European Journal of Integrative Medicine

Editorial Board

2013-06-01

Editorial Board

2013-06-01

Personal budgets for patient centred care

Nicola Robinson — 2013-03-25

An innovative healthcare scheme, ‘personal health budgets’ will become available to people in England with long term health needs over the next year. Interestingly all political parties have pledged their support for this approach. Pilot projects were carried out in 64 primary healthcare trusts from 2009 which allowed people to choose between receiving standard community care as provided by the National Health Service or a budget to spend on services and goods of their choice. Individuals were aware of the amount of money available, provided with information to make informed decisions and allowed to spend on something that they felt would improve their health outcome. This also acted to empower them and engage in shared decision making, partnership and dialogue.

Patient questionnaires for use in the integrative medicine primary care setting—A systematic literature review

Jennifer Hunter, Stephen Leeder — 2013-04-08

Abstract: Introduction: Increasingly, primary care clinics are offering integrative medicine (IM). These clinics, besides treating illness, emphasise holistic health care, health promotion and enhancing well-being. However, very few such clinics are evaluating their services or patient outcomes.Methods: A systematic review was undertaken to identify, appraise and shortlist the best available patient-reported questionnaires to measure outcomes in IM primary care clinics. As well as patient health outcomes, questionnaires measuring proxy outcomes such as lifestyle risk factors, medication use and health services outcomes were included. The internet and Medline, CINAHL and Allied and Complementary Medicine databases were first searched to identify English web-databases listing potential questionnaires. Publication databases were then searched to identify questionnaires measuring underrepresented topics. Potential questionnaires were evaluated using modified guidelines from the Medical Outcomes Trust.Results: Ten web-based databases were identified that cited over 4000 questionnaires. There was a plethora of mental health and quality-of-life questionnaires from which to choose. However, individualised patient-centred questionnaires along with those measuring wellness, holistic health and health promotion/lifestyle activities were lacking. A final shortlist of 71 questionnaires met the inclusion criteria.Conclusions: The majority of the questionnaires had not been tested in the IM primary care setting. The distribution of scores of many popular questionnaires makes them useless when seeking to differentiate or detect changes and improvement in health and wellbeing in healthier populations. Further evaluation is needed to confirm their suitability.

The effectiveness of honey for the management of radiotherapy-induced oral mucositis in head and neck cancer patients: A systematic review of clinical trials

2013-02-25

Abstract: Aim: To evaluate the effectiveness of honey in the management of oral mucositis in head and neck cancer patients undergoing radiotherapy.Methods: The review of the literature was based on a keyword strategy and pre-determined inclusion and exclusion criteria. The keywords “head and neck cancer”, “radiotherapy”, “oral mucositis”, “controlled trial” and “honey” were used as search terms in the EMBASE, CINAHL, COCHRANE and PUBMED databases. The citation and reference list of the eligible articles were also screened for potentially relevant articles. The methodological quality of the selected trials was assessed by the JADAD scale.Results: In total, 5 studies met the criteria and were included in the systematic review. Three studies assessed the effectiveness of honey against other products including golden syrup, lignocaine and saline and two studies assessed the effectiveness of honey against standard treatment regimes. Four out of the five studies demonstrated significant reduction in the mucositis levels and one study reported that honey had no statistical association with less severe mucositis. Methodologically the quality of most studies was moderate due to the small sample size, which might impact upon the significance of the findings.Conclusions: Although honey appears to be a simple, affordable, available and cost-effective treatment for the management of radiation-induced oral mucositis, there is a need for further multi-centre randomized trials to validate these findings.

Does Iranian Astragalus gossypinus honey assist in healing caesarean wounds and scars?

2013-02-18

Abstract: Introduction: This study investigates the effect of Iranian Astragalus gossypinus honey on healing casesarean operation wounds and scars.Methods: A prospective randomized controlled trial was conducted involving 130 women who had required a caesarean operation. They were randomized into three groups treated in honey, placebo and control groups. The REEDA scale on the 10th and Vancouver Scar Scale on the 40th post caesarean days were used to assess overall healing and scar healing, respectively.Results: The mean healing and scar scores in honey, placebo and control groups on 10th and 40th postoperation days were not significantly different.Conclusions: The findings do not support the use of Iranian A. gossypinus honey for accelerated wound healing nor does it have a prophylactic impact on scars.

Effects of coconut water on carbohydrate metabolism and pancreatic pathology of alloxan induced diabetic rats

Prabhakaran Prabha Preetha, Vishalakshiamma Girija Devi, Thankappan Rajamohan — 2013-01-22

Abstract: Introduction: Diabetes mellitus is a chronic disease characterized by hyperglycemia and insufficiency of secretion or action of endogenous insulin. In addition to a good number of known antidiabetic drugs in the market, remedies from natural source are used with success to manage this disease because it has fewer adverse effects, potential cost effectiveness and it is easily available. Coconut water (Cocos nucifera L.) has many medicinal applications to treat metabolic syndromes including hyperlipidemia, hyperglycemia, hypertension, etc. The present study was aimed to evaluate the effects of mature coconut water (MCW) on carbohydrate metabolism in experimentally induced diabetes.Methodology: Diabetes was induced in rats by injecting them with alloxan (150mg/kg body weight) intraperitoneally. After inducing diabetes with alloxan, MCW was given (4ml/100g body weight) to rats orally for 45 days. Effects of MCW on blood glucose, glycated hemoglobin, liver glycogen, various carbohydrate metabolizing enzymes and pancreas were evaluated in normal and experimental rats.Results: Oral administration of MCW in diabetic rats showed a significant reduction in blood glucose and glycated hemoglobin levels with improvement in plasma insulin levels. Activities of carbohydrate metabolizing enzymes were higher in MCW treated diabetic rats along with increased concentration of liver glycogen. Histopathological analysis of pancreas revealed that treatment with MCW reduced the pancreatic damage induced by alloxan and stimulated β-cell regeneration in diabetic rats.Conclusion: The overall results show that MCW exert significant antihyperglycemic potential and could be developed as a potent drug candidate or nutraceutical for the management of diabetes and associated complications.

The suppression effect of Ferula gummosa Boiss. extracts on cell proliferation through apoptosis induction in gastric cancer cell line

Roghaye Gharaei, Hassan Akrami, Shafagh Heidari, Malek Hossein Asadi, Ali Jalili — 2013-02-04

Abstract: Background: Ferula gummosa Boiss. (Barije) is an Iranian endemic plant growing in the northern mountainous regions. The gum extracted from the aerial parts of the plant has been traditionally used in the treatment of wounds, stomach pain and chorea. For the first time, anti-proliferative activity and apoptosis inducing effects of ethanol extracts of the F. gummosa Boiss. leaf and flower were examined.Materials and methods: The ethanol extracts were examined for their anti-proliferative and apoptosis inducing activity in human gastric cancer cell line, AGS, using the concentrations from 10 to 70μg/mL. The anti-proliferative activity was analyzed by Neutral red and Trypan blue exclusion assays. Then apoptosis inducing effect was evaluated using DNA fragmentation test, Annexin-V colorimetric and flow cytometry assays.Results: F. gummosa Boiss. extracts inhibited the cell proliferation of AGS cell line in a dose-dependent manner with an IC50 of 37.47μg/mL for flower and 32.99μg/mL for leaf extracts. F. gummosa Boiss. extracts also induced apoptosis as shown by analysis of DNA fragmentation and plasma membrane translocation of phosphatidyl serine.Discussion: F. gummosa Boiss. extracts exerted anti-proliferative as well as apoptosis induction effect in gastric cancer cell line. Further studies are needed for elucidation of the biochemical performance details and biological activity of the extracts and its active fractions.

Phytothermotherapy in fibromyalgia and osteoarthritis: Between tradition and modern medicine

Sara Tenti, Patrizia Manica, Mauro Galeazzi, Antonella Fioravanti — 2013-01-17

Abstract: Introduction: Phytothermotherapy (PTT) is a singular treatment consisting in immersing oneself in pools of fermenting alpine grass, to exploit its heat and rich aromatic components. The efficacy of PTT in rheumatic diseases (RD) is bolstered by ancient tradition. However, there is a marked lack of clinical validation of its efficacy and tolerability in current literature. The objective of this review was to summarize the actually available knowledges on possible effects of PTT in RD.Methodology: We conducted a search of the literature in May 2012. Medline was searched using the term “phytothermotherapy” and “hay baths” in combination with “rheumatic diseases”, “fibromyalgia syndrome”, “osteoarthritis”.Results: We identified one article reporting the clinical effects of PTT in 56 patients with fibromyalgia syndrome (FMS) and 3 trials describing the results of PTT in osteoarthritis (OA). The available data demonstrate that PTT is efficacy in decreasing pain and disability and improving function in patients with FMS and OA. Furthermore, the tolerability of PTT is excellent. The actual mechanism of action of PTT is yet not completely known, although it's probably due to different combined mechanical, physical and chemical effects.Discussion: PTT could represent a useful aid in the treatment of FMS and OA. However, further studies on a larger number of patients are needed to provide more precise therapeutic guidelines on the modalities of use of PTT. Additionally, there is a need for further botanical investigations and researches on the mechanisms of actions of PTT.

Two-week aroma inhalation effects on blood pressure in young men with essential hypertension

Kayeon Seong, Jun-Hwa Hong, Myung-Haeng Hur, Myeong Soo Lee — 2013-01-23

Abstract: Aim: The purpose of this study is to assess the effects of two-week aroma inhalation on lowering the blood pressure of young patients with hypertension compared with a saline-treated control group.Participants and methods: Forty newly enlisted soldiers undergoing training before placement diagnosed with hypertension were allocated non-randomly either a 2 week-essential oil aroma inhalation (n=20) or saline solution control (n=20). Outcome measures were blood pressure, 24-h ambulatory blood pressures and pulse rate on before, days 2, 5, 9, 12, 14 and 15.Results: There were significant differences between the two groups, before treatment and 15 days after treatment, in the systolic blood pressure (SBP) (p<0.001), diastolic blood pressure (DBP) (p=0.001) and pulse rate (p=0.02). In addition, the 24-h ambulatory full-time SBP (F=6.16, p=0.02), DBP (F=7.48, p=0.01) and PR (F=4.59, p=0.04) were all significantly different between the two groups (values measured before and after the two-week treatment). When the daytime and nighttime blood pressures were analysed separately, the daytime SBP (F=4.82, p=0.03) and DBP (F=5.68, p=0.02) demonstrated significant differences, but daytime PR, nighttime BP and PR did not.Conclusion: A 2 week-aroma oil inhalation lowered the clinic blood pressures and pulse rates measured in the short-term use study. Lower SBP and 24-h ambulatory blood pressures were observed in the long-term use study.

Comparative clinical evaluation of leech therapy in the treatment of knee osteoarthritis

2013-01-14

Abstract: Introduction: Historically physicians have used leech therapy for various ailments. Hirudo medicinalis is commonly used in western countries for medicinal purpose and in other parts of the world, different species are used. In India, Hirudinaria granulosa species is used traditionally for this purpose. Although this treatment approach has been used for many centuries, there is little scientific data on its effectiveness. The aim of this study was to validate the efficacy of leech therapy in knee osteoarthritis.Materials and methods: This study was a randomized, parallel group, controlled trial with the approval of Institutional ethics committee. The total of 60 patients, 30 in each group, completed the study. The outcome measures included; Visual Analogue Scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), range of motion, 15-m walking time and knee circumference were used to assess clinical efficacy. The test group received leech therapy along with a Unani formulation. The other group (control) received the Unani formulation only.Results and discussion: The test group demonstrated highly significant improvements in evaluated parameters when compared with baseline values. Statistically significant differences were observed in KOOS total score and its sub scores (P<0.0001), VAS (P<0.0001) at the 4th week when compared with the control group. The reduction in pain, other symptoms and physical function, were observed even 4 weeks after the treatment (P<0.0001).Conclusion: The leech therapy seems to be an effective treatment for reducing symptoms of knee osteoarthritis and improving physical function with no major adverse effects.

‘New Homeopathic Medicines’ database: A project to employ conventional drugs according to the homeopathic method of treatment

Marcus Zulian Teixeira — 2013-02-11

Abstract: Introduction: Samuel Hahnemann systematized the homeopathy and the effects of the drugs on the state of human health describing a primary action of the drug followed by a secondary and opposite action of the organism. Seeking to employ such secondary action or vital reaction of the organism as a therapeutic method, he formulated the principle of similitude, namely the administration to sick individuals of the drugs that cause similar symptoms in healthy individuals. In modern pharmacology, this secondary action is known as rebound effect or paradoxical reaction of the organism. Besides causing severe and fatal iatrogenic events when appearing after the discontinuation of palliative modern drugs, the rebound effect might waken a healing reaction if the very same drugs involved are employed according to the principle of similitude.Methodology: Using as database The United States Pharmacopeia Dispensing Information (USP DI) a homeopathic materia medica and repertory with 1251 modern drugs was compiled. A third volume presents the scientific basis of the principle of similitude in accordance with the study of the rebound effect.Results: The complete database composed of three eBooks can be freely accessed at http://www.newhomeopathicmedicines.com, allowing anyone to put this proposal into practice immediately.Conclusion: In this way, the therapeutic scope of homeopathy could be broadened through the addition of hundreds of new medicines that could be employed for various diseases and various modern clinical syndromes. Further validation could be achieved by multidisciplinary collaboration.

Psychophysical scale of perception levels in neuromuscular electrical stimulation (NMES)

2013-02-20

Abstract: Neuromuscular electrical stimulation (NMES) is a physical therapy to strengthen muscles by means of electric currents and is becoming widely applied to healthy individuals, especially those involve in sports. Symmetrical biphasic rectangular currents are the most frequently used, because they have no polarity or adverse effects and are available in portable electrotherapy devices.Aim of the study: The objective of this study was to create a psychophysical scale of perception levels in neuromuscular electrical stimulation with symmetrical biphasic rectangular currents.Methodology: An observational descriptive study was performed to create a psychophysical scale, studying thresholds for sensitivity, contraction, and tolerance levels. Each of these three levels was tested in 150 healthy individuals (93 females, 57 males). Two different examiners performed a total of 900 measurements (300 per level). Single-factor repeated measures ANOVAs were performed to study between-subject and within-subject agreement in order to test the validity and reliability of the measurements.Results: Thresholds for both sexes were: sensitivity level of 6.7–7.2±1mA, contraction level of 23.2±24.6mA, and tolerance level of 42.1–43.7±2.5mA.Conclusions: This psychophysical scale of perception levels of symmetrical biphasic rectangular currents provides a valid and reliable instrument for utilization during initial NMES sessions.

Influence of general self-efficacy as a mediator in Taiji-induced stress reduction – Results from a randomized controlled trial

2013-01-14

Abstract: Aim of the study: In this study we examined the effects of Taiji on perceived stress and general self-efficacy (GSE), and investigated the mediating role of a Taiji-induced GSE increase on Taiji-related reduction of perceived stress.Materials and methods: 70 healthy participants were randomly allocated either to the Taiji intervention group or the waiting list control group. The intervention lasted for 12 weeks comprising two Taiji classes per week. Before, shortly after, and two months after the intervention, we assessed the degree of perceived stress and GSE in all participants by employing the Perceived Stress Scale (PSS) and the GSE-Scale.Results: Compared to controls, participants of the Taiji group showed a significantly stronger decrease of perceived stress and a higher increase in GSE from pre- to post-intervention assessment (PSS: p=0.009; GSE: p=0.006), as well as from pre-intervention to follow-up assessment (PSS: p=0.018; GSE: p=0.033). A mediator analysis based on a multiple regression approach revealed that a Taiji-related increase in GSE statistically mediated the reduction in perceived stress after Taiji as compared to baseline. Post hoc testing showed that the mediating effect of GSE was significant (p=0.043).Conclusions: Our findings confirm previously reported Taiji-related stress reducing and GSE enhancing effects with GSE increase mediating Taiji related reduction of perceived stress.