine and the abdomen, looked for muscle trigger points, and, if necessary, conducted a lab exam (biochemistry).Results: We observed in all patients segmental dysfunction of the cervical/thoracic/lumbar spine, the pelvis and the scapula function of the diseased side. In SEMG all patients showed hyperacticity of the m. infraspinatus, m. latissimus dorsi in anteversion/scaption/abduction/internal rotation movement of the diseased shoulder. In 130 patients with shoulder pain on the right side, we found liver and/or gall bladder dysfunction per osteopathic exam of the abdomen and in the former case history. Ninety-six patients with shoulder pain on the left side showed problems with the stomach and/or pancreas. Here, further exams (gastroduodenskopy, sonography, lab, a.s.o.) were necessary in 82 patients.After a 6-week “4-step-therapy” (osthepatic treatment of the spine/pelvis/shoulder/abdomen, special injection techniques-“neuraltherapie”, treatment of the affected inner organs, special physiotherapy including SEMG feedback therapy) 253 from 286 patients had no pain, a normal range of motion of the diseased shoulder and an excellent muscle function.Conclusion: The SEMG is a qualified method to verify hyper-/hypoactivities of the muscles in shoulder pain. It could also be used in controlling therapy effects or in feedback therapy. Segmental dysfunction of the spine/pelvis and the dysfunction of the scapula are very important in chronic shoulder pain. Without a regulation of these disturbances a normal shoulder function is not possible. Dysfuntion and triggerpoints of shoulder/scapula muscles could be initiated by diseases of liver, gall bladder, stomach or pancreas, which means that a complex treatment is necessary for successful therapy of the chronic functional impingement of the shoulder, which especially includes a treatment and normalizing of the affected inner organs.

An exploratory double-blind randomised placebo controlled trial in rheumatoid arthritis to evaluate whether the effects of homeopathy are attributable to the consultation process, or the homeopathic remedy

S. Brien, L. Lachance, P. Prescott, G. Lewith — 2009-12-01

Background: We evaluated the efficacy of homeopathic intervention as an adjuvant treatment in the management of stable rheumatoid arthritis (RA). An exploratory randomized, double-blind placebo controlled trial using 5 treatment arms was designed to identify if any clinical benefits were due to the homeopathic consultation, the remedy or both.Methods: Eighty-three RA patients with active stable disease who were receiving conventional therapy for the preceding 3 months were randomized to homeopathic consultation or no consultation. Those receiving consultation were further randomised to individualised homeopathy, complex homeopathy or placebo. Those having no consultation received a homeopathic complex or placebo (individualised homeopathy can only be prescribed within consultation). Treatment was 24 weeks, with a 12-week follow-up.Co-primary outcomes: A 20% global improvement [American College of Rheumatology, ACR20 criteria] and patient global assessment (PGA). Secondary outcomes: Disease Assessment Score (DAS28), tender and swollen joint count, morning stiffness, Health Assessment Questionnaire (HAQ), visual analogue scales (VAS) of pain, physician and patient global assessment of treatment, and inflammatory markers. Analysis was by intention to treat using longitudinal analytical methods comparing changes from baseline to end of treatment, to identify consultation, treatment and interaction effects.Results: Seventy-seven patients were included in the ITT analysis. There was no significant difference for either of the two primary outcomes. Patients receiving consultation demonstrated significant improvement in DAS28 score [mean difference=−0.70 (SE 0.251), 95% CI 0.208, 1.192, p=0.005], swollen joint count [mean difference=−2.47, 95% CI 0.151, 0.719, p=0.003] and functional status [mean HAQ score difference −0.02, 95% CI −0.046, −0.001, p=0.038] as compared to those not receiving a consultation. Patients receiving individualised homeopathy significantly increased positive mood compared to homeopathic complex or placebo [mean score difference 7.45, 95% CI 1.51, 13.38, p=0.015]. Interaction effects confirmed that receiving individualised homeopathy (with consultation) resulted in significant improvement in DAS28, joint swelling, functional status, joint tenderness and mood. Adverse events were minor with no treatment group differences observed.Conclusion: The primary outcomes are negative. The secondary outcomes show that the homeopathic consultation mediates moderate clinically relevant benefit in relatively stable RA and that the addition of individualised remedy to consultation provides further clinical benefit for patient's subjective experience of their RA. These findings appear robust and warrant further exploration in a cost-effectiveness study

Influence of a peat bath series on heart rate variability (HRV) measures of patients with prolapse of the nucleus pulposus during an inpatient orthopaedic rehabilitation

H. Janik, C. Mau, K. Kraft — 2009-12-01

Introduction: Peat baths are used in rehabilitation medicine to treat, e.g. pain syndromes. The resulting increase of the central body temperature by 1–1.5°C is a substantial stress for the cardiovascular system. The aim of the study was to investigate adaptive reactions of patients on a series of peat baths in a rehabilitative setting by means of HRV.Methods: Cardiovascular healthy, non-smoking patients (19 female, 10 male, 18–55 years) with lumbar prolapse of the nucleus pulposus were exposed to a series of 6 peat baths (40.5°C) during an inpatient orthopaedic rehabilitation of 3 weeks. RR-intervals were determined by a 24h ECG (Ela medical®, SORIN GROUP, France) to calculate HRV-parameters during the first and sixth measuring period. Each measuring period consisted of a recumbent rest V1, (respectively V6), a 20min peat bath M1 (resp. M6) and a subsequent 20min recumbent phase N1 (resp. N6). The high-frequency (HF) spectrum of HRV reflects parasympathetic nervous activity; the low frequency spectrum (LF) and the ratio LF/HF represent sympathetic activity.Results: The comparison of the two measuring periods did not show significant differences for HF, LF/HF and heart rate (HR). The percentage of LF in V6 was reduced compared to V1 (p<0.05). Additionally, frequency shifts (p<0.05) of the HF-peak frequency in the first 6min of M1 vs. M6 and N1 vs. N6 were identified.Conclusions: The decrease of LF during rest (V1 vs. V6) could be interpreted as a reduction of sympathetic activity, which is a cumulative effect of the rehabilitation programme performed during the preceding 3 weeks. Comparable results are known from studies of sports medicine, supporting our results. In contrast, a training effect of the 6 peat baths on the cardiovascular healthy patients could not be demonstrated, as HR, HF and LF/HF were not changed significantly.

Acupuncture for osteoarthritis pain: A randomized controlled trial evaluating the relative effects of real acupuncture and two placebos with respect to patient empathy, empowerment, and the practitioner on treatment outcome

G. Lewith, P. White, P. Little, P. Prescott, V. Irwin, C. Hill — 2009-12-01

Method: This two centre RCT involved three acupuncture practitioners delivering either mock electrical stimulation (MES), real acupuncture (RA) or a Streitberger needle (SN) for OA of the hip or knee. Our primary outcome was pain over the week following the course of treatment using a VAS with a significant result being a 20% improvement in pain. We assessed empowerment, empathy, needling sensation and patient belief in the intervention as well as quality of life. Patients allocated to these three interventions were randomised to received empathic (talking and caring) or nonempathic (just treatment) consultations to evaluate the impact of the therapeutic relationship on pain. The treatment was provided by the three acupuncturists who delivered consistent interventions for all three treatments. Eight 30min treatments occurred over 4 weeks with 1 week of initial baseline recording. The credibility of the three interventions was assessed.Results: A total of 1472 patients were approached, 221 were randomised and 209 completed the study. This is consistent with our initial sample size calculations so the study is adequately powered to detect clinically significant differences. Analysis (ANCOVA) of the differences between empathic and nonempathic consultations indicates that there are no significant differences between these two conditions. There is a nonsignificant trend suggesting that RA is most effective and MES the least effective, The only clinically and statistically significant predictors of outcome was the therapist (P=0.007 95% CI −19.31 to −2.51) providing the intervention and if patients thought the treatment was ‘real’ whatever actual treatment they had received (P=0.05), while gender age and affected joint were not related to outcome. Most patients thought their treatments were real (96% RA, 93% SN, 75% MES).Discussion: The main factor that appears to affect the outcomes of acupuncture treatment for OA pain is the practitioner delivering the treatment and to some extent the belief in the patient that they are receiving real acupuncture. There is no clinically significant difference between the three interventions. Kaptchuk et al.'s suggestion of a dose-related placebo response to an acupuncture-related ritual is not confirmed by our adequately powered study. This study also suggests we are able to deliver convincing acupuncture placebos/controls and that a ‘placebo’ needle (SN) appears as clinically effective as MES. This implies that an enhanced placebo response is not associated with acupuncture needling. This suggests we should consider that the most important factor influencing treatment outcome for pain may be related to the therapist and not the procedure they employ. This hypothesis will require further investigation across a number of different interventions but may be important for pain management.

Preliminary results of a pragmatic randomised controlled trial in general practice investigating the effectiveness of acupuncture against migraine: Qualitative analysis of brain perfusion SPECT

2009-12-01

Background: Migraine is a chronic neurologic disease that can severely affect the patient's quality of life. Acupuncture has emerged as an effective treatment for migrainic patients, but its use remains a controversial issue. Our aim was to determine whether acupuncture, applied under real conditions of clinical practice in the area of primary healthcare, was more effective than conventional treatment.Methods/design: We designed a three-armed randomised pragmatic multi-centre controlled trial comparing the effectiveness of verum acupuncture with sham acupuncture, and with a control group receiving normal care only. Inclusion criteria were patients presenting with migraine and for whom their General Practitioner (GP) considered referral for acupuncture. Consecutive selection and randomised allocation to the three branches of the study were centralised as follows: 1:1:1 distribution (verum acupuncture; sham acupuncture; conventional treatment). One patient in three was randomly selected from each acupuncture group for a brain perfusion SPECT study (baseline scan, one after first acupuncture session and one after treatment). Verum acupuncture consisted of 8 weekly sessions. Sham acupuncture group received 8 weekly sessions applied at non-acupuncture points. Both of them lasted for 30min. The control group was given conventional treatment as the other two groups. Each patient filled a headache diary and several questionnaires to control migraine evolution.Results: Visual qualitative analysis of brain regional perfusion scan suggests inhomogeneous non-specific ischemic pattern among basal studies, more significant when there is a concurrent migraine crisis. Significant changes occur after verum in the acupuncture branch, not observed after sham acupuncture, neither at the first post-acupuncture nor the final brain perfusion scan.Conclusion: Preliminary results illustrate that basal brain perfusion scan resembles a multi-infarct pattern in most patients. Verum acupuncture induces modifications in global and regional brain perfusion scans that also correlate with a clinical improvement in the number and intensity of the migraine crisis.

Design adaptive allocation in a controlled trial on the effectiveness of mindfulness-based stress reduction in migraine

S. Schmidt, M. Aickin, K. Simshäuser, M. Lüking, C. Schultz, H. Kaube — 2009-12-01

Objectives: Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching several types of mindfulness meditation techniques, including mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Patients suffering from migraine usually benefit from behavioural and life-style interventions, but so far no mindfulness-based interventions were assessed.Methods: We applied a new and innovative method termed design adaptive allocation to assign 62 patients to two study arms: (1) MBSR, (2) an active control procedure to account for nonspecific effects. The allocation procedures aimed at paralleling groups according to the predictors sex, age and migraine severity on the basis of a regression analysis and replaces classical randomization. The main outcome criterion of the trial is number of migraine days per month determined by a headache diary. Secondary outcome variables are quality of life, mental health, pain intensity, pain acceptance, medication and mindfulness.Results: Thirty patients were allocated to the control group and 32 to the MBSR intervention. t-Tests indicated that there was a high degree of balance for sex (male 9.4% vs. 10%, p=0.935), age (44.8 vs. 44.5 years, p=0.918), and migraine severity (5.94 vs. 5.93 migraines, p=0.994).Conclusion: It could be shown that this new allocation method guarantees extremely similar groups even with small samples. Our data prove that it is possible to avoid baseline differences in small pilot trials. Thus design adaptive allocation shows an advantage over the classical randomization procedures which often results in unbalanced groups when samples are small.

Analgesic effects of transcutaneous electrical nerve stimulation (TENS): Implications for acupuncture?

K.-E. Choi, M. Strobel, R. Lauche, F. Musial, F. Saha, T. Rampp, G. Dobos — 2009-12-01

The aim of this pilot study was to investigate the mechanisms of analgesic acupuncture effects. Transcutaneous electrical nerve stimulation (TENS) was used to operationalize different types of afferent nerve stimulation. Two types of TENS-induced analgesia were investigated: (i) strong, but comfortable, high-frequent stimulation with homotopic electrode placement (SBCT), suspected to act through mechanoreceptive segmental mechanisms (e.g. gate control, LTP at dorsal horn) and (ii) very intense, heterotopic, low-frequency (acupuncture-like; TOLT) stimulation yielding its analgesic effect through A-delta- and C-fibre-induced spino-medullary mechanisms (e.g. diffuse noxious inhibitory controls). The aim of this study was to investigate these mechanisms using the standard experimental pain paradigm of placebo research, the submaximal effort tourniquet technique (SETT).Methods: To date 59 healthy young men (mean age=25.8 years, SD=5.1 years) were randomized to 3 treatments. Two verum treatments were implemented: SBCT: ipsilateral fossa axilliaris, 110Hz; TOLT: contralateral leg at acupoints GB 34 and GB 39, stimulation up to tolerance, 4Hz. As “sham” control treatment served SBCT: contralateral leg at acupoints GB 34 and GB 39, 110Hz. SETT was performed on the non-dominant arm with 200mmHg cuff pressure (limits: 30min or a pain rating of 10; scale 0–10). TENS was performed with 20min of stimulation prior to and throughout the SETT. Dependent measures were tolerated “time” and “average rating over time”. Baseline and treatment days were separated by 48h (randomized order).Results: Preliminary data (final results are presented after completed data collection) show a main group effect for tolerated time (p=.049). Only subjects treated with the verum treatments (homotopic SBCT or heterotopic TOLT) tolerated the SETT pain for a longer time period and they significantly differ from the sham treatment group (homotopic SBCT: p=.033; heterotopic TOLT: p=.044). There was a tendency to a main group effect for mean pain rating (p=.067), though it was not statistically significant.Discussion: In line with neurophysiological theories, considerable TENS effects were shown using the standard experimental pain paradigm of placebo research SETT. The results support the role of DNIC and gate control in TENS and acupuncture like TENS-induced analgesic effects.

Quantitative sensory testing in patients with chronic neck pain before and after the application of the acupressure pad—A randomized, controlled pilot study

C. Hohmann, R. Lauche, K.-E. Choi, F. Saha, T. Rampp, G. Dobos, F. Musial — 2009-12-01

In the treatment of chronic neck pain alternative and complementary therapies receive increasing attention. One device based on the principles of Traditional Chinese Medicine is the Acupressure Pad. The pad with more than 1000 plastic needles is applied by the patient on the painful part of the body. Its supposed mode of action is thought to be similar to acupuncture or acupressure. It is likely that the pad yields its analgesic effect through direct mechanical stimulation of nociceptors which might affect the transmission and processing of sensory information on the spinal level, which likely will induce measureable changes in mechanical pain and perception thresholds. Therefore we investigated whether a 2-week application of the pad leads to changes in neck pain and sensory thresholds.Methods: In total 40 patients (mean age 46.6±11.6 years) suffering from chronic neck pain for longer than 3 months participated in the study and were randomized to either treatment or waiting list control group. On day 1 actual pain rating was recorded on a 0–10 visual analog scale (VAS) followed by different methods of quantitative sensory testing (QST): mechanical detection threshold with von Frey filaments (MDT), vibration detection threshold (VDT) and pressure pain threshold (PPT) at the point of maximal pain, 10cm next to the pain maximum and two control areas (hand, foot). The treatment group then received detailed information about the application of the acupressure pad. A daily application of at least 30min over a period of 14 days was recommended. Fourteen days later the recording of VAS rating and QST measurement were repeated.Results: Analysis of the change in recorded pain ratings showed a significant group difference (p=0.008) with a decrease in pain only for the treatment group (−31%). PPT significantly increased at pain maximum (p=0.011) and 10cm close to the pain maximum (p=0.039), but not at the control areas. No such effects were found for VDT and MDT.Conclusion: The present data suggest that an effect of the acupressure pad application is not only seen in VAS ratings but also in PPT. The elevated PPT after treatment supports the idea of a direct influence on transmission and processing of sensory information on the spinal level by reflex therapies such as the acupressure pad.

Against all odds—living with fibromyalgia: A single case history on chronic illness and inner growth

V. Kalitzkus, P.F. Matthiessen — 2009-12-01

Introduction: Chronic pain confronts patients with a constant struggle of coping with it and realigning their sense of self. Despite of that, some patients do develop beyond coping and come to personal transformation due to their struggle. The potential of tackling the challenges of severe illness for inner growth is empirically verified; nevertheless conditions to enable such a development are poorly understood. The crucial question about the personal resources fostering such a process remains. We will give insight into the potential of a biographical approach in understanding coping with chronic illness by presenting a single case history of fibromyalgia.Method: The case in question is part of a qualitative study on personal transformation and severe illnesses. Interviews were conducted with a narrative, biographical approach with the aim of finding out what enabled a positive development. In the analysis objective life data as well as the subjective experience of the patient are used. Thus, we are interested in finding out what kind of biographical resources and personal strategies are the decisive ones eventually leading to transformation of the patient to live a life in greater personal autonomy despite pain and suffering.Result: With a narrative approach insights into the lived experience of a fibromyalgia patient that accomplished such a positive development are enabled. The analysis is validated by the outcomes of other studies on subjective patients’ experience with fibromyalgia. Although positive developments of several patients are mentioned by some studies, they do not delve into the meaning of it in the context of a patients’ life nor into the factors that enabled it. The development initiated by the course of the disease became apparent by looking at the patient's biography. Thus it was possible to identify areas in her life and personality where she developed further than what could have been expected. We propose a focus on the biographical resources as a way to encourage such developments in a therapeutic setting. A biographical approach might enable practitioners to gain the necessary insight and rapport with their patients to render possible a process going beyond successful coping.

Randomized controlled pilot study: Quantitative sensory testing in patients with back pain before and after Gua Sha massage

R. Lauche, K. Wübbeling, T. Rampp, A. Michalsen, G. Dobos, F. Musial — 2009-12-01

Question: Permanent nociceptive influx may lead to functional changes in the nervous system, i.e. hyperalgesia and allodynia occur. These processes are suspected to contribute substantially to the ongoing pain process. Reflex therapies, like the Gua Sha, a traditional Chinese massage technique preferentially used in the treatment of back pain, are supposed to affect the transmission and processing of sensory information on receptor and spinal level . If so one could assume that the Gua Sha massage should not only decrease the pain level itself, but also change sensory thresholds in the affected areas. In order to test this, we applied the Gua Sha massage in patients with chronic back pain and evaluated sensory threshold changes.Methods: Thirty patients with chronic back pain (mean age 50.3±10.1 years) were randomized to treatment group (TG) or waiting list control group (WLC). At T1 all patients rated their pain on a 0–10 VAS scale. Baseline sensory testing was then conducted, followed by Gua Sha massage for the TG. Seven days later (T2) sensory testing was repeated and the WLC received Gua Sha. Testing included determination of mechanical detection threshold (MDT), pressure pain threshold (PPT) and vibration detection threshold (VDT) as described in the Quantitative Sensory Testing procedure (QST) by Rolke et al. at the site of maximal pain, 10cm next to the pain maximum and two control areas. In accordance to the QST procedure MDT and PPT scores were logarithmized. For further analysis, differences between T1 and T2 were compared between TG and WLC.Results: First results show a significant decrease in mean pain ratings for the TG compared with the WLC (p<.05). Sensory testing at the control areas served as an estimation of measurement reliability (mean correlation 0.74±0.13). t-Tests revealed no differences for VDT. For MDT and PPT group differences were found 10cm next to the pain maximum, i.e. MDT and PPT increased in the TG, but not in the WLC (p<.05). No such effect could be observed at the site of maximal pain.Conclusions: GuaSha not only decreased pain intensity for 35% on average compared with 4.6% increase in the WLC. TG also showed increased MDT and PPT at 10cm next to the pain maximum. Together with the steady thresholds in both control areas this can be interpreted as the result of functional changes in the sensitized area. It appears that Gua Sha reduced allodynia in the pain surrounding area.

Chronic low back pain: A randomised controlled multicenter trial comparing the local injection of Disci/Rhus toxicodendron comp.® and placebo, and waiting list group

D. Pach, B. Brinkhaus, S. Roll, K. Wegscheider, K. Wruck, C.M. Witt — 2009-12-01

Background: The aim of the study was to investigate efficacy and safety of Disci/Rhus toxicodendron comp.® in patients with chronic low back pain.Methods: Patients with chronic low back pain were randomly assigned to Disci/Rhus toxicodendron comp.® (n=51), placebo (saline solution, n=48), or a waiting list control (n=51). Physicians with different specialisation, in 9 outpatient centres, administered intervention in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks and 26 weeks. The primary outcome was the Visual Analogue Scale (VAS, 0–100) for the average pain of the last 7 days after 8 weeks. An ITT analysis using multilevel models adjusted for baseline values was performed.Results: At total of 150 patients were enrolled from August 2007 to June 2008; eight patients were lost to follow-up at week 8, but were included in the final analysis. The mean baseline-adjusted VAS at week 8 was 37.02±4.38 (mean±se), 97.5% CI [25.27; 48.77] in the verum group, 52.97±4.30 [41.75; 64.19] in the waiting list group, and 41.83±4.59 [30.09; 53.58] in the placebo group. Differences were significant between verum and waiting list group (p=0.001), but not between verum and placebo group (p=0.350). After 26 weeks differences between all groups were not significant. No significant side effects were observed.Conclusion: Disci/Rhus toxicodendron comp.® is a safe treatment. After 8 weeks Disci/Rhus toxicodendron comp.® was superior to no treatment; however, no significant difference was observed between Disci/Rhus toxicodendron comp.® and placebo.

Qigong for chronic neck pain—A randomized controlled trial

D. Rendant, D. Pach, R. Lüdtke, A. Reißhauer, C. Witt — 2009-12-01

Background: Qigong is often used in patients with pain of the spine. The aim of this study was evaluate if qigong is more effective than no treatment and comparable to exercise therapy.Methods: Patients (20–60 years of age) with chronic neck pain (≥40mm on VAS) were included in this study. Participants were randomly assigned to two treatment groups practicing qigong or exercise therapy for 18 sessions over a period of 6 month or to a waiting list group with no treatment. At baseline and after 3 and 6 months patients completed standardized questionnaires including the neck pain and disability scale (NPAD), and a quality of life questionnaire (SF-36). Our primary endpoint was the average VAS neck pain at 6 months.For statistical analysis we used GEE models and adjusted for baseline values and patient expectation.Results: In total 123 patients (age 46±11 years, 87.7% women) suffering from neck pain for 3.2 (SD±1.6) years were included. We found a significant difference between qigong and waiting list control group (VAS mean difference: −14mm [CI, −23.1;−5.4], p=0.002). Improvements in the exercise group were comparable with those in the qigong group (difference between groups in favor of qigong −0.7mm [CI: −9.1; 7.7]; however, non-inferiority could not be proven (p=0.092). NPAD and SF-36 results again showed superiority of qigong over no treatment and similarity of qigong and exercise.Conclusion: Qigong is more effective than no treatment in patients with chronic neck pain. For the comparison between qigong and exercise therapy this study was underpowered a further study with a larger patient sample is needed.

Acupuncture for osteoarthritis: A qualitative analysis to interpret the results of a randomised controlled trial

F. Bishop, C. Hill, P. White, J. Walker, G. Lewith — 2009-12-01

Objective: To develop explanations for the quantitative findings of an RCT by systematically interrogating data from the nested qualitative study.Design: Qualitative study (narrative interviews and framework analysis) nested within an RCT.Participants: A total of 27 RCT participants were purposively selected to interview, to encompass all treatment conditions.Setting: The single-blind RCT examined the efficacy of real acupuncture for pain relief in hip and knee osteoarthritis. Patients were randomised to 3 treatment conditions (real acupuncture vs 2 placebo treatments) and 2 consultation conditions (empathic vs non-empathic). The study involved 3 experienced acupuncturists who delivered all interventions.Findings: Interviewees were active participants who sought to make meaning of their experiences in the trial. They wanted to try acupuncture and thought it might benefit them, thus subverting patient equipoise. Interviewees sought to determine whether they were receiving real treatment and drew on cues including perceived outcomes, treatment sensations, and practitioner behaviours. Evidence for a reciprocal process is outlined in which interviewees’ perceptions of treatment veracity and outcomes were mutually reinforcing. The most successful practitioner was seen as an authoritative doctor. Interviewees reported colluding with practitioners in non-empathic consultations, and inferred empathy from experiences associated with the trial but outside the protocol treatments.Conclusions: This nested qualitative analysis offered novel insights into the RCT findings that would not have been possible from the quantitative data alone. Conceptualising and understanding RCT subjects as active participants has important implications for trial design particularly for interventions such as acupuncture when equipoise is unlikely.

Fundamental research models on high dilution homeopathy—A project on the state of repetition

P.C. Endler, K. Thieves, S. Baumgartner, L. Bonamin — 2009-12-01

Question: This project identifies and classifies fundamental studies in high potency homeopathy that have been submitted to multicentre/independent repetitions.Method: We considered biochemical, immunological, botanical, cell biological, organ biological and zoological studies on high potencies, i.e. beyond a dilution of 10e−23. The main sources of information were MEDLINE and HOMBREX as well as literature reviews.Arrangement of papers:Study types 1–4 were then differentiated:Results: As of May 2009, a total of 76 studies have been found. Of these, 27 were first publications, namely 19 performed by one researcher and 8 performed in a multicentre setting. In the attempt to reproduce one of these initial studies, 37 follow-up studies yielded comparable results, namely 5 performed as a repetition by the same researcher, 28 performed as a repetition in a multicentre setting in contact with the researcher from the first study and 4 as a repetition in a fully independent setting. Two studies showed a consistent, yet different result from the initial study. In the attempt to reproduce one of the 27 initial studies, 10 studies yielded negative results, namely 3 performed as a repetition in a multicentre setting in contact with the researcher from the first study and 7 as a repetition in a fully independent setting.Conclusion: To perform this overview classification, a certain broadness of clusters concerning methodological details of the studies concerned was necessary, albeit further classification may need refinement of categories, this being of importance also for laboratory research recommendations. Data will be discussed and published in detail in Homeopathy, London.

Integration of CAM in medical guidelines

J. Langhorst, F. Musial, P. Klose, G.J. Dobos — 2009-12-01

Medical guidelines aim to provide all professions involved in the treatment of a disease a systematically developed basis for the diagnosis and therapy. They have growing impact on political, juristic and educational issues in Medicine. In Germany, the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) is responsible for the coordination of the development of medical guidelines. In June 2009 a total of 154 scientific-medical societies constitute the group of members of the AWMF.The German Society for Natural Medicine (Deutsche Gesellschaft für Naturheilkunde) is currently not a member.Aim: What is necessary to integrate CAM into medical guidelines?To clarify problems and potential of CAM in medical guidelines, the field of gastroenterology was chosen. In Gastroenterology there are at present 10 S3 guidelines published. Especially inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS) are diseases that can be very well treated with an integrative medical approach including complementary treatment options.Our work will focus on the experience to integrate CAM made in the development of the recently published guidelines for Crohn's disease as well as the guidelines for ulcerative colitis and irritable bowel syndrome which are presently under development.For the integration of CAM in medical guidelines, more high-quality research in CAM is needed. Furthermore, for the future of Integrative Medicine, it is urgently needed for the German Society for Natural Medicine to become a full member in the AWMF. This will be one major step to ensure and facilitate the inclusion of CAM in medical guidelines in the future, which can be estimated as one important step to further develop Integrative Medicine.

Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: Randomized, placebo-controlled pharmaco-clinical trial

J. Melzer, E. Schrader, A. Brattström, R. Schellenberg, R. Saller — 2009-12-01

Herbals drugs – single or in combination – are often used in patients with somatoform disorders, yet the available evidence is limited. Aim of the present short-term study was to evaluate in a pharmaco-clinical trial the additional benefit of butterbur in a fixed herbal drug combination (Ze 185=4-combination versus 3-combination without butterbur versus placebo) in patients with somatoform disorders.A total of 182 patients were randomized for a 3-arm trial (butterbur root, valerian root, passionflower herb, lemon balm leaf versus valerian root, passionflower herb, lemon balm leaf versus placebo) for a 2-week treatment in patients with somatisation disorder (F45.0) and undifferentiated somatoform disorder (F45.1). Anxiety (visual analogue scale—VAS) and depression (Beck's Depression Inventory—BDI) served as primary parameters, Clinical Global Impression (CGI) was a secondary parameter.The 4-combination was significantly superior to the 3-combination and placebo (4 combination >3 combination >placebo) in all the primary and secondary parameters (PP-population). Analysis of the ITT population confirmed these results. As to safety no serious adverse events (AE) occurred. In total 9 non-serious AE were documented but the distribution did not differ significantly between the treatment groups.Butterbur had an additional benefit on the short-term treatment in patients with somatoform disorders. Thus the herbal 4-combination (Ze185) showed to be efficacious and safe.

Improvements in sleep as an indicator of general health and wellbeing following Autogenic Training

N. Robinson, A. Bowden, A. Lorenc — 2009-12-01

Question: Can improvements in sleep be used as an indicator of the wider health benefits of Autogenic Training?Methods: This pragmatic observational prospective study investigated whether resolving sleep problems provides an additional indicator of AT benefits. All new patients attending an AT service in a conventional medical setting at the NHS Royal London Homeopathic Hospital (RLHH) between April 2007 and April 2008 were invited to participate, irrespective of presenting complaint.Participants completed a standard AT course as delivered at RLHH. Eight weekly, 2-h group sessions used six exercises to reduce autonomic activity by focussing the mind on sensations representing relaxation (including heaviness and warmth in the limbs, a calm, regular heart beat, easy natural breathing, abdominal warmth and a cool forehead). Outcome measures were an adapted Pittsburgh sleep quality index, the Hospital Anxiety and Depression scale (HADS) and a patient centred outcome Measure Your own Medical Outcome Profile (MYMOP). Data were collected at initial assessment, start and end of treatment and at follow-up.Results: Complete data were obtained from 142 out of 186 patients. Most (88%) participants had a sleep problem (current or past), despite only 14% reporting a sleep problem at initial assessment. Worry, stress, anxiety or depression was identified as the cause of sleep problems by 51% of patients. In total, 94% of those presenting with insomnia reported stress as their main problem.Evaluation at 8 weeks showed AT resulted in improvements in sleep onset latency (p=0.04), difficulty getting back to sleep (p=0.006), dream recall (p=0.006), energy levels (p=0.023) and feeling refreshed on waking (p<0.001). Presenting symptoms (p<0.001), general health (p<0.001), anxiety (p<0.001) and depression (p<0.001) also significantly improved.Conclusions: These findings support clinical and anecdotal observations by AT trainers that AT improves sleep quality despite sleep neither being the focus or presenting complaint. Stress and anxiety are both likely consequences and causes of sleep problems and AT provided a ‘tool’ to help patients cope. Improvements in sleep exemplify the nonspecific effects of AT, which may not be captured in research but are of real importance and make a difference to patients. This study demonstrated that changes in sleep could be used as a possible outcome measure for evaluating more holistic effects of AT.

Professional development in complementary medicine/homeopathy

K. Werwick, M. Reed, M. Herrmann — 2009-12-01

Introduction: Because of growing patient demand for complementary medical services as well as new ways of financing these from statutory health insurance, specialist doctors, especially in general practice, are finding they need to acquire additional qualifications in, amongst other things, homeopathy. We investigated how doctors arrange their professional development in these areas and also we undertook a survey amongst medical students of their needs and interest in learning complementary medicine.Methods: The questionnaire examined how and when the teaching of complementary medicine should take place in the course of medical studies from the perspective of both students and doctors. We looked at biographical influences, as well as prior knowledge and expectations of students and doctors about complementary medicine. To process it we used a multi-method approach that combined quantitative methods of data ascertainment (standardized questionnaires) as well as qualitative methods (narrative interviews). Using these we questioned students and doctors about how they choose to further develop their understanding of complementary medicine.Results: Both quantitative and qualitative analysis showed that students – no matter what age, sex or prior knowledge – would like more diversified teaching in the area of complementary medicine. They consider this to be integral to a holistic view of the patient. It became clear through the statistical analysis of their needs and interests that the greater their experience with complementary medicine, the greater was their holistic appreciation of their patients. This was also correlated with greater self-reflective behaviour. It seems that attention to complementary medicine before and after studying helps to foster a professional understanding of this field that is additional to the traditional medical studies.Discussion: Through this optional teaching in the area of complementary medicine, interested students may receive the opportunity of early exposure, which may facilitate their further education in complementary medicine.Conclusion: Homeopathy should be included as an optional addition to medical studies. The evaluation results assisted us in the conception of two clinical elective subjects: homeopathy and TCIM. Furthermore we are in the process of developing of a master's degree course in the integrated practice of homeopathy, in cooperation with the central Society of Homeopathy and Otto-von-Guericke-University, Magdeburg.

Why consumers maintain complementary and alternative medicine use: A qualitative study

F. Bishop, L. Yardley, G. Lewith — 2009-12-01

Question: Consumers are thought to use CAM because they are attracted to attributes of specific CAM therapies and discouraged by negative experiences of conventional medicine. Research evidence supports this hypothesis, but there remains a need to distinguish between factors and processes involved in the initial uptake of therapies and those involved in their subsequent maintenance. We therefore conducted a qualitative study to explore and describe consumers’ reasons for maintaining or stopping CAM use.Methods: This was a qualitative study. We interviewed 46 CAM consumers and 9 CAM practitioners, in two high-street CAM clinics in the UK. The interviews were analysed thematically using techniques from grounded theory.Results: Consumers described and evaluated their CAM experiences along four dimensions: interpersonal (e.g. interactions with practitioners), physical (e.g. sensations such as touch or pain during treatment), affective (e.g. empowerment) and cognitive (e.g. beliefs about treatment). They evaluated their experiences in relation to their individual needs and expectations; financial considerations could limit maintenance of CAM use. Practitioners emphasised the effectiveness of treatment and themselves as contributing to consumers maintaining treatment, and recognised the role of financial considerations in decisions to stop CAM use.Conclusions: Further work is needed to test and extend our findings in other settings. This study suggests that experiences of conventional medicine are of limited importance after the decision to initiate CAM. Experiences of CAM were foremost in our consumers’ decisions to maintain or stop specific CAM therapies. Maintenance of CAM could occur even if consumers’ experiences were not entirely positive. CAM practitioners may have a vital role to play in ethically supporting consumers’ decisions to maintain CAM use.

Trade offs: A framework analysis of factors affecting adherence to orthodox medicine in complementary and alternative medicine users with chronic health conditions

S. Brien, F. Bishop, K. Riggs, D. Stephenson, V. Friere, G. Lewith — 2009-12-01

Background: A large proportion of individuals use complementary and alternative medicine (CAM) but little is known how patients co-manage CAM with orthodox medicine (OM). This qualitative study explored the use of CAM amongst participants with chronic conditions to identify how and why it affects their use of OM.Method: Individuals were recruited from the practices of acupuncturists, nutritionists and homeopaths in South of England between 2006 and 2009. Face-to-face semi-structured interviews were undertaken with 35 individuals with a range of chronic health conditions who were currently use CAM. The data was analysed using the Framework Approach.Results: Data saturation was achieved. An explanatory model explaining the use of CAM amongst individuals affects how they use OM for a range of chronic conditions will be described. Eight different types of CAM use, which were affected by their range of factors including their beliefs and experiences of CAM, were identified:Most participants demonstrated that they used CAM in more than one way or would switch between different uses, and no participants abandoned OM totally.Conclusion: Communication between patients and their conventional physicians about patient's use of CAM is often limited. This detailed model explains for the first time, how individuals with chronic illness manage their health by using conventional and complementary systems of healthcare, and the factors that affect the trade off of one system against the other. As such, it will provide a valuable insight for clinicians and could be used as a framework to stimulate communication to maximise the management of patient's ill health.

The implementation of integrative medicine in the Netherlands: A national survey among hospitals, psychiatric-, revalidation- and academic centres

M. Hofstede, I. von Rosenstiel, M. Jong, J. Meijer — 2009-12-01

Objectives: Integrative Medicine (IM) is based on four pillars: (i) relation of health professional with patient; (ii) patients’ responsibility in own healing process; (iii) use of evidenced-based and safe complementary therapies; and (iiii) healing environment. There is significant and growing national interest for introducing IM pillars into conventional medical centres and practices in the Netherlands. However up till now, no quantitative data are available about the impact of IM on national healthcare in the Netherlands. The current study aims to investigate the implementation of the four pillars of IM in the Netherlands, in qualitative terms of health programmes, education, research and human resource management, as a baseline to evaluate future planned IM implementation.Methods: The present study was designed as a cross-sectional survey with a nation wide random sample of board members, directors, medical staff and personnel working at hospitals (±100), psychiatric centres (±100), revalidation centres (±30) and other relevant academic centres (±7). They will be approached by e-mail with an online questionnaire that will take 10min to complete. A reminder email, including the questionnaire once more, will be send to non-responders 2 weeks later. The questionnaire comprises closed and open questions about the following topics: (i) familiarity with the term IM and/or applied health programs or concepts of IM (such as Planetree; the use of mind-body interventions or other complementary treatments); (ii) fase of internalisation (development, preparation, implementation) of each pillar in (iii) health programmes; (iv) education; (v) research; and (vi) human resource management; (vii) use of complementary therapies (such as mind-body techniques, homeopathy, TCM, massage and use of life style coach); (viii) need for knowledge, education and/or research.Results and conclusions: The results and conclusions of the national survey will be presented at the congress.

Integration of traditional Japanese medicine in Japan—A survey on the use of Kampo among patients

L. Hottenbacher, T. Seki, K. Watanabe, C. Witt — 2009-12-01

Background: Kampo is the traditional medicine of Japan. According to a survey around 70–80% of the medical doctors use Kampo from time to time.Aim: The aim was to provide information about the reasons for Kampo utilization and attitudes towards Kampo and conventional medicine in Japanese patients.Methods: We performed a cross-sectional survey and included consecutive patients who visited one of four participating outpatient clinics in Japan for medical treatment in September or October 2008. The participating four clinics represented different settings (clinic 1: Kampo/TCM treatment, clinic 2: conventional medicine and Kampo, clinic 3: Kampo, clinic 4: conventional medicine). The questionnaire included following aspects: socio-demographic data, medical history, general beliefs, experience with Kampo, beliefs about conventional medicine and Kampo, and the reasons for the utilization of Kampo.Results: A total of 500 questionnaires were completed (93 clinic 1, 136 clinic 2, 125 clinic 3, 146 clinic 4). The mean age of the participants was 51.9±16.3 years (63% female). In total 72% had received Kampo treatment before, and half of these patients had chronic diseases (49%). Patients seeking a Kampo clinic had more often experienced Kampo previously than patients seeking a conventional clinic (91% and 88% in clinic 1 and 3 versus 75% and 45.9% in clinic 2 and 4). Overall, patients recommended Kampo over conventional treatment for the following diseases: sensitivity to cold (a “disease” quite common in Japan, called hi′e-shô in Japanese, 49.4%), shoulder stiffness (31.8%), gastrointestinal discomfort (30.2%) and obesity (24.2%). Conventional medicine was reported most frequently to be useful for pneumonia (30.4%). A combination of Kampo and conventional medicine was mentioned for following diseases: common cold (35.6%), asthma (33.2%), depression (32.6%), stress/anxiety (32.4%), bronchitis (32.2%) and high blood pressure (32.3%).These results differ between the clinics. Patients of the conventional clinic suggested more often to use only conventional treatment e.g. for hypertension, cystitis, diabetes, kidney disease, cancer and gastric ulcer.Conclusion: Preliminary analysis shows that Kampo is often used by patients in Japan; also by patients visiting a conventional clinic. For most diseases patients suggest a combination of Kampo and conventional treatment.

Outcomes research in integrative health care clinics: What are the barriers?

A. Kania, M. Verhoef, A. Mulkins, B. Findlay — 2009-12-01

Background: Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine with the purpose of enhancing patients’ health. Various models of IHC clinics have been developed and several studies have aimed to evaluate the outcomes of these approaches. However, outcomes assessment in IHC clinics is challenging. The type of outcome measures used to date tend to be disease oriented and do not capture the patient's lived experience, consider self-identified health goals of patients or fully reflect the IHC philosophy of care. The diversity of measures used in IHC outcomes research makes comparisons across studies difficult. To address these issues, a package of patient-centered outcome measures was designed that reflected the holistic and individualized nature of IHC care. We aimed to test the appropriateness and applicability of this package within IHC clinic settings. However, major challenges arose in conducting this study which prompted the team to hypothesize that a lack of research orientation within the clinics was a fundamental barrier impeding the conduct of outcomes research. This issue was significant enough that the team felt it warranted further investigation. A second phase of the study was developed to explore the barriers in conducting outcomes research in IHC clinics and identify strategies for implementation of successful in-house outcomes research programs.Methods: Given the exploratory nature of the proposed question, a qualitative descriptive research design was followed. Twenty-five in-depth, semi-structured interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews.Results: Barriers identified by participants fell into four main categories: organizational culture, organizational resources, organizational environment, and logistical challenges. Strategies for successful implementation of outcomes research activities emerging from participant interviews were: (1) embedding research values within the organizational mandate, (2) creation of a viable research infrastructure, and (3) integrating research activities and clinical workload into a seamless flow.Conclusion: Assessing and enhancing the research culture within IHC clinics is an important consideration and initial step which needs to be taken for the implementation of productive and cost-effective research programs.

Comparative study of visitors to CAM practitioners in USA and Norway

A. Steinsbekk, M.B. Rise, M. Ackin — 2009-12-01

Question: USA and Norway are among the countries that have highest total expenditure on health per capita and also high utilization of complementary and alternative medicine (CAM). But they have fundamentally different health care systems. The aim was therefore to compare the profile characteristics of adults who have visited a CAM practitioner the last year in the USA and Norway.Methods: Data from the National Health Interview Survey (NHIS) in USA from 2002 and the Level of Living Survey (LOLS) in Norway from 2002 were used. Both surveys were nationally representative household surveys of the non-institutionalized civilian population. The data consist of 6612 individuals from Norway and 31,044 individuals from USA.Results: In USA 7.4% of the population had visited a CAM practitioner during the last 12 months compared with 8.7% in Norway (p<0.001 for difference). In both USA and Norway, Sebeing a CAM visitor practitioner was most strongly associated with visits seeing to other health care practitioners (e.g. visits to mental health practitioner adjusted OR 2.5 in USA and 1.6 in Norway) and having experienced better or worse self-reported health the last year, while being 70 years and older (e.g. over 80 years adjusted OR 0.4 in USA and 0.3 in Norway) or being male (adjusted OR 0.6 in USA and 0.4 in Norway) and a daily smoker reduced the odds of visiting a CAM practitioner in both countries. In USA, but not Norway, having higher education was strongly associated with being seeing a CAM visitor practitioner (masters degree adjusted OR 2.2 in USA). Having higher education and a diagnosis of seizures were the variables with the biggest difference between CAM visitors in USA and Norway.Conclusion: The prevalence of CAM visitors was 18% higher in Norway compared to USA. The profile of an adult who had visited a CAM practitioner the last year was very similar in USA and Norway, except for the influence of education on higher CAM use in the USA.This study indicates that in a country which provides health care services for all based on need regardless of personal income (Norway), the utilization of CAM practitioners is higher and less associated with use of other health care providers than a country with low government expenditure on health (USA).

Quality-of-life-related dimensions in cancer patients treated with mistletoe extract (Iscador): A systematic literature review

A. Büssing, C. Raak, T. Ostermann — 2009-12-01

Purpose: Most clinical studies on the clinical effects of extracts from Viscum album, the European white-berry mistletoe, focus on the survival of cancer patients, while the effects on the patients’ quality of life (QoL) received less consideration. Thus, we intended to determine the effectiveness of the most commonly used mistletoe extracts which is covered by a large spectrum of published studies, the fermented plant extract Iscador, in the treatment of patients with cancer with respect to QoL-related dimensions.Methods: We searched several databases such as PubMed/Medline, Excerpta Medica Database (EMBASE), CAMbase and other. Inclusion criteria were controlled clinical studies on parameters associated with QoL in cancer patients treated with Iscador. Separate search terms were “Iscador” and “study”, “mistletoe” and “study”, and “Viscum” and “study”. Studies were analyzed with respect for trials where patients of the control group received only standard care but no extra treatment. QoL-associated outcome data (mean values and standard deviations, mean/median differences, effect estimates and confidence intervals, odds ratios, etc.) were extracted as they were given in the publication, and converted into standardized mean differences (SMD) and their standard errors using standard formulas.Results: We found 13 prospective and controlled studies (9 of them were randomized) that met the inclusion/exclusion criteria and the intended focus on mistletoe extract versus no extra treatment; two additional randomized studies controlled Iscador against placebo/alternative treatment, and thus were not enrolled in the evaluation. The number of patients enrolled varied considerably from 32 to 396. The addressed studies reported positive effects with respect to QoL and related dimension in favor of the Iscador application. A random effect meta-analysis estimated the overall treatment effect at SMD=0.56 (CI: 0.41–0.71, p<0.0001), indicating a moderate treatment effect. Funnel plot analysis of the trials indicated selective publication of positive trials (asymmetry coefficient=1.99; p=0.02).Conclusion: The analyzed studies give some evidence that Iscador treatment might have beneficial short-time effects on QoL-associated dimensions and psychosomatic self-regulation. However, most studies used instruments not appropriate to measure QoL. Thus, well-designed randomized controlled trials with appropriate test instruments are encouraged.

Safety and immunological effects of Iscucin® Populi and Viscum Mali—A placebo-controlled study

R. Huber, U. Ellwanger, J. Wieber, C. Beckmann — 2009-12-01

Background: Mistletoe preparations Iscucin® Populi (IP) and Viscum Mali (VM, both WALA GmbH) are licensed in Germany as supportive cancer medication within the concept of Anthroposophical Medicine. Safety and immunological effects in humans of these preparations were for the first time investigated in this study.Methods: A 3-armed randomized study in healthy volunteers was performed. The probands injected in increasing doses either IP (strength F, G and H, each for 4 weeks) or VM (strength D3, D2 and 2% each for 4 weeks) or placebo (isotonic solution) subcutaneously twice weekly for a total of 12 weeks. Clinical and safety controls were performed weekly. Immunological outcome parameters (differential blood count, lymphocyte differentiation, interleukin (IL)-6) were analysed every 4 weeks.Results: A total of 71 probands were included (IP=30, VM=21, placebo=20), 69 finished the study regularly and were analysed. Application of IP strength G and H caused strong local reactions at the site of injection. In parallel they resulted in distinct eosinophilia (p<0.001) and significant increase of total leucocyte counts. Furthermore, application of IP strength F, G and H resulted in an increase of T-helper cell counts (p<0.05 compared with placebo). VM caused only mild local reactions and a small but insignificant increase of eosinophils. IP strength G and H were because of local reactions estimated as worse tolerable than placebo. Severe side effects, a stimulation of IL-6 production, and other relevant deviations in safety laboratory parameters did not occur.Discussion and conclusion: Eosinophilia as an effect of mistletoe-lectin (ML) containing mistletoe preparations is well known and was pronounced due to the high content of ML in IP strength G and H. Most of the probands did not tolerate the full dose of IP strength G and H due to local reactions. Repeated injections induced, however, a certain tolerance (smaller local reactions, less eosinophilia despite inreasing dosages), which was accompanied by induction of mistletoe lectin antibodies in all subjects receiving IP (data not shown). Therefore, IP strength G and H should in general be used only after pretreatment with lower dosages. For the first time there was an increase of T-helper cells during application of mistletoe preparations in a placebo-controlled study. This could be beneficial for the treatment of immunosuppressed cancer patients. Eosinophils play a role in host response against cancer and eosinophilia correlates with a better prognosis in a variety of cancer types. Whether eosinophilia during treatment with IP has a clinical benefit for cancer patients has to be further investigated. Both mistletoe preparations have been shown to be safe. VM induces only mild local reactions and is used as mild counter stimulant in patients with painful osteoarthritis.

The influence of self- and autonomic regulation on cancer-related fatigue and distress in breast and colorectal cancer patients—A prospective study

2009-12-01

Objective: Cancer-related fatigue (CRF) has an important impact on the quality of life in breast (BC) and colorectal (CRC) cancer patients. Until now only a limited number of prospective studies have investigated the effect of adaptive salutogenic mechanisms on CRF, in addition to the biological influences. The aim of our study was to assess a possible effect of autonomic Regulation (aR) and self-regulation (SR) on CRF and distress in long-term survivors. Therefore, questionnaires on aR and SR were combined with the Hospital Anxiety and Depression Scale (HADS-D) and the Cancer Fatigue Scale (CFS-D), including three subscales.Method: In total, 95 BC and 51 CRC patients as well as 120 healthy controls (C) had participated in the initial survey in 2000/2001. On average 6 years later, 62 BC, 17 CRC patients and 87 C could be followed up (number of females: 62 for BC, 11 for CRC, 60 C). Forty-one further participants were deceased (14 BC, 25 CRC and 2 C). During the follow-up, patients were requested to complete the CFS-D, HADS-D, aR and SR scales and to determine their Karnofsky-Index (KPI) through self-evaluation. Multiple regression analysis was used to evaluate the influence of aR and SR as well as age, gender and diagnosis groups.Results: On average, disease duration of cancer patients was 10.1 years at a KPI of 93.3% at the follow-up. High aR values showed a significant effect 6 years after initial evaluation, reducing cancer fatigue with β=−0.66 (KI: −0.92 to −0.39; p<0.001), cognitive fatigue with β=−0.20 (KI: −0.31 to −0.09; p<0.001) and anxiety with β=−0.21 (KI: −0.31 to −0.11; p<0.001). SR had a positive influence on global fatigue (β=−2.39 KI: −4.45 to −0.34; p=0.022), anxiety (β=−0.87, KI: −1.65 to −0.10; p=0.028) and depression with β=−0.87 (KI: −1.36 to −0.38; p=0.001).Conclusion: AR had an independent positive effect on anxiety, global and cognitive fatigue. Self-regulation showed an independent influence on fatigue, anxiety and depression-related symptoms. The connection between these parameters is still unclear and awaits further elucidation.

Complementary and alternative medicine in lung cancer patients

O. Micke, J. Büntzel, R. Mücke — 2009-12-01

Introduction: The use of complementary and alternative medicine (CAM) is the norm in tumor patients (Burstein, JCO 2000). CAM is most frequently used in breast and prostate cancer patients. The CAM use in lung cancer patients is widely neglected, and systematic studies are scarce in this field.Therefore, the German Working Group Trace Elements and Electrolytes in Radiation Oncology, AKTE, initiated a study on the use of CAM in lung cancer patients in addition to radiation treatment.Methods: A total of 120 patients (38 f, 72m) of 3 institutions were interviewed by a standardized questionnaire. Besides the tumor parameters and the use of CAM, the reason for the use, information on the receipt of the medication, the information sources and the subjective condition of the patient.Results: Altogether, 54% of the patients reported to use CAM (66% of female patients, 52% of male patients). The CAM measures, most frequent used, were: vitamin combinations (17%), mistletoe (15%), selenium (12%), other trace element combinations (8%), prayer (6%), thymus preparations (5%), homeopathy (3%) and other physical treatment (3%). A total of 52% reported the wish to support the tumor treatment as a reason to use CAM and 27% better feeling using CAM. 50% of CAM was bought by patients themselves and 50% were prescribed by their family physicians. Sources of CAM supply predominantly were pharmacies and drugstores. Information sources mostly were the family physician and other patients. 55% of patients described an improvement of their subjective condition.Conclusions: The use of CAM is a frequent phenomenon in lung cancer patients. Our results suggest that it is very important to obtain information on the CAM use in lung cancer patients and, particularly in controlled clinical trials, to prospectively document it.

An integrative approach of cancer treatment with mistletoe therapy, surgery, irradiation and chemotherapy in CAM settings

2009-12-01

Introduction: Cancer treatment with mistletoe extract (Viscum album L., VA) is among the most widely spread CAM therapies in Germany and is especially popular in anthroposophic medicine (AM). However, relatively little is known about the particular cancer types and stages treated, frequency, duration and route of administration or co-medication used routinely in hospitals or outpatient settings. Therefore it is also difficult to determine possible risks and benefits of VA application in routine care that have been described in clinical studies.Materials: To determine how VA is routinely used and if it is predominantly administered instead of or concurrent with radiotherapy, chemotherapy or surgery, data were analysed from the German arm of the Network Oncology (NO) that operates in several European countries, including Switzerland, Italy and Great Britain. Data were used from patients visiting one of the 4 participating hospitals and 7 outpatient/GP-surgeries in 2006–2008.Results: Of the 6648 patients included, 4522 (68%) received VA treatment (4387 sc, 311 iv and 119 il). Gender ratio was 68% female and most common entities were breast (31.1%), pulmonary (10.6%), colon (7.3%), rectum (4.2%) and pancreatic (3.7%) cancer. Gender and entity distribution did not significantly differ between patients treated with VA or not. 16.2% received conventional therapy and 11.4% VA only, whereas 70.4% received both. However, this rate varied significantly between participating centres (54.9–88.2%). An average (ø) time of application was 89.0 days (d) (±228.6) with a maximum of 1851d. Two distinct groups (0–200 and 365–2100d) became apparent, with averages of 37.8 and 1043.1d. iv and il treatments were predominantly short term and hospital based, whereas sc application was mainly used in long-term treatment (ø 94 apps in ø 240d).Conclusion: In the settings investigated, an integrative approach was predominantly chosen when VA was administered. VA is used on a large variety of entities, predominantly by sc application. It is possible to differentiate between short- and long-term users but no data are yet available if there is a correlation between the length of treatment and either a curative use or the intention to improve quality. These data will provide a solid basis for the comparison of clinical trial data with routine use.Acknowledgements: This project was supported by Weleda AG, Helixor GmbH, and Abnoba GmbH.

Use and comprehension of complementary and alternative medicine in breast cancer patients: Results from cognitive interviews

E. Tautz, A. Hasenburg, F. Momm, C. Güthlin — 2009-12-01

Introduction: Studies about the use of complementary and alternative medicine (CAM) show that oncological patients and, among these, most often women, frequently use CAM. However, prevalence of CAM use differs greatly between different studies. The patients’ understanding of CAM (e.g. what exactly constitutes homeopathy) is rarely investigated.Materials and methods: This study involves 2 steps: (1) surveying female breast cancer patients in a neoadjuvant, adjuvant or palliative treatment situation. A total of 172 patients returned the questionnaire concerning their CAM use plus EORTC-QLQ; (2) cognitive interviews were performed with 17 patients within the framework of validating the questionnaire. By using the think aloud technique, difficulties in understanding the questionnaire were examined, and the comprehension of CAM methods was explicitly probed. Qualitative content analysis was applied to the data and more themes emerged from the cognitive interviews besides validation issues. These results will be presented here.Results: Patients use CAM for both cancer-specific (e.g. prevention of relapse) and non-specific reasons (e.g. general well-being). Some patients reported preferring conventional medicine for the cancer-specific therapy, but integrated CAM as a means of general support. Comprehension of CAM modalities was often vague, e.g. the term “homeopathy” was repeatedly used as a generic term for CAM. Most interviews demonstrated that the allocation of different CAM modalities was unclear. In some cases we evidenced considerable contradictions, e.g. an extensive adjustment of nutrition that was not described as keeping a specific diet.Discussion: A significant lack in patients’ comprehension as to what exactly is a feature of which CAM modality might be a cause of the variability of CAM use seen in different studies. The fact that many patients are not well informed about CAM methods often prescribed by different therapists demonstrates the risk of interactions between CAM modalities among themselves and with conventional medicine.Conclusion: Regarding the integration of CAM and conventional medicine many patients wish for and implement themselves, their comprehension of CAM modalities and modes of action plays an important role. Being aware of this is crucial in order to ensure a patient-centred treatment.

Prescribing love for the heart? Stress reduction and medical effects of altruism, compassion and love

T. Esch, E. von Hirschhausen — 2009-12-01

Objective: Talking points on the therapeutic significance of love offered by neurobiology and positive psychology.Discussion: Love is difficult to define. Looked at neurobiologically, it is closely associated with the concept of pleasure, reward and ‘positive psychology’, i.e., joyful mental states, and therefore has become a feature not only of psychological but also of basic science research and clinical medicine. Though not identical, altruism and compassion show physiological commonalities with the neurobiology of love. This understanding utilizes limbic ‘neural emotionality’, using as substrates, among others, endogenous morphine, dopamine and nitric oxide signaling. Particularly in love responses, oxytocin and vasoppressin additionally fit in.Love in the beginning can be stressful. This is also true of other stress-reducing practices that incorporate a stress component initially, i.e., relaxation and placebo responses. This initial uprise is termed anticipatory stress response (ASR). The initial activation of this stress component of the total response – i.e., relaxation and/or love response – is significant and represents a protective mechanism. Activation is started, then followed by relaxation, i.e., stress release, only if the situation allows for it, guaranteeing an appropriate environment. Stress and love therefore act as biological counterplayers. This function of love is of particular importance for the cardiovascular system and is expressed via stress response pathways and their subsequent down-regulation. Thus, emotional (i.e., non-cognitive) processes became adducts to stress activation, terminating it quickly. Altruistic and compassionate behaviors exactly fulfil this need and thus show stress-reducing capacities. Physiological alterations following such behaviors can be profound and lasting, as demonstrated for the autonomous and the central nervous or the cardiovascular systems. This potential has led to a broad array of studies demonstrating positive medical effects of love, social bonding, volunteering and compassion, especially of benefit for the heart and the brain, implying that this self-healing potential could be used in various therapeutic situations, including integrative medicine.Conclusions: Love facilitates health and stress reduction. This effect can be observed clinically and biologically. Thus, love and companionship not only ensure the survival of individuals and their species, but also support beneficial motivation and health behaviors.

Phlebotomy (bloodletting) in patients with metabolic syndrome: A randomized controlled trial

K. Houschyar, R. Lüdtke, T. Rampp, G. Dobos, A. Michalsen — 2009-12-01

Question: Metabolic syndrome has an increasing prevalence worldwide and there is an urgent need for improvement of medical treatment. In traditional medical systems bloodletting is a frequently recommended therapy in subjects with obesity and vascular disease. Recent randomized studies showed that bloodletting improves insulin sensitivity in patients with diabetes mellitus and increased ferritin concentration and might be beneficial in younger patients with peripheral arterial vascular disease. We aimed to test if traditional bloodletting has beneficial effects in patients with metabolic syndrome.Methods: A randomized controlled study with a study period of 3 months was conducted in 64 self-referred subjects that had a confirmed diagnosis of metabolic syndrome as defined by recent guidelines. Thirty-three subjects (60±7yr; BMI 32.8±5.5kg/m2) were allocated to the bloodletting intervention group and 31 subjects (57±10yr; BMI 32.5±5.6kg/m2) to the control group (waiting list). In the intervention group two phlebotomies with removal of 300–400ml of venous blood were performed at day 1 and after 4 weeks. Primary outcomes were the course of seated systolic blood pressure and of insulin sensitivity as measured by HOMA-Index. Secondary endpoints included diastolic blood pressure, ferritin, serum iron, hematocrit, HbA1c, LDL/HDL-quotient and blood glucose.Results: Baseline characteristics were balanced between groups. Seated systolic blood pressure dropped from 148.5±12.3 to 130.5±11.8mmHg in the intervention group and from 144.7±14.4 to 143.8±11.9mmHg in the control group (group difference −16.6mmHg, 95% CI:−20.7 to −12.5; p<0.001). HOMA-index after 3 months was not different between groups (p=0.251). Diastolic blood pressure, heart rate, blood glucose, HbA1c and LDL/HDL were significantly decreased by bloodletting. Bloodletting led to reductions of serum iron concentration, plasma ferritin and a slight decrease in hematocrit with no serious adverse events.Conclusions: Phlebotomy (bloodletting) effectively decreases blood pressure and improves metabolic parameters in patients with metabolic syndrome. Larger studies should test the longer-term efficacy of bloodletting in metabolic syndrome, hypertension and lipid disorders.

A controlled-feeding feasibility study of the anti-inflammatory diet in insulin-resistant subjects

A. Nedrow, P. Elmers, H. Zwickey, J. Purnell — 2009-12-01

Purpose: To evaluate the feasibility and initial effects of the anti-inflammatory (AI) Diet in type 2 diabetes and pre-diabetes on inflammatory, cardiovascular risk factors and weight outcomes.Methods: A randomized, 6-week, controlled-feeding study of the AI Diet compared with an ADA Control Diet: with 2 weeks of isocaloric followed by 4 weeks of ad lib feeding. The AI Diet was based on the recommendations from the naturopathic community emphasizing foods thought to reduce inflammation (fish, nuts, flaxseed, vegetables, and fruits) and excluding foods considered antigenic (wheat, dairy, corn, soy, eggs, red meat, and citrus) as well as alcohol, caffeine, and refined sugar. The Control Diet was based on guidelines for medical nutrition therapy from the American Diabetes Association (ADA). The two diets were matched on total fat, CHO, protein, and cholesterol, but fatty acids, fiber, and micronutrients differed between the diets. Outcomes included fasting glucose (FG), lipids, hs-crp, cytokines, and weight (Wt), measured repeatedly. Participants had FG≥100 and <200mg/dl and were not on anti-diabetic medications. All food was provided to participants by the Oregon Health & Science University Bionutrition Center.Results: Study population (n=30) included 65% women (mean age 56 years and mean FG 111.7); 26 individuals completed the protocol. FG, TC LDL, HDL, and Wt were reduced in both diet groups; changes (r) for AI Diet vs. ADA Control for isocaloric (2 weeks) and ad lib (4 weeks) phases are as follows (see ):Parametric analyses revealed that participants on the AI Diet generally achieved better results than those on the Control Diet for lipids (i.e., greater and faster reductions in total and LDL cholesterol, increased HDL/LDL ratios), fasting glucose, and both BMI and weight (all greater and faster reductions). Non-parametric analyses found AI Diet participants more likely to achieve clinical targets (e.g., total cholesterol <200, LDL<100, HDL/LDL >0.4, fasting glucose <100). No changes were observed for inflammatory markers, IL6 and TNFa in either diet group, however, significant decrease in hs-crp was found in the AI Diet participants compared to the ADA diet controls.Conclusions: Data from this exploratory study show that both the AI Diet and the diabetic Control Diet have beneficial effects on glucose, lipids and weight. Neither diet affected IL6 or TNFa markers of inflammation, however significant decrease in hs-crp was seen in the AI Diet compared with control diet. The AI Diet tended to have a larger effect on weight-loss than the Control Diet. Limitations include: the control diet, which for ethical considerations reflected current guidelines for diabetes treatment rather than a comparison with the “usual American diet”, the short duration of feeding and small sample size.

Complementary therapeutic effects of definite alternating electromagnetic fields upon local regulating mechanism of microcirculation

K. Rainer — 2009-12-01

Objective: In the context of several studies conform to GCP should be evaluated to what extent definite alternating electromagnetic fields effect in prophylactic use or increase the effect of conventional treatment plans in case of additional complementary use.Materials and methods: The evaluation contained 2 random samples—each n=24, divided into 2 subgroups (Control and True) over a 30-day observation resp. treatment period. One sample consisted of elderly patients in rehabilitation period and the other sample consisted of stress-exposed middle-aged people. The main target parameters were the representative functional characteristics of microcirculation, metabolic parameters and the immunologic characteristics of leucocytes in subcutaneous or intestinal target tissues. The methods of measurement consisted of intravitalmicroscopic exploration unit with secondary computer-assisted image processing, intravitalmicroscopic reflexionspectrometry, combined laser-microflow and white-light spectrometry. For the biometric data evaluation the Wilcoxon test (a=5%) was used. In addition comparative evaluations of the effect of several other magnetic or electromagnetic fields from different pulse configurations and intensities were performed.Results: After application of definite alternating electromagnetic fields with special pulse configuration to stimulate spontaneous arteriolar vasomotion (BEMER Plus System), elderly patients in rehabilitation period verified during the observation period an increase of the spontaneous arteriolar vasomotion by 20% compared to Control. In stress-exposed middle-aged people the value of increase is slightly lower combined with extended fade characteristics. Furthermore similar significant changes of characteristics have been detected about condition of blood distribution within the microvascular networks, the venular disposal, the venular oxygen utilisation and the immunologic characteristics of leucocytes. In contrast, other extremely weak alternating magnetic fields with constant intermittency showed significant lower effect on the characteristics of microcirculation. Weak static magnetic fields showed no effect on characteristics of microcirculation.Conclusion: The evaluated effect of definite alternating electromagnetic fields with special pulse configuration to stimulate spontaneous arteriolar vasomotion (BEMER Plus System) on the microcirculation and the immunologic system is relevant concerning prophylactic and complementary therapeutic use.

Effect of acupuncture on cardiac output

T. Seki, M. Watanabe, S. Takayama, S. Konno, T. Yambe, N. Yaegashi, S.-I. Nitta — 2009-12-01

Background: We have been investigating the effect of acupuncture on peripheral circulation. Because it must be measured using a catheter, examination of cardiac output is invasive, and so there are few reports about the influence of acupuncture on cardiac output in humans. In addition, inserting a catheter endovascularly may cause vasoconstriction that could influence hemodynamics. Therefore, we observed cardiac output during acupuncture with an impedance cardiac output flowmeter.Methods: Thirty healthy volunteers (mean age: 30±8 years; 20 men and 10 women) were enrolled. Using an impedance cardiac output flowmeter (Dash3000, Omron Healthcare Co., Ltd.), the heart rate, systolic blood pressure, diastolic blood pressure, stroke volume and cardiac index were measured. Each subject rested in the supine position for 10min, and then acupuncture needles (disposable stainless steel needles; 1.6mm×40mm) were inserted bilaterally at LR-3 on the instep and manual stimulation was done for 18s. Measurements were obtained at rest, during stimulation, and 30, 60 and 180s after stimulation. Statistical analysis was performed with SPSS software (version 16.0, SPSS Japan Inc., Tokyo, Japan). The percent changes of each variable were calculated and compared by repeated measures ANOVA with a post hoc Dunnett's test. Measurements were performed for 6s, and then the mean values were calculated. The subjects were instructed to breathe once every 6s during the examination.Results: The heart rate decreased significantly after stimulation compared with the resting value (mean±SD: 65.0±8.2% vs. 62.2±7.4%, p=0.001). There was no significant change in cardiac index. Systolic blood pressure decreased significantly at 180s after stimulation compared with the resting value (115.4±9.8% vs. 113.3±10.0%, p=0.04) but diastolic blood pressure did not change significantly.Conclusions: Acupuncture did not have an effect on the cardiac index but decreased the heart rate. It is possible that parasympathetic sympathetic nerve activity due to acupuncture stimulation may decrease the heart rate.

Hemodynamics of the radial artery, the site of traditional pulse diagnosis

2009-12-01

Background: Pulse diagnosis is a method used in traditional medicine around the world, and is mainly performed at the radial artery. However, there are few reports on radial artery hemodynamics because it is difficult to measure the blood flow volume in a thin vessel like this artery.Methods: Thirty-three healthy volunteers (mean age: 34.2±7.6 years; 26 men and 7 women) were enrolled. We measured the hemodynamics of the right radial artery for approximately 50s after 10min of rest in the supine position. Hemodynamics was assessed with a Prosound α10® ultrasound system (Aloka Co., Ltd., Tokyo, Japan). This system had a high-resolution linear array transducer (13MHz) and computer-assisted analytical software (e-Tracking system®, Aloka Co., Ltd.) that allowed automatic detection of the vessel edge, as well as continuous measurement of the vessel diameter and blood flow volume.Analysis: The mean end-systolic radial artery diameter, mean end-diastolic diameter, mean blood velocity, and mean blood flow volume were calculated each second after smoothing the per-beat values of end-systolic diameter, end-diastolic diameter, mean blood velocity, and mean blood flow volume with MATLAB (Ver.2007b, MathWorks).Then, fast Fourier transformation (FFT) was performed with MATLAB to obtain the power spectra of these indices.Results: In all subjects, FFT-end systolic diameter, FFT-end diastolic diameter, FFT-flow velocity, and FFT-flow volume showed peaks of the power spectrum at a low frequency (LF) and a high frequency (HF).The LF and HF peaks of FFT-flow volume were significantly different from the LF and HF peaks of FFT-flow velocity (p=0.011, p=0.041, respectively).However, the LF and HF peaks of FFT-flow volume were not significantly different from the LF and HF peaks of FFT-end systolic diameter and FFT-end diastolic diameter.Conclusion: Two peaks in the power spectrum of flow volume were observed, indicating the existence of fluctuation of radial artery blood flow volume. It is suggested that fluctuation of the blood flow volume is influenced by fluctuation of the end-systolic diameter and end-diastolic diameter.

Trust in God's help as a measure of intrinsic religiosity and its association with depression and life satisfaction in patients with depressive disorders and addictions

A. Büssing, G. Mundle — 2009-12-01

Purpose: There are several studies that indicate that spirituality/religiosity (SpR) may be associated with lower incidence of depression and anxiety. Most of these studies were from the US, and one may doubt that these results can easily be transferred to more secular countries. We thus indented to investigate whether patients with depressive disorders and/or addiction utilize intrinsic religiosity as a resource to cope.Methods: The sample of this cross-sectional survey contained 96 patients recruited consecutively in 3 psychotherapeutic German clinics, i.e. Oberberg Clinics Schwarzwald, Weserbergland and Berlin/Brandenburg. Their mean age was 47.2±10.5 years; 50% women; 67% had a Christian denomination; 32% none; 67% had depressive disorders and 33% addictions (mostly alcohol). To measure non-organized intrinsic religiosity in the context of disease coping, we used the 5-item scale Trust in God's Help (TGH, Cronbach's alpha=0.914), which is derived from the AKU questionnaire. Depressive states were measured with Beck's Depression Inventory (BDI), and the scale which Escape from Illness. Life Satisfaction was measured with the Brief Multidimensional Life Satisfaction Scale (BMLSS).Results: TGH was moderately expressed in the patients (47.1±35.2), indicating that this coping strategy was of minor significance; the strong variations can be explained in part by the lack of a religious denomination in about 1/3 of the patients. Patients with depressive states had significantly lower TGH than patients with addictions (40.9±31.9 versus 61.4±37.2; F=7.7, p<0.01). Albeit not significantly, patients with high TGH had lower depression (F=2.6; p=0.08) and higher life satisfaction (F=2.4, p=0.10) than patients without or indifferent TGH, while Escape scores were significantly lower (F=3.6, p=0.03) in patients with high TGH. In contrast, patients within a depressive state had significantly lower life satisfaction (F=29.6, p<0.001) and TGH (F=5.5, p=0.02). Correlation analyses confirmed that TGH correlated weakly (negative) with depression (r=−0.24, p=0.03) and Escape (r=−0.25, p=0.01), and positively with life satisfaction (r=0.24).Conclusions: The results indicate that it is not intrinsic religiosity that accounts for the significant effects on depression, but instead it is the depressive state, which is associated with lower Trust in God's Help as an attitude which includes an engagement in private religiosity.

Integrative medicine and whole systems approaches: From heterogeneous practice to comprehensive scientific concepts

P. Heusser — 2009-12-01

Background: So far, the integrative medicine mostly consists of a pragmatic inclusion of heterogeneous practices from diverse historical and cultural backgrounds into research and practice of conventional medicine. Conceptually, complementary or alternative medical theories remain largely unrelated to the molecular models of conventional medicine; and a rational integration of diverse medical theories is elusive.Objective: To develop a common, intersubjectively testable basis for diverse medical systems concerned with integrative or whole systems approaches, based on observation and thinking.Method: An epistemological analysis of the relation between observable phenomena and their corresponding rational concepts, applicable to all possible fields of experience: external and internal, physical, organic, emotional, mental, and spiritual.Results: Conclusions: This could facilitate mutual understanding and common concepts between disciplines and lay the basis for their conceptual integration.

Western and alternative medicine: A comparison of paradigms and methods

R. Hoenders, F. Willgeroth, M. Appelo — 2009-12-01

Background: Although the practical integration of western medicine (WM) and complementary and alternative medicine (CAM) seems to be growing, their paradigms and therapeutic methods seem, at first sight, almost impossible to reconcile. Is the integration of WM and CAM really an illusion or is the presumed gap mainly related to our points of view?Method: A literature search through Medline, PsychLit, books, internet resources and in-depth interviews with several experts on this subject.Results: We found 12 main differences between WM and CAM, which can be ordered into 5 factors: paradigm, perspective, organisation, procedure and scientific method. These distinctions do not seem to be categorical but rather dimensional; except for the factor ‘paradigm’ (mechanism versus vitalism), which is categorical and has been one of the greatest controversies in philosophy. This absolute contrast is of a meta-theoretical nature and therefore cannot be solved through standard scientific logic. Supporters of each viewpoint cannot be convinced by scientific evidence to the contrary because their points of view concerns an existential premise, a conviction regarding the question of ‘why’ things are as they are.Conclusion: The presumed gap between WM and CAM seems to consist only of different paradigms, so it seems mainly related to our point of view. The biopsychosocial model as proposed by Engel seems valuable in bridging this presumed gap.

Salutogenesis as a possible link between conventional medicine and complementary methods

J. Mergelsberg — 2009-12-01

Background: Understanding the genesis of health is a fundamental theme in the medical professions. However, conventional medicine with its focus on causal explanations of diseases has led to a neglect of this issue. In recent times, the question was brought back into the focus of scientific enquiry within the framework of salutogenesis. The term originates in the work of medical sociologist Aaron Antonovsky (1923–1994). He raised the question how certain survivors of the Holocaust could remain healthy despite their terrifying experiences in concentration camps. He developed the concept of the “sense of coherence”, with which he tried to explain how people manage psychosocial stress and do not succumb to ill health. He proposed salutogenesis as a completion of the pathogenetical paradigm in modern medicine.However, the theme of salutogenesis is not new in medicine. Starting with Hippokrates, medical history shows a multitude of approaches to the understanding of hygieia, i.e. health. Nowadays various concepts of complementary medicine use a salutogenetical approach by empowering self-healing processes. But Antonovsky's concept of salutogenesis is not totally congruent with approaches in complementary medicine. A main difference is that Antonovsky focuses on mechanisms of psychosocial resistance, while complementary medicine focuses on the whole organism and its possibility to regain health. Nevertheless, the basic perspectives on health and sickness seem similar.Methods: The present work explores two approaches in complementary medicine, by naturalist L.R. Grote (1886–1960) and the founder of Anthroposophical Medicine, Rudolf Steiner (1861–1925). Reviewing the fundamental assumptions of their work, it will be proposed to use Antonovsky's concept of salutogenesis as a theoretical framework to link concepts of conventional medicine and complementary methods.Results: In his work, Antonovsky shows that the pathogenetic paradigm of conventional medicine is limited by its focus on repairing health-defects. He argues that health is not a passive matter, but an active process, present even during illness. This suggests that medical practice should find ways to facilitate this process in order to heal diseases. Unlike conventional medicine, both Grote and Steiner address this in their different approaches. In different ways, they substantiate Antonovsky's claim for the completion of the pathogenetical paradigm in modern medicine.

The homeopath's personality profile

M.B. Rise, A. Steinsbekk — 2009-12-01

Background: Research has indicated several specific characteristics of the homeopathic consultations and their patients. Homeopaths treat more children; their consultations are longer and encompass a whole-person-approach to a greater degree than in general medical practice. This is likely to indicate a difference in treatment philosophy, but might also be indication of difference in personality traits. Personality profiles of different occupational groups have been studied and include investigations on the personality traits of doctors, medical students, surgical residents, urology residents, and psychotherapists, and on personality as a prognostic factor for speciality choice in medicine. However, to date no study has investigated the personality trait of homeopaths.Aim: The aim of this study was thus to describe the personality traits of homeopaths in Norway, and to compare these traits to the Norwegian population.Methods: A cross-sectional survey among all members of the Norwegian association for homeopaths was conducted in the fall 2007. Personality was measured using the Norwegian translation of the Revised NEO Personality Inventory (NEO-PI-R). The NEO-PI-R questionnaire is based on the Five Factor Model and consists of a 240-item self-report questionnaire that describes five personality traits: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness.Results: In total 325 homeopaths were invited to participate and 130 homeopaths (40%) agreed and returned completed questionnaires. The analysis shows that compared to the average Norwegian population, the homeopaths had a significantly lower score on Extraversion (difference −1.7 points, 95% CI −3.1 to −0.3, p=0.017) and a significantly higher score on Openness (4.7, 3.3–6.2, p<0.001), Agreeableness (8.0, 6.5–9.6, p<0.001), and Conscientiousness (2.3, 0.9–3.7, p=0.001). There was no significant difference for Neuroticism (−0.3, −1.9–1.2, p=0.663).Conclusion: The homeopaths in this study had significantly higher scores on the trait Agreeableness. Agreeableness describes the way a person relates to other people. A high score might characterise a person who is trusting, kind, altruistic, and caring. The abilities to listen, understand, care, and comfort are probably vital in therapeutic work. Persons with a relatively high score on Agreeableness might be more prone to choose homeopathy as a vocation.

Health and economic profit with equitable licencing

P. Tinnemann, S. Yekta — 2009-12-01

Public funds provide approximately 50% of the funding for research and development of new medical innovations. The German federal government aims with the “Patentverwertungsoffensive” to increase patenting of university inventions. Innovations are mostly exclusively licenced to private pharmaceutical companies, with the belief that pharmaceutical industries are the only bodies capable of translating basic research results into marketable products.With acquired patent rights, or exclusive licences of patent protection, private companies hold a monopoly over production, marketing and pricing of the innovation, which can last a minimum of 20 years. Without alternative licencing arrangements, patents can prevent cheap and affordable production of vaccines, diagnostics and medicines by generic manufacturers.Newly developed vaccines, diagnostics and medical treatments could save lives and enhance life quality for millions of poor people, but they are mostly too expensive and out of reach. Today, many low- and middle-income countries represent a negligible percentage of the global pharmaceutical market.There is a clear need for creating new systems that accommodate intellectual property rights to encourage innovation by scientists in the public sector as well as transformation of research into marketable products by the pharmaceutical industry. Equitable licencing of medical research discoveries is a step forward in reaching global health equity. Equitable licencing introduces a set of different licencing conditions for publicly funded research when licenced to the pharmaceutical industry. The aim is to facilitate access to new medical innovations for patients in low- and middle-income countries. The concept of equitable licences does not infringe upon intellectual property rights, patents and their owners. It serves alongside the existing patent system by creating a win-for-all situation for all stakeholders: the publicly funded research institutions, the pharmaceutical industries and the patients.

Citrus/Cydonia comp. for seasonal allergic rhinitis: A randomized study to compare treatment effects of the subcutaneous and the nasal routes of administration

E. Baars, M. Jong, H. Savelkoul — 2009-12-01

Objectives: Allergic rhinitis is a condition characterized by sneezing, watery nasal discharge, nasal obstruction and itching. It is an increasingly prevalent condition, particularly in the Western world where it affects around 20% of the adult population. Citrus/Cydonia comp. is an anthroposophic medicine, which contains extracts of lemon (Citrus lemon) and quince (Cydonia oblongata). Several observational studies have shown that Citrus/Cydonia comp. solution either as a subcutaneous injection or as a nasal spray might be an effective treatment for seasonal allergic rhinitis (SAR) patients. In addition, in vitro is has been shown that it has a selective effect on the differentiation of T-cells by producing relatively more IL-10 than IL-12. By that, it also seems to have an effect on the induction of regulatory (IL-10 producing) T-cell subsets. Therefore, it has been concluded that Citrus/Cydonia comp., at least in vitro, is capable of neutralizing (to some extent) the changes, characteristic to allergic rhinitis, with regard to the maturation, differentiation, and activity of the immune system.The aim of the present study is to compare the efficacy and safety of subcutaneous versus nasal spray administration in SAR patients by specifically investigating which route of administration is more effective in the differentiation and inductions of (regulatory) T-cells.Methods: A national, randomized, comparative clinical trial with two parallel groups. A total of 28 patients with grass pollen SAR are recruited at primary care practices or through advertisements. After a 2-week run-in period without allergy medication, patients are randomized to a 6 weeks treatment period with either Citrus/Cydonia comp. 1% subcutaneous injections (2 injections per week) or Citrus/Cydonia comp. 1% nasal spray (1–2 sprays in each nostril, 4 times a day). The primary outcome variables are changes in immunological parameters such as IL-10, IL-12 and IL-5 at week 6, as studied in PBMCs isolated from the blood of the patients. Further objectives are to investigate the influence of Citrus/Cydonia comp. subcutaneous injections versus Citrus/Cydonia comp. nasal spray on the change in clinical symptoms by means of nasal and non-nasal symptom scores. The safety and tolerability of both injections and nasal spray will be investigated by determining adverse events surveillance.Results and conclusions: The outcome of this randomized comparative study will be presented at the congress.

Acupuncture in Seasonal Allergic Rhinitis (ACUSAR)—Multidisciplinary approach of a clinical trial including experimental and qualitative research

2009-12-01

Background and aim: Acupuncture is used by patients for relief of seasonal allergic rhinitis (SAR) although there is only limited evidence of its effectiveness, as well as limited knowledge of the mechanisms of action attributable to acupuncture. In December 2006, the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) funded the clinical trial (Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) to evaluate the effectiveness of acupuncture in 400 patients with SAR. The aim was to develop a research infrastructure to investigate physiologic effects (e.g. on immune system and autonomic nervous system) of acupuncture in patients with SAR and to explore psychological effects (e.g. patient's characteristics and expectations) that might influence the results.Methods: ACUSAR is a three-armed, randomised, controlled multicentre trial with a total follow-up time of 16 weeks. The aim of ACUSAR is to investigate through hierarchical evaluation whether acupuncture is (1) non-inferior or (2) superior to (a) penetrating sham acupuncture and (b) rescue medication in the treatment of seasonal allergic rhinitis. Main outcome parameters are the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the Rescue Medication Score (RMS) between weeks 6 and 8. To complement these subjective outcome parameters with more objective endpoints we implemented two experimental trials in two subgroups of ACUSAR patients to study the effect of acupuncture on immunological parameters (ACUSAR EXP; n=30) and vegetative functions (AUTO ACUSAR; n=30) in SAR. Furthermore, the ACUSAR trial is accompanied by a pilot qualitative study (ACUSAR QUAL) which aims to identify patients’ and physicians’ attitudes and behaviour to study intervention and a questionnaire on patient characteristics (ACUSAR CONST) which aims to determine parameters of potential treatment responders.Conclusion: The ACUSAR study is one of the largest and most rigorous studies of acupuncture including a sham control group conducted in SAR thus far. The additional sub-trials are aimed to complement the clinical results leading to a better and more complex understanding of acupuncture in SAR.

Strengthening self-healing—Integrative approaches to cancer therapy with mind/body medicine

A. Paul — 2009-12-01

Cancer patients often perceive themselves as radically injured in their capacities to self-regulate their health and well being. Their mind literally feels betrayed by their bodies. This condition of hopelessness diminishes their self-efficacy and greatly adds to their suffering. At the Clinic for Naturopathy and Integrative Medicine in Essen we have developed an 11-week outpatient program in Mind/Body Medicine that empowers patients to regain responsibility for their own well being. In addition to their conventional therapies patients learn to use self-help strategies like regular exercise and a healthy diet as well as relaxation and mindfulness techniques. To most of our cancer patients the experience that through applying these measures in their daily lives they can positively influence their condition opens up a new dimension of well being, strength and hope. The mindful reflexion on self-harming cognitive processes and the practice of a more accepting and caring attitude towards themselves and others within a supportive group setting adds to this valuable experience. During the program many patients become able to truly change their lives. The presentation introduces the philosophy, context and content of the intervention and summarizes our research findings.

Life quality and subjective feeling with additional homeopathic treatment in cancer patients

M. Frass, H. Friehs, C. Marosi, K. Zedtwitz-Liebenstein, C. Zielinski — 2009-12-01

Questions: The purpose of the study was evaluation of quality of life (QoL) and subjective existential orientation of oncological patients making use of additive homeopathic treatment.Methods: In total 90 patients with breast (35), colorectal (10), renal (7), cerebral (7), and pancreatic (6) cancer; sarcoma (5); bronchial (4) cancer; lymphoma (4); pharyngeal (3) cancer; and others (9) underwent an elaborate medical history including questions relating to social and private circumstances. Symptoms given by patients were correlated with the signs of homeopathic evaluation of remedies as recorded in repertories (Zandvoort, Complete Repertory; MacRepertory®). Patients received individually selected remedies including Pulsatilla (15), Phosphor (15), Lachesis (11), Acidum arsenicosum (7), Calcium carbonicum (3), Toxicodendron quercifolium (2) as the main first line homeopathic therapy in addition to regular conventional treatment. Patients were requested to complete visual analogue scales as well as a specially developed form evaluating subjective existential orientation and, finally, EORTC QLQ-C30 form version 3.0.Results: With respect to the latter, the mean QoL improved by 0.31 points (4.33±1.54 before vs. 4.64±1.59 after additive homeopathic therapy; p=0.008, Student's-t-test for paired data) between first and last registered consultation which lay apart by a mean of 24 weeks. This result corresponded to an improvement of 11.6% in a seven part-series. Similar results were found for the specially developed form: the visual analogue scale showed a difference of 0.71 (5.60±2.06 before vs. 6.31±2.3 at the third consultation, p=0.043; corresponding to an improvement of 16.1% in a 10 part-series), and a difference of 0.59 (5.56±2.15 vs. 6.15±2.31, p=0.007; 13.3% improvement in a 10 part-series) between first and last consultation. Following the fourth consultation, analysis in 45 participants revealed that 80% (n=36) felt an improvement of the general condition, while 20% (n=9) experienced no effect. In total 24.4% (n=11) sensed the improvement mainly physically; 51.1% (n=23) physically as well as psychologically; 2.2% (n=1) only psychologically; the remaining one patient did not comment. Improvement was ascribed to combination of homeopathy and conventional therapy by 23/36 (63.9%) of the improved patients; 10 (27.8%) ascribed improvement to homeopathic treatment only, 1 patient (2.8%) to oncologic therapy only, 1 to the season, 1 patient remained without comment. All patients were interested in continuing homeopathic treatment.Conclusion: In summary, homeopathy was well accepted by the investigated patients. Improvement in QoL as well as in subjective existential orientation warrants further investigations. Oncologists may want to receive information about the use of homeopathy and other forms of complementary medicine in patients undergoing treatment for cancer.

CHOICE, an international, observational study to examine current practice use of darbepoetin alfa in the management of chemotherapy-induced anaemia

2009-12-01

Introduction: In February 2008, the European product label for darbepoetin alfa (DA) in the treatment of chemotherapy-induced anaemia (CIA) was changed to stipulate target haemoglobin (Hb) values between 10 and 12g/dL. EORTC guidelines on ESA use state similar Hb target levels. The primary aim of this study is to assess adherence to the recommended Hb target range in patients (pts) receiving DA in routine clinical practice.Methods: This prospective, multicenter, observational study evaluated the routine clinical practice use of DA in 11 European countries in pts with various non-myeloid malignancies (breast, colorectal, ovarian and lung cancer) at any time during chemotherapy treatment. Key outcome measures were Hb levels and the requirement for red blood cell (RBC) transfusions.Results: 336 (mean±SD age 61.8±10.9 years) out of 1300pts were included in this interim analysis. 80pts had breast, 57 colorectal, 131 lung (33 small cell lung and 98 non-small cell lung cancer) and 68 ovarian cancer. 25% and 61% of pts had stage 3 and 4 disease at baseline, respectively. At baseline, 60% of all pts (53% of breast cancer and 62% of lung cancer pts) had a baseline Hb value of <10g/dL and 93% (96% of breast cancer and 92% of lung cancer pts) had a baseline Hb value below 11g/dL. 79% of all pts (91% of breast cancer and 75% of lung cancer pts) had a baseline Hb value between 9 and <11g/dL.At week 9, Hb values for 243pts (72%) were available. Of these, 136pts (56%) had Hb levels between 10 and 12g/dL, 59pts (24%) had a Hb value > 12g/dL and for 48pts (20%), a Hb value below 10g/dL was reported. The Kaplan-Meier percentage of pts with Hb levels ⩾10g/dL was 89% (see table). The Kaplan-Meier percentage of pts requiring RBC transfusions from week 5 to end of treatment period was 17% (see table). A median DA dose of 500μg was administered 3 times (median). Additional efficacy outcomes are presented in the table below. A treatment related non-serious adverse drug reaction (back pain) was reported for one patient only.Table 1Efficacy outcomesCI, confidence interval; Hb, haemoglobin; EOTP, end of treatment period; K-M, Kaplan-Meier; RBC, red blood cell; wk, week.aOnly patients with Hb<10 g/dL at baseline are included in this analysis.bOnly patients that were in the study for at least 29 days after starting DA treatment are included in this analysis.Conclusions: This interim analysis suggests that the majority of pts were treated according to the European product label for DA and EORTC guidelines and did not surpass Hb levels of 12g/dL. Furthermore, only 17% needed RBC transfusions from week 5 to end of treatment period. These data further support the effectiveness of DA for the treatment of pts with CIA. Sponsored by Amgen GmbH.

Prostate cancer and its treatment with Iscucin®Populi—Introduction and case reports: der Merkurstab, Heft 3, 2009, pp. 255–261

R. Kempenich, U. Meyer, M. Willeke — 2009-12-01

Background: Since prostate cancer is the most frequently diagnosed malignancy among males, the treatment of this disease becomes more and more important. A number of well-established forms of treatment are available in conventional medicine. These treatments are effective, but patients often suffer from considerable side effects (particularly concerning their sexuality), leading to an increased interest in complementary treatments.Objectives: Misteltoe therapy is a frequently applied complementary treatment in oncological practice, however, the state of knowledge regarding misteltoe therapy in prostate cancer is so far limited to very few publications.Case reports: Three patients with prostate cancer refused conventional therapies, because they were worried to risk their quality of life (their sexuality in particular).The first case, a fifty-two year old man with prostate cancer classified T1bNoMo with Gleason 6 (3+3). Diagnosed: 13/06/2006 after transurethral resection of the prostate for benign prostate enlargement, PSAlevel: 1,22ng/ml before the operation. He refused radical prostatectomy and never followed conventional cancer therapy. Start with Iscucin® Populi therapy: 24/11/2006.The second case, a fifty year old man with prostate cancer classified T1cNoMo with Gleason5(2+3), PSA level: 5,2ng/ml. Diagnosed: 14/02/2006. He refused radical prostatectomy and never followed conventional cancer therapy. Start with Iscucin® Populi therapy: 12/03/2006.The third case, a sixty-one year old man with prostate cancer classifed T3aNoMo with Gleason 7 (3+4), PSA level: 13,6ng/ml. Diagnosed: 22/02/2002. Initial treatment with radiotherapy and hormone therapy (Enantone®). This patient refused the continuation of the hormone therapy after 18 months of treatment. After a relapse (03/04/2006): Start with Iscucin® Populi therapy: 20/06/2006.Patients were followed regularly with clinical examinations, PSA level and MRI investigations.Results: The three patients showed an evidence of improvement of quality of life and no side effects were observed, in particular concerning their sexual life. Two cases showed a complete remission respectively after two and a half years and three years, and one case showed a partial remission after three years.The role of Iscucin® Populi (WALA) therapy in prostate cancer should be evaluated in future clinical studies.

Impact of mistletoe therapy on the quality-of-life of cancer patients

M. Brandenberger, P. Simoes-Wüst, L. Rist, R. Saller — 2009-12-01

Quality-of-life (QoL) of cancer patients is an issue both in conventional and in complementary/alternative medicine (CAM). In clinical studies, QoL is usually estimated by questionnaires, which represent a possibility to objectively quantify it in a wide number of patients, but lack the subjective dimension of each patient's QoL perception.Mistletoe (Viscum album) preparations are often used in the adjuvant setting and several clinical studies have shown that mistletoe – often in combination with standard treatments – can improve QoL [1]. In our previous work, we have detected a tendency for an improvement of the patients’ QoL as detected by various questionnaires (EORTC QLQ-C30 Version 3.0 [2], SELT-M [3] and HLQ Version 2.5 [4]), in a cohort of 25 patients with different types of malignant diseases during treatment with subcutaneous applications of mistletoe preparations [5].This cohort study, which was authorized by the ethical commission of the canton Zurich, included an additional questionnaire focusing on the therapies used (mistletoe, conventional and others) and on their impact on the QoL as perceived by the patient. The patients filled in the questionnaire at the beginning of the mistletoe therapy (n=25), and approximately 3 months later (n=21), to document the evolution during this time period. When the patients agreed, they were interviewed by the researchers at both occasions (n=12). For comparison reasons, only the questionnaires data of the patients, which were as well interviewed, are considered in the present analysis.The analysis of the questionnaires showed that the patients had most expectations concerning the improvement of QoL on the mistletoe therapy. Furthermore, they perceived the mistletoe therapy as the one leading to an improvement of QoL and to a better coping – including dimensions like positive thinking and a conscious lifestyle – with the disease.These results were supported by those of the interviews’ analysis, which further revealed that the successful coping with a cancer disease is associated with secondary (indirect) but effective components of the QoL, such as the interpretation of the disease (both of the patient and of the loved ones), the perceived sense or meaning of the disease, the received treatment (preferences, concept, setting) and the personal world's view. The coping with the disease was in some cases associated with changes in the private (psychosocial) space and in other cases in the professional space.Taken together, our results show that the patients adopt the mistletoe therapy with a supportive goal rather then as an anti-tumour therapy. Mistletoe therapy seems to offer a platform for an integrative coping with the disease, which might be important to reconcile the perceived shock of an existential disease with a good QoL, by releasing forces of motivational origin.

Traditional European Medicine—After all, is Hildegard von Bingen really right?

O. Micke, J. Hübner — 2009-12-01

The term of Traditional European Medicine (TEM) was coined analogue to Traditional Chinese Medicine (TCM). TEM consists of various approaches of traditional medical healing systems in Europe, beginning with Hippocrates in ancient Greece and ending in current times. In the German-speaking areas, the so-called Hildegard medicine (HM) is very popular and according to a national survey about 3% of all inhabitants of Germany trusts on HM.However, the use of HM in tumor patients is not well described. An own exploratory interview study in 120 tumor patients showed, that 7.5% of patients are actively using HM, 56.6% know about HM and 20.8% are interested in HM, further 12.5% would like to try it. On the other hand 15% of patients completely reject HM.HM should trace back to the life and visions of Saint Hildegard von Bingen (1098–1179). She was an abbess and the most important German mystic of the Middle Ages and aside she focused on religion, medicine, music, ethics and cosmology. Their thoughts of unity and the holistic based on the belief, that cure and salvation is only possible in the devotion to god, who is the great healer. Disease is an imbalance, health a balance of the soul. Her works are written in Latin and a visionary language and therefore, are not intended for the use by laymen, are not easy to understand, and offer a large range for interpretation.The currently popular term Hildegard Medicine cannot be found in her original writings. About 30 years ago the ideas of Hildegard von Bingen have been reactivated by two physicians, Gottfried Hertzka and Wighard Strehlow. They are suggesting the drugs as well as Hildegard's dietary recommendations as an appropriate medical healing system for today. Hertzka and Strehlow follow a highly commercialised attempt while suggesting that the medical recommendations by Hildegard are of divine origin. This, however, cannot be true as the medical texts compiled by Hildegard are not relying on her visionary experiences as do their religious treatises. HM represents a typical example of current Complementary and Alternative Medicine.Thus, it has to be stated that the actual importance of the remarkable person Hildegard must not be seen in any recommendation for today's therapy but in the fact that she compiled medieval medical knowledge. Under the name of HM, poorly defined overpriced preparations are distributed. A treatment after the principles of HM of serious or malignant disorders is strongly discouraged.

Durable tumour responses following primary high-dose induction with mistletoe extracts: Two case reports

M. Orange, A. Lace, M. Fonseca, H.B. von Laue, S. Geider — 2009-12-01

Mobilising the host's innate defences against established cancer and residual disease is an attractive and rational therapeutic approach to treat solid tumours and their known and occult metastases, from which relapses occur. Over the last decades significant progress has been made in understanding the immunological mechanisms that develop in relationship between the host and a developing tumour. However, the effectiveness of immunotherapy in humans remains quite limited. Tumours have robust mechanisms that disable tumour-specific immunity. It is generally accepted that an effective anti-tumour response of the immune system will require breaking the tumour-induced immune suppression and eliciting anti-tumour immunity. Immune-augmentative therapy with Mistletoe extracts (Viscum Album L., VAE) is an unconventional treatment modality for cancer patients and has cytotoxic and immune modulatory properties that have been extensively researched. Although the benefits of Mistletoe treatment for improving the quality of life and tolerance for mainstream cancer treatments (chemo- and radiotherapy in particular) are well documented, the evidence for improved (and relapse free) survival is less convincing. However, cohort studies and case histories describe tumour remissions—mostly following high dose and local application with VAE. Since the first report on successful intra-tumoural application of Mistletoe in 1996, a body of anecdotal evidence for this application has grown. The authors present unexpected remissions following treatment with VAE alone. These cases possibly exemplify the benefits of the primary induction using high doses of VAE. Furthermore, the method of administration may be critical for achieving a disease response. Two case histories show durable disease responses to Mistletoe therapy, starting with high doses of VAE (>20.000ng/ml Mistletoe Lectin I) as induction, and using intra-tumoural and subcutaneous administration. In one case intravenous application was part of both the induction and maintenance treatment. The first case is a 50-year-old menopausal lady with synchronous bilateral breast cancer, who had a complete response following 18 month intratumoural and high-dose application with VAE; remarkably, the untreated breast tumour completely regressed—suggesting that a systemic- and tumour-specific immune response was involved. The second case describes a 75-year-old lady who had a complete regression following 5 months of Mistletoe treatment for an axillary recurrence of Merkel Cell carcinoma. The results were unexpected and may offer guidance in developing effective strategies of neo-adjuvant immunotherapy with VAE. Primary high-dose Mistletoe induction elicits a marked local (erythema, oedema) and systemic (flu-like symptoms, high-grade fever) acute-inflammatory response. The benefits of such marked reactions, needed to initiate a joined-up innate and adaptive immune response are considered here—and it will be argued that intra-tumoural application could provide the robust priming that is required for breaking tumour escape in the host.

A preliminary study on the efficacy of medicinal plants from Sundarbans used against all forms of cancer

M.A.H. Mollik, D. Sen, A. Chowdhury, M. Badruddaza, M.S. Rahman — 2009-12-01

Sundarbans, the largest single block of tidal halophytic mangrove forest in the world, located in the south-western part of Bangladesh. It lies on the Ganges–Brahmaputra delta at the point where it merges with the Bay of Bengal. The forest lies a little south to the tropic of cancer between the latitudes 21°30′N and 22°30′N, and longitudes 89°00′E and 89°55′E. With its array of trees and wildlife the forest is a showpiece of natural history. Cancer continues to be one of the leading killers of the century. No matter how much information is gained about this dreadful and mysterious disease, it still haunts the imagination of humanity, which continues to suffer from its relentless attack. Despite the huge advancement in science and technology: its new age and all-round research breakthroughs involving billion dollar marketing of its new generations of drugs, this disease still continues to wreak havoc among the lives of millions of people across the world, particularly among the less privileged lots. We conducted an ethnobotanical survey amongst the traditional healers in Sundarbans area of Bangladesh and noted that their formulations contain a number of medicinal plants not usually used by traditional healers in other regions of Bangladesh. Plant specimens as pointed out by the traditional healers were collected and identified at the Bangladesh National Herbarium. These plant species (with family name given in parenthesis) included Leonurus sibiricus (Labiatae), Croton tiglium (Euphorbiaceae), Zizyphus mauritiana (Rhamnaceae), Swertia chirata (Gentianaceae), Vitex negundo (Verbenaceae), Carica papaya (Caricaceae), Kaempferia galanga (Zingiberaceae), Jatropha gossypifolia (Euphorbiaceae), Wedelia chinensis (Asteraceae), Randia dumetorum (Rubiaceae), Streblus asper (Moraceae), Acanthus ilicifolius (Acanthaceae), Hygrophila auriculata (Acanthaceae), Mucuna pruriens (Leguminaceae), Withania somnifera (Solanaceae), Morus alba (Moraceae), Pilea microphylla (Urticaceae), and Piper betle (Piperaceae). It was clearly observed that medicinal plants from Sandarbans did have a positive healing effect upon many cancer cases. It was also shown to produce some encouraging effects in terms of several important factors like: delaying the tumor progression, pain reduction, enhancing the immune response and life expectancy, and over all well-being of the patients. Project support received in part by the Peoples Integrated Alliance and SHACO-Health & Education Society.

Mistletoe therapy as a therapeutic option in a child with lymphomatoid papulosis/CD 30-positive cutaneous lymphoproliferative papulosis

G. Kameda, K. Michael, A. Längler — 2009-12-01

Lymphomatoid papulosis (LP) is a very rare skin disease in childhood within the spectrum of the CD30-positive lymphoproliferative disorders. The cause of the disease is unknown. Sometimes the disease resolves spontaneously, but also malignant courses are possible, either as a cutaneous or systemic CD 30-positive anaplastic large cell non-Hodgkin lymphoma. In adults between 5% and 20% of the LP-patients develop malignant lymphomas. In children the experiences are limited, but the overall survival seems to be excellent and similar to adults . Different therapeutic regimens are performed. Besides watch-and-wait therapy, topical steroids or PUVA therapy also low-dose methotrexate therapy are treatment options.A 12-year-old girl with weight loss, swelling of the lymph nodes and general weakness was admitted to our integrative pediatric oncology department. Also small erythematous and violaceous papules over the whole body were seen. In the diagnostic the ESR and CRP were elevated and an infectious or autoimmune etiology were ruled out. In MRI the patient showed enlarged left cervical and left axillary lymph node regions. An open biopsy of the suspected lymph nodes and skin-lesions, including bone marrow puncture were performed. The immunhistochemical examination of the lymph nodes showed a malignant ALK-negative CD 30-positive lymphoma. But the immunhistochemical examination of the skin diagnosed a lymphomatoid papulosis. The bone marrow-smear did not show evidence for malignant infiltration.On the basis of the diagnosis lymphomatoid papulosis with involvement of the lymph nodes in a clinical stable patient without strong evidence of a malignant disease and based on experience of a second patient with LP and lymph-node-involvement, a therapy with a mistletoe-preparation intravenously was initiated . We escalated the dosage over 3 days given once per day as an infusion over 3h. After the third day we continued mistletoe treatment subcutaneously 2 times per week. On the fourth day after beginning of the treatment the size of the cervical lymph nodes were decreasing and new papules were not seen any more. After 1 week of treatment the patient was discharged with almost normal blood samples. Four weeks after starting of the treatment all skin and suspected lymph nodes were vanished, proven by clinical examination and ultrasound. During the follow-up ultrasound was done every month and MRI of the lymph nodes was performed every 3 months. Six months after diagnosis the patient is in a stable remission. The therapy with mistletoe is continued twice per week.In conclusion we present a patient with a rare skin disease (LP) with lymph node involvement who is successful treated with mistletoe as a new promising therapeutic option for patients with lymphomatoid papulosis. Further studies should be initiated.

Portuguese physician and pharmacist attitudes towards the use of herbal complementary and alternative medicines in oncology

E. Mendes, M.T. Herdeiro, A. Figueiras, F. Pimentel — 2009-12-01

Background: Complementary and alternative medicines (CAM) are becoming extremely popular among health products consumers and patients in Portugal.Although many forms of CAM pose no risk or a minimal risk to consumers and patients, others make use of some herbal substances and preparations containing ingredients known to be toxic, genotoxic and carcinogenic, which may become reasons of concern at specific levels of exposure.The use of herbal complementary and alternative medicines is growing among Portuguese cancer patients, contributing to a higher risk for unwanted interactions, especially due to the narrow therapeutic index of most oncolytic drugs.Although physicians and pharmacists are becoming aware that patients use some forms of CAM, few discuss these therapies with them. Therefore, it is very important to assess both physicians and pharmacists familiarity with most commonly used forms of CAM and to evaluate their attitude towards its use by cancer patients. Unfortunately, in Portugal, no questionnaires have been developed to measure this topic.Objective: Evaluate the reproducibility of ad hoc designed questionnaires.Methods: Questionnaires were separately constructed for physicians and pharmacists. Both included 3 questions related with 15 most common CAM therapies and 1 set of questions related with phytotherapy.To assess reproducibility, each questionnaire was used in a pilot test. One pilot test was performed at the Hospital Infante D. Pedro (Aveiro) on a sample of 15 doctors and the other was performed at 8 pharmacies in the surrounding area of the Hospital, on a sample of 15 pharmacists. The questionnaires were administered twice, with 3 weeks interval. The questionnaires reproducibility was assessed using Cohen's kappa coefficient.Results: Kappa values obtained in the pilot studies were above 0.6 for the majority of the questions, revealing a substantial degree of agreement.Conclusion: The level of reliability estimated suggests that physicians and pharmacists familiarity with CAM, and attitude towards its use by cancer patients, can be adequately measured by the developed questionnaires.

Complementary treatment with plant food constituents—Powerful or harmful?

J. Hübner — 2009-12-01

Question: Food and pharmaceutical industry are promoting complex preparations from fruit and/or vegetables and single preparations with high doses of flavonoids and other substances. Vegetables like tomatoes which are enriched with lycopene are designed. The question is which strategy to recommend to the general population or to our cancer patients.Methods: This overview of the literature will focus on the 6 most promising plant food constituents: the flavonoids quercetin, resveratrol and EGCG, the isoflavone genistein, the carotinoid lycopene and curcumin from curcuma longa. Three topics are regarded: prevention, antitumoral effects and side effects.Results: For most of the discussed substances we do not know how much we consume with a healthy diet. Only few data on pharmacokinetics are known. Some substances seem to have special effects like genistein. This phytoestrogene is an example of a substance that seems to be useful in general but perhaps not in every situation. Its action is different in men and young women compared to older women with breast cancer. Whereas soy products are a healthy part of diet, isoflavones in greater concentrations are not recommended for women with breast cancer because of growth promoting effects. Interesting but still preliminary data are found for BRCA 1/2 positive cancer.Another concern is the question of dose and overdose which is accentuated by the lack of data on pharmacokinetics. Quercetin given at 2-fold concentration turns from a preventive to a toxic substance and may even induce tumors. Without exact data on bioavailability and normal dose preparations consumed by people may do more harm than good.Curcumin is tested as antitumoral substance and many patients are taking tablets with curcumin during chemotherapy or targeted therapy. We do not know much about interactions and these data mainly come from preclinical experiments. When using this substance as complementary we should look at consequences on the success of our therapies and we have to ask for data on primary endpoints like disease free and overall survival before giving recommendations for usage.Resveratrol is a most interesting molecule and two recent publications have provided (contradictory) first facts concerning its different effects on tumor cells with p53 wild type or mutation. While we have learned to take into consideration predictive factors and to plan studies with translational subquestions in conventional medicine we still seem to believe that natural substances will fit for any tumor situation. Perhaps important effects of these molecules are missed in studies because we do not plan targeted.Conclusions: In the presentation data concerning prevention, antitumoral therapy and side effects for each substance will be presented distinguishing epidemiological, experimental and clinical reports. Some suggestions on how to go on with clinical studies will be given.

Integrated treatment of cardiovascular common pathologies with conventional pharmacological therapy integrated with a typical remedy of anthroposophic medicine, Cardiodoron (Onopordon/Primula comp)

E. Mariani, C. Donarini, D. Grampella, T. Guerrerio, G. Landoni, E. Portalupi — 2009-12-01

Anthroposophic medicine (AM) in Italy is mostly practiced in private settings: practices, multidisciplinary day-centers and a thermal clinic. In the General Medicine Department of the Istituto Clinico San Siro (ICSS), in Milan, AM has been used since 2000 in an integrated context, as a complementary or alternative treatment to conventional therapies.The department has one ambulance and 10 beds and treats acute, subacute and chronic orthopedic, postoperative, cardiovascular and oncological pathologies. Approximately 250 patients are treated each year. ICSS is a private clinic operating under a convention with the Italian NHS. The department medical team practices also anthroposophic medicine.At the beginning of XX century, the typical remedy Cardiodoron (a special composition of Onopordon acanthium, Primula officinalis, Hyoscyamus niger) was introduced in the context of AM for regulating cardiovascular system. Typical remedies have been conceived as image and support of the healthy balance of an organ, or an organ system or of a human complex function. In the ICSS department, patients with diagnose of heart failure, arrhythmia and hypertension, after giving their consent, receive systematically also oral Cardiodoron as a long-term regulating treatment. Since 2000, over 2000 patients have been treated and registered in the department. Both conventional and anthroposophical treatments are paid by the Italian NHS. The compliance to AM is high.To have an assessment of Cardiodoron use, 30 records of inpatients with heart failure (NYHA II/III) from period 2002 to 2003 have been randomly selected and statistically analysed in a pilot epidemiological–clinical observational study.The 30 patients (19 female, 11 male), mean age 78.9–78.5, respectively, were monitored with instant and Holter ECG, arterial pressure and cenesthesis. Improvement of these parameters and a quick disappearance of fear and anxiety were reported in all patients. In the present study, it was not possible to differentiate the effect of conventional and anthroposophical treatments, administered together. The hypothesis is of an optimising therapeutic effect of conventional therapies given by Cardiodoron.The department records since 2000 are being included in a database in order to have an overview of the value added of Cardiodoron treatment. Preliminary results will be presented.

Systematic review of women's knowledge of warning signals and risk factors of stroke

N. Stroebele, F. Müller-Riemenschneider, C. Nolte, S. Willich — 2009-12-01

Effective stroke risk reduction also depends on the public's knowledge of stroke. To determine people's knowledge of stroke and possible gender differences in knowledge of stroke warning signals and risk factors a systematic review of the literature was conducted. Studies published up to August 2008 were searched using MEDLINE and EMBASE. Studies were eligible if the research question addressed stroke knowledge, if results were reported separated by gender (or women only), and if they focused on adult populations. In total, 2158 studies were identified and 22 studies (20 cross-sectional, 2 longitudinal) were included in the review. Overall, there seems to be only inadequate knowledge of both warning signals and risk factors in the general population of various countries including but not limited to the US, Australia, India, Ireland, Germany and Spain. Knowledge of stroke risk factors appears to be especially limited. Women appear to be better at recognizing and naming warning signals as well as risk factors compared to men. Eight out of 15 studies reported better knowledge of warning signals in women. For risk factors, 8 out of 18 studies reported no gender differences whereas 4 studies reported a better knowledge in women. In addition, younger women as well as women with lower socioeconomic status seem to show a lack in knowledge in both warning signals and risk factors for stroke. Successful strategies for increasing stroke knowledge in the general population and especially in women with limited knowledge are urgently needed to improve prompt medical attention and to decrease the global stroke incidence.

Effectiveness and tolerability of the homeopathic treatment Vertigoheel for the treatment of vertigo in hypertensive subjects in general clinical practice

E. Seeger-Schellerhoff, M. Corgiolu — 2009-12-01

Background: Vertigo is common in hypertensive subjects, particularly the elderly. The effectiveness and tolerability of the homeopathic preparation Vertigoheel for the treatment of vertigo was studied in elderly hypertensive subjects in daily clinical practice.Methods: Prospective observational study conducted in 106 general practices in Germany. Subjects were aged >50 years, with vertigo and diagnosed history of hypertension (ICD10 code). Vertigoheel was given as a monotherapy ⩾3 tablets per day, with scope for changes to the daily regimens at the discretion of the treating physicians. The total observation period was 9 months. Effectiveness was evaluated by physicians and patients every 3 months on overall symptomatic improvement (Likert scale) and on the number, duration and intensity of attacks.Results: A total of 493 hypertensive subjects were included in the effectiveness and the safety populations. The mean period of observation was 9.1 months. Most subjects (72%) were women. The mean age was 75.9±9.3 years and mean BMI 27.2±4.1kg/m2. One-third (34%) of subjects were on a high-fat diet and 13% were smokers. Mean systolic blood pressure (SBP) at baseline was 141.7±15.2mmHg and mean diastolic BP (DBP) 82.2±8.8mmHg. Less than 5% of subjects received concomitant therapy for arteriosclerosis-related vertigo. At the end of the observation period clinically relevant symptomatic improvements were reported for 82% of subjects. The mean number of daily vertigo attacks was reduced from 3.4±2.3 at inclusion to 1.4±1.3 at the last visit. At baseline, 80% of vertigo attacks lasted >2min; this was reduced during the study to 26% of all attacks at the last observation. The average intensity of the attacks (on a scale from 0 to 4, where 0 is asymptomatic) was reduced from 2.3±0.7 at baseline to 1.0±0.7 at the end of the observation period. The majority of physicians (87%) as well as of patients (90%) judged the overall effectiveness as ‘very good’ or ‘good’. Treatments were well tolerated.Conclusions: Vertigoheel appears to have positive effects on vertigo in hypertensive patients >aged 50 years. Given its good tolerability Vertigoheel could be particularly beneficial for treating vertigo in an elderly population with a diagnosis of hypertension and further concomitant diseases.

Medicinal plants from Sundarbans used for the prevention of cardiovascular diseases: A pragmatic randomized ethnobotanical survey in Khulna division of Bangladesh

M.A.H. Mollik, M.R. Faruque, M. Badruddaza, A. Chowdhury, M.S. Rahman — 2009-12-01

Khulna division of Bangladesh has cool and salubrious climate that favor the growth of diversity of medicinal plants. For the reason that in the south-western part of Bangladesh, in the districts of Khulna, Satkhira and Bagerhat lays the Sundarbans, the beautiful forest. About 33 medicinal plants being used by Khulna division as folk medicines have been identified and documented along with their curative properties for the treatment of cardiovascular diseases. Use of medicinal plants and cultural ethics are closely linked among the Khulna division and they possessed high conservative and descended through generations. They keep outmost secrecy of the curative properties of the plants in the form of oral and traditional ethics which help in the conservative management of rare and endangered medicinal plant species of the Khulna division. Most of the medicinal plants are herbs followed by shrubs and a few trees available at different seasons of the year. Plant specimens as pointed out by the traditional healers were collected and identified at the Bangladesh National Herbarium. These plant species (with family name given in parenthesis) included Siegesbeckia orientalis (Asteraceae), Terminalia catappa (Combretaceae), Typhonium giganteum (Araceae), Punica granatum (Lythraceae), Bacopa monnieri (Scrophulariaceae), Nymphaea nouchali (Nymphaeaceae), Adiantum capillus-veneris (Pteridaceae), Carica papaya (Caricaceae), Portulaca oleracea (Portulacaceae), Dipterocarpus turbinatus (Dipterocarpaceae), Terminalia belerica (Combretaceae), Rosa damascene (Rosaceae), Cycas rumphii (Cycadaceae), Polygonum minus (Polygonaceae), Terminalia arjuna (Combretaceae), Enydra fluctuans (Asteraceae), Sida cordifolia (Malvaceae), Euphorbia antiquorum (Euphorbiaceae), Nerium indicum (Apocynaceae), Aegle marmelos (Rutaceae), Heritiera fomes (Sterculiaceae), Passiflora coccinea (Passifloraceae), Lepidagathis hyalina (Acanthaceae), Putranjiva roxburghii (Putranjivaceae), Nigella sativa (Ranunculaceae), Corchorus capsularis (Tiliaceae), Setaria italica (Graminaceae), Citrullus vulgaris (Cucurbitaceae), Cicer arietinum (Leguminosae), Mangifera indica (Anacardiaceae), Swertia chirata (Gentianaceae), Zingiber officinale (Zingiberaceae), and Phyllanthus niruri (Euphorbiaceae). These medicinal plants can be sources of further scientific studies towards discovery of newer and more effective drugs. Project support received in part by the Peoples Integrated Alliance and Biogene Life Care.

Primary prevention of stroke in women: A course concept and its feasibility

C. Bürger — 2009-12-01

Background: Cerebrovascular diseases, mainly strokes, are one of the most frequent causes for mortality worldwide and one of the causes for persistent disability and reduced quality of life. Studies focusing on the gender differences regarding cerebrovascular diseases have shown a higher lethality as well as limited functionality in women compared to men. Women participate more in health promotion and prevention programs.Objective: Regarding these outcomes a course concept for primary prevention of strokes in female high-risk patients has been developed. Its feasibility has been tested in two groups of women focusing on the evaluation of the course by the participants and changes in their risk behaviour regarding stroke because of the participation in the course.Method: The development of the 12-week-course-program based on well-known risk factors for stroke, which can be affected by changes in life style: stress management, relaxation, nutrition, exercise and, above all, adherence to medication. Twenty-four women 50 years and older participated in two groups. Laboratory and physical parameters, which might influence the stroke risk has been obtained before the beginning and after the ending of the course. In addition information on nutrition and smoking status as well as the German Diabetes Risk Score (Dife), the International Physical Activity Questionnaire, the Health Survey (SF-12), the short form of the Patient Health Questionnaire (PHQ-D) and the Cohen Perceived Stress Scale were collected at these two measuring times as well as 3 months after the ending of the course.Results: Results of the qualitative and quantitative analyses of the mentioned methods will be presented.Conclusion: On the basis of the results modification of the course concept will be made if needed and the prevention course will be realized in target populations, which are not easy to reach for primary stroke prevention.

A comparison of intima-media thickness of common carotid artery in diabetic and non-diabetic patients who refer to the Radiology Department of Poursina Hospital in Rasht City in 2008

M. Banijamali, N. Rahman Amlashi — 2009-12-01

Background: Diabetes mellitus is a common disease. Vascular complication of that can affect carotid artery with formation of atherosclerosis.Aims: As in Iran the ages of diagnosis is higher than in the rest of the world the complications are seen more. So screening of diabetic patients for decreasing the mortality and morbidity seems to be mandatory. The aim of this study is to compare the IMT of common carotid artery in diabetic and non-diabetic patients who refer to the Radiology Department of Poursina hospital in 2008.Material and method: This is a cross-sectional study. There are 80 participants (40 diabetic, 40 non-diabetic) in our study which is matched for age and gender. IMT of distal carotid was measured. t-Test and ANCOVA were used to data analysis.Results: Diabetic patients had significantly higher IMT than non-diabetic (0/97 vs 0/63) (CI95%:−0/2 to −0/47, p-value<0/001). Age and gender are the variables which had significantly positive effects on increasing IMT in diabetic patients (CI95%:0/003 to −0/017, p-value<0/005,CI95% −0/025 to −0/287, p-value<0.05, respectively). With increasing of the length of being diabetic, IMT significantly increases (CI95%:0/07–0/55, p-value<0/05). Past medical history of CVA and CAD were significantly associated with increasing IMT in diabetic patients (p-value 0/027 and 0/019, respectively). Other confounding variables such as cigarette smoking, HTN and HLP were not significantly associated with increasing IMT in diabetic patients.Conclusion: Measuring of IMT of carotid artery by sonography is a useful tool for screening of diabetic patients. It needs more study for determining how to use these measurements in promoting the patients outcomes.

Role of Homoeopathy in the treatment of cases of heartburn with the help of different repertory and Materia Medica Pura

M. Jani — 2009-12-01

Following medicines are most frequently used in different sensation with heartburn.Here, my conclusion is that rubric heartburn is not complete in the sensation of heartburn is concern, because many repertories are successful to cover modalities but all repertories fail to note down different sensations or pains of heartburn. Different types of pains are given in our Meteria Medica Pura.Short list of different sensations or pain in throat during heartburn is given bellow.Burning—Incomplete burning eructation rise only to pharynx, there burn for hours. Lyc. (Boericke).Contracted—In Bell. esophagus dry; feels contracted (Boericke).Choking—In Pulsa. choking pain in the oesophagus, as if a large lump of new backed bread had been swallowed (M.M.Pura).Pricking—In Rhus. tox. when swallowing and yawning there is a prick in her throat, as if she had swallowed a needle (M.M.Pura)Scraping—In Nux. vom. Scraping in the throat at the opening of the larynx as after rancid heartburn (M.M.Pura).Splinter—In Arg. nit. Paroxysms of cramp in the oesophagus. Sensation of a splinter in throat on swallowing (Beoricke).Excoriation—Ars. alb is useful in case of gulping of acid and bitter substances which seems to excoriate the throat (Boericke).Advantages of pain or sensation in heartburn are to complete the symptoms and to give super advantages over prescribing only with modalities.

Changes of blood flow volume in the superior mesenteric artery and brachial artery with abdominal thermal stimulation

2009-12-01

Background: In traditional Chinese medicine, moxibustion is a local thermal therapy that is used for several conditions. Quantifying the effects of moxibustion therapy has been difficult because the treatment temperature depends on the physician's experience, and the temperature distribution in the target area is not uniform.Aims: This prospective observational study aims to quantify the effect of local thermal stimulation to the abdomen.Methods: We developed a heat transfer control device (HTCD) for local thermal stimulation. Twenty-four healthy subjects were enrolled and they underwent abdominal thermal stimulation to the para-umbilical region with the device for 20min. Blood flow volume in the superior mesenteric artery (SMA) and brachial artery, the heart rate, and the blood pressure were measured at rest, 15min after starting thermal stimulation, and 10, 20, 30, and 40min after completing thermal stimulation. Blood flow parameters were measured by high-resolution ultrasound.Results: In the SMA, blood flow volume was significantly increased during thermal stimulation (p<0.01), as well as at 10min (p<0.01), and 20min (p<0.05) after stimulation. In the brachial artery, blood flow volume decreased at 40min after stimulation (p<0.01).Conclusions: We could quantify the effect of local thermal stimulation with an HTCD and high-resolution ultrasound. Thermal stimulation of the para-umbilical region increased blood flow in the SMA 20min after stimulation in healthy subjects.

Bioresonance therapy with children suffering from allergies—An overview about clinical reports

M. Galle — 2009-12-01

In 1976, Morell and Rasche, the inventors of the classical bioresonance therapy (e.g. MORA, BICOM, IMEDIS, HOLIMED), postulated a weak, low-frequency electromagnetic field (1–105Hz) in a human organism that was considered to induce important regulative functions. It is historically interesting that at the same time Popp and Ruth rediscovered the biophotons, an electromagnetic regulation field in the optical frequency range.In the endogenous form of bioresonance the postulated oscillations are picked up by means of hand and foot electrodes and after an electronic inversion they are transmitted back to the body for therapeutic purposes. Within the exogenous form, the postulated oscillations of bio-active substances are transmitted after an electronic inversion (e.g. allergens) or amplification (e.g. nosodes) for therapeutic purposes in the human organism.For about 30 years the exogenous bioresonance therapy has been used for therapy with children all over the world who were suffering from allergic diseases (e.g. bronchial asthma, allergic rhinitis, eczema).As a summary and for the evaluation of clinical results in bioresonance therapy reports we have the following literature available: nine non-controlled and five controlled clinical studies, which give clear evidence of the clinical effectiveness in allergy therapy with children. These trials were carried out by physicians and scientists in universities, hospitals and medical practices all over the world.The nine non-controlled (1050 patients) and three controlled studies (537 patients) are unrestrictedly positive according to the author's report. Two controlled studies (74 patients) had been evaluated negative according to the author's conclusion. However, even in these reports there is some evidence of the clinical effectiveness of bioresonance therapy.Particularly remarkable in the results is the clear and strong dependence of the effectiveness with respect to the age of the probands in the trials. The younger the probands, the higher the effectiveness of bioresonance therapy.In each trial no side effects were observed.Conclusion: The greater majority of the performing scientists and physicians believe – on the basis of their investigations – that the classical bioresonance therapy is clinically effective in allergy therapy for children.

Homeopathic therapy in paediatrics: An observational study from 1998 to 2008

E. Rossi, P. Bartoli, M. Da Frè — 2009-12-01

Methods: An observational longitudinal study was conducted on 2141 patients consecutively visited at the Homeopathic Clinic situated at the Campo di Marte Provincial Hospital—ASL 2 Lucca from its establishment in September 1998 until December 2008, and 514 patients (24%) are below or equal to the age of 14. The homeopathic prescription strategy is to administer a single remedy and involves the initial use of the remedy in Quintamillesimal dilutions (De Schepper L. 1999) beginning with 6Q and on a progressive scale of dilutions; if there is a subsequent phase, the prescription then proceeds with a single dose according to Hahnemann's centesimal scale (CH).Treatment of acute cases generally involves the use of remedies in centesimal dilutions at low potencies (from 6 to 30 CH).Results: The most frequent pathologies observed in children are: respiratory pathologies: 303 (58.9%), mainly allergic diseases (asthma and rhinitis); dermatological complaints 90 (17.5%), mainly atopic and allergic dermatitis; psychological problems 41 (8%); digestive tract pathologies 31 (6.3%); food disturbances 6 (1.7%) and headache 6 (1.7%). A significant difference was observed in the distribution of pathologies by age. In childhood, two-thirds of the patients came to the homeopathic clinic for respiratory pathologies, compared with 25% of patients aged 15–39 and 15% of patients 40 or more. The duration of follow-up was of 1 year or greater for 50% of cases in childhood age, instead 37% for patients between the ages of 15–39 and 35% for those of 40 or above. In order to assess the effectiveness of therapy practice in pediatrician, data were collected concerning homeopathic consultations for all patients who are below or equal to the age of 14 and returned for at least one check-up subsequent to the initial visit at the clinic. The GHHOS (Glasgow Homeopathic Hospital Outcome Score) was used to assess outcome (Richardson WR 2001); whereas the degree of symptom intensity as reported by the patient and the regression after treatment (if any) were assessed by means of a numerical rate scale (NRS). The reference values of the GHHOS scale, distributed according to a Likert scale from −1 to +4, define different degrees of improvement as follows: 0=none, 1=Slight improvement, 2=Moderate improvement, 3=Important improvement, 4=Cured/Back to normal, and −1=Slight worsening. The improvement is considerably linked to age (p=0.001), the prior use of conventional therapies (p=0.008), the pathology being treated (p=0.019) and the period of follow-up (p<0.001).Conclusion: The results tend to identify greater therapeutic effect of the homeopathic treatment in young patients.

Phytotherapy in neonatology: A systematic literature review

M. Thiel, A. Längler — 2009-12-01

Background: Aim of this study was to give an overview about current Literature concerning clinical trials on phytotherapy in neonatology.Methods: A systematic review was performed in the following databases: Cochrane, EMBASE, NCCAM, NLM, DIMDI, CAMbase and Medline as well as the Journal archives of Karger, Kluwer, Thieme, Springer and Merkurstab. It has been searched for clinical controlled studies concerning phytotherapy in neonatology.Results: In total 9 articles that matched the study criteria were found:1 randomised controlled study, 7 case-control studies, and 1 observational study with control group. Topics were icterus, aromatherapy and the external use of oils.Conclusion: Indication, study design and study power of these publications were quite heterogeneous. Data about aromatherapy are most promising. Phytotherapy is used very commonly and parents ask for it frequently, studies are necessary to fulfill the academic and economic demands of this part of CAM. This Literature review shows that there is a lack of sufficient data.

Effectiveness and tolerability of Euphorbium comp. SN for the symptomatic treatment of rhinitis in children aged 2–6 years

I. Urlea-Schön, M. Corgiolu — 2009-12-01

Background: Complementary/alternative medicine (CAM) is commonly used for symptomatic treatment of rhinitis. The effectiveness and tolerability of the homeopathic preparation Euphorbium comp. SN in young children was studied in daily clinical practice.Methods: Prospective observational study conducted in 25 practices (paediatric, general and internist) in Germany. Included were children aged 2–6 years, diagnosed with acute rhinitis. The treatment with Euphorbium comp. SN was administered as nasal spray dosed at 3×1 spray puffs/day. Changes in doses and daily regimens were at the discretion of the treating physicians. The observation period was 6 days. Only patients with no concomitant therapies administered as nasal sprays during the course of the observation period were included in the analysis. Effectiveness was evaluated on symptomatic improvement (Likert scale) between the time of enrolment and the last observation. Effectiveness variables were symptoms of rhinitis, overall degree of illness, improvement (yes/no) and tolerability of therapy. Effectiveness and tolerability were evaluated by the treating physicians together with parents.Results: The study included 283 subjects, 47% of which were female. Mean age was 4.1±1.1 years; height 102.7±10.6cm (range 76.0–103.0cm); mean weight 16.9±3.8kg (range 10.0–16.0kg). The mean duration of observation was 6.6 ±2.1 days. At inclusion, the mean duration of illness was 5.4±10.7 days. Doses of Euphorbium remained unchanged during the observation period in 97% of subjects. The percentage of subjects with moderate-to-severe symptoms was reduced during the course of therapy from 137 (48%) at the first visit to 18 (6%) at the final observation. No subjects had severe symptoms at the end of the observation period, down from 5 at inclusion. At the end of the observation period, the overwhelming majority of subjects (95%) were considered improved and 82% were free of symptoms. The mean lag time between the start of therapy and the first symptomatic improvement was 2.1±1.3 days. The treatment was well tolerated, with 97% of treating physicians reporting ‘very good’ or ‘good’ tolerability. This assessment was shared by 96% of parents.Conclusions: The homeopathic preparation Euphorbium comp. SN is an effective and well tolerated therapy for the symptomatic treatment of acute rhinitis in young children in everyday clinical practice.

Impact of yoga on chronic pain—A review

A. Büssing, W. Schnepp, T. Ostermann, E.A.M. Neugebauer — 2009-12-01

Purpose: Mind–Body therapies are considered as adjunctive treatments to help ameliorate or at least cope with chronic pain conditions. Despite a lack of scientific acceptance, these approaches are of interest to patients which widely use relaxation techniques, biofeedback, imagery, hypnosis, etc. We intended to analyze the scientific literature with respect to the impact of yoga on chronic pain conditions.Methods: In January 2009 we searched the databases Medline, Pubmed and CAMbase. The search terms were >yoga< and >pain<.Results: We found 15 studies which addressed the impact of yoga on chronic pain conditions. The studies enrolled patients with chronic low back pain (n=6), headache/migraine (n=2), various other chronic pain conditions (n=6), and one experimental study with healthy individuals. Fourteen studies addressed pain perception or disability, 6 mood states (anxiety/depression) and distress, and one study health-related quality of life. Nine studies were randomized, 2 controlled, and 3 had a single arm design; one study was an experimental study with yoga trained and non-trained individuals. The number of patients in the randomized or controlled studies ranged from 15 to 101. The randomized and controlled studies described positive effects in terms of decreased pain frequency and intensity, decreased anxiety/depression, and improvement of fatigue- and health-related quality of life.Conclusions: There is reasonable evidence that yoga practices may have positive effects on pain perception and mood states. The overall positive findings in the identified studies indicate that yoga may enhance patients’ self-efficacy, inner balance, adjustment and coping abilities. Nevertheless, there are several research questions, which have to be addressed in future studies, i.e., adequate control interventions; patients’ positive expectations; patients’ ability and will to change behavior, etc. Several of the unspecific effects of distinct mind–body therapies are nevertheless critical aspects (i.e., expectancy, sense of control, mindfulness, etc.) which cannot be ignored as they contribute to the intended treatment effect. Mind–body interventions such as yoga may become important adjunctive interventions in the multi-modal treatment of patients with chronic pain conditions as they foster self-control and self-management.

Chronic pain in Ayurveda Medicine and Neuroscience—An Integrative medical approach

F. Fischer — 2009-12-01

With the present work I am setting out to use an integrative medical approach to describe the perception and processing of chronic pain. Neuroanatomical and biological (neuroscience) concepts and the associated computer-controlled high-tech brain examination methods will be integrated with the concepts of Ayurvedic medicine in a complementary semantic manner.Although positron emission tomography (PET) and fMRI (functional magnetic resonance imaging) can be used to make the perception of pain in the brain visible and thus forms of mental experience can be displayed objectively as a snapshot, many questions remain unanswered. This is especially true with regards to the many individual differences in this experience of pain. The subjective analysis method of Ayurveda, which has been tried and tested for over 2000 years and is assured by its reproducible explanatory power, can contribute to comprehension here. An important part of traditional Ayurvedic medicine consists of examining the individual influences within the subjective sensation of perception (e.g. pain) with regards to personal constitution and as the consequence of personal living circumstances.Connections within the flow of bodily functions and mental processes are always described as holistic conditionalities in Ayurveda.Combining both medical approaches using existing analogies can contribute to a deeper understanding of chronic pain. This especially holds true in cases in which no findings, physical findings or tangible diagnoses accompany processing and treatment to explain the causes to physicians, therapists and, most importantly, to the patients. Acceptance and compassion often no longer take place in the world of modern medicine due to the lack of objective data.With the increasing understanding of the significance of emotional intelligence (limbic system) and the discovery of mirror neurons, we know that, with few exceptions, healing relationships depend on empathy and treatment of pain cannot be successful without care. Not only those affected by pain, but also treatment providers suffer from this.Many therapeutic options provided by Ayurvedicmedicine have to do with contact and touch, serve to strengthen inner experience and can help break through the often fatal cycle of pain and stress. I hope to make a small contribution to revealing the importance of integrative medical approaches and stimulating the dialog required for this to happen.

Pain, stress and relaxation: Involvement of basic biological principles and healthy autoregulation

T. Esch, S.M. Esch, G.B. Stefano — 2009-12-01

Trauma and stress often involve the expression of pain. In the course of traumatic and stressful events, an ‘orchestra’ of neurobiological mechanisms and signaling molecules get activated with the primary goal of ensuring survival and fighting against the perturbating event, i.e., stressor. Pain can be a major process in this phenomenon, directing attention to the initial trigger situation. It is now known that pain processes also involve local and/or systemic immune as well as cardiovascular and neuronal pathways, including proinflammtory endogenous opioid peptides (e.g., endorphins) and down-regulatory opiate alkaloids (e.g., morphine). Usually, relaxation is a result of the systemic down-regulation that occurs after stress response pathways get shut-down, following their initial induction. As pain occurs in the primary phase of this process, it gets an inhibitory push-back under the influence of endorphins and other analgetic endogenous signaling molecules in this still early, i.e., stress response-associated stage. The rationale of this phase would be that the ‘stressed’ organism chiefly fights against the stressor and then, subsequently, cares about the possible wounds and traumas acquired. These secondary processes include endogenous morphine signaling, allowing the pain to come back again, yet in an altered and more ‘distant’ way, enabling the organism to face it and decide upon necessary actions for recovery and learning. This secondary phase also reduces over-stimulation, e.g., of the immune system, involving anti-inflammation. Hence, down-regulation serves recovery, i.e., systemic back-up. Stress induction and subsequent termination follow each other automatically and naturally, i.e., ideally, therefore activating, among others, endogenous limbic reward and motivation circuitries. However, little is known about the interplay between pain perception and its relationship with catecholamine molecules other than dopamine serving as an endogenous morphine precursor. We believe that the perception of pain and the body's self-attempt to alleviate it, utilizing conventional homeostatic mechanisms, is mediated by key catecholamines, and that this effect is further modulated by nitric oxide. We further propose a paradigm which biologically links pain, autoregulation, endogenous morphine and the catecholamines together, demonstrating a complex symbiotic signalling system. Integrative, complementary and mind–body medicine would, by their nature, include this paradigm in their underlying concepts and therapeutic strategies.

How do patients choose acupuncturists? A mixed methods project

F. Bishop, Y. Massey, G. Lewith — 2009-12-01

Question: Government policy is to develop statutory regulation of complementary medicine practitioners in the UK. Acupuncturists are not yet subject to statutory regulation and hence potential patients face difficult decisions. A qualitative study explored patients’ experiences. A quantitative vignette study investigated the impact of 3 practitioner-factors (gender, training location, qualifications) and 1 patient-factor (gender).Methods: Qualitative study: 35 acupuncture patients were recruited from 7 clinics and the community (maximum variation sampling). Semi-structured interviews about their experiences of acupuncture were recorded, transcribed, and analysed using thematic analysis.Quantitative study: 83 participants imagined wanting to consult an acupuncturist for persistent back pain. They rated 8 fictional acupuncturists.Results: Acupuncture patients were concerned to find trustworthy acupuncturists and valued personal recommendations from trusted others. In the absence of such recommendations potential patients preferred female acupuncturists (F(1,76)=30.63, p<.01) with medical qualifications (F(1,76)=125.72, p<.01), who trained in China (F(1,76)=8.53), p<.01).Conclusions: People are concerned about the trustworthiness and authenticity of acupuncturists. (Potential) patients need to be clearly informed about statutory regulation and its implications, and GPs could better support their patients in choosing complementary medicine practitioners.

Application and subjective benefit of Crataegus extracts in patients with incipient heart failure with regard to performance and quality of life—A qualitative study

P.W. Guendling, E. Mesenholl-Strehler — 2009-12-01

Background: Heart failure is one of the most common and most expensive chronic diseases in western industrial countries. And it is increasing because of the demographic development. While the effect of standardized Crataegus extracts for heart failure NYHA I-II is well proven , these results do not allow detailed conclusions about how the use of Crataegus extract influences quality of life and everyday life of patients with heart failure in an early state and how its personal benefit is estimated from a patient's point of view .Methods: Descriptive interview study with 3 groups of patients with heart failure in an early stage and with vs. without intake of a standardized Crataegus extract for at least 90 days. In total 40 patients were randomised from a patients’ file of a general practitioner and in order to maximize the variance of the probability distribution another 20 patients with the same requirements were acquired by advertisement. The severity of heart failure was estimated by screenings (history, Goldman's Specific Activity Scale and NYHA criteria), pattern of utilisation and concepts of usefulness were collected by a semi-structured interview guide. Additionally the general and heart specific quality of life was evaluated by SF-36 and Kansas City Cardiomyopathy Questionaire (KCCQ) and the comorbid depression by PHQ-D.Results: The qualitative content analysis suggests that in the analysed sample CAM is applied non-specifically as well as specifically with different concepts of usefulness. Patients who take Crataegus extracts have a better general and heart-related quality of life. The complete data will be demonstrated at the congress.Discussion: Pattern of utilisation of CAM in general and of Crataegus extracts in particular are only superficially analysed. Our data show, that patients who take Crataegus extracts, have a better quality of life, which seems to be the benefit of Crataegus. This effect seems to apply all the more, as the costs for these remedies must be born from the patients themselves and so patients who suffer a lot prefer to invest in their health.Conclusion: Patients with heart failure in an early stage can estimate the benefit and the absence of side effects of Crataegus extracts. In most cases they agree to bear the costs for the medicine.

Integrative psychosomatics east–west in pain treatment

W. Maric-Oehler — 2009-12-01

Asian and western cultures have developed different concepts of the connection between body, mind and spirit strongly influenced by culture, worldview and spirit of the age. These concepts are reflected in different medical systems, their different diagnostic and therapeutic procedures.An integration process of different psychosomatic concepts is going on in east and west.In the last decades the west has become increasingly interested in the holistic/psychosomatic approach of acupuncture, Ayurveda and Tibetan medicine. After the integration of western scientific medicine China is looking more and more for western mental health strategies, respectively, for western psychotherapy and its broad spectrum of schools. Based on the different historical and cultural background the process of integration is different.In this context also the phenomenon of pain is differently understood in east and west. It cannot be separated from the laws of universe and nature as well as from the human nature.The concepts of acute and chronic pain are diverse. Chronic pain is a specific reaction and part of a long time process of imbalance in the relations between the somatic, energetic/psychic and mental level of the patient.The treatment of pain should be an integrative therapeutic setting of different biomedical and CAM strategies including diagnostics and methods of Asian medical systems, their specific psychotherapeutic settings in combination with western psychotherapeutic interventions.The concepts of Asian medical systems are opening the possibility to work out an individual and specific therapeutic setting.

Anthroposophical injectable Arnica montana extract in acute low back pain: A prospective study

2009-12-01

Acute low back pain is a common pathology, often treated with use or misuse of NSAID. NSAID are often used as over the counter medications, can have side effects and increase health costs.In anthroposophic medicine (AM), potentised Arnica montana extracts ampules are often prescribed for acute low back pain. A. montana is a trauma and pain remedy, well known in phytotherapy, traditional and homeopathic medicine. According to anthroposophical medical system, it is prescribed as a remedy against inflammation, through warmth and neurosensory organism modulation.To assess safety and effectiveness of arnica in acute low back pain, a non-randomised prospective trial was performed in the General Medicine Department of the Istituto Clinico San Siro (ICSS), in Milan, where AM is regularly prescribed as complementary or alternative treatment by the medical team, under patient informed consent, in daily practice. The study was performed in the context of the regional research program for CAM of Region Lombardy.A cohort of 30 inpatients (age 50–87), with acute low back pain and without other acute pathologies, have been evaluated with medical interviews, examination and parameters such as Schober's test and costo-vertebral mobility. They have been prospectively treated with an injectable anthroposophical potentised acqueous extract of Arnica planta tota Rh D3, administered locally subcoutaneously once a day for 6 days. After hospital treatment, the patients have been randomised in 2 groups: 15 patients (group C) did not receive any further treatment and 15 patients (group A) received further 3 months of arnica ampules treatment. The acute treatment and the consolidation treatment were well tolerated. All patients improved during acute treatment with no side effect. Patients without consolidation treatment presented again symptoms and signs after 3 months. Patients receiving consolidation treatment kept improving. Treatment with anthroposophical injectable low-potency A. montana showed to be safe, effective and cost-effective in acute and consolidation treatment of low back pain.

Sensation and perception of pain according to the theory of constitution in Tibetan Medicine

S. Maric — 2009-12-01

Based on a holistic humoral medical theory and practice, Tibetan Medicine, Sowa Rigpa, opens access to a deep understanding of specific concepts of chronic diseases. The threefold humoral theory of the interaction of wind (rLung), bile (tripa) and phlegm (bedken) can only be revealed by the core of Tibetan Medicine, its body mind concept. Constitutional weakness as well as the patient's diet and behavior play a central role in medical theory, diagnosis and therapy. The theory of constitution is an important diagnostic method to differentiate between constitutional disorders and humoral diseases.The three main constitutions in Tibetan Medicine are differentiated as follows: wind constitution, bile constitution and phlegm constitution, followed by four mixed constitutions. Constitution implies a variation of general and specific weaknesses in psychological and physical aspects. Therefore constitution also varies in the sensation and perception of pain.In Tibetan Medicine pain in general is considered as a symptom of infection or inflammation, which has heated the ‘nerves’ and blocked the local wind. That penetrates or burns the body's tissues in general and specific locations. The body consciousness perceives the pain through wind and the nervous system.The transmission of the sensation of pain is depending on the stimulation ability of the system. Wind constitutions tend to experience a strong sensation of pain, a low tolerance and hypersensitivity. Their sensation of pain underlies often changes in perception and is strongly dependent on the general current emotional and mental state of the patient. But also a pathologic sense of touch and neurological disturbances and disorders are among the tendencies of a wind constitution. The disease pattern ‘Wind in the Heart’ (Nying-rLung) exemplifies the connection between mind, wind and pain. Bile constitution has a semi-strong sensation of pain. Due to the tendency to inflammatory disorders it tends to lead to sharp pains. Migraine is a typical pain caused by bile. Phlegm constitution has a low sensation of pain and a great tolerance. Phlegm causes non-inflammatory disorders. Fibromyalgia is an example for pain resulting from a phlegm disorder.The theory of constitution is a useful tool in the patient's process of understanding and accepting his/her own disease and helpful in preventive medicine.

Quantitative sensory testing as a neurobiological tool for measuring “specific” effects of naturopathic reflex therapies in chronic pain

F. Musial, D. Spohn, G. Dobos — 2009-12-01

Evidence from recent RCTs has shown that naturopathic reflex therapies such as massage, acupuncture, Gua Sha, cupping, wet packs, etc. are helpful in reducing symptoms of chronic pain . These bodily oriented therapies are likely able to influence chronic pain not only through brain mechanisms, but also at the level of the nociceptor and the spinal cord. However, the neurobiological basis of these effects has rarely been investigated even though the accumulating knowledge of the pathophysiology of chronic pain syndromes allows for specific hypotheses.

The scientific validation of Unani Eye drop on conjunctivitis

A. Latif, A. Razique, R. Sukul — 2009-12-01

Material and methods: The scientific validation of Unani Eye drop on conjunctivitis is comprises of physico-chemical, experimental studies on animals, safety evaluations and clinical trials on conjunctivitis.The formulation of eye drop consists of the following ingredients: Results: In vitro antimicrobial activity of eye drop and standard drug in the dose and standard (Berberine) was carried out using different organic solvent systems of 10μl/disc against Escherichia coli, Staphylococcusaureus, Streptococcusmutans and Klebsiella, showed significant results.The test drug was also tested for antihistaminic activity on isolated guinea pig ileum. It was antagonized the effect of histamine on the tissue. Anti-inflammatory activity of test drug was observed in turpentine liniment-induced ocular inflammation in rabbit's eye. In anti-inflammatory activity, the signs and symptoms of ocular inflammation was subsided on tenth day in control group, whereas in test group the signs and symptoms subsided within 7 days.In the safety evaluation, no adverse effects were observed in ocular structure in rabbit's eye: cornea, iris and conjunctiva were normal.The clinical study was carried out on 60 patients of diagnosed conjunctivitis. The total therapeutic response of test drug (eye drop formulation) was shown as 93.3% in allergic, 90% in mucopurulent and 100% in viral conjunctivitis as compared with control group. In allergic conjunctivitis 66.7% cases cured, 20% cases relieved and 6.7% cases partially relieved and no response was observed 6.7% cases.Conclusions: Thus eye drop have triple action as an anti-inflammatory, antimicrobial and anti-allergic and is safe and effective in the treatment of conjunctivitis.

Therapeutic effects of mud packs on joint ailment and quality of life from patients with gonarthrosis—A controlled clinical study

P.W. Guendling, S. Schaedle, K. Jork — 2009-12-01

Background: Osteoarthritis, the early decline of a joint, is a common illness. Due to walking upright a high burden is exerted on the lower limb, which causes arthrosis especially on the knee joint. More than 90% of over 65 year olds suffer from gonarthrosis. Initial symptoms are pain triggered by motion, later on accompanied by pain at rest during the night and morning stiffness. Frequently gonarthrosis progresses in waves with acute pain attacks accompanied by restricted movements. Patients experience increasing difficulty in accomplishing activities of daily living independently, which leads to enormous social problems.While positive effects of different naturopathic treatments on pain relief and quality of life for patients with gonarthrosis are demonstrated , clinical studies to examine the effect of mud packs are still lacking, although literature on expert knowledge has repeatedly alluded to it's positive effects on joint diseases.Methods: Patients with knee ailment were recruited from a general practice and by advertisement in a daily newspaper. They were informed and randomly assigned to intervention and control group. The control group received additionally to their regular treatment a written information on special gymnastic exercises, while the intervention group received mud packs on both legs for 60min twice a week for 3 weeks (altogether 6 applications). The SF 36 was used as the main measure for the quality of life immediately before, directly after and 3 month after the end of treatment. Further measures used as a control were WOMAC-questionnaire to assess range of movement, a 10-point analogue scale for the subjective sensation of pain (in the knee joint), and the consumption of analgesic drugs.Results: Subjective as well as objective measures improved, especially the sensation of pain.Discussion: Because gonarthrosis cannot be treated in a causative manner and many symptomatic curing therapies are associated with considerable risks, a gentle, effective physical therapy is a beneficial alternative. Since cold applications of kneippism show positive effects on joint ailment , comparing the effects of both therapies in a following study might be of interest.Conclusion: Results suggest that mud packs raise the quality of life and lowering the discomfort of patients with gonarthrosis. It is an additional therapy which has low side effects.

Teaching homeopathy as part of the integrative curriculum in medical school

K. Werwick, A. Rathmann, M. Reed, M. Herrmann — 2009-12-01

Background: The project aims to improve the teaching of Homeopathy in medical school. The introduction to classical homeopathy is part of a single lecture (Natural Remedies) and the accompanying seminar in the fifth academic year. In order to deepen understanding a clinical elective in homeopathy is offered for a maximum of 15 students (a total of 54h over several weekends). It consists of the following: Introduction, basics, history, literature and the development and testing of homeopathic medicines.Summary of work: The elective was evaluated both before (past experiences and expectations of the students) and after the event (key learning and improvements of the students, as well as the need for regulation) using part standardized questionnaires (especially Likert-scale) and the results were compared. The aim was to examine the needs and interests of the students of medicine more closely.Summary of results: The majority of the surveyed students had, before the start of the course, little or average knowledge of alternative and complementary treatments. Only 14% claimed to have any significant knowledge. This was predominantly in the fields of Classical Homeopathy (23%) and Traditional Chinese Medicine (27%). Their prior knowledge was mainly acquired through their own treatment experiences, through internships or by personal study. Students felt that these areas (and also chiropractic) were the ones they were most likely to use in their future professional capacity. Knowledge of lifestyle and environment are crucial aspects in agreeing treatment plans with patients.From the post-evaluation of the elective results, it was found that the students showed much more extensive knowledge of alternative and complementary medicine than beforehand. All students demonstrated average or better abilities. Practical exercises and treatment experiences during the course were felt to contribute particularly towards improvements.Conclusions: The elective in homeopathy increased the motivation of students to continue to study and receive teaching in this field. The course was evaluated by the majority of students as good or very good. On the negative side, many felt the course to be too long in duration. Where prior attitudes were concerned some students found that they re-evaluated these, whereas others found theirs strengthened.Take-home messages: A good understanding can be gained of the field of Homeopathy, as well as increased motivation in the students. This was developed particularly through experiencing practical exercises and treatment participation.

Teaching TCIM as part of the integrative curriculum in medical school

K. Werwick, A. Rathmann, M. Reed, M. Herrmann — 2009-12-01

Background: The project aimed to improve the teaching of traditional Chinese and integrative medicine in medical school. The introduction to the basics of TCIM takes place in the context of a single lecture in the fifth academic year. In order to deepen understanding we also offer a clinical elective in traditional Chinese and integrative medicine (TCIM) for a maximum of 15 students, also in the fifth academic year. This takes place over several weekends (total 54h) and ends with an examination. The elective consists of the following: Introduction, basics, diagnostics and acupuncture.Summary of work: The elective was evaluated both before (past experiences and expectations of the students) and after the event (key learning and improvements of the students, as well as the need for regulation) using part standardized questionnaires (especially Likert-scale) and the results were compared. The aim was to examine the needs and interests of the students of medicine more closely.Summary of results: The majority of the surveyed students had, before the start of the course, little or average knowledge of alternative and complementary treatments. Only 14% claimed to have any significant knowledge. This was predominantly in the fields of classical homeopathy (23%) and TCIM (27%). Students felt that these areas (and also chiropractic) were the ones they were most likely to use in their future professional capacity. Their prior knowledge was mainly acquired through their own treatment experiences, through internships or by personal study.From the post-evaluation of the elective results, it was found that the students showed much more extensive knowledge of alternative and complementary medicine than before. All students demonstrated average or better abilities. Practical exercises and treatment experiences during the course were felt to contribute particularly towards improvements.Conclusions: The elective in TCIM increased the motivation of students to continue to study and receive teaching in this field. The course was evaluated by the majority of students as good or very good. Negative comments included the lack of structure to the seminars and the final examination.Take-home messages: A good understanding can be achieved, as well as increased motivation of students in the field of TCIM. This was developed particularly through experiencing the practical exercises and treatment participation.

Treatment of pollen allergy with Multi-Integrative Kinesiology Activity (MIKA) and voice frequency analysis (VFA) as controlling method—Controlled trial practice with 26 patients

B. Boot, H. Arno — 2009-12-01

Objective: A controlled practical study should clarify whether pollen allergy patients treated with specific immunotherapy (SIT) targeted to immunological stress response and still suffering from pollen allergy symptoms improve under treatment with Multi-Integrative Kinesiology Activity (MIKA).Method of measurement: To determine the patient's individual emotional and functional responses and their involvement in the allergy-related psycho-social environment, the diagnosis system Voice Frequency Analysis (VFA) by Heinen (Poster 84, 85 Allergo J. 16/2007, 582) was applied in addition to sensitivity- and symptom-scores.Treatment method: Multi-Integrative Kinesiology Activity (MIKA) Design of study: Treatment of 15 patients with pre-treatment of SIT and remaining symptoms. VFA-measurements: 4 weeks before MIKA, day of first MIKA, day of last MIKA, during maximum pollination in 2008 and 2009. The control groups contained 16 healthy persons and 20 pollen allergy patients after SIT treated with placebo (NaCl).Hypothesis: MIKA can significantly improve the effect of SIT and improve and stabilize the success of treatment on a 1 year basis.Discussion: The study suggests, that MIKA, which in addition to SIT concerns the patient's individual emotional and functional responses and thereby the entire internal and external milieu of the organism, stabilizes pollen allergy patients on a long-term basis. The individualized emotional–functional diagnosis by VFA is an appropriate tool to monitor this finding. The additional attention to individual emotional and functional responses – in the sense of an integrated medicine – can to be of great importance for success in the treatment of pollen allergy patients.

Treatment of pollen allergy with high-potency homeopathy C 50,000 (HP50) and voice frequency analysis (VFA) as controlling method—Controlled trial practice with 15 patients

A. Hummel, H. Arno — 2009-12-01

Objective: A controlled practical study should clarify whether pollen allergy patients treated with specific immunotherapy (SIT) targeted to immunological stress response and still suffering from pollen allergy symptoms improve under treatment with high-potency homeopathy C 50,000 (HP50).Method of measurement: To determine the patient's individual emotional and functional responses and their involvement in the allergy-related psycho-social environment (PSE), the diagnosis system Voice Frequency Analysis (VFA) by Heinen (Poster 84, 85 Allergo J. 16/2007, 582) was applied in addition to sensitivity- and symptom-scores.Treatment method: High-potency homeopathy C 50,000 (HP50) of individualized drugsDesign of study: Treatment of 15 patients with pre-treatment of SIT and remaining symptoms. VFA-measurements: 4 weeks before HP50, day of first HP50, day of last HP50, during maximum pollination in 2008 and 2009. The control groups contained 16 healthy persons and 20 pollen allergy patients treated with placebo (NaCl).Hypothesis: HP50 can significantly improve the effect of SIT and improve and stabilize the success of treatment on a 1 year basis.Discussion: The study suggests, that HP50, which in addition to SIT concerns the patient's individual emotional and functional responses and thereby the entire internal and external milieu of the organism, stabilizes pollen allergy patients on a long-term basis. The individualized emotional–functional diagnosis by VFA is an appropriate tool to monitor this finding. The additional attention to individual emotional and functional responses – in the sense of an integrated medicine – can to be of great importance for success in the treatment of pollen allergy patients.

Clinical research in CAM: Promoting dialogue between promoters and evaluators

F. Cardini — 2009-12-01

Since 2005 the Emilia Romagna Region (Italy) adopted the policy of introducing traditional/non-conventional treatments the Regional Health Service after a strict evaluation of their safety and effectiveness. In order to introduce and evaluate those treatments in a western ethno-cultural context, a strategy including a plurality of research designs is required. Increasingly often, the local Ethical Committees (ECs) had to consider and evaluate research designs and protocols on complex procedures with long-standing practice but scarce biological foundations. Intense discussion and dialogue between researchers and the ECs was and is still needed in order to develop shared knowledge and reciprocal understanding. In particular, the central role of pragmatic trials and qualitative research in CAMs’ field has to be stressed and justified. In the framework of Non-Conventional Medicines Experimental Program of Emilia-Romagna Region a parallel, challenging, educational strategy is needed and is in course, addressed to CAM researchers (about clinical research general methodology), and to Ethical Committees’ members (about the specificities of clinical research in CAM).

Peoples integrated alliance: Supplementing Bangladeshi traditional medical practice with western technologies

M.A.H. Mollik, M.R. Faruque, M.O.F. Chowdhury, M.F. Hossain, M.S. Rahman — 2009-12-01

Bangladesh is a country in South Asia. It is bordered by India on all sides except for a small border with Myanmar to the far southeast and by the Bay of Bengal to the south. Traditional medical system is part of every society. It reveals the concept of health and illness which is unique to that particular society and behavioral dimensions of the illness and health. Despite massive technological developments throughout South Asia, most medical technologies bypass the Bangladeshi nomadic population who continue to experience high levels of poor health, infant mortality and lack of access to basic health care and education. Living at high altitudes, remote from towns and villages, Bangladeshi herders and farmers maintain the traditions and cultures that have existed for thousands of years. Peoples Integrated Alliance is a registered charity in Bangladesh that aims at working with nomadic and semi-nomadic populations in the Bangladesh, namely Bedey, Garo, Santal, Manipuri, Boam, and Khashia in providing necessary health education and training. The non-political, non-religious organization works with Bangladeshi doctors in Bangladesh in creating long-term, sustainable education and training that covers mother and child health, general health and hygiene, diet and nutrition, and first aid, to nomadic communities. Following the Palli Karma-Sahayak Foundation tradition of respecting and cultivating local traditions, Peoples Integrated Alliance aims at ensuring an understanding of nomadic environments and traditions. The organization is fully aware of the socio-cultural and political implications of introducing Western medical practices and technologies to this unique culture and environment. This paper will explore these ‘risks’ – medical, social, political and environmental – through the citing of examples of the work that has already been done as well as the plans the organization has for the future. The organization believe that it is through their participation with local doctors, always starting with the principles of traditional Bangladeshi medical practices, that Western medicine will best be used to ensure nomadic survival. Now it is right time to act as there is political commitment in the country to digital Bangladesh. Prudent investment and careful planning will allow Bangladesh to achieve its public-health goals by 2030, if not by 2021. Project support received in part by the Peoples Integrated Alliance and Mohona Environment Development Society.

Inter-rater reliability in homoeopathic repertorisation and remedy selection

2009-12-01

Question: Whether different homeopaths performing a repertorisation and selecting a remedy for one and the same patient would come to analogous conclusions, and whether a respective research protocol can be standardized.Methods: Homeopathic repertorisation, i.e. the technique of finding a suitable homeopathic remedy, starts with observing a patient's symptoms. These symptoms are then compared with existing databases which were compiled by testing a remedy for its effects on healthy subjects (remedy proving). By matching the symptoms of their patient with the symptoms reported to have been provoked in healthy subjects homoeopaths are able to narrow down the number of candidate remedies (a) to a few or, in the ideal case, (b) to the one best fitting remedy (the similimum). The outcome is influenced by the therapist's experience and the quality of the databases used. The purpose of this study was to determine whether or to what degree different persons performing a repertorisation for one and the same patient come to analogous conclusions.Homeopathy students were asked to study video-documented case-takings. As a rule 8 students each studied 5 case-takings. Each student independently (a) performed his or her own repertorisation to narrow down the number of candidate remedies and (b) finally selected one single remedy. A computer-assisted repertory (Radar) comprising 4497 possible remedies was used. Inter-rater reliability was expressed in terms of Cohen's kappa (0=no agreement, 1=full agreement).Results: Conclusion: The experimental design presented here should be further investigated by experienced homeopaths.

Proposal for a comparison of relative differences in fundamental botanical homoeopathy research

P.C. Endler, A. Pfleger, K. Thieves, T. Reischl, C. Reich, H. Lothaller — 2009-12-01

Question: To standardise a statistical approach to comparing relative differences in homoeopathy research.Background: Betti et al. (1997) and Brizzi et al. (2005) reported a stimulation of the longitudinal growth of wheat stalks through treatment of the seeds with high potencies of arsenic. On replicating the experiment however, Binder et al. (2005) found a significant decrease in longitudinal growth. Hamann et al. (2003) described biphasic effects of seed germination under high dilutions of gibberellic acid.Several independent researchers working at the Interuniversity College found significantly reduced longitudinal growth of wheat stalks in groups treated with gibberellic acid 30× (stepwise diluted and succussed, 10e–30: G 30×) as compared with groups treated with water 30× (W 30×) when experiments were performed in autumn or spring. However, replications of this experiment in winter produced higher values in the G 30× groups. From this one could draw the global conclusion that the G 30× model is not reliably reproducible and that G 30× and W 30× do not differ for all data pooled.On the other hand, the data appear too well ordered to allow the conclusion that the tested substance(-s) have no effect. On the contrary, there does appear to be an effect, and it even proves to be statistically homogeneous within the individual trials.Methodological proposal: To date the results obtained with this model have been analysed by means of variance analyses comparing the growth rates under G 30× and W 30×. Variance analyses were also performed to compare growth within the individual trials and within the G 30× and the W 30× group.For future evaluations we propose using the relative difference between groups as an absolute value for the following calculations, regardless of which group showed more growth.This may permit a more meaningful interpretation of seemingly contradictory results as they are so often observed in homoeopathy research. Our interpretation of the botanical trials is that G 30× (and possibly also W 30×) gives a physiological stimulus which the organism may respond to in different directions.

Biophoton emission in high-potency research on wheat seeds models

G. Peters, R. Van Wijk, P.C. Endler — 2009-12-01

Background: Researchers at the interuniversity college for health and development Graz/Castle of Seggau, showed in a model with seeds (Triticum aestivum), that homeopathic gibberellic acid (GA3) D30 is able to influence the growth length of the seeds, which had been measured after 7 days. The inhibition or the stimulation of the growth length correlated to the time period in which the researches had been done (winter, spring or autumn).Objective: Is it possible to recognize the long-term effects from homeopathic gibberellic acid on the growth length, in very early stages, by studying coherence effects with biophoton emission measurings?Materials and methods: The biophoton emission from Triticum aestivum was measured in dry and wet conditions for different time periods. For wet conditions 4 different trigger solutions were chosen: gibberellic acid (GA3) D30, water D30, gibberellic acid (GA3) molecular and water molecular. The homeopathic agents were ultra-high dilutions above the Avogadro number to prevent molecular interactions.Results: In total 64,000 measuring points on the different samples were corrected by the background signal and evaluated. The trigger solutions showed significantly different photon emission patterns during early development.Conclusion: The results back the hypothesis, that the effects of homeopathic agents on biological systems may be recognized in very early stages by biophoton coherence measurings. The observations of the present data showed similarities with the growth length experiments, which had been done in the same time period. The wheat seed model which showed some fluctuations, has to be refined, and might thus be an interesting model for studying coherence interactions in relation to homeopathic agents. Further research is required to make the model more stable, to define his boundaries and to increase the amount of data.

Structure of S-3 medical guidelines—Implications for CAM researchers

P. Klose, W. Häuser, R. Lüdtke, F. Musial, G. Dobos, J. Langhorst — 2009-12-01

Medical guidelines are intended to guide decisions and criteria regarding diagnosis, management, and treatment. Strategy is to review, summarize and evaluate the best evidence and most current data on prevention, diagnosis, prognosis and therapy. Then the most important questions related to clinical practice are defined and all possible decision options and their outcomes are identified. There are currently about 800 German guidelines available, classified into 3 levels. Only 50 of them are of the highest, the so-called S-3 level, incorporating expert opinion on the basis of current evidence within the paradigm of evidence-based medicine.To date, Complementary and Alternative Medicine (CAM) is not yet a well integrated part of existing medical guidelines. However, responding to patient request the medical societies react to the change in medical culture, acknowledging CAM and involving CAM experts into the guideline process.The process of developing guidelines involves the identification of key search words and the search for relevant systematic reviews (SR) and publications of randomized controlled trials (RCT) in defined databases. In most cases evaluation is performed according to the 5 grade classification (1–5) of the Oxford Centre of Evidenced Based Medicine. This classification leads to the definition of the 4 grades (A–D) of recommendation. Only SR and/or RCT with an Oxford classification grade 1 can achieve highest recommendation A. During a consensus conference, evaluations and recommendations with their corresponding evidence are discussed. Several guidelines also list the strength of consensus found for each item.It is possible to integrate and incorporate CAM into medical guidelines however study quality is generally low. There are several CAM specific difficulties investigators are facing: e.g. randomization is sometimes difficult, because patients often refuse to accept the conventional treatment in the control group, and for some procedures, like acupuncture or cupping, blinding is impossible. The paper will focus on the general procedures developing guidelines and evidence grades for recommendations and discuss the particular problems of CAM research (blinding, sham procedures) and how the impact of these specificities affects their appearance in the guideline. However, the authors are convinced based on experience in several guidelines, that CAM can be successfully incorporated.

Classifying the questionnaire on self-reported autonomic regulation (aR)

2009-12-01

Objective: Our three-dimensional inventory of self-reported measures of autonomic regulation (aR) includes 18 items regarding autonomic functioning of rest/activity regulation, orthostatic-circulatory regulation and digestive regulation. aR is influenced by constitution, gender and age. It is rather stable in healthy people, yet acute and chronic diseases can reduce aR (loss of regulation). We present the results of a classification of the aR aiming for best separation of patients with various diagnoses from healthy controls.Method: We used aR data from 3 own studies: (a) 21 breast (BC) and 7 colorectal (CRC) out of 57 cancer patients, and 50 healthy controls (C); (b) 41 BC and 25 CRC patients under chemotherapy; and (c) 81 BC, 39 CRC, 55 diabetic (D), 29 coronary disease (CD), 26 rheumatic disease (R) and 31M. Hashimoto (H) patients, and 106 C. For analysis, the different diseases were assigned to 2 groups called ‘high burden’ (BC, D, R, H: low constitutional aR/high loss of regulation) and ‘low burden’ (CRC, CD: high constitutional aR/low loss of regulation), and compared against C. We performed moving threshold cut-off analyses regarding the aR scale by iteratively categorizing the data into 4 classes and calculating respective, gender-stratified χ2 test for trend statistics with regard to their frequency distributions within the 3 groups. aR cut-off thresholds yielding maximum χ2 values were selected.Results: Median (min.–max.) aR: C 43 (34–52), ‘low burden’ 43 (30–53), ‘high burden’ 40 (20–54). Cut-off analyses indicated medium aR with unclear loss of regulation or low constitutional aR starting at 46, and probable loss of aR at 39. aR values below 34 showed patient distribution patterns different from other classes with a higher ‘low burden’ proportion, which may indicate a very probable aR loss.Conclusion: The aR scale is a reliable questionnaire indicating probable loss of regulation below 34, suspected loss of aR from 39, unclear loss or lightly low constitutional aR from 40 to 47 and no constriction above 47. The possible qualitative differences between low constitutional aR and loss of aR demand further research.

Integrative medicine—Answer for burn out patients

C. Kramer, T. Doering, C. Petrynowski, S. Winter-Martin, B. Böttger — 2009-12-01

Introduction: The burnout syndrome is a highly complex constellation with emotional, mental, somatic and social deficits. A psychosomatically oriented module has been developed with the integrative medicine approach.Methodology and conclusions: In total 60 patients (36 female, 52±8.5J; 24 male, 49±5.8J.) were treated with the above therapeutical concept. Pre- and post-treatment situations were assessed on the basis of the stress management questionnaire, the Maslach inventory and a concept appraisal, which was developed specifically for this purpose. It was possible to show in a significant way that stress management and the degree of the burnout risk constellation were improved. According to the treated patients’ evaluation, the concept builds up synergistically and is profound.

Immune messengers in Neuralgia Inducing Cavitational Osteonecrosis (NICO) and systemic disease

J. Lechner — 2009-12-01

Question: In the practice of the author astounding improvements of systemic complaints which accompanied apparently rheumatic, neuralgic and other chronically inflammatory systemic diseases are consistently observed after cleaning pain-free edentulous areas of the jaw. These are marked by fatty-degenerative osteonecrosis of the cancellous bone (NICO). Where is the connection between the local surgery of the jaw bone and the systemic results?Methods of research: In order to clarify systemic interrelations of NICO, samples of cancellous bone have been extracted from six subjects. The specimens were then analyzed by bead-based multiplex technology and tested for 27 immune messengers.Results: All six specimens concordantly showed highest concentration for IL 1-ra (Interleukin-1-receptor antagonist) and RANTES. In addition, in all samples FGF-basic and PDGF-bb have been distinctly evidenced. A statistically high concentration on RANTES is noticeable here. The samples’ small distribution and specific concentration RANTES, despite the high number of 27 tested mediators, is a striking figure. The present research is the first to analyze immune messengers within the scope of a screening of processed samples of degenerated jaw bone tissue (NICO). There is no study with similar purpose known to the authors.Clinical and systemic conclusion: The author develops an immunological-based explanatory model of systemic phenomena with two case histories: one case had pain in the knee joints with previous diagnosis rheumatic arthritis and previous prescription of Prednisolon/Metotrexat. Case two had asthma with previous treatment of cortisone. After surgical cleaning of NICO jaw sites both lost symptoms and needed no cortisone any more. The author approaches to a mediator-based hypothesis of systemic-causal relations and a pathogenetic aspect of chronic-inflammatory NICO lesions based on elevated levels of RANTES: removal of NICO lesions often results in disappearance of various inflammatory symptoms in chronic diseases. Additionally proinflammatory RANTES is discussed to play a role in development of MS, cancer and as a messenger in maligne cancer metastasis. Thus NICO and RANTES give a possible complementary and integrative aspect of systemic diseases.

Hospital-to-home®-mobility supported postoperative care management for surgical wards

J. Harms, U. Ax, D. Harms, C. Kalkhoff, H.H. König — 2009-12-01

Background: To reduce costs in the inpatient sector, hospitals are tending towards reducing the duration of hospitalisation. With respect to demand- and resource-based inpatient admissions and bed-occupancy planning, patient management systems have proven their value and are established on surgical wards. Nevertheless, as the final link in the process chain, patient-centred inpatient discharge procedures are not without problems. In many cases, in the absence of provision for competent aftercare in the patient's home, the situation becomes a crisis-management scenario, particularly for post-operative surgery patients.Methods: Solutions to this area of potential conflict have been developed by hospital-to-home® mobile health services. These prototypical solutions were monitored and evaluated during clinical application at a university hospital in cooperation with and with the agreement of the regional association of doctors serving patients with statutory health insurance, in this instance under the designation Medmobil.Results: The concept developed by hospital-to-home® mobile health services enables inpatient discharge even for complicated cases where potential risk exists (e.g. with wound-healing disorders).Data: Patient recruitment n=201/6month observation period, 87% visceral- and transplantation surgery. Wound status and discharge points, 37% primary and 63% secondary wound-healing disorders. Motivation to access Medmobil service; 96% return to usual surroundings at home, 84% avoidance of unnecessary waiting time, 83% confidence in the hospital service personal and 27% personal obligations. Assessment of quality of life (SF-36). In summary, highly significant improvement in the general status (physically >mentally, p<0.001). Conclusion of hospital-related treatment by Medmobil within the 14 days service period could be achieved in 52.7% of the patients. 47.2% required ongoing medical supervision. Total amount of costs per visitation accounted 52€, in contrast to daily hospital rate of 400€. There is no fragmentation in the provision of medical care and the care requirements in the patient's home. The fragmentation of economically required and surgically necessary just-in-time care and post-operative at-home care requirements can be optimised in the interests of all parties at the end of the process chain. Under clinical conditions, the concept solution from hospital-to-home® mobile health services is primarily a patient-focused, logical outcome of the requirements of the DRG (diagnosis-related groups) system.Conclusion: The interests of the patients, the hospital owners and the insurance companies are represented. Given the positive response from patients, no obstacles exist – contrary to initial expectations – at the general practitioner level and in terms of external care services; rather, they exist primarily with respect to hospital care structures.

Stiff-Man-Syndrome: Association of an autoimmune-encephalomyelitis with endocrinopathies and organ-specific antibodies

N. Keilbar — 2009-12-01

Stiff-Man-Syndrome (SMS) is a complex neuroimmunological disease of the Central Nervous System (CNS) with endocrinological, motoric, vegetative symptoms and is associated with autoantibodies to glutamate decarboxylase (GAD). SMS and its variants, stiff limb syndrome (SLS) and progressive encephalomyelitis with rigidity and myoclonus (PERM), appear to occur more frequently than hitherto thought. The cause of SMS is unknown.In a retrospective assessment of 92 patients (1989–2005) we investigated the correlation between SMS/SLS/PERM, associated autoimmune disorders, organ-specific antibodies and immungenetic HLA-association to find out the immunological differences between SMS, its variants and GAD-Ab positive- and negative patients. In total 54 of 92 patients with SMS and its variants were associated with 96 autoimmune diseases included autoimmune-endocrinopathies, e.g. Diabetes mellitus Typ I n=40, Hashimoto Thyroiditis n=13, Vitamine B12 Hypovitaminosis n=11, Pernicious anemia n=4 and Atrophic gastritis n=4. Associated immunopathies are most presented in patients with GAD-Ab: in 65 patients with GAD-Ab appeared 83 immunopathies, 26 patients without GAD-Ab only 13. In total 70% of autoimmune-endocrinopathies were diagnosed after the manifestation of this neurological disorder.Organ-specific antibodies are more frequent in patients with GAD-Ab than in patients without GAD-Ab, e.g. beta cell antibodies were found in 23 of 40 patients with GAD-Ab, but no antibodies were found in 13 patients without GAD-Ab. Two different groups can be distinguished pathogenetic. GAD-Ab as a Master-Ab is leading the way in the diagnostics of SMS.We have observed a noticeable association of this autoimmune-encephalomyelitis between GAD-Ab and HLA-haplotypes DQB1*03, DRB1*04, DQB1*02 and DQA1*0102. This show a similarity with diabetes mellitus Type I and may represent a genetic disposition.These results show interactions between neuroimmunology, endocrinology, immungenetics. Diagnostic, therapy and treatment of these patients indicate integrative and complementary proceedings. We hope that, e.g. natural medicine, ayurveda, TCM will help to find the cause of this disease and extend the therapeutical options in the treatment of Stiff-Man-Syndrome and many other neuroimmunological diseases.

Strategies for increasing spontaneous Adverse Drug Reaction reporting rates among Portuguese pharmacists

I. Ribeiro Vaz, T. Herdeiro, A. Figueiras, J. Polónia — 2009-12-01

Background: It is well known worldwide, that Adverse Drug Reactions (ADRs) are an important cause of morbidity and mortality in developed countries. In Portugal, as in many other countries, ADR reporting rate is rather low , and as a consequence there is a lack of information being transmitted to the Medicines Regulatory Authority, which does not effectively represent the real number of adverse events.Objective: Our aim was to increase the number and relevance of ADR reporting among pharmacists, with workshops and telephone interviews.Method: We conducted a cluster-randomized controlled trial, among pharmacists working in the Northern region of Portugal.Results: The ADR reporting rate increased 3-fold as a result of this action (RR=3.22; 95% CI 95%: 1.33–7.80) compared with the control group, during the studied period. Besides, the relevance of ADR reported was also increased. In fact, serious ADR reports increased 4-fold (RR=3.87; 95% CI: 1.29–11.61) and unexpected ADR reports increased 5-fold (RR=5.02; 95% CI: 1.33–18.93), compared with the control group.Conclusions: Educational interventions are efficient in increasing the ADR spontaneous reporting rate, among Portuguese pharmacists. Among this professional group, workshops are as efficient as telephone interview to improve ADR spontaneous reporting.

Effectiveness and tolerability of Lymphomyosot N solution for injection in treating oedemas and swellings of thrombotic or inflammatory aetiology in general clinical practice

V. Moyseyenko, V. Corgiolu — 2009-12-01

Background: Complementary and alternative medications are often used for mild inflammatory disorders. The effectiveness and tolerability of the homeopathic preparation Lymphomyosot N for the treatment of oedemas and swellings of thrombotic or inflammatory aetiology was studied under conditions of everyday clinical practice.Methods: Prospective observational study conducted in 13 general and specialist clinics in the Ukraine between January 2009 and June 2009. Subjects were ⩾18 years old, diagnosed with oedemas and swellings of thrombotic or inflammatory aetiology with different localisation, mainly in lymphatic vessels and nodes, and allergic diseases. Lymphomyosot N injection solution was administered according to local prescribing information and practices (ranging from once daily to once weekly) with changes in regimens at the discretion of the treating physicians. Other therapies for concomitant diseases were documented during the course of the study. The total observation period was 8 weeks. Effectiveness was evaluated 1 week after the initiation of therapy and at the end of the observation period, with voluntary weekly interim evaluations recommended. The effectiveness variables were severity of oedema, severity of oedema symptoms, global severity of disease (pathological process), time to first global symptomatic improvement and an overall evaluation of the therapeutic effectiveness. Effectiveness was assessed on a 5-point Likert scale by the physicians together with the patients. All analyses were conducted on the effectiveness population, defined as all subjects who received treatment with Lymphomyosot N solution for injection. Tolerability was evaluated both locally at the injection site 30min after injections and globally, both on a 4-point Likert scale from ‘no issues’ to ‘severe intolerance symptoms’. Quality of life was evaluated with the EQ-5D questionnaire. Safety data were collected on all serious and non-serious adverse reactions considered related to the administration of Lymphomyosot N solution.Results: Data will be presented for ∼150 subjects. The analysis is ongoing at the time of abstract submission and all final results will be available at the time of the congress.Conclusions: The results will show whether Lymphomyosot N can be considered an effective and well-tolerated treatment of oedemas and swellings of thrombotic or inflammatory aetiology under conditions of everyday clinical practice.

Attitudes towards remedies of Complementary Medicine of pharmacy customers and pharmacists

T. Ostermann, E. Seydak-Doht, P.F. Matthiessen — 2009-12-01

Background: Remedies of Complementary Medicine (CAM) constitute a significant part of the German pharmaceutical market. This cross-sectional study intended to give a first overview on knowledge and appraisal of complementary remedies in a sample of pharmacy customers and pharmacists in Germany.Material and methods: Based on expert hearings in the run-up to the study two questionnaires for customers and pharmacists were developed. Customers and pharmacists all over Germany were asked randomly to take part in this study. From October to December 2005 a total of 1300 questionnaires then were distributed in Nordrhine-Westfalia (70%), Bavaria (10%), Saxonia (5%), Mecklenburg-Western Pomerania (5%), Schleswig-Holstein (5%) and Hesse (5%).Results: More than 75% of the customers stated to have used CAM-remedies more than once in the past. Efficacy of CAM-remedies was rated high in more than 70%, whereas 25% believed, that this kind of treatment takes longer compared with conventional medicine. The pharmacist was ranked at the first place as consultant for CAM (50%) followed by the general physician and the healing practitioner. Customers showed significant shifts in attitudes with respect to gender, age, level of education and social status. More than 80% of female, but only 50% of male customers tended to be positive about remedies of complementary medicine. Particularly participants aged between 40 and 65 years were open minded for this topic. For the pharmacists herbal remedies ranged first before vitamins and minerals and homeopathic remedies. In total 80% of the pharmacists affirmed a correlation between level of education and the interest in CAM. A similar percentage judged their advisory skills with respect to CAM as adequate and qualified. The interest in CAM was significantly higher in women and younger participants showed a greater open mindedness with respect to skill enhancement. About 90% of the pharmacists were positive about the efficacy of CAM remedies.Discussion: The area of CAM will gain in importance in official pharmacies. Therefore reliable sources of information are necessary for the pharmacist to satisfy the increasing demand on CAM. As a consequence a cross-sectional area of education in complementary medicine should be part of curriculum in pharmaceutical studies. Additionally, independent and certified continuous pharmaceutical education programs for CAM should be developed.

A systematic review of remedies and indications of the use of homeopathic Hypericum perforatum (St. John's Wort) in dental practice

C.K. Raak, A. Büssing, T. Ostermann — 2009-12-01

Objective: Homeopathic treatment in dental practice has only insufficiently been appraised. Based on the findings of a formerly conducted comprehensive literature review of case reports of homeopathic remedies in dental care , this work investigates the use of homeopathic Hypericum perforatum (St. John's Wort) in dental practice.Material and methods: The following electronical databases were used to find articles on homeopathy in dentistry: Medline, CAMbase and the electronic archives of the journals Zeitschrift für klassische Homöopathie and Allgemeine Homöopathische Zeitung (Erfahrungsschatz Homöopathie). The search terms used were homeopath* AND (dental OR dentistry) and their translations in German and French. Finally, we searched our CAM library for literature not listed in the above-mentioned databases. The results were full text-screened and filtered for the mentioning of Hypericum.Results: We found 423 citations of 89 homeopathic remedies relevant for the use in dental practice. Among these, preparations of Mercurius (37 citations; 8.7%) and Acidum nitricum (23 citations; 5.4%) were mentioned most frequently. Hypericum was only mentioned in 9 cases (2.1%). However, with 8 citations the main indication was “tooth pain (ICD10: K08.8) and unspecified haemorrhagic conditions and prevention (ICD10: D69.9; 1 citation)”. Thus, Hypericum is the most frequently mentioned homeopathic remedy for pain, in particular for preparation or grinding trauma. Surprisingly, we found a high divergence in indications of Hypericum: while case reports suggest its use in neuropathic pain conditions, studies tend to investigate the efficacy of Hypericum mainly in post extraction pain and swelling.Discussion: Although the identified case reports suggest a high therapeutic potential of Hypericum for neuropathic pain, this effect up to now was not proven in clinical studies. Based on our results, studies on Hypericum in dental care going beyond the indication of post-extraction pain are highly encouraged.

Influence of Traumeel on cultured chondrocytes and recombinant human matrix metalloproteinases: Implications for chronic joint diseases

B. Seilheimer, C. Wierzchacz, R. Gebhardt — 2009-12-01

Background: Chronic joint diseases, such as osteoarthritis, are associated with insults to articular cartilage. Imbalance between extracellular matrix production and degradation as well as defects in chondrocyte proliferation and differentiation lead to progressive degeneration of cartilage. In this study we have investigated whether Traumeel, an anti-inflammatory and wound-healing agent, affects chondrocyte proliferation and differentiation as well as activity of matrix metalloproteinases (MMPs) that are implicated in matrix degradation.Methods: Chondrocytes from porcine knee joints were cultured in agarose layers in Dulbecco's Modified Eagle's Medium (DMEM) supplemented with 10% Foetal Calf Serum (FCS). To maintain the differentiation state of the chondrocytes they were treated with collagen type II in absence of FCS. Viability and proliferation of chondrocytes upon Traumeel application in combination with transforming growth factor beta (TGF-ß) treatment were determined by MTT assay and 3H-thymidine incorporation, respectively. Levels of sulfated glycosaminoglycans (sGAG), which are characteristic of chondrocyte functional activity, were measured with the dimethylmethylene blue assay. Activities of recombinant catalytic domains of human MMPs were determined with a chromogenic assay.Results: Addition of Traumeel significantly enhanced TGF-β-induced proliferation, but did not affect basal proliferation of chondrocytes in the presence of FCS. In chondrocytes in the differentiated state, Traumeel enhanced viability of the cells and stimulated biosynthesis of sGAG. Several MMPs were screened for inhibition by Traumeel; MMP-13 was found to be most inhibited (by 30%), while MMPs-2, -3, and -9 were not affected.Discussion: While influence of Traumeel on proliferation of chondrocytes appears to be context-dependent, differentiation was supported under all tested conditions. Since Traumeel is also known to inhibit the production of cytokines which may reduce the functional capacity of chondrocytes, survival and function of these cells is likely to be improved by Traumeel on various levels. Remarkably, Traumeel inhibited MMP-13 which is closely associated with the pathology of joint destruction. Thus, Traumeel might also indirectly slow down the progression of cartilage degeneration.Conclusion: Our data suggest that Traumeel offers a potential therapeutic option for chronic joint diseases which needs to be further investigated.

Speech therapy changes blood circulation and oxygenation in the brain and muscle

M. Wolf, D. von Bonin, P. Heusser, U. Wolf — 2009-12-01

Introduction: Anthroposophic speech therapy (ATS) affects heart rate variability . The aim of this pilot study was to investigate whether ATS also affects important physiological parameters, i.e. hemodynamics and tissue oxygenation in the brain and skeletal muscle of the leg measured by near infrared spectrophotometry (NIRS).Material and methods: Seven subjects (professional speech therapists, 3 male, 4 female, age range 29–49 years) were measured during ATS. The measurement included 10min pre-baseline before reciting, 10min reciting a hexameter followed by 10min post-baseline. An ISS OxiplexTS NIRS instrument non-invasively measured oxy-, deoxy- and total hemoglobin (O2Hb, HHb, tHb) and tissue oxygen saturation (StO2). The last 5min of pre-baseline were compared with hexameter recitation and post-baseline by a paired t-test (* indicates p<0.05 and **p<0.01).Results: In the leg, the tHb and HHb concentration decreased by (mean±SEM) 1.23±0.49μM* and 0.76±0.25μM*, respectively, during the first 5min of hexameter recitation and tHb increased by 0.75±0.29μM* during the last 5min of post-baseline. All other parameters did not change significantly.In the brain during the first 5min of hexameter reciting, tHb, O2Hb and StO2 decreased by 1.01±0.36μM*, 1.16±0.32μM* and 1.22±0.30%**, respectively, and continued decreasing during the second 5min of recitation (tHb: 1.29±0.49μM*; O2Hb: 1.75±0.54μM*; StO2: 2.29±0.67%*). HHb did not change significantly during recitation. These findings can be interpreted as a decrease in cerebral blood flow.During the post-baseline in the brain tHb returned and was not significantly different from pre-baseline. However, O2Hb and StO2 remained reduced during post-baseline for the first 5min by 1.55±0.48μM* and 2.83±0.53%** and second 5min by 1.19±0.44μM* and 2.77±0.55%**, while HHb increased by 0.94±0.08μM** during the first 5min and 1.08±0.15μM** during the second 5min of post-baseline. These findings can be interpreted as an increase in cerebral blood flow to baseline levels, while oxygen consumption in the brain increases, which corresponds to activation.Conclusion: The results show that ATS leads to a decrease in cerebral blood flow during recitation and to brain activation thereafter.

Treatment of severe insulin-resistance with a 2-day oat-diet in clinical routine

R. Zerm, M. Jecht, A. Hein, E. Millet, M. Girke, M. Kröz — 2009-12-01

Introduction: The estimated prevalence of Diabetes Type 2 (T2D) in Europe is 8% with increasing tendency. Key feature of T2D is the insulin resistance (IR) which is accompanied amongst others by raised inflammation markers and increased risk for cardiovascular diseases and sleep apnoea. In Diabetes therapy, oat diet is being used since decades. Recently there has been a publication of data concerning the treatment of severe IR with oatmeal. The goal of this study is to verify feasibility within clinical routine.Methods: Retrospective assessment of data of 30 patients (13f, 17m, age 62.1, SD 15.9) with a daily insulin dose (DID) of 134 IU (SD 48.9) and HbA1c of 10.2% (SD 2.0) having been treated with a 2-day diet of 3×3 carbohydrate units of oatmeal. Mean blood glucose (MBG) and DID was measured before and during treatment as well as on day 2 and 4 after treatment.Results: Mean DID decreased from 134 IU to 96.3 (SD 41.48) on day 2 (Z=−4.52, p<0.001) and to 102.3 IU (SD 49.6) on day 4 (Z=−3.59, p<0.001) after treatment (29%, resp., 23% reduction). Simultaneously MBG decreased from 183.7mg/dl to 158.1 (day 2, Z=−2.25, p=0.025), respectively, to 152.3mg/dl (day 4, Z=−3.05, p=0.002, each Wilcoxon-rank-test). Responder-rate (defined as >20% reduction of DID) was 75% (day 2), respectively, 64% (day 4).Discussion: Treatment of IR in a clinical setting remains challenging. A recently published pilot study showed in n=9 patients 4 weeks after oatmeal diet a reduction of the DID of 47%. Pathophysiological mechanisms are unknown. Interestingly, 4 weeks after treatment there was an increase in adiponectine, a protective adipokine. The present study under everyday conditions, showed a reduction of the DID of 29% (on day 2), resp., 23% (on day 4). Responder rate was at 64%. Therefore, this diet is an effective and cheap treatment option for IR. Further studies concerning response-determining factors and pathophysiology are necessary.

The Dutch complementary and alternative medicine (CAM) protocol

R. Hoenders, M. Appelo, E. van den Brink, B. Hartogs, C. Berger, H. Tamsma — 2009-12-01

Background: There are heated debates on complementary and alternative medicine (CAM) in the Netherlands. There are also many false prejudices for and against CAM which make things more difficult.Method: A literature search through Medline, PsychLit, books, Internet resources and in-depth interviews with several experts on this subject. CAM professional rules and Dutch legislation pertaining to CAM were studied. Extensive discussions among authors followed.Results: We found nine common prejudices against CAM (the use of CAM in the population and among patients, the characteristics of users, scientific evidence for WM and for CAM, using CAM instead of or together with Western Medicine (WM), how CAM users view WM, CAM and EBM, support by large institutions) and four common predudices for CAM (natural, harmless, scientific evaluation not possible or not needed), all not correct. Based on this, the CAM protocol was created to ensure the safe and wise use of CAM within a non-academic outpatient psychiatric clinic.Conclusion: In this presentation the prejudices are negated and the CAM protocol is presented.

Case conference on integrative medicine—Results of an experiment and future perspectives of a new interdisciplinary approach

2009-12-01

Background and aim: Patients are often faced with a choice between conventional and complementary medicine. The aim of the innovative Case Conference on Integrative Medicine was to explore the interface between conventional and complementary forms of treatment and the potential of integrative approaches.Methods: An interactive case conference was held in December 2006 in Düsseldorf, Germany. Experts in conventional medicine and complementary medicine (naturopathy, Chinese medicine including acupuncture, homeopathy, and anthroposophical medicine) discussed strategies for diagnosis and treatment based on two case reports on chronic pain diseases (fibromyalgia and irritable bowel syndrome).Results: Initially, the question of definitions and of the boundaries between conventional and complementary treatment strategies was not successful. The Physicians of different medical fields proposed multimodal treatment concepts including psychosomatic intervention that allowed for the inclusion of adjunctive therapy from either realm of medicine. However, as the focus turned to the patient and his or her complexity as an individual, the different points of view were brought closer together. In this regard, the diversity of perspectives was perceived as a valuable resource for promoting individualization in medical treatment.Conclusion: The Case Conference on Integrative Medicine should serve as a model for testing similar activities in academic hospitals and establishing such approaches in routine care. This integrative strategy has the potential to improve patient care in medicine.

Water drinking cure for alleviating menopausal complaints—A randomised controlled trial

M. Ortiz, R. Stange, B. Uehleke — 2009-12-01

Question: To investigate the efficacy of drinking St. Leonhard's Water in comparison to tap water on menopausal symptoms. St. Leonhard's Water is low mineralized water from a natural fountain in the German prealp region, which claims to be beneficial in menopausal complaints.Methods: We conducted a double-blinded, randomised controlled clinical trial in 60 out-patients with a minimum score of 15 on Menopause Rating Scale II (MRS II). Patients were randomised to either drinking 2L daily of St. Leonhard's Water (verum) or 2L of tap water (control) from identical looking bottles.Main outcome parameter was the group difference of MRS II changes after 12 weeks of intervention. MRS II was evaluated every 3 weeks during intervention and at follow-up after 9 months. Secondary outcomes include the course of MRS II and its subscales and patients global assessment on change of menopausal symptoms and general well-being. Feasibility and compliance were recorded in a diary.Results: In total 59 out of 60 patients completed the study (age 54.9±5.2, range 46–67). In total 95% of the patients were postmenopausal. Mann–Whitney U test showed no statistical difference between groups. MRS II for verum decreased significantly by 42.5% (23.2±6.4–13.3±6.6; p<0.01), as well as for control by 38.3% (24.3±5.3–15.0±7.5; p<0.01). MRS II scores at follow-up remained nearly unchanged (15.1±8.7 for verum, 14.5±7.3 for control). There was no difference between groups regarding assessment of effects on menopausal complaints. General well-being differed slightly in favour of verum. Compliance and feasibility were satisfying in both groups. The average consumption of water per patient increased from 1.30L daily before to 2.04L at the end of intervention.Conclusions: The study failed to show a superiority of drinking St. Leonhard's water compared to tap water against menopausal symptoms. The sustaining alleviation of menopausal complaints found in the follow-up may be due to unspecific effects or a general beneficial effect of increased water intake. Further studies should show, if the intensity of menopausal symptoms can be influenced by fluid intake.

A gait analysis pilot study of back pain patients before and after a multimodal pain therapy

F.J. Saha, W. Kowalczyk, F. Musial, G. Dobos — 2009-12-01

Question: The current pilot study focuses for the first time on the analysis and comparison of the human gait of patients suffering from chronic low back pain (LBP) before and after multimodal therapy based on an integrative medical concept combining mainstream medicine, complementary medicine and mind–body–medicine. The aim of the study was to investigate whether multimodal intervention could influence static and gait in patients with LBP.Methods: This pilot study comprised a group of five low back pain patients. The patients were treated with an integrative medical concept, combining guideline-based conventional medicine (e.g. analgetics, physiotherapy) with complementary therapies (chiropractice, acupuncture, neuraltherapy, cupping) and mind–body–medicine. For the biomechanical measurements the three-dimensional 8-camera Vicon system (Oxford Metrics Ltd.) and complete set of the standard Plug-In-Gait marker placement was used. The measurements were carried out within two sessions; the first immediately before treatment and the second one after 10–12 days inpatient treatment. The results of the gait analysis are shown as diagrams of knee flexion/extension, hip flexion/extension, hip ab/adduction, trajectory of marker C 7 and marker T 10 with respect to pelvis fixed direction. Additionally, further gait parameters like, e.g. cadence, walking speed, step length were analysed.Results: The analysis of data collected in the gait laboratory show differences between the gait patterns recorded before and after therapy. Especially changes in the trajectories of pelvis, C7 and T10 markers as well as in knee and hip angles illustrate the beneficial influence of the therapy applied.Conclusion: The analysis of gait parameters confirms changes in gait patterns and indicates an increase in symmetrical gait and lower stride-to-stride variability as a result of the multimodal integrative pain therapy.

Impact of eurythmy therapy on stress coping strategies and health-related quality of life

J.L. Kanitz — 2009-12-01

Background: Eurythmy therapy (EYT, Greek: eurythmy=harmonious rhythm) is a mind–body therapy derived from anthroposophic medicine. EYT is an approach that allows patients to participate actively in the process of achieving balance and good health and can lead to long-term alleviation of chronic disease symptoms. However, there is a discrepancy between the prevalence of EYT use and its empirical data base regarding efficacy.The aim of this study was to investigate the impact of EYT on stress coping strategies (SCS) and health-related quality of life (hrQoL) in a controlled study with moderately stressed subjects (N=74).Participants/method: In total 55 healthy adults (age=42.2±8.2) performed 10h of EYT over 6 weeks in a group setting. Controls did not receive any intervention (n=19; age=43.6±13.7). SCS (AVEM) and hrQoL (SF-36) were assessed by questionnaire before and after the 6-week EYT intervention.The AVEM allows variable-oriented evaluation, as well as the classification of persons into four patterns of coping strategies (G, S, A, B). The distinction between these patterns makes it possible to identify problematic tendencies of professional engagement. Hypotheses were tested by multivariate analysis of variance and t-test.Results: In two of the eight functional scales of the SF-36 (“physical health”, “mental health”) a significant group×time interaction was found (multivariate F (1/74)=7.22; p<.01). A significant impact on SCS was shown in seven AVEM scales (group×time interaction: multivariate F (1/74)=4.60; p<.05). Regarding mean differences over time, significant and clinically relevant changes from baseline to follow-up of at least 5 scale points were found for “bodily pain”, “general health”, “vitality” and “mental health”, and of at least 10 scale points for “emotional role” and “social functioning” (p<0.01 in all cases). With regard to the changes in pattern affiliation, 15 out of 55 persons (experimental group) showed a positive change towards healthier and better coping patterns (AVEM).Conclusion: Significant effects concerning perceived hrQoL and SCS were found in the experimental group compared to control over time. All effects were found independently of the sociodemographic and anthroposophic background of the test subjects. Further randomised studies need to be performed to allow a causal interpretation of the positive impact of the EYT.

Water temperature affects heart rate and core body temperature during whole body immersion

S. Göbel, D. Cysarz, F. Edelhaeuser — 2009-12-01

Background: Whole body immersion (WI) is one of the oldest therapeutic concepts of medicine and still constitutes a significant role in the area of CAM as well as in rehabilitation facilities. Medical baths have strong effects on the cardiovascular regulation and the autonomic nervous system, mainly mediated by buoyancy, hydrostatic pressure and water temperature. However, scientific literature with respect to this medical practice is limited. In particular, little is known about the effects of different water temperatures on heart rate, heart rate variability (HRV) and body core temperature. Hence, we investigated the effects of WI with water temperatures of 33 and 36°C (indifferent temperature) and 39°C on heart rate, HRV and core body temperature before, during and after bathing.Methods: In total 21 healthy subjects (average age: 24.3±2.3 years, 11 female, 10 male) underwent WI with water temperatures of 33°C (WI33), 36°C (WI36), 39°C (WI39). “Dry-bath”(DB; bathtub without water to assure same body position as during WI) was used as a control. The procedure consisted of three successive intervals: 30min resting in a supine position, 20min WI and 30min rest in the supine position. The recording of an electrocardiogram was started after 20min of rest before WI. It was continued throughout the rest of the procedure. In addition, core body temperature was recorded using a rectal sensor. Here, we report on the effects with respect to the last 60s at the end of each interval.Results: During WI33, WI36 and DB the average heart rate was not affected (70.2, 74.2, and 67.2beats/min) compared to baseline before WI. Correspondingly, the standard deviation of normal-to-normal heartbeats (SDNN) did not change (68, 63, 62ms). Furthermore, the core body temperature was not affected (36.9, 37.0, 37.0°C). However, during WI39 the heart rate increased to 97beats/min and SDNN decreased to 24ms. At the same time the core body temperature increased to 37.5°C. During rest after WI39 the core body temperature stayed at 37.5°C, but the heart rate decreased to 73.9beats/min and SDNN increased to 60ms.Conclusion: WI with a water temperature of 39°C increased heart rate and core body temperature and decreased HRV. Hence, WI at this temperature induces moderate cardiovascular stress and moderate hyperthermia. Spectral components of HRV and more specific analysis of temperature regulation may reveal more subtle changes during WI at different water temperatures.

Health-related quality of life in patients with musculoskeletal complaints in a general acupuncture practice: An observational study

I. van den Berg — 2009-12-01

Question: Aim of this study was to (i) compare the HRQoL of patients undergoing routine acupuncture treatment for musculoskeletal complaints with a Dutch population sample and (ii) to investigate changes in HRQoL during the course of acupuncture treatment.Methods: We performed an observational study of 26 patients between 18 and 65 years of age in a single acupuncture practice. HRQoL was measured on eight functional domains using a RAND-36 health survey at baseline and after six and twelve treatment sessions. Baseline RAND-36 scores were compared with data from a Dutch population sample (n=1063) using t-test, and longitudinal data were analyzed using repeated measurement analyses.Results: At baseline, patients had significantly lower RAND-36 scores compared with the Dutch population sample for three domains: role-physical limitations (51.9 vs. 79.4; p<0.001), bodily pain (49.3 vs. 79.5; p<0.001) and social functioning (75.5 vs. 86.9; p=0.005). During the course of treatment, RAND-36 scores increased significantly for five domains: physical functioning (79.3 vs. 97.4; p<0.001), role-physical functioning (51.4 vs. 94.1; p<0.001), bodily pain (47.3 vs. 95.7, p<0.001), social functioning (74.5 vs. 92.0, p<0.001) and vitality (69.1 vs. 85.7; p<0.001).Conclusion: The observed improvements in HRQoL suggest a subjective, clinically relevant, benefit of routine acupuncture therapy in treating musculoskeletal complaints.

Cost-effectiveness of Breech Version by Acumoxa for women with a breech fetus at 33 weeks gestation: A modelling approach

I. van den Berg, G. Kaandorp, J. Bosch, J. Duvekot, L. Arends, M. Hunink — 2009-12-01

Question: To evaluate the effectiveness and costs of the strategies Breech Version using Acumoxa and expectant management for women with a breech fetus at 33 weeks gestation.Methods: A decision model was developed to compare Acumoxa with expectant management to rectify breech presentation, including associated events as External Cephalic Version (ECV), treatment compliance, and costs. We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds Ratios (OR) and cost differences of Acumoxa versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed.Results: The percentage of breech presentations after Acumoxa was 32% versus expectant management 53%, (OR 0.61, 95%CI 0.43, 0.83). After Acumoxa, the percentage caesarean sections was 37% versus expectant management 50% (OR 0.73, 95%CI 0.59, 0.88). The mean cost-savings per woman was €451 (95%CI €109, €775; p=0.005) using Acumoxa. Sensitivity analysis showed that if 16% or more women offered Acumoxa complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use Acumoxa. The expected value of perfect information from further research was €0.32 per woman.Conclusions: Our results suggest that offering Acumoxa to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections, and is cost-effective compared with expectant management including associated events as External Cephalic Version.

Dissimilarities in reception and development of TCM in Germany and the USA

I. Tao — 2009-12-01

Chinese Medicine has been labeled traditional in its external communication since the 1950s. It is widely thought of as a coherent, orthodox medical system that has been handed down to us in pristine and unaltered teachings. However, as Chinese Medicine is going global it is unlike orthodox teachings simultaneously adapting swiftly to local patterns of perception and interpretation, thereby being shaped into hitherto unknown forms. The globalization of Chinese Medicine produces multiple localized visions of a healing system that is permeable to external ideas and influences and very open to individual interpretations.In Germany biomedical patterns of perception and adaptation and a tendency to physiologize prevail among patients and Chinese Medical therapists whereas in the US the psychologizing of Chinese Medicine and a holistic interpretation can be observed. In this American appropriation of Chinese Medical practices psychological and spiritual elements once inherent to Chinese Medicine are reemerging.In Germany, where the acupuncturist as an independent profession does not exist and acupuncture is dominated by the biomedical establishment, practitioners have, with some variation in theoretical background and application appropriated certain aspects of Chinese Medicine into their daily practice. In acupuncture for example the great majority feels comfortable with reductionist versions of mere needling techniques and believes that this method can do completely without a complex Chinese theoretical framework.Notably, both the physiological and the psychological interpretation of Chinese Medicine do not differ in terms of outcome in the sense of being equally effective.This paper will attempt to discuss the complex process by which patients’ and practitioners’ perception of Chinese Medicine and its effectiveness are shaped by considering sociological, medical and historical factors.

Antiviral activity of a composition of Gentiana lutea L., Primula veris L., Sambucus nigra L., Rumex spec. and Verbena officinalis L. (Sinupret®) against viruses causing respiratory infections

B. Glatthaar, A. Saalmüller, J. Haunschild, A. Amon — 2009-12-01

Sinupret®, an aqueous-ethanolic extract from five plants, Gentiana lutea L., Primula veris L., Sambucus nigra L., Rumex spec. and Verbena officinalis L., is frequently used in the treatment of acute and chronic rhinosinusitis and respiratory viral infections such as common cold. To date little is known about basic mechanisms of its potential antiviral activity. Therefore experiments have been performed for the detection of its antiviral activity against a broad panel of human pathogenic enveloped and non-enveloped RNA and DNA viruses causing infections of the upper respiratory tract: influenza A virus, parainfluenza virus, human rhinovirus B, coxsackievirus, adenovirus C, and respiratory syncytial virus.Determination of virus production was performed after treatment of the infected cells with non-toxic concentrations of the commercially available product using plaque-reduction assays, analyses of cytopathogenic effects and ELISAs for viral proteins.Antiviral activity of Sinupret® could be detected independent of the type of the viruses in RNA as well as in DNA virus infected cell cultures and also against coated and uncoated viruses. A very strong inhibitory activity was obvious against adenovirus and respiratory syncytial virus infections.These results demonstrate that Sinupret® showed a broad antiviral activity which basic mechanisms are still unclear. This has to be elucidated in further studies.

Health training—A health coaching developments with integrative medicine

T. Doering, C. Zempel, M. Lieck, U. Selz, A. Schwarzl — 2009-12-01

Far-reaching changes, developments and trends can currently be witnessed in the fields of health counselling and health training. New and innovative counselling/training forms come more and more into the limelight and try to establish themselves, besides well-known and proven professions such as nutrition, exercising, relaxation, etc., as new professions in the service sector. Coaching belongs to those counselling models which are currently most under discussion. It is marked by a highly ambilvalent reputation: on the one hand, it is very successful in practice as a sound panacea that promises, to people who are afflicted with crises, rapid and professional help for self-help. On the other hand, it is looked upon rather sceptically since the term has not been defined so far; coaching has not been established qualitatively either, and it cannot be sufficiently delimitated from other forms of counselling and training. Against this background, we have undertaken an international literature research and interviewed experts and patients. Surprisingly, we found that the interviewed target groups consider the notion of health coaching as an advancement, which is understood as a multimodal setting.

Uncontrolled therapeutic observations in complementary medicine—What is the benefit?

Jens C. Türp, Christian Endler — 2009-12-01

Objective: A considerable part of articles about complementary therapies focus on uncontrolled interventions administered in the context of clinical practice. According to the therapy-related hierarchy of scientific evidence 〈http://www.cebm.net/index.aspx?o=1025〉, however, such publications are associated with a very low evidence level. Since a perceived positive therapeutic result gained after an uncontrolled intervention may be due to at least seven factors, six of which are unspecific , no conclusion can be drawn regarding a specific therapeutic effect (i.e., post hoc ergo propter hoc). Does that mean that such reports do not have any benefit?Method: A systematic search was carried out in electronic databases as well as in current textbooks on evidence-based medicine and complementary medicine. The reference lists of all relevant articles were perused.Results: The identified contributions suggest that the (anecdotal) information gained in uncontrolled therapeutic interventions may indeed be valuable, particularly in (but no limited to) the following cases:Discussion: Vandenbroucke suggested differentiating between two hierarchies of study design: one for intended effects of therapy (cf., 〈http://www.cebm.net/index.aspx?o=1025〉) and another one for discovery and studying new explanations. In the latter hierarchy, the traditional ranking of the levels of evidence is reversed: uncontrolled interventions administered in the context of clinical practice (as well as findings in patient or laboratory data and in the literature) are given the greatest importance because they may serve as catalysts for follow-up research (using the traditional hierarchy), which in turn might lead to new knowledge regarding diagnosis, therapy, and/or prevention. This double strategy may open another door towards the concept of integrative medicine.

The NADA-Protokoll-standardised groupacupunture for improvement of metal state in patients with different psychiatric diseases

A. Röbe, J. Röbe, A. Yassouridis, U. Hemmeter — 2009-12-01

Acupuncture provided for a single person is time- and cost consuming and there is less experience with acupuncture in psychiatric diseases because of the common opinion that acupuncture is not useful in acute crisis or severe phases of psychiatric diseases.In the 1970 a standardized earacupunture (NADA-Protocol) for treatment of drug addiction provided for a group setting of patients was developed and showed positive clinical effects: relief of agitation and disturbance of sleep, reduction of stress and relaxing effect for patients with different mental problems. The method is used in a group setting on dressed patients without need of any detailed diagnostic steps. Therefore it is very time- and cost effective and works also well on severe sick patients.The goal of the study was to investigate the effect of earacupunture according to the NADA-protocol on general mental state additional to usual treatment in a psychiatric day care unit with mixed patients (main diagnosis field of schizophrenia, affective disorders, especially depression, anxiety –and somatoform disorders).The treatment was done once a week in a group session. In 6 month there were treated 27 patients, total treatments 211. 15 mental state characteristics were analysed.A significant advancement was demonstrated on following mental state characteristics:Lethargy [(F(4;48)=15.03, p<0.0001], sleep disorder [(F(4;48)=7.16, p<0.0001], anxiety [(F(4;48)=6.33, p<0.0001], headache [(F(4;48)=3.95, p=0.007] and feeling cold [(F(4;48)=5.91, p=0.001]. A marginal significant advancement was demonstrated: Irritability [(F(4;48)=3.48, p=0.014], lack of concentration [(F(4;48)=3.43, p=0.015], tension [(F(4;48)=3.30, p=0.018] and sweating [(F(4;48)=2.74, p=0.039].There was shown that NADA-earacupunture is a method with no side effects and can be used for severe sick psychiatric patients. Partly significant improvements in mental state were shown, so that we considered this method as a cost-effective supplement to the basic psychiatric therapy.

Author Index

2009-12-01

Guide for Authors

2009-12-01