Complementary Medicine Treatments Research Articles

Yoga for the primary prevention of cardiovascular disease: Summary of a Cochrane review

This column is one of a series published periodically in EXPLORE on recent Cochrane systematic reviews. Cochrane is an international non-profit organization that prepares systematic reviews of randomized controlled trials of a wide range of interventions. The Cochrane Complementary Medicine Field, which coordinates this column, is a group within Cochrane that is dedicated to facilitating the production and dissemination of Cochrane systematic reviews focused on complementary, alternative, and integrative medicine interventions. The Field is supported by the National Center for Complementary & Integrative Health of the National Institutes of Health under award number R24AT001293. For additional information on Cochrane and the Cochrane Complementary Medicine Field please contact L. Susan Wieland, PhD at swieland@som.umaryland.com.

Use of Acupuncture for the Treatment of Sports-Related Injuries in Athletes: A Systematic Review of Case Reports.

Acupuncture is one of the representative complementary and alternative medicine treatments used for various types of pain. This systematic review summarized and analyzed clinical case reports/series utilizing acupuncture for treating sports injuries in athletes, thereby providing the basis for further research to establish clinical evidence on acupuncture treatment in sports medicine. A comprehensive literature search was conducted in Embase including MEDLINE up to 21 August 2019 without language and publication date restrictions. Due to the heterogeneity of each study, explanatory and descriptive analyses were performed. As a result, in each case report/series, it was confirmed that acupuncture was applied for treating various types of sports injuries experienced by athletes. Acupuncture can help relieve short-term pain and recover from dysfunction and has been used as a useful, noninvasive, and conservative modality for managing sports injuries such as lateral meniscus rupture, femoral acetabular impingement, ganglion cysts, and sports hernia. In addition, acupuncture has been suggested as a treatment worth trying for diseases such as yips and delayed onset muscle soreness. The included cases showed some potential of acupuncture in the treatment of various types of sports injuries, beyond pain control in musculoskeletal disorders. However, considering that this review was based on case reports/series, a limited understanding of the clinical value of acupuncture in athletes is required. In the future, more specific research questions and hypotheses should be addressed to generate evidence based on experimental research.

Mothers’ Attitudes toward the Use of Complementary and Alternative Medicine in Children with Cancer

Background: Children who have cancer suffer from a wide range of symptoms and side-effects of disease and treatment, and such conditions have harmful effects on the quality of life of a child and family. So, the families of such children turn to complementary and alternative medicine treatments for children with cancer. Objectives: Therefore, this study aimed at determining the mothers’ attitudes toward the use of complementary and alternative medicine in children with cancer. Methods: This cross-sectional research was conducted from January 2018 to January 2019 in the oncology section of Yazd Shahid Sadooghi Hospital in a nonrandom and convenience sampling method on 150 mothers of children with cancer. The instruments of data collection include demographic information questionnaires and a 6-part questionnaire to evaluate mothers’ performance. To investigate the face and content validity of the questionnaire, the opinions of 10 experts were considered, and to investigate the reliability of the questionnaire, the test-retest method was used, and the intraclass correlation coefficient (ICC) was reportedly 0.80. After completing the questionnaires, the collected data were analyzed, using SPSS 23 by utilizing descriptive statistics, including mean, standard deviation (SD), frequency, and percent. Results: Overall, 83.34% of mothers mentioned praying as a way of complementary and alternative medicine, 67.34% used complementary and alternative medicine to increase child recovery chance, 74% reported general child recovery, 20% reported the occurrence of side-effects following the use of complementary and alternative medicine, 67.33% introduced their friends as their information source, 33.6% avoided informing the physician regarding the use of complementary and alternative medicine, and 76% maintained that due to the objection of physicians, they avoided informing him/her. Conclusions: The use of complementary and alternative medicine is common among mothers but due to the occurrence of side-effects, using invalid information sources and hiding it from a physician, the oncologists must provide a suitable opportunity for asking and answering to guide mothers for correct performance in the use of complementary and alternative medicine.

Reproductive outcomes in women and men using complementary and alternative medicine treatment and not receiving artificial reproductive technology: a systematic review

PurposeInfertility is a global problem, but only a minority of couples access assisted reproductive technologies due to financial and sociocultural barriers. Complementary and alternative medicine are seen as another option. We aimed to determine the impact of complementary and alternative medicine on conception, miscarriage and live birth rates in couples not receiving assisted reproductive technology treatments.MethodsThe electronic databases EMBASE, PubMed, Web of Science and the Allied and Complementary Medicine Database were systematically searched before March 24th 2020. Reference lists of eligible studies were searched for relevant studies. Eligible studies included trials and observational studies that assessed a complementary or alternative medicine and conception, miscarriage or live births in men or women not undergoing fertility treatment. Data were extracted by two independent reviewers using a pre-designed data collection form. The study protocol was published in the PROSPERO database (CRD42018086980).ResultsTwenty randomized controlled trials were identified, including 2748 individuals. Most studies did not demonstrate any effect of a complementary or alternative medicine on pregnancy, live birth or miscarriage rates. Limited evidence was found for a positive effect of herbal therapies taken by women on conception rates. There was substantial diversity in quality across the studies.ConclusionThere is limited evidence of the effectiveness of complementary and alternative medicine on improving the chances of conception and live births, or increasing miscarriage risk. Owing to the generally sub-optimal quality and heterogeneous nature of the evidence, rigorous studies are needed to determine the impact of complementary and alternative medicine on fertility.

The Roles of Inflammation, Oxidative Stress and the Gut-Brain Axis in Treatment Refractory Depression in Youth: Complementary and Integrative Medicine Interventions

Teen depression and suicide rates have risen despite conventional treatments. This article reviews adjunctive interventions that may improve outcomes. A search of the National Library of Medicine database used tailored searches with combinations of specific terms. Modern lifestyle is associated with increased inflammation and pro-inflammatory cytokines leading to, for instance, hyperactivation of the hypothalamic-pituitary-adrenal axis, which promotes depression. Inflammation also increases oxidative stress, leading to mitochondrial dysfunction, also associated with depression. Diets with less probiotic-containing fermented foods change the microbiome and decrease the bio-availability of mood-regulating B vitamins crucial to neurotransmitter production. Vitamin D deficiency allows increased pro-inflammatory cytokines and disrupts mitochondrial function and monoamine production. Deficiencies/insufficiencies of magnesium, Vitamin D, and B vitamins correlate with depression severity. Deficiencies of the folate and methylation cycles may lead to treatment-resistant depression. Imbalance of omega-6 and omega-3 fatty acid intake allows more pro-inflammatory eicosanoids (prostaglandins, thromboxanes, leukotrienes) from omega-6 than anti-inflammatory eicosanoids from omega-3. Refractory youth depression may be linked to abnormalities in functional biological systems, with excessive inflammation, oxidative stress, and gut-brain issues. Mediterranean diet, vitamins/minerals, omega-3 fatty acids, methyl donors, meditation, and exercise are worth considering as adjunctive treatments. More research is needed.

Association of pharmacy students' cultural beliefs with perceived knowledge, beliefs, confidence, and experience with complementary medicine

Background and purposeCulture has been shown to inform patients' acceptance and use of complementary medicine (CM) treatment. It is unknown how a pharmacist or pharmacy student's culture may be associated with perceptions of CM relating to patient care. Gaining a better understanding of this concept within student populations may inform educational needs for programs situated within culturally diverse settings. The purpose of this study was to explore how pharmacy students' cultural beliefs influence perceived knowledge, confidence, and practice with respect to CM. Educational activity and settingA cross-sectional survey was distributed to all undergraduate pharmacy (professional years 1–4) and postgraduate doctor of pharmacy students. Results from the item “CM is an important aspect of my culture” were correlated with all other items using Spearman's correlation coefficient. FindingsSenior students who had completed a two-credit hour course appeared to be more confident in their practice skills relating to CM and showed positive correlations with culture and effectiveness of CM. Senior students acknowledged the importance of CM knowledge as a student and within pharmacy practice. Junior students showed a positive correlation with culture and past use. SummaryPharmacy students in the College of pharmacy were positive towards the use of CM, with culture playing an important role. Students who perceived CM as an important aspect of their culture were more confident in their practice skills relating to CM. Future research is required to assess impact of students' cultural beliefs on practice.

Use of Complementary and Alternative Medicine in Fibromyalgia: Results of an Online Survey

BackgroundFibromyalgia is a chronic condition which may negatively impact various aspects of patients' lives. Many people with fibromyalgia look to complementary and alternative medicine treatments for symptom relief. AimsThe three main objectives of this study were to examine self-reported complementary and alternative medicine use in patients with fibromyalgia, to determine associations between the use of complementary and alternative medicine treatments and patients’ self-reported quality of live and self-reported pain levels. DesignCross-sectional survey. SettingWeb-based. Participants/SubjectsAdults over the age of 18 years who had been diagnosed with fibromyalgia. MethodsPatients with fibromyalgia responded to an online questionnaire regarding the following: treatments (complementary and alternative medicine, prescription and over-the-counter medications), quality of life (Quality of Life Scale-16), assessment of current pain (visual analog scale), and demographic information. ResultsApproximately 66% of the respondents used complementary and alternative treatments. Vitamins, massage therapy, and meditation were the most commonly used complementary and alternative therapies. Results indicated respondents using a combination of complementary and alternative medicine and pharmacologic treatments (prescription or over-the-counter) had significantly higher quality of life versus those using pharmacologic treatments alone, p = .011. Similarly, respondents using only complementary and alternative medicine treatment reported significantly lower pain levels versus those using pharmacologic treatment alone, p = .046. ConclusionsThe study suggests that a large proportion of fibromyalgia patients use complementary and alternative medicine, and these treatments may offer beneficial effects to these patients. Integration of complementary and alternative medicine into conventional treatment regimens may provide opportunities for a holistic treatment approach and greater symptom relief for fibromyalgia patients. This approach is timely, as controlled substances are increasingly difficult for patients with fibromyalgia to access.

CAM treatments for cough and sore throat as part of an uncomplicated acute respiratory tract infection: a systematic review of prescription rates and a survey among European integrative medical practitioners

IntroductionMost Complementary & Alternative Medicine (CAM) interventions have not been tested in clinical trials and systematic reviews (SRs). It is therefore important to collect knowledge from experienced practitioners to identify (lower level) evidence to support their use and to prioritize interventions for future research. This study aimed to document the CAM treatments for cough and sore throat as part of uncomplicated, acute respiratory tract infections (RTI), most frequently recommended by experienced integrative medical practitioners; and to assess whether these approaches have been tested in clinical trials and SRs. MethodsData on treatment approaches were collected by means of (1) a SR on prescription rates of CAM treatments for RTIs in CAM practice by searching Pubmed and CINAHL databases; and (2) a survey among integrative medical doctors and TCM practitioners in five European countries. ResultsThe SR identified 336 articles. After screening five studies were included (Anthroposophic Medicine (AM): two and homeopathy (HOM): three). The survey resulted in 262 responses (including 99 AM and 95 HOM experts). Of 19 products that were described in both the SR and the survey, two (22%) AM (Hustenelixier, Echinacea) and three (30%) homeopathic products (Belladonna, Hepar sulphuris, Mercurius solubilis) had been studied in a clinical trial and one AM treatment (Echinacea) in a SR for this indication. ConclusionsCAM treatments for RTI related cough and sore throat were identified (medicinal products, syrup, external applications, tea and acupuncture). These treatments have hardly been studied in clinical trials (26%) and SRs (5%) and require further evaluation.

Complementary and alternative medicine beliefs in type 2 diabetes: The Fremantle Diabetes Study Phase II

Complementary medicine (CM) treatment beliefs of people with type 2 diabetes were assessed using a validated three-domain questionnaire. Belief in holistic health, but not natural treatments or participation in treatment, was independently associated with CM use (P = 0.003). Strong holistic health beliefs could identify present/future CM use, with potential management implications.

Tuina (massage) therapy for diarrhea in COVID-19: A protocol for systematic review and meta-analysis.

Background:In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19.Methods:We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses.Results:This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect.Conclusions:This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.

COVID-19 Modifications for Remote Teleassessment and Teletraining of a Complementary Alternative Medicine Intervention for People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial.

BackgroundAccess to comprehensive exercise and rehabilitation services for people with multiple sclerosis (MS) remains a major challenge, especially in rural, low-income areas. Hence, the Tele-Exercise and Multiple Sclerosis (TEAMS) study aims to provide patient-centered, coordinated care by implementing a 12-week complementary and alternative medicine (CAM) intervention for adults with MS. However, due to the societal impact of coronavirus disease (COVID-19) in mid-March 2020, the University of Alabama at Birmingham announced a limited business model halting all nonessential research requiring on-site visits, which includes the TEAMS study.ObjectiveIn compliance with the shelter-in-place policy and quarantine guidance, a modified testing and training protocol was developed to allow participants to continue the study.MethodsThe modified protocol, which replaces on-site data collection and training procedures, includes a teleassessment package (computer tablet, blood pressure cuff, hand dynamometer, mini disc cone, measuring tape, an 8” step, and a large-print 8” × 11” paper with ruler metrics and wall-safe tape) and a virtual meeting platform for synchronous interactive training between the therapist and the participant. The teleassessment measures include resting blood pressure and heart rate, grip strength, Five Times Sit to Stand, Timed Up & Go, and the Berg Balance Scale. The teletraining component includes 20 sessions of synchronous training sessions of dual tasking, yoga, and Pilates exercises designed and customized for a range of functional levels. Teletraining lasts 12 weeks and participants are instructed to continue exercising for a posttraining period of 9 months.ResultsThe protocol modifications were supported with supplemental funding (from the Patient-Centered Outcomes Research Institute) and approved by the University Institutional Review Board for Human Use. At the time nonessential research visits were halted by the university, there were 759 people enrolled and baseline tested, accounting for 92.5% of our baseline testing completion target (N=820). Specifically, 325 participants completed the 12-week intervention and follow-up testing visits, and 289 participants needed to complete either the intervention or follow-up assessments. A modified analysis plan will include sensitivity analyses to ensure the robustness of the study results in the presence of uncertainty and protocol deviations. Study results are projected to be published in 2021.ConclusionsThis modified remote teleassessment/teletraining protocol will impact a large number of participants with MS who would otherwise have been discontinued from the study.Trial RegistrationClinicalTrials.gov NCT03117881; https://clinicaltrials.gov/ct2/show/NCT03117881International Registered Report Identifier (IRRID)DERR1-10.2196/18415

Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed

PURPOSEPatients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.METHODSFour hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.RESULTSThe mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.CONCLUSIONPatient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

"Chasing hope": Parents' perspectives on complementary and alternative interventions for children with autism in Kazakhstan.

The article reports the findings of a qualitative research study on how and why parents of autistic children in Kazakhstan utilize complementary and alternative medicine. We found that parents turn to complementary and alternative medicine because of the lack of professional care options available to them and in pursuit for hope and opportunities for their children with ASD.

Use of complementary and alternative medicine treatments by mothers of children with developmental disabilities: a cross sectional study.

This study aims to determine the rates of complementary and alternative medicine methods used by mothers of children with developmental disabilities, reasons for using methods, and comparison of methods according to diagnosis groups. The cohort in this cross-sectional and correlational study consisted of the mothers of 390 students with developmental disabilities; 77.2% of the mothers reported using at least one complementary and alternative medicine treatment. The highest level of use was found in the groups of mothers of children with cerebral palsy (100%) and autism spectrum disorder (88.5%). The most commonly used treatments were biological therapies consisting of special diets and multivitamins, manipulative and body-based methods including massage and exercise, and mind-body interventions such as prayer, wearing amulets, and seeking help from a Muslim preacher (hodja). However, mothers never used alternative medicine treatments such as homeopathy, acupuncture, or Ayurveda, nor did they use energy-based healing techniques such as reiki, tai chi, yoga, kinesiology, or neurofeedback exercises. Health care professionals, especially nurses as health care team members, should be knowledgeable and careful about the benefits, side effects, administration methods, and contraindications of complementary and alternative medicine treatments.

Interventions for sexual dysfunction following stroke.

Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management. To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke. We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors. Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach. We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation. Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.

A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions

BackgroundNetwork meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions.MethodsAn information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review.ResultsA total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1–4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias.ConclusionThe use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed.Systematic review registrationhttps://ruor.uottawa.ca/handle/10393/35658

Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study.

Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy.Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM).Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C.Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.

Herbal medicine for inflammatory bowel diseases: development of pattern identification algorithms by retrospective analysis of case series data

IntroductionHerbal prescriptions are frequently sought as complementary medicine treatment for inflammatory bowel disease (IBD). However, variability in pattern identification of Traditional Medicine has been criticised. Using patient data on clinical remission, we aimed to develop pattern identification (PI) algorithms refined by identified pattern and key symptoms which practitioners can easily differentiate. MethodsSymptoms of IBD patients with remission were divided into Large intestine, Water-dampness, Respiratory, Upper gastrointestinal (GI) tract, and Coldness patterns. Using the term frequency-inverse document frequency (TF-IDF) method, symptoms described as indications of the herbal prescriptions and 5 patterns were matched. Decision tree modeling was used for prediction of relevant patterns from symptoms. Five-fold cross validation and sensitivity analysis was conducted to validate the model. ResultsIncomplete feeling of bowel emptying for Large intestine pattern, water dampness for Water-dampness pattern, chronic rhinitis for Respiratory pattern, gastric stuffiness for Upper GI tract pattern, and abdominal pain for Coldness pattern were selected by TF-IDF analysis. Overall accuracy of the decision tree was 64.4 %. In the treatment algorithm by the decision tree modeling, associations emerged between presence of incomplete feeling of bowel emptying and Large intestine type (100 %), chronic rhinitis and Respiratory type (100 %), water dampness symptoms and Water-dampness type (78.4 %), and gastric stuffiness and Upper GI tract type (58.3 %). ConclusionsThe PI algorithm we suggest can help clinicians determine patterns of IBD. Future studies with a large sample could yield an improved algorithm that predicts not only patterns but also corresponding herbal medicine prescriptions.

Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer.

Complementary and alternative medicine (CAM) use is common amongst cancer patients. However, there is growing concern about its safety and efficacy. Online crowdfunding campaigns represent a unique avenue to understand the cancer patient's perspective for using CAM or declining conventional cancer therapy (CCT). Five hundred GoFundMe campaigns from 2012 to 2019 detailing financial need for cancer treatment were randomly selected and reviewed for endorsement of CAM use, reasons for using CAM, and reasons for declining CCT. Descriptive statistics were used to compare patient and campaign characteristics between 250 CAM users and 250 non-CAM users. Compared to non-CAM users, CAM users were more likely to be female (70% vs. 54%, p < 0.01), to report more stage IV cancer (54% vs. 12%, p < 0.01), and to have a history of delayed, missed, or misdiagnosis (10% vs. 4%, p < 0.01). Reasons for using CAM include endorsing curative/therapeutic effects 212 (85%), pain/stress reduction 137 (55%), and dissatisfaction with current or past medical treatment options 105 (42%). 87 (35%) CAM users that declined CCT reported that they wanted to try to fight off cancer using CAM first 57 (61%), that CCT was too "toxic" to the body 39 (42%), and cancer was already too advanced, so that CCT would be futile or too aggressive 25 (27%). Cancer patients on GoFundMe using CAM highly value quality of life, comfort, and autonomy. Physicians should educate themselves on CAM to set realistic expectations and provide comprehensive counseling of the risks and benefits of CAM usage to patients who choose to use CAM to either augment or completely replace CCT.

The health care utilization and out-of-pocket expenditure associated with asthma amongst a sample of Australian women aged over 45 years: analysis from the ‘45 and up’ study

Objective This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure. Methods A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman’s correlation coefficient, student’s t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data. Results Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum. Conclusions The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma.