Complementary And Alternative Medicine Research Research Articles

Complementary and alternative system of medicine for type 2 diabetes mellitus and its complications: A scoping review

Background This review aims to map the evidence on the effectiveness of Complementary and Alternative Medicine (CAM) for Type 2 Diabetes Mellitus (T2DM) and its associated complications and identify research gaps in key outcomes and CAMs. Methods Our scoping review was informed by Johanna Briggs Institute guidelines. We searched electronic databases from inception to March 2020 and references of included studies. The experimental and non-randomized studies with intervention and control arm were mapped based on the effectiveness of various CAM (Yoga, Ayurveda, Homeopathy, Siddha, Naturopathy, Unani, and Sowa-rigpa) on outcomes among individuals with prediabetes or metabolic syndrome, and T2DM. Results A total of 249 studies were included after screening 3798 citations. Most of the included studies were conducted in India (30.52 %) and Iran (28.51 %). Of the 249 studies, 21 were efficacy, feasibility or pilot interventional studies. Most frequently studied CAM interventions include Ayurveda, and herbal products (58.63 %) followed by Yoga (20.88%). Unani medicines (n = 2 studies), Sowa-Rigpa (n = 1) and Homeopathy (n = 1) were the least studied modalities. With regards to population, 15 studies recruited newly diagnosed T2DM and 59 studies had included T2DM with comorbidity. Sixteen studies included population with mean ages 45-years or younger. Twenty-eight studies included pre-diabetic or metabolic syndrome, 46 studies included T2DM with no oral glycemic drugs, and 116 included T2DM with oral drugs. Blood sugars (fasting and postprandial) were the most measured outcomes. Outcomes such as HbA1c, lipid profiles, anthropometric measures, adverse effects were also assessed. Among complications, ulcer healing in diabetic foot ulcers was a commonly reported. Conclusion Future investments for research in CAM may focus on assessing the quality of existing trials and finding out an optimal dose, frequency, and duration of CAM that is beneficial, both as an alternative and complementary approach (or not) by carrying out a systematic review.

Complementary and alternative system of medicine for type 2 diabetes mellitus and its complications: A scoping review

Background This review aims to map the evidence on the effectiveness of Complementary and Alternative Medicine (CAM) for Type 2 Diabetes Mellitus (T2DM) and its associated complications and identify research gaps in key outcomes and CAMs. Methods Our scoping review was informed by Johanna Briggs Institute guidelines. We searched electronic databases from inception to March 2020 and references of included studies. The experimental and non-randomized studies with intervention and control arm were mapped based on the effectiveness of various CAM (Yoga, Ayurveda, Homeopathy, Siddha, Naturopathy, Unani, and Sowa-rigpa) on outcomes among individuals with prediabetes or metabolic syndrome, and T2DM. Results A total of 249 studies were included after screening 3798 citations. Most of the included studies were conducted in India and Iran. Of the 249 studies, 21 were efficacy, feasibility or pilot interventional studies. Most frequently studied CAM interventions include Ayurveda, and herbal products (58.63 %) followed by Yoga (20.88%). Unani medicines (n = 2 studies), Sowa-Rigpa (n = 1) and Homeopathy (n = 1) were the least studied modalities. With regards to population, 15 studies recruited newly diagnosed T2DM and 59 studies had included T2DM with comorbidity. Sixteen studies included population with mean ages 45-years or younger. Twenty-eight studies included pre-diabetic or metabolic syndrome, 46 studies included T2DM with no oral glycemic drugs, and 116 included T2DM with oral drugs. Blood sugars (fasting and postprandial) were the most measured outcomes. Outcomes such as HbA1c, lipid profiles, anthropometric measures, adverse effects were also assessed. Among complications, ulcer healing in diabetic foot ulcers was a commonly reported. Conclusion Future investments for research in CAM may focus on assessing the quality of existing trials and finding out an optimal dose, frequency, and duration of CAM, both as an alternative and complementary approach.

Approach to Study the Efficacy and Safety of New Complementary and Alternative Medicine Formulations: Lesson during COVID-19 from Sri Lanka.

COVID-19 affected Sri Lanka from early 2020, a time of considerable ignorance accompanied by wide media coverage of a devastating epidemic in Italy and Europe. Many were attracted to complementary and alternative medicine (CAM) or traditional medicine (TM) in this desperate situation. Several preparations were claimed to be effective against COVID-19 globally. Dammika Bandara Syrup© was one such preparation promoted for preventing and treating SARS-CoV-2 infection. It was based on bees' honey, pericarp and mace of Myristica fragrans (nutmeg), the seed of Foeniculum vulgare and fresh rhizome of Zingiber officinale, all believed to have anti-viral properties. Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage. The producer claimed of Goddess Kali revealing the formula added an anthropological, cultural, and religious complexity to the issue. The demand for the product increased rapidly as a debate raged both in public and in the parliament on utilizing such products in combating COVID-19. The Department of Ayurveda, which is statutorily responsible for regulating CAM/TM had to respond to the situation. The legislation to regulate such indigenous medicinal products was weak, and the crisis deepened as thousands converged to the production facility, defying mobility restrictions introduced to control COVID-19. This led to the Ministry of Health requesting academics to form a team and conduct a clinical trial to prove its efficacy. This paper outlines the process and issues faced during the regulatory approval for the trial in a polarized political environment. Some health professionals accused the researchers of bowing to political pressure and questioned the scientific justification for the trial. However, the team considered this as an opportunity to streamline a path for research into CAM/TM therapies in situations such as COVID-19. Several processes were identified and addressed, such as the provisional registration of CAM preparations, assessing the potential efficacy of a CAM product, confirmation of authenticity and safety, standardization and supervision of production respecting cultural identities, obtaining approval for human use, choice of comparators, and ethical issues. We believe the study has helped set standards and a benchmark for CAM and TM research in Sri Lanka.

Application of Virtual Reality Technology in Clinical Practice, Teaching, and Research in Complementary and Alternative Medicine.

Background The application of virtual reality (VR) in clinical settings is growing rapidly, with encouraging results. As VR has been introduced into complementary and alternative medicine (CAM), a systematic review must be undertaken to understand its current status. Aim This review aims to evaluate and summarize the current applications of VR in CAM, as well as to explore potential directions for future research and development. Methods After a brief description of VR technology, we discuss the past 20 years of clinical VR applications in the medical field. Then, we discuss the theoretical basis of the combination of VR technology and CAM, the research thus far, and practical factors regarding usability, etc., from the following three main aspects: clinical application, teaching, and scientific research. Finally, we summarize and propose hypotheses on the application of VR in CAM and its limitations. Results Our review of the theoretical underpinnings and research findings to date leads to the prediction that VR and CAM will have a significant impact on future research and practice. Conclusion Although there is still much research needed to advance the science in this area, we strongly believe that VR applications will become indispensable tools in the toolbox of CAM researchers and practitioners and will only grow in relevance and popularity in the era of digital health.

Mixed methods research in complementary and alternative medicine: a scoping review.

To update the current characteristics about the scope and quality of mixed methods research (MMR) in complementary and alternative medicine (CAM) after nearly 10 years. A 5-stage approach for conducting a scoping review was adopted. Articles published on the top 10 journals in CAM with the highest impact factor in 2020 were screened for MMR. Information of included articles were extracted, and then synthesized to illustrate the current state. Methodological quality was evaluated according to the Mixed Method Appraisal Tool (MMAT) 2018 version. A total of 55 (55/2991, 2%) articles using mixed methods were retrieved, including 17 medical studies and 38 ethnobotanical studies. We performed an in-depth analysis on the 17 medical studies, which studied cancer, stress, pain, fatigue, exercises, mindfulness intervention, herbal medicine use, art and acupuncture. Thirteen pilot studies applied MMR to evaluate the feasibility of interventions or programs (13/17, 76%); phenomenology was inferred as the most common philosophical assumptions (13/17, 76%); the most applied type of MMR was convergent design (16/17, 94%); integration often took place at integration (12/17, 71%). Among the 16 eligible studies for quality appraisal, majority were rated as good (14/16, 88%), whereas two studies were rated as poorly described. Primarily, a poor rating was due to incomplete reporting of data analysis and citations in qualitative components; lack of confounder controlling and the sampling strategy in quantitative components; poor description of integration and justification for mixed methods. Comparing with the previous review, fewer MMR were published in 2020 in CAM, but the proportion of studies that clearly reported MMR has increased by 4 times (4%→15%). CAM researchers need to realize the benefits that MMR can have on conducting further health care research. Our findings highlight that applying MMR will be helpful to understand the complex dynamics and interdisciplinary nature of complex intervention. In addition, addressing a standardized reporting criteria for MMR is recommended.

Complementary and alternative system of medicine for type 2 diabetes mellitus and its complications: A scoping review

Background: This review aims to map the evidence on the effectiveness of Complementary and Alternative Medicine (CAM) for Type 2 Diabetes Mellitus (T2DM) and its associated complications and identify research gaps in key outcomes and CAMs. Methods: We followed the Johanna Briggs Institute guidelines to undertake this scoping review. We carried out a comprehensive search from inception to March 2020 in electronic databases and registers. Forward and backward citations of included studies were also searched. The randomized controlled trials (RCTs) and non-randomized studies with intervention and control arm were mapped based on the effectiveness of various CAM (Yoga, Ayurveda, Homeopathy, Siddha, Naturopathy, Unani, and Sowa-rigpa) on outcomes among individuals with prediabetes or metabolic syndrome, T2DM with and without any comorbidities. Results: A total of 249 studies were included after screening 3798 citations. Most of the included studies were conducted in India and Iran. Most frequently studied CAM interventions include Yoga, Ayurveda, and herbal products as compared to other CAM therapies. Conclusion: Although we identified a lot of literature on the effectiveness of CAMs for T2DM, there is a lack of standardization of preparation of these medicines and the interventional modalities. To validate the potential benefits of CAM, robust research with high-quality RCTs and systematic reviews are needed to bridge the gap of evidence in CAM therapies. Future investments for research in CAM may focus on assessing the quality of existing trials and finding out an optimal dose, frequency, and duration of CAM, both as an alternative and complementary approach.

An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study.

BackgroundMost studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research.MethodsThis research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis.ResultsCAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes—lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes—intrinsic perceptions in CAM, and lack of communication within and outside CAM.ConclusionsPromoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges.

Safety of Complementary and Alternative Medicine (CAM) treatment among children and young adults who suffer from adverse effects of conventional cancer treatment: A systematic review.

Background:Complementary and Alternative Medicine (CAM) is widely used around the world to treat adverse effects derived from cancer treatment among children and young adults. Parents often seek CAM to restore and maintain the child’s physical and emotional condition during and after cancer treatment.Objectives:The objectives of this review were (i) to identify literature that investigates CAM use for treating adverse effects of conventional cancer treatment, (ii) to investigate the safety of the included CAM modalities, and (iii) to evaluate the quality of included studies.Methods:Five scientific research databases were used to identify observational, quasi-experimental, and qualitative studies from January 1990 to May 2021. Included studies investigated the use of CAM to treat adverse effects of cancer treatment in childhood cancer.Results:Fifteen studies were included in this review. Ten quasi-experimental, 3 observational studies (longitudinal/prospective), 2 qualitative studies, and 1 study with a quasi-experimental and qualitative arm were identified. Less than half (n = 6; 40%) of the studies included reported adverse effects for the CAM modality being studied. Among the studies that reported adverse effects, they were mostly considered as direct risk, as 13% reported mainly bleeding and bruising upon acupuncture treatment, and dizziness with yoga treatment. All adverse effects were assessed as minor and transient. CAM modalities identified for treating adverse effects of cancer treatment were alternative medical systems, manipulative and body-based therapies, biologically-based therapies, and mind-body therapies. CAM modalities were used to alleviate anxiety, pain, toxicity, prevent trauma, and improve health-related quality of life, functional mobility, and physical activity levels. All studies assessed scored 70% or above according to the Joanna Briggs Institute critical appraisal for study quality checklists.Conclusion:Most of the studies (58.3%) included in this review did not report adverse effects from CAM modalities used to treat adverse effects of cancer treatment in children and young adults. This lack of safety information is of concern because parents need to know whether the modality represents an extra burden or harm to the child. To improve awareness about safety in the field, a universal and uniform reporting system for adverse effects in CAM research is needed.

Complementary medicine in Germany: a multi-centre cross-sectional survey on the usage by and the needs of\xa0patients hospitalized in university medical centers

BackgroundThe results of recent surveys indicate that more than 50% of the German population has experience with complementary and alternative medicine (CAM) or uses CAM regularly. This study investigated the CAM usage and CAM-related needs of hospitalized patients at university medical centres in the state of Baden-Württemberg, Germany.MethodsA multi-centre, paper-based, pseudonymous survey was carried out by the members of the Academic Centre for Complementary and Integrative Medicine. Patients of all ages, regardless of sex, diagnosis and treatment, who were hospitalized in the Department of Cardiology, Gastroenterology, Oncology, Gynaecology or Surgery at the university medical centres in Freiburg, Heidelberg, Tübingen and Ulm were eligible for inclusion.ResultsOf the 1275 eligible patients, 67% (n = 854) consented to participate in the survey. Forty-eight percent of the study participants stated that they were currently using CAM. The most frequently used therapies were exercise (63%), herbal medicine (54%) and dietary supplements (53%). Only 16% of the patients discussed CAM usage with their attending physician. Half of the patients (48%) were interested in CAM consultations. More than 80% of the patients desired reliable CAM information and stated that physicians should be better informed about CAM.ConclusionsThe frequency of CAM usage and the need for CAM counselling among hospitalized patients at university medical centres in Baden-Württemberg are high. To better meet patients’ needs, CAM research and physician education should be intensified.Trial registrationGerman Clinical Trial register (DRKS00015445).

Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BackgroundOver the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM.MethodsThe scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data.ResultsOf the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers.ConclusionsWhile the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Barriers to the conduct and application of research among complementary and alternative medicine professions in Australia and New Zealand: A cross-sectional survey

IntroductionDespite the growing international popularity and use of complementary and alternative medicine (CAM), the uptake of evidence-based practice (EBP) in CAM has been slow. This cross-sectional survey aimed to further our understanding of the factors impacting EBP uptake in CAM. MethodsThe 32-item oBSTACLES instrument was administered online using the SurveyMonkey™platform. The survey evaluated barriers to both the conduct and application of research among CAM practitioners and researchers, from multiple CAM disciplines across Australia and New Zealand. Participants were recruited via practice-based research networks, professional associations, CAM educational institutions, CAM research centres, pertinent product manufacturers and social media platforms. Data were analysed using descriptive statistics. ResultsSix hundred and eighty-two CAM stakeholders responded to the survey. Barrier items were divided into two interlinked constructs, “capacity” and “culture”. Capacity related to issues regarding access, competency, bias, incentives, and time, whereas culture related to values and complex systems. Under capacity, the greatest proportion of participants (>70 %) agreed that access was a barrier to the conduct and application of research, including lack of funding, institutional support, research training and collaborations. In terms of culture, the majority of participants (>60 %) agreed that values were a barrier to research conduct and application, including limited undergraduate research opportunities and diverse views of evidence. ConclusionFindings from this research suggest a multitude of barriers negatively impact the conduct and application of research in CAM. Insights gained from this research will be instrumental in developing actionable strategies aimed at mitigating the impact of these barriers to improve research engagement in CAM.

Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review

BackgroundThe prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals’ practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM).MethodsLiterature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals.ResultsEleven studies (two of ‘high-quality’, seven of ‘moderate-quality’, and two of ‘low-quality’) were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums.ConclusionsNine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand.

Evaluating the reliability of the oBSTACLES Instrument

ObjectivesEach health profession has a responsibility to generate and implement evidence to support its practices; however, many obstacles continue to impede such progress. The 32-item BarrierS To the Application and Conduct of rEsearch (oBSTACLES) instrument was developed and subsequently validated to help identify these obstacles in complementary and alternative medicine (CAM) practice. The objective of this study was to assess the test–retest reliability of the oBSTACLES instrument. DesignTest–retest data were collected at baseline (round 1) and two-weeks later (round 2) from researchers and practitioners in CAM (n = 23). Intraclass correlation coefficients were used to measure test-retest reliability. Cronbach's alpha was used to assess internal consistency. ResultsThe majority (29/32, 91%) of oBSTACLES items achieved intraclass correlation coefficients ranging between 0.441 and 0.913 (“excellent”, “good” to “fair”). A high degree of internal consistency (α = 0.78) was demonstrated for the instrument overall, as well as for the conduct (α = 0.79) and application (α = 0.88) parts of the instrument. ConclusionsThe results indicate the oBSTACLES instrument is a reliable measure of the barriers to the conduct and application of research evidence in complementary and alternative medicine. Access to such psychometrically sound tools can enable future surveys of CAM practitioners and researchers to identify the extent to which each of these barriers impacts the generation and application of evidence in CAM within the various complementary and alternative medicine disciplines.

Effects of shiatsu on the health-related quality of life of a person with secondary progressive multiple sclerosis: A mixed methods N-of-1 trial within a whole systems research case study

IntroductionMultiple Sclerosis (MS) is a chronic neurological disorder with high prevalence in Finland. Most people with MS will develop Secondary-Progressive MS (SPMS) over time. People with MS report lower than the average Health-Related Quality of Life (HRQoL) and use Complementary and Alternative Medicine (CAM) for their symptoms. Personalised interventions such as shiatsu have an insufficient evidence base. The n-of-1 trial is a promising study design for personalised interventions in chronic conditions but has not little used in CAM research. The aim was to investigate if shiatsu affects the HRQoL of a person with SPMS. MethodsSix-periods counterbalanced mixed-methods n-of-1 trial within a Whole Systems Research (WSR) case study was used. The short version of the MSQLI, data collected from a semi-structured interview and case notes were used to assess the effect of the treatment. The collected data analysed quantitatively and qualitatively and synthesised as a descriptive case study. ResultsThe study was able to document improvements in spasticity, bowel function, fatigue, pain, sleep and relaxation. No adverse events occurred. Preliminary estimations of the onset and wash-out of shiatsu effects were inferred. Advantages and drawbacks of the design are discussed to improve future applicability. ConclusionsShiatsu was able to improve some domains of the HRQoL of the specific person with SPMS. It was a safe treatment with no adverse events. Mixed methods n-of-1 trial within a WSR case study was an appropriate design for the study.

Homeopathy and Antibiotic Resistance

Summary Antibiotic resistance (AR) has long been a problem for doctors and healthcare organizations worldwide. In recent years the issue has become even more pressing: the Global Antimicrobial Surveillance System (GLASS), launched by the World Health Organization in October 2015, bears witness to the growing emergence of antibiotic-resistant microorganisms. In Italy, AR levels are still among the highest in Europe. This is presumably due to over-use of antibiotics. According to the recent Italian National Surveillance Report on bacteriemia, the incidence of AR is on average, for the most widespread bacteria, 25-30%. The causes of the development of AR are complex, but undoubtedly include the excessive and inappropriate use of antibiotics then each strategy to correct these misconducts will be effective. Complementary and alternative medicine (CAM) offers a conceptual alternative to the use of conventional treatments, but in recent years a different model, that of integrated medicine (IM), has been gaining ground. Several studies show that CAM can allow to reduce the recourse to antibiotics in the treatment of respiratory symptoms, without increasing the incidence of complications. A recent study conducted by our Italian Paediatric Society's CAM research group investigated the efficacy of homeopathy in the treatment of acute otitis in children. Ninety children were enrolled and randomized to a homeopathy treatment group or to a control group, each of 45 patients. Antibiotics were prescribed in 33.3% of children in the treatment group and 62.2% of children in the control group (p = 0.006). In conclusion, there is evidence in the literature demonstrating that the use of CAM in general, and homeopathy in particular, can reduce recourse to antibiotics, with positive repercussions for strategies to combat antibiotic resistance.

“I’ve Only Just Heard About It”: Complementary and Alternative Medicine Knowledge and Educational Needs of Clinical Psychologists in Indonesia

Background and objectives: The inadequate knowledge of complementary and alternative medicine (CAM) among health professionals may put their clients at risk because clients would then find information about CAM from unreliable sources. Clinical psychologists (CPs), as health professionals, also have the opportunity to provide psychoeducation on the latest scientific CAM research for their clients. The current study aimed to explore knowledge and educational needs regarding CAM among CPs in Indonesia because previous studies on exploring CAM knowledge and educational needs regarding CAM were primarily conducted in Western countries. Materials and Methods: Data were collected through semi-structured face-to-face interviews with 43 CPs in public health centers (PHCs) in Indonesia. Most interviews were conducted at the PHCs where the participants worked and lasted for 55 minutes on average. The interview recordings were transcribed and were analyzed using deductive thematic analysis. Results: Five main themes emerged within participants’ responses regarding CAM knowledge and educational needs. First (CAM understanding), participants’ responses ranged from those with little or no prior knowledge of CAM treatments and uses, to those with much greater familiarity. Second (source of knowledge), participants’ access ranged widely in terms of references, from popular to scientific literature. Third (why is it important?), participants identified CAM as an essential part of Indonesian culture and considered it therefore crucial to have this cultural knowledge. Fourth (the challenges and what is needed?), the challenges for improving participants’ knowledge came from personal and institutional levels. Fifth (what and how to learn?), participants advised that only CAM treatments that fit in brief psychotherapy sessions should be introduced in professional training. Conclusions: This qualitative study discovered that CAM was neither well-known nor understood widely. Participants advised that professional associations and health institutions should work together in enhancing knowledge of CAM and incorporating CAM education into psychology education.

Indonesian clinical psychologists’ perceptions of complementary and alternative medicine research and knowledge: a content analysis study

PurposeAs part of a nationwide research about knowledge, attitude, experiences and educational needs towards complementary and alternative medicine (CAM) among Indonesian clinical psychologists (CPs), the purpose of this paper is to explore CPs’ perceptions of CAM research and their interest in learning CAM.Design/methodology/approachA link to an online survey was e-mailed to all 1,045 CPs across Indonesia. At the end of the survey, two open-ended questions were asked: “What do you think about CAM research in Indonesia?” and “Why are you interested in learning about CAM?”, which were responded to by 127 participants (87 per cent of females; Mage=36.67, SD=9.02). Participants’ responses were analysed using inductive qualitative content analysis.FindingsIt was found that two global themes for CPs’ perceptions of CAM were to improve participants’ professionalism and as part of continuing education and development for mental health professionals. The favourable responses in this study may reflect participants’ willingness to be involved in collaborative CAM research and education. Moreover, CAM was perceived as part of Indonesian culture and participants viewed CAM research and knowledge as a chance to promote Indonesian local wisdom to complement conventional psychotherapy.Research limitations/implicationsThese findings might call for stakeholders to integrate CAM knowledge into psychology education, facilitate CAM research in psychology settings and encourage collaborative CAM research. However, self-selection bias may limit the findings of this study.Originality/valueThis study explored perceptions of CAM research and interest in learning CAM that have rarely been investigated among mental health professionals and particularly, until now, have not been investigated in Indonesia.

Cancer Biomarkers for Integrative Oncology.

There has been an increasing interest in using complementary and alternative medicine (CAM) approaches to treat cancer. It is therefore relevant and timely to determine if CAM biomarkers can be identified and developed to guide cancer diagnosis and treatment. Herein, we review the status of cancer biomarkers in CAM research and treatment to stimulate further research in this area. Studies on promising anti-cancer natural products, such as PHY906, honokiol, bryostatin-1, and sulforaphane have demonstrated the existence of potential cancer biomarker(s). Additional studies are required to further develop and ultimately validate these biomarkers that can predict clinical activity of the anti-cancer natural products used alone or in combination with chemotherapeutic agents. A systematic approach is needed to identify and develop CAM treatment associated biomarkers and to define their role in facilitating clinical decision-making. The expectation is to use these biomarkers in determining potential options for CAM treatment, examining treatment effects and toxicity and/or clinical efficacy in patients with cancer.

Complementary and alternative therapy (CAM) in haemophilia pain management: a review of published literature

Abstract Pain continues to be a significant issue for people with haemophilia (PWH), whether it is acute pain from a joint bleed, a needle stick when receiving clotting factor treatment, or chronic pain from chronic synovitis and arthritic changes. In the US, there has been controversy and uncertainty regarding the use of oral medications and opioids for the management of chronic pain, including haemophilia pain. Both PWH and their clinicians have started to explore nonpharmacologic options for managing pain, with many PWH trying to limit their use of oral pain medication and using alternative methods. There is little research around the use of complementary and alternative medicine (CAM) for pain management in the haemophilia community. This paper aims to provide a comprehensive literature review of current English language research on the use of therapies that fall into four distinctive domains of CAM in PWH. English language articles were obtained via searches in Medline, Embase and CINAHL using the target search words “haemophilia” or “bleeding disorders” in combination with other search terms relating to CAM. All references were considered regardless of year. Twenty-three CAM articles that included PWH or other bleeding disorders were identified; ten were evidence based while the remainder provided case reports and descriptions of CAM use in PWH. This indicates that there is limited current research in the area of CAM use for pain management in PWH. Evidence of the benefit of CAM is seen in studies of its use to treat pain in other conditions and health-related circumstances. Additional evidenced-based CAM research is needed so that alternative pain management therapies can be utilised in a safe and beneficial manner in PWH.

The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: a Delphi study

BackgroundAs Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers.MethodsA three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥ 70% agreement on a four-point Likert scale was determined to have reached consensus.ResultsConsensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the “BarrierS To the Application and Conduct of rEsearch” (oBSTACLES) instrument.ConclusionThis study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum.