European Journal of Integrative Medicine

Editorial Board

2012-03-01

Reviewer Acknowledgement

2012-03-01

Editorial

Kathi J. Kemper — 2012-01-24

Welcome to this issue of the European Journal of Integrative Medicine, highlighting work on Integrity in Integrative Medicine. The words “integrity” and “integrative” share a common root, integer (Latin), meaning whole or to bring different parts together to make a whole. In the 1900s, integration took on a social connotation related to racial and ethnic desegregation, and had previously been used as a mathematical term to solve a differential equation using calculus. More recently, the field of complementary and alternative medicine (CAM) has embraced the term integrative to refer to the patient-centered use of diverse therapies, based on sound evidence, to promote optimal health and healing.

Ethical integrative pediatric care: A new perspective

David N. Gottsegen — 2012-01-25

Abstract: The practice of integrative medicine has raised new questions for medical ethicists and providers of care. These questions are complicated by the particular ethical considerations in the care of children and adolescents. Several authors have provided guidelines for the use of complimentary and alternative therapies in pediatric care. In this manuscript, typical case scenarios from the author's clinical experience provide a springboard for the expansion and modification of these guidelines. The implications for provision of optimal compassionate pediatric care are discussed.

Pediatric integrative medicine and the balance of power

Lynn A. Gershan — 2012-01-09

Abstract: The relationship between practitioner and patient in pediatric integrative medicine is complex. The balance of power, contributing factors, and suggestions for strategies are discussed.

Integrity in patients’ stories: ‘Meaning-making’ through narrative in supportive cancer care

Maggie Evans, Ali Shaw, Debbie Sharp — 2012-01-16

Abstract: Introduction: ‘Personal integrity’ refers to a ‘state of being whole, entire, undiminished’. To help patients preserve a sense of integrity, care needs to be responsive to their individual illness experience. This study explores ‘holistic assessment’, a consultation in which patients with cancer tell their illness story to a health professional who responds to the integrity of their story and the whole person, in contrast to the reductionist approach taken by specialists treating the disease.Methodology: An ethnographic study of two UK centres that provide CAM therapies to patients with cancer, using non-participant observation of thirty four holistic assessments with a maximum diversity sample of patients. Sessions were audio-recorded and transcribed. The data were analysed using a narrative approach with the support of Atlas.ti software.Results: During holistic assessment, patients told long stories about their illness experience. A typology of stories emerged: ‘factual’, ‘emotional’ and ‘moral’, with over-arching processes common to all: Loss, uncertainty and conflict, embracing or resisting change. Patients’ stories provided a ‘window’ into their inner experience, in a collaborative activity with the listener. This provided cues and information about supportive care needs and also contributed to a process of personal meaning-making for patients.Discussion: Making meaning is an important part of adjusting to a life-threatening illness. Holistic assessment allows patients to express and integrate their vulnerable self, alongside the strong image many feel the need to project in everyday life. The need for holistic assessment within mainstream care has recently been recognised in the UK.

Focus groups used to explore patients’ experience in a randomised controlled trial of traditional Chinese acupuncture for chronic stress

Weidong Huang, Judith Howie, Nicola Robinson — 2012-01-30

Abstract: Introduction: In order to investigate the effect of traditional Chinese acupuncture treatment for perceived chronic stress, a pragmatic randomised controlled pilot study was carried out. Participants were randomised into three study groups: traditional Chinese acupuncture, attention only and control. Given that this was a small pilot study quantitative data may not be enough to demonstrate significance or explain differences given the study's small sample size. Focus groups were carried out to explore and highlight the differences and similarities between individuals’ experiences.Methods: Participants were asked about their experience of two study interventions (traditional Chinese acupuncture or attention). Two facilitated focus groups were tape recorded and transcripts analysed using thematic content techniques.Results: The focus groups generated useful information on participants’ experience and responses during and after their intervention. This approach helped to define the boundaries of specific and non-specific effects of treatment and allowed the opportunity to explore the effects of the treatment on specific symptoms as well as participants’ experiences of having treatment.Conclusions: A qualitative method combined with quantitative data of an RCT provided useful information on participants’ opinions, which could help to improve practice and future research trial design as well as contributing to the evidence base.

The perceived impact of integrative medicine in a surgical department

2011-12-08

Abstract: Introduction: Integrative medicine in a surgical department is an innovative phenomenon. Patients in acute conditions are treated with guided imagery, hypnosis, acupuncture and reflexology for perioperative symptoms in the surgical department of an Israeli hospital. The purpose of this research was to inductively explore how diverse stakeholders perceive the impacts of integrative medicine.Methodology: The research was conducted in the surgical department of a public teaching hospital by means of observations; in-depth qualitative interviews with managers, physicians, senior nurses, integrated complementary medicine (CM) practitioners and patients; and analysis of electronic medical records.Results: The most prevalent CM treatments addressed pain, anxiety and nausea. Most of the patients reported improved wellbeing following the treatments. Surgeons reported heightened awareness of patients’ emotions. CM practitioners assisted surgeons and nurses by dealing with patients’ emotions and other perioperative symptoms, such as high blood pressure and urinary retention. Some surgeons and nurses reported using lower doses of analgesics. CM practitioners welcomed the opportunity of gaining practical experience and participating in team work. Disadvantages were also mentioned: some patients reported feeling no benefit; a sense of intrusion to their daily routine was reported by nurses; CM practitioners mentioned certain drawbacks associated with working in the hospital, such as low salary, feelings of marginality, and the dominance of biomedical knowledge.Conclusions: This inductive exploration paves the way for further research that should examine patients’ experiences, cost-effectiveness and means to facilitate multidisciplinary collaboration.

Introducing integrative integrated migraine care (IIMC): A model and case presentation

R. Lauche, H. Cramer, A. Paul, G.J. Dobos, T. Rampp — 2011-12-23

Abstract: Introduction: Chronic migraine is one of the most common neurological disorders. Although different complementary therapies are available, few are integrated into standard patient care.Concept: The Department of Integrative Medicine at the University of Duisburg-Essen offers integrative integrated migraine care (IIMC); reimbursed by a large German statutory health insurance company. Treatment options include complementary therapies such as Traditional European naturopathy, Traditional Chinese Medicine (e.g. acupuncture, herbal medicine) and Mind/Body therapy, delivered in inpatient, outpatient and day care settings.Cases: Three patients, treated with IIMC in the above context, are presented here. Each received different treatments to meet their individual needs. IIMC may be effective in the short term for patients who do not make lifestyle changes, and possibly effective in the longer term for those who do.Conclusion: IIMC appears to indicate positive effects for treating headache and migraine. Further studies and randomized controlled trials are necessary to confirm these results.

Effect of oriental medicine music therapy on idiopathic chronic fatigue: A case study

2012-01-04

Abstract: Introduction: Chronic fatigue is a “persistent and recurrent fatigue” that lowers an individual's quality of life. The cause and treatment of idiopathic chronic fatigue (ICF) have not been clearly established. Oriental medicine music therapy (OMMT), which is one of the alternative therapies applied to many chronic diseases, is distinct from conventional music therapies in terms of active participation and being originated from the theory of traditional oriental medicine. Many studies have shown that patients with chronic fatigue are related to hypocortisolism. Based on salivary cortisol concentration, a validated fatigue severity scale (FSS) and visual analog scale (VAS) of overall fatigue, we identified a patient who recovered from ICF with the aid of OMMT.Materials and methods: An outpatient with ICF was treated with OMMT for 40min (1 session) 3 times a week. The treatment included listening to selected music and playing a musical instrument under the direction of an oriental music therapist. Twelve sessions of treatment were conducted, with salivary cortisol concentration measured before each session. The FSS and VAS were checked each week.Results: After treatment with OMMT, the values of the FSS and VAS were significantly decreased. In contrast, the salivary cortisol concentration increased, which generally could indicate a recovery from chronic fatigue.Conclusions: This case suggests that OMMT may be an alternative treatment for ICF.

Effects of auricular stimulation on obese women: A randomized, controlled clinical trial

Chun-Ying Lien, Li-Lan Liao, Pesus Chou, Chung-Hua Hsu — 2012-03-01

Abstract: Aim of the study: To investigate the therapeutic effect of different auricular acupoint stimulations on obese women.Methodology: The subjects who met our inclusion criteria were randomly allocated to receive auricular stimulations by needles or metal beads or sham auricular acupuncture on each ear alternatively at each treatment. The inclusion criteria included body mass index (BMI)>27kg/m2 and taking no weight-control treatments in the two months before and throughout the study. The outcomes evaluated included: physical parameters, biochemical characteristics using blood samples, obesity-related hormone peptides and life quality scores at both baseline and after 4-weeksof treatment for comparison.Results: Though our results showed no significant differences in any of the outcome measures between the three groups after treatment, but there were significant reductions in body weight, body mass index (BMI), and waist circumferences within the groups receiving needles and metal beads auricular stimulations (p<0.05 and p<0.001, respectively. N=30 in each group). Furthermore, there was a 1.9-unit reduction in insulin-resistance level in the auricular acupuncture group, and a 41.3pg/ml decrease in ghrelin level in the metal beads auricular stimulation group.Conclusions: The group receiving metal beads auricular stimulation showed a decreasing trend similar to that of the auricular acupuncture group, indicating that metal beads could replace needles when using auricular acupoint stimulation as obesity adjuvant treatment with less adverse effects. Our pilot study obtained findings worthy of further and more in-depth research.

A survey of health professionals’ views about integration of Traditional Chinese Medicine (TCM) Acupuncture into NHS Scotland

L. Hehir, S.A. Williams — 2011-12-14

Abstract: Study aims: To gain understanding of perspectives of physiotherapists and doctors regarding experience and practice of acupuncture together with their views on potential for integration of Traditional Chinese Acupuncture (TCMAc) into NHS Scotland.Methodology: A cross-sectional postal survey involved 107 physiotherapists, 207 general medical practitioners and 317 other medically qualified personnel working with Forth Valley Health Board in Central Scotland. Enquiry addressed (a) personal experience and clinical usefulness of acupuncture, (b) whether TCMAc services should be integrated into NHS Scotland within defined models of care and practice and (c) willingness to refer to TCMAc services.Results: An overall 51% response rate (320/631) included 74% (79/107) physiotherapists and 49% (101/207) general medical practitioners (GPs). Physiotherapists were most familiar with acupuncture, followed by GPs. 93% of both physiotherapists and GPs ‘agreed’ that acupuncture was clinically useful. Although few claimed detailed knowledge about TCMAc, 32% (24/76) physiotherapists and 21% (48/231) doctors agreed that it should be integrated into NHS Scotland. Barriers included ‘lack of NHS resources’ and ‘lack of evidence’; 29% (88/307) respondents thought such services could be sited at health centres. ‘Assimilation’ was the preferred working arrangement for physiotherapists, while doctors cited ‘collaboration’. 33–39% of respondents were willing to refer to TCMAc; 7% (7/96) GPs already did so.Conclusions: Despite strong support for acupuncture per se, significant lack of awareness about TCMAc hampered informed opinion about its integration by the majority. Raising health professionals’ awareness regarding available research evidence is clearly indicated. Nevertheless, opinions reflect potential for integration.

Perceptions and self-use of Complementary and Alternative Medicine (CAM) among Malaysian dental students

Muneer Gohar Babar, Shahzad Hasan Syed, Cho Min Naing, Nur Hidayah Binti Hamzah — 2011-12-16

Abstract: Introduction: A high self-use of CAM by medical students has been reported however, studies of CAM use among dental students is limited. The present study assesses the perceptions and self-use of CAM among dental students in Malaysia.Methods: A cross-sectional study of the perceptions and self-use of CAM among 267 randomly sampled dental students from 1 public and 2 private universities in Malaysia was undertaken using a validated self-administered questionnaire. Descriptive and inferential statistics were calculated using SPSS® version 18.Results: Seventy-six percent of the sample reported using CAM at the time of the survey. Of these, 21.7% (58) reported using Complementary Medicine (CM) and 16.5% (44) reported using Traditional Chinese Medicine (TCM). More than half (204, 76.4%) of the participants were currently using CAM while 95.8% (256) had used it previously. Students perceived all types of CAM as effective (mean score≤3). Lack of trained professionals was reported by 64% of the sample as the main barrier to the use of CAM. A majority of students (58.4%, n=156) reported that friends and family members were their main source of information about CAM. Students supported the integration of CAM education into their dental curriculum (mean score≤3).Conclusions: Data from this study adds to the understanding of dental students’ current and previous self-use of CAM. The dental students in this study agreed that CAM knowledge is necessary to be a well-rounded professional and supported the integration of CAM education in the dental curriculum.

Application of complementary and alternative medicine in epileptic children at a tertiary pediatric neurology center in Turkey

Barış Ekici, Burak Tatlı, Saygın Abalı, Nur Aydınlı, Meral Özmen — 2011-11-16

Abstract: Aim: The aim of this study was to evaluate the application of complementary and alternative medicine (CAM) in pediatric epilepsy patients.Methods: The parents of 202 epilepsy patients being followed at the Pediatric Neurology outpatient clinic of the Istanbul Medical Faculty were interviewed face-to-face between November 2010 and February 2011.Results: At least one CAM method had been used by 95% of interviewed families. Religious practices were used by 94.1% of families. Non-religious spiritual practices were used by 9.9% and other alternative treatment methods by 27.7%. Families had started to use CAM at the suggestion of their doctor in 6.9% of the cases. Compared to the medium and high-income group, religious practices (96.8% vs 64.7%, p: 0.000) and regular prayer (92.4% vs 58.8%, p: 0.000) were significantly more prevalent in the low-income group. Regular prayer was more common in families where patients had moderately frequent or frequent seizures, while families of patients with rare seizures more commonly used religious practices other than regular prayer (p: 0.038, 0.027). The number of antiepileptics used and special education were found to correlate with the use of other alternative treatment methods (p: 0.002, 0.000). Families of patients with rare seizures are more inclined to see benefit in CAM (p=0.043).Conclusion: Religious practices are the most frequently used type of CAM in families with epileptic children. The economic status of the parents and the course of the disease are the main factors that influence the choice between religious, spiritual and other CAM practices and the perception of benefit from them.

Citation classics in the integrative and complementary medicine literature: 50 frequently cited articles

Wilson W.S. Tam, Eliza L.Y. Wong, Faye C.Y. Wong, Annie W.L. Cheung — 2012-01-04

Abstract: Aim of the study: The objective of the current study is to characterise the most frequently cited articles published in integrative and complementary medicine (ICM) journals.Materials and methods: We utilised the ISI Journal Citation Reports: Science Edition 2009 database in May 2011 to determine the most frequently cited published articles. The top 50 most cited articles were selected and evaluated according to the type of journal, country of publication, topic, study design, and year of publication.Results: The 50 selected articles were published in 7 out of 16 journals between 1980 and 2009, the majority of which originated from the US. The most common study design was literature and systematic reviews. The efficacy of ICM on pain was the most common topic, followed by the anti-inflammatory effect of ICM, prevalence of ICM utilisation, questionnaire development for pain, adverse effects of ICM, discussion of study design in ICM, chemical component of ICM, animal model testing, and obesity.Conclusions: The findings provide a historical perspective on the scientific progress in integrative and alternative medicine. We revealed that majority papers (∼60%) were published between 1995 and 2004, suggesting that ICM has gained increasing attention since 1995. In terms of study design, review-type and questionnaire-related studies constituted approximately 60% of the articles. The actual number of citations from these articles was lower than the articles from the citation classics in other medical fields. The review of the articles having the greatest public recognition could help to establish and expand the role of ICM.

Chinese herbal medicines for treatment of hand, foot and mouth disease: A systematic review of randomized clinical trials

Huijuan Cao, Zhaolan Liu, Peter Steinmann, Yujie Mu, Hui Luo, Jianping Liu — 2012-01-11

Abstract: Background: Chinese herbal medicines are widely used in treating hand, foot and mouth disease (HFMD) in China. Single clinical studies have shown positive results of Chinese herbal medicines on HFMD compared with Western medication. A systematic review was conducted to critically appraise the available evidence on the potential benefits and harms of Chinese herbal medicines’ use in HFMD.Methods: Randomized controlled trials comparing Chinese herbal medicines with no treatment, placebo, or Western medications for HFMD were included. Databases searched included: PubMed, the Cochrane Library, Chinese Biomedical Database, China Network Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan Fang Database. All searches ended in July 2011. Four authors extracted data and assessed the study quality independently. RevMan 5.0.25 software was used for data analysis with effect estimate presented as relative risk and mean difference with a 95% confidence interval.Results: Seventy six trials were included, with generally poor methodological quality. According to the results of each single trial and meta-analysis of 18 trials, herbal medicine with or without active drugs may have effect for reducing fever clearance time, rash subsidence time, oral symptoms healing time and healing time of HFMD.Conclusions: This review suggests herbal medicine, combined with Western medications or used separately might improve symptoms of HMFD. However the current evidence is not of sufficient quality to allow unconditional recommendations to be made about the wider application of any kind of herbal medicine for the treatment of HFMD.

Cognition boosting effect of Canscora decussata (a South Indian Shankhpushpi)

Neeraj K. Sethiya, Alok Nahata, V.K. Dixit, S.H. Mishra — 2011-12-12

Abstract: Aim of the study: In southern India, ayurvedic practitioners traditionally employ the whole herb of Canscora decussata Schult. (CD) (Gentianaceae) as a traditional ayruvedic medicine, Shankhpushpi for its memory potentiating, anxiolytic and tranquilizing properties. The present study investigated the effect of CD, which is regarded as Shankhpushpi, for its effects on learning and memory in rodents. The extract was further studied for its in vitro acetylcholinesterase (AChE) inhibitory potential which can correlate with its cognition boosting effect.Materials and methods: Ethanol extract of CD was analyzed by high performance thin layer chromatography (HPTLC) and high performance liquid chromatography (HPLC). Ethanol extract of CD was investigated for its AChE enzyme inhibitory activity. Nootropic activity using Elevated plus maze apparatus, passive avoidance (Cook and Weidley's pole climbing, step down) paradigms and active avoidance (two compartment shuttle box) test were used to learning and memory.Results: HPTLC and HPLC fingerprinting of ethanol extract revealed presence of mangiferin as its main constituent. It was found that CD potentially inhibits AChE with 50% inhibitory concentration (IC50) of 165.667±0.213μg/ml. It was found that groups (n=6), receiving ethanol extract in doses of 200 and 400mg/kg p.o. significantly reversed the amnesia induced by scopolamine (0.3mg/kg i.p.). Nootropic activity was compared using piracetam (100mg/kg p.o.) as the standard.Conclusion: Ethanol extract of CD showed significant effects on learning behavior and memory enhancement as evidenced from the experiments performed. The activity may be attributed to the presence of various xanthones and mangiferin, a polyphenolic xanthone.