Collaborative Medicine Research Articles

When regulation ignores evidence: The case of Denmark’s Ashwagandha ban and the Technical University of Denmark’s misguided risk assessment

The recent ban on Ashwagandha (Withania somnifera (L.) Dunal) supplements in Denmark, based on a risk assessment by the Technical University of Denmark (DTU), exemplifies the challenges in regulating traditional herbal medicines within modern frameworks. This article critically examines the DTU report, highlighting methodological flaws including overreliance on animal studies and selective literature review. The report’s disregard for Ashwagandha's long history of traditional use and mischaracterization of its effects, particularly alleged abortifacient properties, contradicts a growing body of scientific evidence supporting its safety and efficacy. The current research demonstrating Ashwagandha's benefits in stress reduction, sleep improvement, and cognitive function further underscores the disparity between scientific findings and the DTU’s conclusions. The ban’s implications extend beyond Denmark, raising questions about regulatory consistency and proportionality in evaluating herbal products globally. The Indian Ministry of Ayush’s critique emphasizes the need for a more comprehensive, evidence-based approach for assessing traditional medicines. This controversy may catalyze the development of integrated evaluation methods, such as the Collaborative Medicine and Science framework, bridging diverse knowledge systems in regulatory decision-making. The case underscores the necessity for a global health paradigm that harmonizes traditional and modern medical approaches, ensuring public safety while preserving access to beneficial traditional remedies.

Validation of collaborative cyberspace virtual reality oculometry enhanced with near real-time spatial audio

Currently, most medical image data, such as optical coherence tomography (OCT) images, are displayed in two dimensions on a computer screen. Advances in computer information technology have contributed to the growing storage of these data in electronic form. However, the data are usually processed only locally on site. To overcome such hurdles, a cyberspace virtual reality (csVR) application was validated, in which interactive OCT data were presented simultaneously to geographically distant sites (Lucerne, London, and Barcelona) where three graders independently measured the ocular csVR OCT diameters. A total of 109 objects were measured, each three times, resulting in a total of 327 csVR measurements. A minor mean absolute difference of 5.3 µm was found among the 3 measurements of an object (standard deviation 4.2 µm, coefficient of variation 0.3% with respect to the mean object size). Despite the 5 h of online work, csVR was well tolerated and safe. Digital high-resolution OCT data can be remotely and collaboratively processed in csVR. With csVR, measurements and actions enhanced with spatial audio communication can be made consistently in near real time, even if the users are situated geographically far apart. The proposed visuo-auditory framework has the potential to further boost the convenience of digital medicine toward csVR precision and collaborative medicine.

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans.

Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.

Trend Analysis of Korean-Western Medicine Collaboration Studies by Disease Group

Objectives The purpose of this study was to analyze trends in Korean-Western Collaborative Medicine studies by disease group. Methods Articles published until May 2020 were searched in domestic databases (NDSL, RISS, KISS, DBPIA, and KoreanTK) using the keywords ‘한양방’, ‘양한방’, ‘협진’, ‘협의진료’, ‘의한의’, ‘의⋠한의’, and ‘통합의학’. The articles were analyzed according to the publication year, journal type, research methodology, and disease group using the major and intermediate classifications of the Korean Standard Classification of Diseases (KCD-7). Results In total, 112 articles were selected. The most frequent major disease groups were disease codes G, C (D), I, and M, in that order. The medium disease groups numbered 41 and most commonly involved collaborative studies on cerebrovascular diseases. Among the three top KCD-7 major group diseases, publications on Group C (D) were increasing significantly, publications on Group G were slightly increasing, but, publications on Group I decreased in the 2010s compared to the 2000s. Conclusions In this study, we analyzed the frequent disease groups treated with domestic Korean-Western medicine in collaborative studies using the major and medium classifications of KCD-7. Well-designed clinical trials and economic evaluation research are needed, and this study can provide directions for future collaborative studies using Korean-Western medicine. Keywords: Korean medicine, Western medicine, collaborative treatment, integrative medicine, disease group

Implementing a collaborative medicine and pharmacy educational activity in two countries

ABSTRACT Background To promote better collaboration for patient care, interprofessional education (IPE) is required in many health professions courses. However, successful IPE implementation at scale can be challenging because of complicated logistics and competing priorities. Implementing across multiple geographies adds further complexity. Objective This paper describes the implementation of a full cohort IPE activity for medical and pharmacy students delivered at both the Australian and Malaysian campuses of Monash University. Design We designed a 150-minute, blended learning activity centred around asthma care for second-year medical and pharmacy students. Student perceptions were measured with a pre- and post-activity survey using the validated ten-item, three-factor, SPICE-R2 instrument. Analysis focused on differences between professions and countries. Results All second-year medicine (N = 301 in Australia and N = 107 in Malaysia) and pharmacy students (N = 168 in Australia and N = 117 in Malaysia) participated in the learning activity. A total of 326/693 (47%) students participated in the associated research by completing both the pre- and post-activity surveys. The pre-activity survey showed significant differences in four items between medicine and pharmacy students in Australia and two items in Malaysia. Post-activity, we observed significant changes in 8/10 items when the two professions were combined. Specifically, we noted changes across the countries in perceptions of roles and responsibilities for collaborative practice and patient outcomes from collaborative practice. Conclusions IPE across different professions and countries is feasible. Positive outcomes in role understanding and perceived patient outcomes are achievable through a context-sensitive, locally driven approach to implementation. Longitudinal experiences may be required to influence perceptions of teamwork and team-based care.

S20-1. From the standpoint of physicians involved in electroencephalograms

The process of electroencephalogram (EEG) involves preparation, recording, extraction of EEG findings, overall evaluation, and interpretation. The physicians and technicians and both fully understand this process, and a series of EEG with greater quality is thought to be achieved by working together in a bi-directional manner. First, the physician ordering an EEG needs to clearly note why an EEG for the patient is requested and what kind of information he/she hopes to gain from the EEG. Subsequently, the EEG technician needs to accurately ascertain the information from the requesting physician and to perform the EEG that corresponds to the request. Furthermore, the physician creating the report the final EEG findings and briefly describes the degree of abnormality in the patient’s brain function reflected on the EEG such that the requesting physician can understand the report even if he/she is not a neurology specialist. Currently, the environment surrounding EEG is advancing daily. From the standpoint of being responsible for collaborative medicine, it is my hope that physicians and technicians learn together such that EEG continues to be a tool that greatly contributes to patient diagnosis and treatment in the everyday clinical setting.

Feasibility of collaborative precision medicine oncology between academic- and community-based hospitals.

e18015 Background: The Rutgers Cancer Institute of New Jersey (CINJ) is conducting an ongoing, prospective, observational clinical trial that is evaluating use of comprehensive genomic profiling (CGP) and molecular tumor board (MTB) review to assist in caring for patients with rare or refractory cancers. As part of this precision medicine approach to cancer care, CINJ has formed a partnership with community hospitals (Meridian Health) to enroll patients in this study, and to actively participate in MTB meetings. The purpose of this cohort analysis is to evaluate the feasibility of using CGP to identify clinically-relevant genomic alterations as an aid to guiding point-of-care management in a community hospital setting. Methods: Meridian Health staff was trained in patient selection, enrollment, and follow-up. CGP was performed by Foundation Medicine, Inc. The patient case’s clinical history, pathology, and CGP results were presented at an MTB meeting. The enrolling physicians (n = 11) were invited to attend the MTB in person or through web-accessible video conferencing. A letter listing MTB consensus recommendations on potential treatment options was sent to the referring physician, and patient follow-up was scheduled at regular intervals. Results: 35 patients were enrolled by Meridian Health. Gyn and GI cancers were the most common types at enrollment (each 26%, 9 out of 35), followed by breast cancer (20%, 7 out of 35). At study enrollment, the mean KPS was 91%, and 23 patients (66%) had stage IV disease. The median duration between study enrollment and MTB presentation was 44 days. 3 patients were excluded because of deteriorated clinical status at the time of the MTB. MTB-based treatment options were implemented in 9 of 32 patients (28%). This result is similar to those reported in published analyses of patients enrolled at CINJ. Conclusions: Collaborations between an academic cancer center and a community hospital is a feasible approach to facilitating access to precision medicine for cancer patients treated in the community. A larger cohort is needed to determine the impact on patient’s outcomes.

Medical Family Therapy in a Primary Care Setting: A Framework for Integration

As the profession of marriage and family therapy (MFT), as well as the emerging sub-specialty of medical family therapy (MedFT), continue to grow and evolve within the current healthcare system, the arena of integrated primary care (IPC) presents an ideal environment for professionals who are relationally and systemically inclined. Although there has been a inundation of literature detailing collaborative systems of healthcare, several gaps still exist: (a) a lack of horizontally integrated models (i.e., models that do not target specific diseases or demographic populations), (b) a lack of model utilization regardless of disease trajectory (i.e., decline, stabilization, improvement), and (c) a lack of IPC models explicitly utilizing MedFT/MFTs as the mental health providers within the system. In lieu of these gaps, the authors present a framework for IPC, utilizing MedFTs/MFTs, that is neither population nor disease specific, as well as a model geared towards implementation regardless of disease trajectory. The framework, which was obtained using ethnography of communication, details MedFTs’ interactions with front line medical providers and patients from initial contact through coordination of a shared treatment plan. Recommendations for future research studies incorporating the use of MedFTs in integrated primary care settings are extended in the context of a three world view framework (Peek in Collaborative medicine case studies: Evidence in practice. Springer, New York, pp 25–38, 2008; Peek and Heinrich in Family Syst Med 13:327–342, 1995, Integrated primary care: the future of medical and mental health collaboration. Norton, New York, pp 167–202, 1998).

Collaborative Medicine Case Studies: Evidence in Practice

Collaborative Medicine Case Studies: Evidence in Practice

The Effectiveness of Collaborative Medicine Reviews in Delaying Time to Next Hospitalization for Patients With Heart Failure in the Practice Setting

Background— Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded. Methods and Results— This retrospective cohort study using administrative claims data included veterans 65 years and older receiving bisoprolol, carvedilol, or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure. We compared those exposed to a general practitioner–pharmacist collaborative home medication review with those who did not receive the service. The service includes physician referral, a home visit by an accredited pharmacist to identify medication-related problems, and a pharmacist report with follow-up undertaken by the physician. Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups. There were 273 veterans exposed to a home medicines review and 5444 unexposed patients. Average age in both groups was 81.6 years (no significant difference). The median number of comorbidities was 8 in the exposed group and 7 in the unexposed ( P <0.0001). Unadjusted results showed a 37% reduction in rate of hospitalization for heart failure at any time (hazard ratio, 0.63; 95% CI, 0.44 to 0.89). Adjusted results showed a 45% reduction (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) among those who had received a home medicines review compared with the unexposed patients. Conclusion— Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines.

Applying Integrative Healthcare

Given a choice, most of us would opt to have the widest array and combination of therapies availabletouswhenfacedwithdisease ordisability.Iftherewasatherapythatwas known to be effective and safe, wouldn’t we want to know about it? Unfortunately, that is not always the case in healthcare today. Medicine still tends to be operating in silos of Western medicine and complementary therapies, with integrative and collaborative medicine still a somewhat distant ideal. And justly so. Applying integrative and collaborative medicine is no easy feat—it requires hard work and time commitment by all. The term integrative healthcare is commonly used to describe a team of healthcareprovidersworkingtogethertoprovide patient care. Seven models of team-oriented practice have currently been identified 1 :

"End-of-life care"in Kyoto University for the patients bearing progressive gynecologic malignancies under the support of the Department of Community Network and Collaborative Medicine

"End-of-life care"in Kyoto University for the patients bearing progressive gynecologic malignancies under the support of the Department of Community Network and Collaborative Medicine

Review of Collaborative medicine case studies: Evidence in practice.

Review of Collaborative medicine case studies: Evidence in practice.

Collaborative Medicine Deemed Best for Patients

Collaborative Medicine Deemed Best for Patients

Discourses of collaborative medical work

AbstractThis article looks at the hospital as an expert system organized to promote distributed processes of collaborative medical problem solving. It is composed by subsystems and the collaborative processes resemble processes of socially distributed cognition. Terms like ‘medical discourse’ or ‘institutional interaction’ have been used to describe verbal activities in collaborative medical practice. But the definitions of these terms give a limited understanding of collaborative medicine. Observations of medical practice in a thoracic ward show that medical discourses work at institutional, professional, and moral levels. They deal with a multiplicity of problem types, involve a diversity of human and nonhuman agents, and take place within and generate complex layers of contexts. The development of the problem complex has to be professionally but subtly managed at an interactional level to reach conclusions that are institutionally, professionally, and morally acceptable. While extra-situational contexts may have a strong impact on these processes, medical problems are met and dealt with as concrete situational tasks, in restricted settings with different but concrete participants that operate within and generate local, linguistic, and interactional contexts.

Designing Relational Models of Collaborative Integrative Medicine That Support Healing Processes

The concept of optimal healing environments (OHE) includes a variety of elements that require exploration, definition, measurement, and interpretation. One key element is the relationships between healer and patient/client and between healers themselves. These complexities mean that models of OHE that include relationship dynamics as resources in the healing processes need information to help planning, execution and measurement. This paper examines aspects of a proposed model of optimal healing that utilizes relational dynamics as central to healing processes. The dynamics of relationships between healers and clients are critical to the effectiveness of healing as a process of transformation. Conscious examination of healers' emotional availability in relationship-centered care may be important in determining primary roles in delivering care.

Teaching EBM Teachers

A collaborative Evidence-Based Medicine (EBM) course, co-taught by medical and library faculty, targets the needs of health care and information professionals involved in teaching and practicing EBM by introducing concepts, methods and tools of the EBM process. The one-week course engages working teams of health care and information professionals in case-based activities to encourage participation in the learning process and the “Train the Trainer” approach of the course. The interdisciplinary partnership, both of teachers and learners, has led to a successful and effective educational program that accentuates the strengths and contributions of each group. Further research will determine whether this collaborative experience leads to ongoing partnerships between these professional groups in the clinical setting.

Rational and irrational clinical strategies for collaborative medicine.

Individual practitioners and health care systems/organizations increasingly understand the rationale for collaborative medicine. An absence of collaboration can compromise the quality and safety of patient care. But having a rationale to provide collaborative medicine without also having a rational clinical strategy can be equally compromising to the quality and safety of patient care. Reasonable evidentiary criteria must be used to determine whether specific therapies merit inclusion or exclusion in a collaborative medicine model. Ranking therapies hierarchically on the basis of their risk-benefit ratio simplifies matching of therapies with the needs of the patient. A unifying taxonomy that categorizes all therapies (complementary/alternative and conventional) on the basis of how we think they work (presumed mechanisms of action) facilitates development of a clinical strategy for collaborative medicine. On the basis of these principles, a rational clinical strategy for collaborative medicine is described to help optimize the quality and safety of patient care.

Commentary: patient-centered care, the sine qua non of collaborative medicine.

Collaborative medicine requires practitioners and disciplines with varied training and philosophies to work together toward a common clinical goal. Distinct differences between the various practitioners and disciplines can serve as both opportunities for synergy and barriers to collaboration. There must be a clear and compelling reason that motivates different practitioners and disciplines to do the hard work needed to overcome barriers to collaboration. Patient-centered care is the compelling reason, the defining characteristic that must underlie all collaborative medicine efforts. The practical application of this principle is illustrated by the experience of a large health care system (Catholic Health Initiatives). From a complexity theory standpoint, patient-centered care and collaboration can be thought of as simple rules that guide desirable behaviors in a complex system. The application of these two simple rules is as relevant in the microcosm of collaborative medicine as it is in the larger macrocosm of health care.

Treatment of the Whole Person

This article is about healing in the context of the oncology hospital setting. It suggests the benefits of collaborative medicine and its enhancement through music therapy. An empowerment perspective guides its emphasis on the necessity of meeting the psychosocial needs of patients, encouraging participation in treatment, and facilitating a psychologically positive hospital experience through the application of music. A review of the literature and an outline of the specific physical and psychological benefits of music in oncology treatment are provided. The authors argue that psychological symptoms, such as depression and anxiety, which are commonly experienced by long-term hospital patients, can be prevented when oncology care teams follow a philosophy of healing the whole person rather than merely treating an illness. They suggest that researchers and care teams further explore the development of creative arts programs in hospital settings.