Integration Of Complementary And Alternative Medicine Research Articles

Are we meeting cancer patient needs? Complementary and alternative medicine use among Saudi cancer patients: A qualitative study of patients and healthcare professionals’ views

IntroductionThe use of Complementary and Alternative Medicine (CAM) among cancer patients in Saudi Arabia is an emerging subject in the field of healthcare. This study aimed to examine the dynamics between perspectives of cancer patients and healthcare professionals in tertiary hospitals that do not provide CAM. MethodQualitative interviews were undertaken with 38 cancer patients and 30 healthcare professionals. After familiarization with the data, results were analyzed using interpretation, categorizing and thematic analysis. ResultsThe analysis suggests that CAM is highly popular among cancer patients. All the cancer patient respondents used at least one type of CAM as an adjunct to conventional medical treatments. These patients affirmed their understanding that CAM originates from a non-biomedical healthcare model. Patients desired CAM treatments and frequently questioned why CAM was not made available alongside conventional medicine. In contrast, the data showed that healthcare professionals were concerned about the implications of mixing CAM, in the form of cultural interventions provided by nonprofessional healers, with biomedicine. Doctors, in particular, were less willing to establish policies or to follow guidelines regarding the integration of CAM into cancer treatment and care. ConclusionThe impacts of cancer are not confined to physical realms. Cancer creates a medical crisis that affects a patient’s mind, spirit and lifestyle. This research suggests that, in Saudi Arabia, cancer should be understood not only in biomedical terms but in light of cultural beliefs about disease aetiology and the contingent need for culturally-appropriate supportive CAM treatments. The application of conventional medicine alone does not appear to adequately address cancer patients’ expressed needs. The authors concluded that healthcare professionals in Saudi Arabia should be prepared to discuss with patients their perceived benefits of CAM as an integral element of their patient-centred care.

Prevalence and Predictors of Complementary and Alternative Medicine (CAM) Use Among Health Workers in Nigeria

BACKGROUND: The use of complimentary and alternative medicines has risen globally. We therefore, explored the prevalence and predictors of use of complementary and alternative medicines among healthcare workers. 
 
 METHODS: This was a cross-sectional study that was conducted between 1st June and 31st August 2018 on the use of complementary and alternative medicines among health workers in Federal Medical Center Makurdi and Benue State University Teaching Hospital, Makurdi in Benue State. Questionnaire was used to collect data from respondents and data analysed using logistic binary regression models. 
 
 RESULT: Response rate for the study was 80.2% out of which females were 196 (58.2%) with 215 (65.7%) in the age bracket of 31 – 60 years. Married respondents were 244 (72.4%) while Medical Doctors followed by Nurses were 87 (25.8%) and 84 (24.9%) respectively. Majority of the respondents, 113 (33.8%) have a monthly salary of above N100,000 (277.8 USD @ exchange rate of N360) while health workers of Tiv ethnic extraction had the highest number of 202 (60.7%) followed by those of Idoma extraction, 95 (28.5%). Those with years of work experience between (0 -15) were 268 (87.9%). The most used CAM was spiritual therapy, 230 (68.2%) while whole-body therapy was the least with 84 (24.9%). Use of biological therapy and manipulative therapy were 182 (54%) and 207 (61.4%) respectively. The odds of a female health worker using spiritual therapy was more than twice that of their male counterpart, (AOR: 2.218, 95% CI: 1.391 – 3.538). The odds of a Community Health Extension Worker and a medical doctor using a biological therapy among the study population were four times and almost thrice respectively compared to a pharmacist (AOR: 4.117, 95% CI: 1.690 – 10.030) and (AOR: 2.541, 95% CI: 1.095 – 5.896). The odds of an Idoma health worker using a manipulative and body-based therapy was thrice that of a Tiv health worker (AOR: 3.00, 95% CI: 1.318 – 6.829). While the odds of a Tiv health worker using whole-body therapy was seven times that of Idoma (AOR: 7.420, 95% CI: 2.186 – 25.188. 
 
 CONCLUSION: There was high prevalence of CAM use by health workers and this has potentials to influence integration of CAM with conventional medicines.

Contending Worldviews in the Clinical Encounter: An Empirical Study of Complementary and Alternative Medicine Deliberations in Contemporary Medical Oncology.

In this article, the authors characterize the different ways patients and clinicians discuss complementary and alternative medicine (CAM) during routine cancer care. Over a period of two years, the authors audio-recorded clinical interactions between 37 medical oncology clinicians and a sample of 327 oncology patients at an academic cancer center in the Midwest United States. Recordings of conversations that included any discussion of CAM were transcribed and analyzed using a qualitative content analysis approach. Out of 327 conversations, CAM was mentioned and/or discussed in only 31 encounters. Communication dynamics between clinician and patient involve several factors: the condition of the patient and his or her knowledge about and experience with CAM, the clinician's knowledge and values about CAM, perceived assumptions and stereotypes about CAM, and institutional response to the integration of CAM in cancer care. Addressing the difficult and sensitive topic of CAM in cancer care requires hearing patients in a manner meaningful to them. In that sense, CAM can serve as an important marker and test case in the march toward shared decision-making and patient-centered communication generally.

Use of the hCONSORT criteria as a reporting standard for herbal interventions for common dermatoses: a systematic review.

The use of complementary and alternative medicine (CAM) is increasing in Western countries, including in the area of dermatology. However, Western healthcare providers have not integrated CAM into regular practice owing to a lack of reliable data supporting its use. To encourage high-quality research related to the use of CAM and specifically herbal interventions, the CONsolidated Standards Of Reporting Trials (CONSORT) extension criteria on reporting herbal interventions (hCONSORT) were published in 2006. To evaluate the adherence of randomized controlled trials (RCTs) investigating herbal interventions for acne, atopic dermatitis (AD) and psoriasis to the hCONSORT criteria. A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted. RCTs published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, AD or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. anova was used to examine differences in scores by disease entity. The vast majority of reviewed studies reported < 50% of information recommended in the hCONSORT criteria. Limitations include the small number of dermatological conditions examined, exclusion of reports based on language and lack of assessment of overall adherence to CONSORT criteria. Our data indicate lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high-quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers.

Convergent priorities and tensions: a qualitative study of the integration of complementary and alternative therapies with conventional cancer treatment.

Demand for complementary and alternative medicine (CAM) is high among cancer patients. This, alongside growing evidence for the efficacy of some CAM therapies, is driving change within cancer centres, where evidence-based CAM therapies are increasingly provided alongside standard cancer treatments. In Australia, commitment to equitable access to healthcare is strong, and some cancer centres are now providing integrative services at no cost to the patient. This represents a significant shift in healthcare provision. This study aimed to examine health professional and patient dynamics in an integrated cancer service where CAM is provided at no cost to patients alongside standard cancer treatments. It specifically sought to understand what might drive or hinder further integration of CAM with standard treatment in the cancer context. Qualitative interviews were undertaken with twenty key stakeholders-cancer patients, cancer nurses, and oncologists-who were delivering or receiving care in an Australian public hospital where acupuncture services are provided at no cost to patients alongside standard chemotherapy and radiation treatments. Findings point to key areas where the concerns and priorities of cancer patients, cancer nurses, and oncologists converge and diverge in ways that reflect core personal and professional interests regarding patient care needs, the evidence base for CAM efficacy and safety, and rising healthcare costs. Understanding points of convergence and divergence could assist clinicians and service providers in negotiating ways forward for integrative cancer services.

The Role of Complementary and Alternative Medicine in the Healthcare System: A German Paradox

Background: This paper examines a paradox in the German healthcare system: Complementary and alternative medicine (CAM) practices are a major element of medical encounters in Germany. Patients seek them, physicians provide them, and public health insurances pay for them in part. Despite all this, CAM practices are not acknowledged as scientifically valid. Material and Method: I will examine this situation in detail based on 2 ethnographic studies. The first study refers to an attempt to introduce homeopathic education at a German university. The second one is a study in the context of cancer and CAM. These cases are perfect examples of the current power struggles that are impeding the expansion of CAM practices in Germany. Results: The results should be seen from the theoretical angle of the study of science. The conventional method of proving scientific validity is in contradiction to those frameworks in which the impact of CAM might be demonstrated. There are economic interests invested in preventing the integration of CAM into existing scientific structures. However, the current hybridization of CAM with conventional medicine might be a step towards an institutionalized heterogenization of medical practices in Germany. Conclusions: A broader understanding of scientific methods within the CAM community could provide a useful frame for future research. I suggest that the CAM community more actively takes part in the discourse with representatives of conventional medicine and come out of the closet.

Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users

ObjectiveThis study was intended to examine CAM among Australian hospital-based nurses, identifying their knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users. Methods and materialsNurses holding a qualification in nursing and working in surgical wards were included using a convenience sampling technique. A self-complete questionnaire was developed to achieve the aims of the study. Descriptive and non-parametric statistics were calculated to describe and analyse data. ResultsOverall, 95.7% and 49.7% of nurses reported personal and professional use of CAM, respectively. The most popular CAM/CAM domain personally and professionally used by nurses was massage therapy and mind-body therapies. The primary reason for personal use of CAM was “[it] fits into my way of life/philosophy”. Furthermore, massage therapists were the most commonly recommended CAM practitioners to patients. Only 15.8% of nurses would always ask patients about use of herbal medicines as part of nursing history taking. Over one-fifth (22.4%) of nurses rated their attitude as having a very positive, and 60.3% rated themselves as having very little or no knowledge of CAM. A positive correlation was also found between knowledge and attitude about CAM. Positive attitude and higher knowledge about CAM were positively correlated to CAM referrals. Several socio-demographic factors predicted personal and professional use of CAM. ConclusionThis study revealed that nurses generally believe not to have sufficient knowledge of CAM but are open to use CAM with patients. Nurses' positive attitude toward and personal use of CAM could be an indication that they are poised for further integration of evidence-based CAM into nursing practice to treat whole person.

Integrating Complementary and Alternative Medicine (CAM) into emergency care

Background: Current biotechnology and medical procedures have made remarkable progress, yet the use of complementary and alternative medicine (CAM) is rapidly developing and expanding in the healthcare sector. This trend has significantly increased in contemporary civilizations, particularly in developing nations. To effectively address the health-seeking behavior of individuals, it is essential to integrate CAM practitioners into the mainstream healthcare system. Aim of Work – The aim of this initiative is to offer comprehensive training, adequate facilities, and support for referring patients, when necessary, thereby facilitating the integration of CAM into conventional healthcare. Methods: The approach involves the implementation of empirical CAM (EBCAM) treatments, which have demonstrated significant efficacy in treating various illnesses. Additionally, the integration of existing CAM systems is crucial for the exchange of evidence-based information. Results: While there is a positive combined impact from the interaction between conventional medicine and CAM, significant gaps remain in the EBCAM field that require further research. This research is essential to gather data and establish best practices for CAM. Conclusion: Enhancing people's health through the integration of CAM into mainstream healthcare necessitates ongoing research to fill the gaps in knowledge and practice.

Processes and Outcomes from a Medical Student Research Training Program in Integrative, Complementary, and Alternative Medicine.

In response to the growing need to train a new generation of clinician scientists, a research program was developed to train medical students in integrative, complementary, and alternative medicine (ICAM) research early in their careers. A total of 25 students (100%) successfully completed a 10-week program. Students reported significantly increased levels of knowledge in all 7 integrative, complementary, and alternative medicine topics at the conclusion of the program. All students presented their work at one or more local research symposia. In addition, the average number of quality research outputs, which included manuscripts, awards, and abstracts presented at national and international meetings, was 1.5 per student, which exceeded benchmarks based on prior program outcomes. Results from this program may be useful when planning larger or longer-term projects aimed at attracting physicians who will become our next generation of academicians, researchers, and healers.

Pragmatic Model for Integrating Complementary and Alternative Medicine in Primary Care Management of Chronic Musculoskeletal Pain

Background: Integration of complementary and alternative medicine (CAM) into conventional care is driven by patients’ needs for holistic care. This study aimed to develop a model for integration of CAM into primary healthcare in close collaboration with patients suffering from chronic musculoskeletal pain (CMP). Methods: The study had a qualitative inductive approach following the principles of Grounded Theory, where data were collected and generated via several data sources and steps; individual and focus group interviews and meetings with patients, general practitioners (GPs), CAM practitioners, health insurers and other key informants. Results: Consensus was reached on a model in which shared decision making was introduced to facilitate discussions on CAM between patients and GPs. Guided by evidence and best-practices, GPs refer patients to one of five selected and reimbursed CAM therapies (acupuncture, homeopathy, naturopathy, osteopathy or Tai Chi) and respective practitioner within their integrative network. CAM practitioners report treatment outcome back to the GP who follows-up on the patient for further evaluation. Conclusions: In conclusion, it was feasible to develop a model for integration of CAM into primary healthcare management of CMP that was driven by patients’ needs and obtained consensus of all stakeholders. The model is the first in the Netherlands to provide for integrative health services in primary care. It needs to be tested in a study setting before further implementation is recommended.

Challenges and opportunities in integrating complementary and alternative medicine into mainstream of the Malaysian healthcare system

Complementary and alternative medicine (CAM) practice is still popular among the Malaysian population nowadays although western or allopathic medicine is the first line of treatment. Dissatisfaction with health services and therapeutic effects of western medicine or preference for holistic, integrative approach in treatment are common reasons favouring the increasing popularity of CAM practices. The efforts toward integration of CAM and western medicine in Malaysia were rather slow and in a piec-meal fashion. Strategic efforts in strengthening government and self-regulation among practitioners, formalizing education, promoting research, and cultivating national and international networks are necessary to achieve an integrative system. Regulations to restrict the practice and sale of CAM products to licensed practitioners, strict and mandatory registration of the practitioners, inclusion of CAM in essential medicines list, and pricing regulations must be comprehensively discussed. Development of curriculum, offers of scholarship and incentives, promotion of courses and seminars for professionals is necessary to increase the numbers of CAM experts. Malaysia should follow the efforts of other countries on the production and documentation of local CAM data, allocation of funding, and establishment of research centres to assess the efficacy of potentially useful local products. Local and international collaboration in research and continuous education is important for exchange of knowledge and skills. In conclusion more coordinated efforts in regulation of CAM practice and products, formalizing CAM training and education would significantly move the process forward and allow the public to enjoy more health benefits from CAM practice in Malaysia.

The effect of introducing Complementary medicine course in the curricula of undergraduate medical students on changing the attitudes towards CAM

Purpose: This pilot study aims to evaluate medical and pharmacy faculty and students’ attitudes and perceptions toward complementary and alternative medicine (CAM) in Turkey. Methods: A self-administered questionnaire was developed based on the previous studies carried out in Turkey and other countries. It was administered to 23 medical faculty and students at the Medipol University and 44 pharmacy faculty and students at the Istanbul University who attended the introductory course on Korean Medicine. The attitudes and perceptions on CAM among study population were evaluated and the difference betweenmedical faculty and students and pharmacy faculty and students was compared. T-test and fisher’s exact test were used. Results: The response rate was 39% at the medical school and 57% at the pharmacy school. Majority of the respondents strongly agreedwith the effectiveness of CAM and importance of integrative medicine. They also agreed with the statement that physicians should know about CAM and recommend it to the patients. Other than a few statements including perceptions on the effectiveness and placebo effect of CAM, there was no significant difference between medical and pharmacy students and faculty. The most well-known CAM modalities were acupuncture, herbal medicine, massage, naturopathy and hypnosis. Most of them(99%) have interest in CAM and agreed that CAM should be integrated into curriculum. Conclusion: The result suggests that majority of the respondents have positive attitude toward CAM and have interest in CAM. They also showed favorable attitude toward integration of CAM in their curriculum. However, due to small sample size and limitation of representativeness of the respondents, the results from this pilot study should be cautiously interpreted. Contact: Yu Lee Park, kiki2877@naver.com

A pilot study on attitudes toward complementary and alternative medicine among medical and pharmacy faculty and students in Turkey

Purpose: This pilot study aims to evaluate medical and pharmacy faculty and students’ attitudes and perceptions toward complementary and alternative medicine (CAM) in Turkey. Methods: A self-administered questionnaire was developed based on the previous studies carried out in Turkey and other countries. It was administered to 23 medical faculty and students at the Medipol University and 44 pharmacy faculty and students at the Istanbul University who attended the introductory course on Korean Medicine. The attitudes and perceptions on CAM among study population were evaluated and the difference betweenmedical faculty and students and pharmacy faculty and students was compared. T-test and fisher’s exact test were used. Results: The response rate was 39% at the medical school and 57% at the pharmacy school. Majority of the respondents strongly agreedwith the effectiveness of CAM and importance of integrative medicine. They also agreed with the statement that physicians should know about CAM and recommend it to the patients. Other than a few statements including perceptions on the effectiveness and placebo effect of CAM, there was no significant difference between medical and pharmacy students and faculty. The most well-known CAM modalities were acupuncture, herbal medicine, massage, naturopathy and hypnosis. Most of them(99%) have interest in CAM and agreed that CAM should be integrated into curriculum. Conclusion: The result suggests that majority of the respondents have positive attitude toward CAM and have interest in CAM. They also showed favorable attitude toward integration of CAM in their curriculum. However, due to small sample size and limitation of representativeness of the respondents, the results from this pilot study should be cautiously interpreted. Contact: Yu Lee Park, kiki2877@naver.com

Perceptions of complementary and alternative medicine among cardiac patients in South Trinidad: a qualitative study.

BackgroundComplementary and alternative medicine (CAM) has been practiced for centuries owing to the absence or limited availability of conventional medicine. CAM has persisted globally with over USD34 billion spent annually, despite modernization, globalization, technological advancement, and limited supportive evidence. The present qualitative study explores the perception of CAM among cardiac patients with respect to rationale, perceived outcomes, influences, and public health concerns.MethodsThis study used a qualitative, interpretative approach. Twelve cardiac disease patients were recruited from private clinics in South Trinidad and interviewed. The study obtained ethical approval, and all participants provided written consent. The semi-structured interviews were digitally recorded, transcribed, and thematically analyzed. Participants with poor cognitive function, difficulty speaking, and those not understandable owing to language barriers were excluded.ResultsCAM use was based largely on patient perception regardless of the clinical reality. The perceived mode of action and its natural character was responsible for the therapeutic outcomes and uses. Participants reported that CAM provided holistic care, improved the quality of life, overcame the limitations of conventional medicine, satisfied their increased expectation for comprehensive care, and prevented or counteracted adverse effects caused by conventional medicine. Participants reported a lack of scientific information on CAM and stated that policy makers should assist patients through increased research, public health education, and improved integration of CAM and conventional medicine.ConclusionsThe participants’ use of CAM was largely based on perception. CAM was thought to improve therapeutic outcomes, provide holistic care, decrease or prevent complications from conventional medicine, and improve quality of life. Participants acknowledged that they may be ill-informed about the basic concepts or actions of CAM. They urged policymakers to create an environment that assists the public and health care providers in promoting safe and effective CAM practice.

Knowledge , Attitude and Practice of Primary Health Care Physicians in Bahrain towards Complementary and Alternative Medicine ( CAM )

Introduction : The use of CAM has become popular and widely practiced among the general population. The integration of CAM into the ordinary medical system has been encouraged by World Health Organization (WHO) to improve the quality of care in the health for all strategy. This research aims at studying the knowledge, attitude and practice of primary health care doctors towards CAM in Bahrain. Method: A cross sectional study of all the 323 primary health care doctors who are working in the governmental health centers in Bahrain were the study population. A self-filled questionnaire was used for data collection. The Questionnaires were distributed to all primary health care doctors by name and collected after one week through the chief of medical services of primary health care. Data were entered and analyzed using SPSS program version 18. Results: Two hundred and twenty two (68.7%) questionnaires out of 323 questionnaires were completed. Around half (50.5%) of the respondents stated that they have a poor level of knowledge about CAM, while only 6 (2.7%) of them stated that they have an excellent level of knowledge. General non-medical sources were the main source of knowledge about CAM with general reading ranked as the main source (48.2%), followed by general media like TV and radio (34.2%), and followed by internet (23%). In general, the attitude of primary care doctors toward CAM was positive with 72.5% of them interested in CAM, 81.1% believe that training in CAM would affect their practice as doctors, and 73.9% agreed that CAM is beneficial. Regarding the practice of PHC doctors toward CAM, more than half (59.5%) had used CAM with their patients, while only 23% of them had referred patients to CAM practitioners. Most of PHC doctors (79.7%) stated that they asked their patients about the use of CAM. Conclusion: Primary Health Care doctors in Bahrain have a poor knowledge about CAM and would like to know more about it. On the other hand, they have a good attitude towards using CAM with their patients.

Complementary and Alternative Medicine: Knowledge and Attitude of Medical Students of the UniKL-RCMP, Perak, Malaysia

Introduction: Complementary and alternative medicine (CAM) is widely used in the prevention, diagnosis, and treatment of an extensive range of ailments from ancient days. The booming popularity of CAM among people all over the world had influenced this research evaluating the knowledge and attitude of the medical students in UniKL RCMP. Methods: This cross-sectional study was conducted in the first three years of medical students in UniKL-RCMP using questionnaires designed to assess their knowledge and attitude towards CAM therapies in Malaysia. Results: UniKL RCMP medical students possessed high knowledge on massage, acupuncture and homeopathy compared to other assessed CAM therapies. Overall, the students had the positive attitude towards CAM modalities. Conclusion: Integration of CAM in medical curriculum will be a measure to increase the knowledge and gain positive attitude towards CAM among medical students as the country is looking forward to the integration of CAM with conventional medicine in the health care system.

The Use of Complementary and Alternative Medicine among Lebanese Adults: Results from a National Survey

Objective. To examine the prevalence and correlates of Complementary and Alternative Medicine (CAM) use in Lebanon. Methods. A cross-sectional survey was conducted through face to face interviews on a nationally representative sample of 1,475 Lebanese adults. The survey questionnaire explored the sociodemographic and health related characteristics as well as the types and modes of CAM use. The main outcome in this study was the use of CAM during the last 12 months. Results. Prevalence of CAM use was 29.87% with “folk herbs” being the most commonly used (75%). Two out of five CAM users indicated using it as alternative to conventional therapies and only 28.4% of users disclosed the use of CAM to their physician. CAM use was significantly associated with higher income, presence of a chronic disease, and lack of access to needed health care. Lower odds of CAM use were observed among older adults and those with a higher education level. Conclusions. This study revealed a high prevalence of CAM use in Lebanon. Health policy and decision makers need to facilitate proper regulation and integration of CAM into mainstream medicine and educate health care providers and the public alike on the safe and effective use of CAM therapies.

The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals.

BackgroundIntegrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT.MethodsAn anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05.ResultsReturn rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach’s alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features.ConclusionThe lower quality of PGMT in German hospitals can be attributed to larger departments, more difficult working conditions, and less favorable structural features for PGMT in AM, possibly also in relation to increased financial pressure.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

BackgroundComplementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care.MethodsHealth service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage.ResultsFindings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach.ConclusionsFrom the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well-being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno-nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.