Integrative and Natural Approaches to Thyroid Nodule Treatment: Evidence and Emerging Trends.

The 2018 Declaration of Astana* issued by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) represents a
\nlandmark step for all of primary health care, public health, and traditional
\ncomplementary and integrative medicine. It brings together the priorities of the
\nWHO’s 1978 Alma-Ata Declaration, the international importance of universal
\nhealth coverage, and the ongoing efforts of the global community to reach
\nUNICEF’s Sustainable Development Goals. It is the first global primary health
\ncare document to explicitly acknowledge the value and importance of traditional medicine systems in achieving successful primary health services;
\n‘success’ being underpinned by specific commitments and evaluated by key
\nsuccess measures**. The Declaration explicitly refers to the application of
\ntraditional knowledge and the appropriate inclusion of traditional medicines as
\nfactors that will drive the success of primary care. However, the Declaration
\nalso makes commitments and identifies other success drivers that, despite
\nnot being directly linked to traditional and integrative care, are equally relevant. These omissions represent potentially untapped and overlooked opportunities for meaningful engagement to improve primary care.

I am excited to join with you for the beginning of a new era for The Journal of Alternative and Complementary Medicine (JACM). We plan to push the boundary of what a peer-reviewed ''CAM'' journal can mean for health and medicine. This column outlines some of my early, amendable thinking. Let me know your thoughts and responses.

The efficacy paradox in randomized controlled trials of CAM and elsewhere: beware of the placebo trap.

In children, thyroid lesions both palpable (nodules) and non-palpable, but visible during ultrasound (incidentaloma), require a full diagnostic procedure in accordance with the nodular goiter management algorithm. It is especially important because in children the risk of neoplastic process in thyroid nodule is 4-5 times higher than in adult patients, and reaches between 9 and 50% (on average 25%). The pathogenesis of a goiter is not entirely known. Among the causative factors for thyroid nodules or focal lesions the literature mentions: environmental factors i.e. iodine excess or insufficiency, exposure to radiation, natural goitrogens, chemical substances (lithium carbonate), pollution (phenols, phthalates, pyridines and aromatic carbohydrates), hormonal factors (TSH, IGF-I, EGF, FGF), neuropeptides, cytokines (TGF- β), immunoglobulins (TGI) and genetic factors – TSH receptor mutation, RAS oncogene mutation (mainly responsible for follicular adenoma), mutations and polymorphisms of several genes including thyroid peroxidase gene, thymoglobulin gene, sodium-iodide symporter gene, BRAF gene, as well as mutation of genes encoding microRNA. The DICER 1 mutation and germinal mutation of KEAP 1 have recently been discovered. It is also worth mentioning that during adolescence, when the requirement for thyroid hormones is increased, the thyroid gland is particularly susceptible to enlargement. Hyperglobulinemia resulting from augmented estrogen secretion in girls is another factor. It causes an increase in the pool of globulin-bound hormones and therefore relative free thyroxin (FT4) deficiency. That, in turn, leads to increased TSH levels, which is the most important factor stimulating thyroid growth. Thyroid nodules are present in 0.2-5% of children, more frequently in girls. Morbidity increases with age. The rate of malignancy in thyroid nodules is greater in children before the age of 10 and in boys. Similarly, as in adults, papillary carcinoma is the most common thyroid malignancy. Thyroid nodules in children demonstrate particular characteristics. Most neoplastic and non-neoplastic lesions tend to form singular nodules. Children present clinical signs such as dyspnea, dysphagia or hoarseness more rarely than adults. Patients are usually asymptomatic. Thyroid nodules in children comprise neoplastic and non-neoplastic masses, among the latter the nodular type of Hashimoto disease is the most frequent. However it is important to remember about the possibility of thyroid congenital disorders. The main goal of thyroid nodule diagnostic process is to detect patients with malignancy risk factors. Primarily, the medical history should be obtained to gain information about the occurrence of thyroid diseases, including cancers, in patient’s family. Especially, the family history in first-degree relatives should be carefully determined for MEN (multiple endocrine neoplasm) type 1 and 2, familiar medullary thyroid cancer and familial non-medullary thyroid cancer. Medical history should also include information about exposition to therapeutic or environmental radiation, about symptoms which may indicate hyper- or hypothyroidism, the history of nodule growth (rapid growth), neck pain or any symptoms of compression. Palpation allows estimation of the size and consistency of the thyroid gland, nodules and local lymph nodes. Among complementary diagnostic methods, the main role is reserved for ultrasound-guided fine needle aspiration (FNA). Moreover, thyroid function tests should always be performed, including measuring concentrations of TSH, thyroid hormones, and anti-thyroid autoantibodies. Thyroid scintigraphy is recommended in some cases, such as preparation for radioiodine therapy of hyperthyroidism, examination of ectopic thyroid gland or diagnosis of congenital hypothyroidism. It is important to evaluate calcitonin level in the following cases: clinical suspicion of medullary cancer or confirmed RET mutation, non-diagnostic FNA with no further plans for surgery, FNA indicating follicular neoplasm, coexistence of thyroid nodules and adrenal gland lesions, and – finally – before each thyroid surgery, as the knowledge of calcitonin level enhances pre- and intraoperative diagnosis of medullary cancer and helps to determine the extent of the surgery. In benign thyroid nodules that do not enlarge, it is acceptable to follow a “watch and wait” approach. Pharmacotherapy with levothyroxine (L-T4) is recommended in small, benign nodules presenting in children inhabiting iodide-deficient regions. The aim is to suppress TSH secretion. The dose of L-T4 is regulated based on TSH level, which should remain in lower limit of normal range. If the environmental iodide supply is adequate, this kind of therapy ought to be considered when anti-thyroid autoantibodies are detected. Nevertheless, thyroidectomy (subtotal or – less frequently – lobectomy) remains the most efficient therapeutic measure in thyroid nodules in children.

Radiofrequency Ablation for an Autonomously Functioning Thyroid Nodule

Complementary and Alternative Medicine Use and Initiatives in Europe

Complementary and Alternative Medicine (CAM) covers a heterogeneous spectrum of ancient to new-age approaches that purport to prevent or treat disease. By definition, CAM practices are not part of conventional western-style medicine because there is a perception of insufficient proof that they are safe and effective or because they are not taught in conventional medical and nursing schools. Complementary interventions are typically used together with conventional western-style treatments, whereas alternative interventions are used instead of conventional approaches. When combined with conventional practices they are often labeled Integrative Medicine (IM). Many people in the United States (US) use CAM and IM modalities1–7 and its use is increasing.2 In 1990, a national survey estimated that 33.8% of US adults used CAM modalities in the previous year,7 which increased to 42.1% in 19973 and 62% in the 2002 National Health Interview Survey (NHIS).1 These surveys included spiritual healing and "folk" medicine (remedies common, ethnically derived remedies used at home), in the CAM modality definition. Recently published results of the 2007 NHIS used a different CAM modality taxonomy and excluded these practices.2,8,9 When prayer specifically for health reasons was excluded, the 2002 and 2007 NHIS found 36% and 38.3%, respectively, of US adults reported using some form of CAM modality in the last 12 months.1,2 These national surveys only include civilian, noninstitutionalized individuals; they do not include our 1.8 million active duty military personnel and families. In the last 10 years, there has been an increase in interest and use of CAM modalities and IM in the military.9 This important segment of the US population receives health care from both military and civilian practitioners; and is subject to similar health risks as civilians plus additional physical, emotional, and cognitive stress of deployment with associated family separations for both the active duty member and families, and the consequences of combat.10,11 It would not be unexpected for military personnel to seek to improve their health through complementary practitioners, potentially at a greater extent due to health and performance expectations,10 and for the same reasons reported by civilians.1,2,11,12 This interest in CAM has been accelerated by the surge of chronic pain, chronic stress, and chronic symptoms associated with trauma and injuries from over a decade of wars in Iraq and Afghanistan.13 However, until recently there were little data to determine which CAM modalities are being used, how often, by whom, and for what purposes. Recently, these informational gaps are being filled in and the current picture is summarized below. USE OF CAM IN THE MILITARY The use of CAM in the military is higher than in the civilian population. Samueli Institute and Research Triangle International conducted the largest and most comprehensive survey of CAM use in over 16,000 active duty service members in all branches stationed both in the United States and overseas.14 Data were drawn from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors among Active Duty Military Personnel, which draws on a worldwide, random sample of over 40,000 service members from all branches, sexes, races, and ranks.15 It asked about overall CAM use and 19 specific CAM therapies using a methodology that closely matched the NHIS used by the National Center for Complementary and Alternative Medicine.16 This military survey showed that approximately 45% of active duty military personnel reported using at least 1 CAM type in the previous 12 months. CAM use when not counting self-prayer was approximately 36%. The 8 most frequently reported CAM approaches included 4 mind body therapies (prayer for your own health: 24.4%; relaxation techniques: 10.8%; art/music therapy: 7.7%; exercise/movement therapy: 6.8%), 2 biologically based therapies (herbal medicine: 8.9%; high-dose megavitamins: 8.4%), and 2 manipulative and body-based methods (massage therapy: 14.1%; chiropractic: 5.2%). Eleven CAM types were used by <5.0% of respondents and 6 types were used by <1% of personnel. When both surveys were adjusted for the 2000 census bureau demographics, CAM use by military personnel was significantly higher than that of the general population (44.5% vs. 36.0% and 38.3% in the 2 NHIS surveys, respectively, P<0.001). Significantly more military personnel reported use of energy healing, guided imagery therapy, massage therapy, hypnosis, and relaxation techniques than civilians in both NHIS surveys (P<0.001) with more reported use of "folk" remedies, high-dose megavitamins, and spiritual healing by others than the 2002 NHIS survey (P<0.001) and more frequent use of biofeedback than the 2002 NHIS and 2007 NHIS surveys (P<0.001 and P<0.01, respectively). There were no statistical differences in reported use of acupuncture and homeopathy. Overall, the prevalence of CAM use in this study was consistent with smaller military surveys where 49.6% CAM use was reported by military veterans in the Southwestern United States,17 and with 37.2% use of 12 CAM modalities (excluding prayer) in US Navy and Marine Corps personnel.18 The vast majority of CAM health care occurs outside the military health system, some of it provided by TRICARE, the military's health insurance program. However, as in the civilian population, most CAM is paid for out of pocket by military personnel as TRICARE covers very few CAM modalities. Massage therapy, used by 14% or an estimated 137,000 personnel, is not a covered benefit, whereas biofeedback (for certain conditions) is covered. Chiropractic is the only CAM modality that is currently included in a systematic manner in the military health system; however, access to chiropractic practitioners is limited. In 2005, 54% of active duty personnel resided in areas served by chiropractic clinics, and the remaining 46% were not served by clinics because of living overseas (14%), in remote areas (5%), or in US installations without chiropractic clinics (28%).19 Herbal medicines and high-dose vitamins also are not covered by military health care. However, many military installations include a General Nutrition Center store on the premises where these products readily are available. Three CAM modalities (yoga, massage, and imagery), which are commonly used for stress management were used by military populations at an estimated 2.5–7 times the rate of civilians. The fact that military members and their families are seeking and personally paying for these therapies outside both direct military care system and the TRICARE System may reflect access problems in Military Treatment Facilities (MTF), a preference for CAM/IM over traditional modalities (ie, not turning away from traditional medicine but rather turning toward and preferring CAM/IM), growing concern about the results of traditional pharmacologically based treatments, and an increasing interest in and need for appropriate access to CAM modalities within the military health system to decrease symptoms and improve function for military members suffering from the "wounds of war." Unmonitored and uninformed use of CAM modalities in the military may have negative consequences on health and military performance. A number of large randomized, placebo controlled trials of herbal treatments20–22 and acupuncture7,23,24 have been negative, making the substitution of these CAM modalities for proven therapies risky. In addition, some CAM therapies, particularly herbal supplements, have been associated with potential harm through toxicity and herb/pharmaceutical interactions.25,26 Herbal medicines and nutrients in doses well above the Dietary Reference Intakes27 are 2 of the CAM modalities most commonly used by military personnel. With 45% of the over 1million active duty personnel reportedly using CAM modalities, and a steady increase globally, it is important to understand why military personnel are using CAM, the role these therapies should play in their health care, and for military health care providers to recognize, monitor, and integrate CAM modalities into their health care practices. OFFERINGS OF CAM IN MTF Two recent surveys have assessed the use of CAM across DoD medical facilities and evaluated their reported effects and attitudes by health care leaders in military MTFs. The first is in a report entitled "Integrative medicine in the military health system report to congress" by the DoD Undersecretary of Personnel and Readiness (P&R).28 In this survey, 29% (120) of 421 MTFs reported offering a total of 275 CAM programs including 213,515 CAM patient visits in calendar year 2012 for active duty members. The most visits were for chiropractic care (73%) and acupuncture therapy (11%). The report states that, of those doing evaluation of CAM they have found: (1) patients reporting a reduction in anxiety levels and improved sleep with meditation; (2) breath-based practices reportedly helped patients to remain sober and reduced overall stress levels; (3) patients using massage therapy noted 75% improvement of symptoms, including pain; and, (4) overall positive outcomes were reported by 50%–90% of patients using massage therapy. The Report also states that patients practicing yoga had declines in psychological symptoms and improvement in overall health. Over 30 research projects have been funded by DoD and have reported improvements in symptoms and sleep, reduction in anxiety and psychological symptoms across a number of CAM practices being used. The Report concluded that: "There is wide-spread use of CAM therapies across the [Military Health System] MHS. Providers and patients were interested in using CAM therapies even though many are not evidence-based. Some providers have added CAM therapies as an adjunct to conventional therapies for a holistic approach to patient management." The second survey, completed by Samueli Institute did a more in-depth survey of CAM availability across a more limited sample of both MTFs and morale, welfare, and recreation (MWRs) centers. The study examined the CAM services offered during the year 2013 in 47 DoD MTFs, and MWRs locations across all military service branches.29 Information was collected on the prevalence of CAM modalities provided; the attitudes and beliefs towards CAM among the leadership in the different facilities; the obstacles and barriers to access in military facilities; the funding sources for CAM offered at military facilities; and, whether CAM is part of the strategic plan for the future of health care delivery. In addition, information was collected on the provision of CAM treatments for highly prevalent conditions in military personnel (pain, combat-related stress, and rehabilitation), how beneficial medical leaders thought CAM was, and how practitioners were accredited to practice CAM modalities. The results of this survey showed that 30 (70%) of the 47 facilities surveyed provided some type of CAM service with most being provided for active duty service members (70%), followed by family members (43%) and retirees (36%). Less than 9% of the participants reported providing CAM services to federal employees, contractors, or members in the community. Overall, acupuncture and chiropractic were among the top 3 most prevalent practices followed by yoga and massage. For pain management the primary CAM modalities were acupuncture (36.2%), chiropractic or osteopathic medicine (27.7%), and breathing exercises (25.5%). For stress and stress-related conditions, the top modalities were acupuncture (25.5%), breathing exercises (21.3%), and biofeedback (17%). For wellness and fitness, offerings included weight management, diet-based therapies, and movement practices. In this Samueli Institute survey, 57% of medical leaders felt that CAM practices were either beneficial (40%) or highly beneficial (17%) with 40% being neutral on the benefit and 3.3% feeling CAM practices were not beneficial. Despite this generally favorable response, over 75% had no provision or guidelines for CAM use in their strategic plans. Still, 46% funded CAM services out of their general budget, with 12% receiving money from the Office of the Army Surgeon General, 8% receiving congressional money, and 4% private money for CAM. Only 10% reported any research or evaluation of CAM going on in their facility. This survey also examined the challenges to improving access to these practices. Although the majority of leadership responses (57%) rated CAM modalities as highly favorable or favorable, the identified obstacles and barriers for access to CAM in military facilities included (in order of frequency): (1) inadequate space to provide services; (2) patients do not know to ask for CAM; (3) CAM costs too much; (4) CAM is too time consuming; and (5) CAM does not contribute to workload coverage. The prevalence of CAM practices provided by MTFs and MWR across DoD shows 75% availability within MTFs, and 33% within MWR facilities and programs. There were no appreciable differences in availability of CAM across military branches. MINDING THE GAP: ALIGNING PATIENTS, PRACTICE, AND POLICY In the report to Congress by DoD P&R, it was recommended to evaluate CAM programs for safety and effectiveness, as well as cost-effectiveness and consider widespread implementation in the military health system if cost-effective. The criteria for how to do this are specified. Part 199 of Title 32, CFR, governs TRICARE benefits and restricts services to those medically necessary drugs, devices, treatments, or procedures for which safety and efficacy have been proven to be comparable or superior to established therapies. Established criteria state that unproven drugs, devices, treatments, or procedures may not be covered: (1) unless reliable evidence shows that any medical treatment or procedure has undergone well-controlled clinical studies that show maximum tolerated dose, toxicity, safety, or efficacy compared with standard treatment or diagnosis; (2) if the available reliable evidence is considered inadequate by experts who recommend further studies or clinical trials are needed. The criteria for making a determination of proven safe and effective to nationally accepted medical standards are evidence that comes from: (1) well-controlled studies of clinically meaningful endpoints published in referred medical literature; (2) published formal technology assessments; (3) published reports of national professional medical associations; and (4) published reports of national expert opinion organizations. However, these guidelines and criteria and not being applied appropriately to CAM modalities. Biofeedback is the only CAM practice currently covered under TRICARE guidelines, and TRICARE only covers biofeedback therapy for nerve injury, not stress management. The 2 most widely used CAM modalities (chiropractic and acupuncture) are excluded in Title 32 CFR section 199.4 (g) even though neither has been evaluated using TRICARE guidelines. In other words, none of the CAM modalities (with the possible exception of biofeedback) have been evaluated by the DoD or TRICARE using their own guidelines for determining which practices should be covered. Despite this, TRICARE declines to pay for acupuncture but will pay for biofeedback. Chiropractic (which also has not been evaluated by TRICARE guidelines) is provided to DoD beneficiates through MTFs but not through TRICARE. Chiropractic is currently being implemented across DoD even though research on the effectiveness of chiropractic in the DoD is only recently underway because of a Congressional mandate and special appropriation.30 Acupuncture is both widely accepted and used in the DoD and currently the Defense and Veteran's Pain Task Force is training medical practitioners in "Battlefield Acupuncture" (BA). BA is a specific auricular acupuncture protocol developed by Col (Ret) Richard Niemtzow, an Air Force physician, seeking to add a simple nonpharmacological pain management technique that could be used by a broad array of first responders and primary care providers to help reduce pain, reduce medication load, and improve function.31 Acupuncture has been shown to be superior to conventional therapy for several chronic conditions prevalent in the military, and has also been shown not to be due only to placebo effects.32 Samueli Institute has performed a comprehensive systematic review of acupuncture for the Trauma Spectrum Response, an important collection of comorbidities often experienced by service members after deployment.33 Recently, a comprehensive review of self-care CAM modalities for pain has been published in a special issue of Pain Medicine in which reasonable evidence for use of yoga, tai chi, and music were found for the treatment of pain.34 These areas are ripe for evaluation by the military and TRICARE Systems for possible inclusion into the array of services provided. CONCLUSIONS Over a decade of war has left hundreds of thousands of our service members and their families suffering from a range of psychological and physical injuries, many leading to or exacerbating chronic pain. They and their health care providers have surged ahead in seeking out drug-free and self-care healing practices to help them recover and return to wholeness in peacetime. The availability of efficacious CAM modalities adds needed access to a cadre of promising services and practices that promote healing and improved function with less medication and fewer unwanted side effects. However, DoD policy and priorities have not kept up with this surge, leaving the majority of active duty service members, veterans, and their families to fend for themselves, to pay for or go without the beneficial effects of CAM and IM practices. As stated in the DoD P&R report to Congress, "At this time, there are insufficient internal evaluations and reported results to determine whether the CAM programs being provided in the MTFs meet these [TRICARE] criteria." It is time for the DoD to step up their efforts to complete these evaluations and ensure that "sufficient evaluation" occurs in a more timely manner. Our long-suffering heroes deserve nothing less!

The Journal of Alternative and Complementary MedicineVol. 12, No. 4 EditorialsEvidence-Based Complementary and Alternative Medicine: Back to BasicsRichard Hammerschlag and Heather ZwickeyRichard HammerschlagSearch for more papers by this author and Heather ZwickeySearch for more papers by this authorPublished Online:24 May 2006https://doi.org/10.1089/acm.2006.12.349AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Evidence-Based Complementary and Alternative Medicine: Back to Basics." , 12(4), pp. 349–350FiguresReferencesRelatedDetailsCited ByPoultry eggshell-derived antimicrobial materials: Current status and future perspectivesJournal of Environmental Management, Vol. 314Inter-Rater Agreement of Biofield Tuning: Testing a Novel Health Assessment Procedure Richard Hammerschlag, Eileen D. McKusick, Namuun Bat, David J. Muehsam, James McNames, and Shamini Jain8 October 2020 | The Journal of Alternative and Complementary Medicine, Vol. 26, No. 10 Acupuncture versus Various Control Treatments in the Treatment of Migraine: A Review of Randomized Controlled Trials from the Past 10 Years 1 August 2020 | Journal of Pain Research, Vol. Volume 13Effects of Electroacupuncture for Knee Osteoarthritis: A Systematic Review and Meta-AnalysisEvidence-Based Complementary and Alternative Medicine, Vol. 2016Der Blick über den Tellerrand – Fünf mutige Beispiele10 March 2015A Clinical Study of Integrating Acupuncture and Western Medicine in Treating Patients with Parkinson's DiseaseThe American Journal of Chinese Medicine, Vol. 43, No. 03Should systematic reviews assess the risk of bias from sham–placebo acupuncture control procedures?European Journal of Integrative Medicine, Vol. 6, No. 2Acupuncture Pain Research: Quantitative and Qualitative11 September 2013Traditional Korean medicine practitioners’ attitudes toward evidence based medicine: A qualitative studyEuropean Journal of Integrative Medicine, Vol. 4, No. 4Acupuncture and the Emerging Evidence Base: Contrived Controversy and Rational DebateJournal of Acupuncture and Meridian Studies, Vol. 5, No. 4Acupuncture for the Trauma Spectrum Response: Scientific Foundations, Challenges to Implementation20 December 2011 | Medical Acupuncture, Vol. 23, No. 4Effects of GV20 Acupuncture on Cerebral Blood Flow Velocity of Middle Cerebral Artery and Anterior Cerebral Artery Territories, and CO2 Reactivity During Hypocapnia in Normal Subjects20 March 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 3Paradoxes in Acupuncture Research: Strategies for Moving ForwardEvidence-Based Complementary and Alternative Medicine, Vol. 2011Der Blick über den Tellerrand ‒ Fünf mutige BeispieleMainstreaming Acupuncture: Barriers and Solutions23 July 2010 | Complementary health practice review, Vol. 15, No. 1Time-variant fMRI activity in the brainstem and higher structures in response to acupunctureNeuroImage, Vol. 47, No. 1Developments in Acupuncture Research: Big-Picture Perspectives from the Leading Edge21 September 2008 | The Journal of Alternative and Complementary Medicine, Vol. 14, No. 7Acupuncture modulates resting state connectivity in default and sensorimotor brain networksPain, Vol. 136, No. 3Evidence overviews: the role of systematic reviews and meta-analysesPhysiological dynamics of acupuncture: correlations and mechanismsNeuroimaging Acupuncture Effects in the Human Brain25 August 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 6The Importance of Early Phase Research28 May 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 4Acupuncture in an Outpatient Clinic in Fortaleza, Brazil: Patients' Characteristics and Prevailing Main Complaints4 May 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 3Auriculotherapy with Magnetic Pellets Produces Longitudinal Changes in Sleep Patterns of Elderly Patients with Insomnia4 May 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 3Image Cycling for Hands-on Healers4 May 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 3Clinicians' Attitudes and Usage of Complementary and Alternative Integrative Medicine: A Survey at The Johns Hopkins Medical Institute4 May 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 3Challenges of Integrating CAM and Biomedicine27 March 2007 | The Journal of Alternative and Complementary Medicine, Vol. 13, No. 3Controversies In Acupuncture Research: Selection of Controls and Outcome Measures In Acupuncture Clinical Trials9 January 2007 | The Journal of Alternative and Complementary Medicine, Vol. 12, No. 10Neuroimaging for the Evaluation of CAM MechanismsDer Blick über den Tellerrand — Fünf mutige Beispiele Volume 12Issue 4May 2006 InformationCopyright 2006, Mary Ann Liebert, Inc.To cite this article:Richard Hammerschlag and Heather Zwickey.Evidence-Based Complementary and Alternative Medicine: Back to Basics.The Journal of Alternative and Complementary Medicine.May 2006.349-350.http://doi.org/10.1089/acm.2006.12.349Published in Volume: 12 Issue 4: May 24, 2006PDF download

The Adoption of Ultrasound-guided Radiofrequency Ablation of Thyroid Nodules in the United States.

The Journal of Alternative and Complementary MedicineVol. 16, No. 1 EditorialComparative Effectiveness Research and CAMMikel AickinMikel AickinSearch for more papers by this authorPublished Online:27 Jan 2010https://doi.org/10.1089/acm.2009.0718AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Comparative Effectiveness Research and CAM." , 16(1), pp. 1–2FiguresReferencesRelatedDetailsCited ByThe Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists19 January 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. 2Spiritual Leadership and Self-Development Model5 May 2021Acupuncture for the treatment of trigeminal neuralgiaMedicine, Vol. 97, No. 11Effect of catgut implantation at acupoints for the treatment of allergic rhinitis: a randomized, sham-controlled trial10 November 2016 | BMC Complementary and Alternative Medicine, Vol. 16, No. 1Exploring the prospect of a complementary and integrative medicine database for use in the Australian primary care settingAdvances in Integrative Medicine, Vol. 1, No. 1Parental Perspectives on Use, Benefits, and Physician Knowledge of Complementary and Alternative Medicine in Children with Autistic Disorder and Attention-Deficit/Hyperactivity Disorder Angela Huang, Kapila Seshadri, Tara Anne Matthews, and Barbara M. Ostfeld6 September 2013 | The Journal of Alternative and Complementary Medicine, Vol. 19, No. 9A double-blind controlled clinical trial assessing the effect of topical gels on striae distensae (stretch marks): a non-invasive imaging, morphological and immunohistochemical study12 April 2013 | Archives of Dermatological Research, Vol. 305, No. 7Review of Cochrane Reviews on Acupuncture: How Chinese Resources Contribute to Cochrane Reviews Shuang Jiao, Kiichiro Tsutani, and Nobuhiko Haga2 July 2013 | The Journal of Alternative and Complementary Medicine, Vol. 19, No. 7Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials6 September 2012 | BMC Complementary and Alternative Medicine, Vol. 12, No. 1The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial9 July 2012 | Trials, Vol. 13, No. 1Development of a Chinese Medicine Pattern Severity Index for Understanding Eating Disorders Sarah Fogarty, David Harris, Chris Zaslawski, Andrew J. McAinch, and Lily Stojanovska11 July 2012 | The Journal of Alternative and Complementary Medicine, Vol. 18, No. 6Decontextualized Versus Lived Worlds: Critical Thoughts on the Intersection of Evidence, Lifeworld, and Values Jeff Flatt17 May 2012 | The Journal of Alternative and Complementary Medicine, Vol. 18, No. 5Key Issues in Clinical and Epidemiological Research in Complementary and Alternative Medicine a Systematic Literature ReviewForschende Komplementärmedizin / Research in Complementary Medicine, Vol. 19, No. s2The Intersecting Paradigms of Naturopathic Medicine and Public Health: Opportunities for Naturopathic Medicine Jon Wardle and Erica B. Oberg16 November 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 11Naturopathic Medicine and Public Health: Teaming Up for a Transformative Tomorrow Elizabeth Sutherland16 November 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 11Introduce the idea of comparative effectiveness research to clinical research of Chinese medicineJournal of Chinese Integrative Medicine, Vol. 9, No. 8Revised STRICTA as an Extension of the CONSORT Statement: More Items Should Be Involved in the Checklist Zhao-Xiang Bian and Yung-Hsien Chang23 February 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 2Improving the prediction of response to therapy in autismNeurotherapeutics, Vol. 7, No. 3 Volume 16Issue 1Jan 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Mikel Aickin.Comparative Effectiveness Research and CAM.The Journal of Alternative and Complementary Medicine.Jan 2010.1-2.http://doi.org/10.1089/acm.2009.0718Published in Volume: 16 Issue 1: January 27, 2010PDF download

Thyroid nodules are common. Thyroid cancer is rarer. No guidelines exist for management of thyroid nodules in the Indian context and these recommendations are intended for this purpose. The consensus committee reviewed important articles, including previously published consensus statements. Management points were scored according to the level of evidence. These guidelines cover the clinical evaluation and include the interpretation of imaging and fine needle aspiration cytology of thyroid nodules. The guidelines also cover the management of special situations like thyroid incidentalomas, cystic thyroid lesion and nodules detected during pregnancy. The consensus guidelines represent a summary of current medical evidence for thyroid nodule management and the committee has attempted to optimize the guidelines for the clinical practice setting in India.

To clarify the mechanisms by which smoking is associated to toxic and nontoxic goitre and thyroid nodules. Cohort study. Sweden. A cohort of 874,507 parous women identified through the Medical Birth Registry, with smoking behaviour assessed through self-reported information at the first pre-natal visit, and follow-up between 1983 and 1997. Hospital diagnoses of toxic and nontoxic goitre and thyroid nodules, identified by record-linkage with the national Inpatient Registry. Cox regression was employed to estimate the hazard ratio (HR) of smokers compared with nonsmokers and the corresponding 95% confidence limits (CL). There was a significantly increased risk of goitre and nodules amongst smokers. The positive association was stronger for toxic (age adjusted HR = 1.94, CL = 1.74-2.16) than for nontoxic goitre and nodules (age-adjusted HR = 1.26; CL = 1.14-1.38). There was generally no clear risk trend with regard to amount smoked (below and above 10 cigarettes per day). Elevated body mass attenuated these associations, whilst being born in Swedish areas of endemic goitre enhanced the association with nontoxic goitre and nodules. Smoking enhances the risk of thyroid goitre and nodules requiring hospital admission. Iodine deficiency and body weight are likely to be important modifiers of the risk of thyroid hyperplastic diseases amongst smokers.

OPEN ACCESSApril 12, 2012Responding to Patients' Questions About Complementary, Alternative, and Integrative Medicine Shelley Adler, PhD, Yvette Coulter, Ginger Polich, Katherine Hyland, PhD, June Chan, ScD Shelley Adler, PhD University of California, San Francisco, School of Medicine Google Scholar More articles by this author , Yvette Coulter University of California — San Francisco Google Scholar More articles by this author , Ginger Polich University of California — San Francisco Google Scholar More articles by this author , Katherine Hyland, PhD University of California — San Francisco Google Scholar More articles by this author , June Chan, ScD University of California — San Francisco Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9152 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis resource features a collection of activities, including an independent exercise and small-group session, developed to help first- and second-year medical students explore the issues that arise when communicating with patients regarding integrative medicine or complementary and alternative medicine use. These activities are designed to prepare students for situations in which they need to have discussions with patients regarding healing modalities about which most physicians have little or no information. They are also meant to give students tools to help them communicate with patients about different health beliefs and health care models in a way that promotes a stronger doctor-patient relationship. Likewise, they are intended to teach students how to evaluate the quality of, and synthesize information from, a variety of sources to answer patient questions about integrative medicine or complementary and alternative medicine use. This resource was created and first taught in 2002 and has been updated annually to reflect evolving research in integrative medicine. The linked exercise was designed to enrich both independent and interactive components of the required curriculum in integrative medicine at the University of California, San Francisco (UCSF). This portion of the curriculum is presented in the Mechanisms, Methods and Malignancies course of the second preclinical year. Together with a 2-hour overview lecture on the history, prevalence, and use of complementary and alternative medicine, this content forms the foundation of UCSF's undergraduate medical education instruction in integrative medicine and reinforces the social/behavioral sciences and epidemiology/evidence-based medicine curricular themes. Educational Objectives By the end of this session, learners will be able to: Identify and evaluate the quality of a variety of complementary, alternative, and integrative medicine information resources, including databases, printed materials, and internet-based options.Summarize and synthesize information from a variety of sources to answer patient questions about integrative medicine and complementary and alternative medicine.Apply information about complementary and alternative medicine in a simulated discussion with a patient about different health beliefs and health care models.Generate a strategy for situations in which they need to have discussions with patients regarding modalities or treatments for which there is insufficient or no information. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: CAM-IM Module Instructor's Guide and Materials.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2012 Adler et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsHealth BeliefsIntegrativeHealing Modalities Disclosures None to report. Funding/Support None to report. Loading ...

Journal of Integrative and Complementary MedicineAhead of Print The Changing Global Public Health Landscape of Traditional, Complementary, and Integrative Medicine in Primary Care: Responding to the Vision of the Declaration of AstanaGail D. Hughes, Elizabeth Sommers, and Amie SteelGail D. HughesMedical Biosciences Department, Faculty of Natural Sciences, University of Western Cape, Bellville, South Africa.School of Health Professions, University of Missouri-Columbia, Columbia, MO, USA.Integrative, Complementary and Traditional Health Practices Section, Public Health Association of South AfricaSearch for more papers by this author, Elizabeth Sommershttps://orcid.org/0000-0001-6848-6834Department of Family Medicine, School of Medicine, Boston University, Boston, MA, USA.Integrative Medicine and Health Disparities, Boston Medical Center, Boston, MA, USA.Integrative, Complementary and Traditional Health Practices Section, American Public Health Association, Washington, DC, USA.Search for more papers by this author, and Amie SteelAddress correspondence to: Amie Steel, PhD, MPH, BHSc(Nat), Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, School of Public Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street, Ultimo, NSW 2064, Australia E-mail Address: amie.steel@uts.edu.auhttps://orcid.org/0000-0001-6643-9444Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, Australia.Complementary Medicine Evidence, Research and Policy Special Interest Group, Public Health Association of Australia, Deakin, Australia.Search for more papers by this authorPublished Online:24 Apr 2023https://doi.org/10.1089/jicm.2023.0071AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Changing Global Public Health Landscape of Traditional, Complementary, and Integrative Medicine in Primary Care: Responding to the Vision of the Declaration of Astana." Journal of Integrative and Complementary Medicine, , pp. –FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Gail D. Hughes, Elizabeth Sommers, and Amie Steel.The Changing Global Public Health Landscape of Traditional, Complementary, and Integrative Medicine in Primary Care: Responding to the Vision of the Declaration of Astana.Journal of Integrative and Complementary Medicine.ahead of printhttp://doi.org/10.1089/jicm.2023.0071Online Ahead of Print:April 24, 2023PDF download

Fine needle aspiration (FNA) biopsy is an established procedure by which to sample thyroid nodules to ascertain etiology and produce a diagnosis conveying risk of malignancy with recommended patient follow-up. This procedure is well-tolerated and endorsed given the accessibility and vascularity of the thyroid gland. FNA cytopathology has proven efficacious for the primary assessment of thyroid nodules. Well-differentiated papillary thyroid carcinoma (PTC) and benign lymphocytic (Hashimoto) thyroiditis (HT) are distinct thyroid lesions that may be reported with diagnostic confidence based on their characteristic cytomorphologic features. However depending on the adequacy of FNA sampling and the morphology of aspirated cellular material, thyroid nodules with coexisting PTC and HT may pose diagnostic pitfalls. This may be dependent upon: (a) the architectural nature of the coexisting lesions in-vivo; (b) whether both lesions are adequately sampled through FNA; and (c) which of the cell types and cytomorpholo...