Concept Of Integrative Medicine Research Articles

[China Anti-Cancer Association (CACA) guidelines for holistic integrative management of cancer-peritoneal tumours from gastrointestinal tract].

Peritoneal tumours have a large population and a poor prognosis with limited therapeutic options available, and are common originated from gastric, colorectal, appendix and other cancers. Traditionally, peritoneal tumours have long been considered to be a terminal condition with a median survival of 3-6 months, and the palliative symptomatic treatment is recommended. Recently, the multimodal therapeutic strategy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in more effective on the prevention and treatment of peritoneal metastasis, which can significantly improve the survival and quality of life. Under the guidance of the China Anti-Cancer Association (CACA), the "CACA Guidelines for Holistic Integrative Management of Cancer-Peritoneal Tumours" was jointly completed by experts in related fields organized by the Chinese Society of Peritoneal Oncology. This guideline is guided by the concept of integrative medicine and focuses on the domestic epidemiology, genetic background and original studies. It emphasizes the multidisciplinary team to holistic integrative medicine (MDT to HIM), and pays attention to the whole-course management of "prevention, screening, diagnosis, treatment, and rehabilitation". This guideline mainly focuses on peritoneal metastasis from gastrointestinal tumours, aiming to standardize the clinical diagnosis and treatment process, and jointly promote the management of peritoneal metastasis in China.

Building Public Health Imagination in Controlling NCDs through Integrative Medicine - A Narrative Synthesis Scoping Review on its Challenges & Future in India

Background: India is amidst an epidemiological transition with the country’s health system being tested to manage the dual burden of communicable and Non-Communicable Diseases (NCDs) and it is prudent that policy bearers should ensure stratification of data collected through large-scale surveys like NFHS & NSS for better understanding of NCDs in India and AYUSH users for NCDs. The subject scoping review focuses on the uptake of the AYUSH system of medicines in the backdrop of NCDs in India, systems approach to healthcare, the concept of integrative medicine and the challenges it faces in terms of scalability and mass adoption. Design & Method: Through a comprehensive literature review exercise, and nationally representative NFHS data on health, the qualitative research work presents an analysis to comprehend the evident prevalence of NCDs in India and the usage of the AYUSH system of medicine to restrain these chronic conditions with mechanisms like integrative medicine. Results: Out of the 1087 articles validated, 27 were finalised for a detailed review with respect to the identified thematic analysis. The selected articles assimilated through multiple themes and theories include the theory of the classical model of epidemiological and demographic transition and its inference in Indian settings with essential data on diseases (communicable and NCDs) in India, usage of Complementary and Alternative Medicines (CAM/ AYUSH) in global/ Indian context and its mainstreaming with biomedicine, systems approach to healthcare and global innovations in digital health.

Integrative Medicine as a New Treatment Model and the Future of Health Care Systems in the World in the Context of Rare Diseases

Purpose: This article aims to present integrative medicine as a new treatment model representing the future of health systems globally, including rare diseases. Design/Methodology/Approach: The article consists of three parts. The first one covers the definitions of integrative medicine as well as other terms. The second part of the study deals with the model of patient treatment in integrative medicine. It draws attention to a multidisciplinary and holistic approach to the treatment process. The third part, showing the possibility of using an integrated model in the management of a rare disease, refers to the example of childhood CLN2 dementia. The fourth part of the article focuses on the main challenges facing health systems in the world. Findings: Integrative medicine, combining conventional medicine with alternative medicine, is an innovative approach to the treatment process. It results from the need for individualized, holistic treatment of the patient. Integrative medicine is a challenge and the future of health systems globally in establishing interdisciplinary cooperation and educating medical professionals at the primary healthcare level. The integrated model responds to the needs of people suffering from rare diseases and their families. Practical Implications: Modern medicine should focus on improving communication between all participants of the treatment process and shaping good doctor-patient relations. Planning and policy making should involve conventional and alternative medicine practitioners, as specialists in both medical disciplines would be crucial in integrating health services. These services should be adapted to the culture and requirements of a given community. The integrated model addresses the challenges of rare disease management in the context of the patient and his family. Originality/Value: The concept of integrative medicine shows that the approach is justified in managing rare diseases, treated both causally and symptomatically. Furthermore, it explains the need to consider the perspective of the patient and his family - caregivers and healthy siblings.

Thoughts on Future Trends in Cardiology

Cardiovascular diseases (CVDs) have been recognized as the leading cause of death worldwide. It is estimated that CVDs led to 17.8 million deaths worldwide in 2017, increased by 21.1% from 2007.[1] China is one of the countries that have the highest burden of CVDs with stroke and ischemic heart disease being the top two overall causes of deaths in China.[2] The massive population with CVDs, the high mortality rate and disability rate, and the great burden to the society and the economy have significantly promoted investments in CVDs research globally, making it the fastest growing discipline in the medical field. Based on the recent major progress in CVDs prevention and treatment worldwide, with the changes brought by the COVID-19 pandemic, this article puts forward some ideas on the present situation and prospect of several key topics related to CVDs. Close relationship between metabolic diseases and CVDs It is well acknowledged that metabolic disorders are closely related to CVDs. Numerous data from animal experiments and clinical studies have demonstrated that metabolic disorders of many substances, including glucose, lipids, uric acid, and purines, are involved in the pathogenesis of CVDs. It is gratifying to note that some drugs for the treatment of metabolic diseases have demonstrated benefits to CVDs patients, which best explains the necessity to establish a new specialty, namely metabolic cardiology. The EMPA-REG study in patients with diabetes and CVDs has confirmed the cardiovascular-protective effect of sodium-glucose cotransporter two inhibitor (SGLT-2i) for the first time.[3] The DAPA-HF,[4] EMPEROR-Reduced,[5] and DAPA-CKD[6] studies have also demonstrated that SGLT-2i could reduce the risk of CVD death in patients suffering from heart failure and chronic kidney disease with or without the presence of diabetes. This ex-diabetes benefit of SGLT-2i seems to be attributed not only to the control of blood glucose but also to its direct effect on the cardiovascular system. On the other hand, the proprotein convertase subtilisin kexin 9 inhibitor has been a game changer in cholesterol management. Both the ODYSSEY[7] and the OSLER[8] studies have found decreases of 60% in low-density lipoprotein cholesterol level from the mean of 120 mg/dL, which reduced the composite CVD endpoints by half. Lately, a large-scale cohort study in gout patients demonstrated that urate-lowering therapy alone reduced risks of incident coronary artery disease and stroke by 30% and 32%, respectively, and this protective effect appeared to have a dose-response trend.[9] As shown in the above studies, although the specific mechanisms remain unclear, the improvement of cardiovascular outcomes imposed by the treatment of metabolic disorders has proved the impact of metabolic disorders on the cardiovascular system. It confirms again the importance of risk factor control, lifestyle management, and upstream treatment. It is of greater significance from a population perspective, as large-scale population management of modifiable factors may help in changing the CVDs epidemic and bending the curve both in China and in similar countries experiencing the same process. Healthcare delivery mode for CVDs prevention and management in the e-medicine era after COVID-19 pandemic Artificial intelligence (AI) technology has already been tested in different subspecialties of CVDs healthcare with encouraging results. Pilot studies indicated that AI can identify pathological features of valvular disease and cardiomyopathy or identify arrhythmic events based on various kinds of machine learning of echocardiography or electrocardiograms.[10,11] As a consequence, multiple wearable devices have been developed and shown to be effective in detecting and diagnosing arrhythmia or in monitoring heart failure patients.[12,13] Big data analysis enables machine to be involved in the physician's decision-making when they prescribe anti-coagulant to patients with atrial fibrillation.[14] Although these smart health technologies are still far beyond routine clinical use, what they have brought to the cardiovascular field is the revolution of healthcare delivery mode. E-medicine allows patients to participate in their own CVDs’ management, fully interact with healthcare providers, and share their decision; then promotes the transformation of healthcare mode from doctor-centered to patient-centered. The COVID-19 pandemic has greatly impacted the global healthcare system and re-shaped all aspects of medical practice, including the modes of health services delivery, patient behaviors, and doctor-patient interaction. It has exposed many weaknesses of the global public health system, especially potential discrepancies in the allocation of healthcare resources. As a large number of COVID-19 patients are in urgent need of diagnosis and treatment, the healthcare resources have to be diverted, and the resource for diagnosis and treatment of many other acute and chronic diseases are reduced in efficiency and quality. Multiple observational studies show that during the COVID-19 outbreak in different areas, there was a consistent decline in the admission rates for patients with acute coronary syndrome worldwide, due to the shortage of healthcare resources and lower willingness of patients to seek medical who were self-quarantined at home. Patients who were eventually admitted to the hospital often had worse outcomes than those in the pre-pandemic period.[15] The number of patients hospitalized for heart failure and the number of elective cardiovascular interventions also decreased significantly compared with the same period in previous years.[16] Nevertheless, with the pandemic continuing, it is found that many patients with chronic CVDs who were “forced” to use telemedicine actually did well over time. For example, hypertensive patients or chronic heart failure patients can self-adjust their medical treatments under physicians’ virtual guidance, whereas pacemaker patients can report their devices’ performance from home without office visits.[17–19] These facts reflect that face-to-face consultation may not be necessary in many occasions, and the COVID-19 crisis allows us the opportunity, unintentionally, to re-evaluate the cost-effectiveness of the conventional CVDs healthcare mode. On March 28, 2020, the Chinese Society of Cardiology (CSC) issued the “CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic”.[20] This document, based on the experiences of Chinese cardiologists and infectious disease specialists, emphasized the necessity of practicing telemedicine in the management of CVDs in response to the crisis. As more evidence is gathered, telemedicine has thrived and emerged worldwide as an indispensable resource to deliver a high-quality, timely healthcare to CVDs patients, which will consequently reduce the social and economic burden associated with unnecessary office visits. Apparently, the CVDs service capacity will be enhanced, and the cost of service will decrease with minimum pathogen exposure. This is probably paradoxical, and we should turn the crisis caused by COVID-19 pandemic into the opportunity of medical service improvement by promoting telemedicine. New hopes in “non-curable” CVDs With the development of basic research, we have gradually recognized the role of genetic background in the pathogenesis and progression of many CVDs, especially cardiomyopathy and arrhythmia. Driven by the need to improve the diagnosis and treatment of inherited CVDs, the CSC published “Guideline for the Genetic Diagnosis of Monogenic Cardiovascular Disease” [21] in 2019, which helps cardiologists to provide individualized risk stratification and disease management. However, these diseases are usually considered non-curable and non-preventable as they are caused by genetic variation. In the year 2019, a healthy baby was delivered at the First Affiliated Hospital of Zhengzhou University, Henan Province, China, the mother of whom is a hypertrophic cardiomyopathy (HCM) patient. This is the first case using the pre-implantation genetic diagnosis technique that successfully blocked the heredity of HCM. Mavacamten is a novel, first-in-class, small molecule, allosteric inhibitor of cardiac-specific myosin adenosine triphosphatase. It specifically reduces excessive cross-bridging with actin that is believed to be an important contributor to the pathological hypercontractility associated with HCM. In the phase II PIONEER-HCM study[22] and phase III EXPLORER-HCM study,[23] Mavacamten treatment resulted in not only improvement of symptom, decrease of pressure gradient at LVOT, but most importantly, regression of myocardial hypertrophy. These achievements open a window to patients with inherited CVDs like HCM, making these diseases both curable and preventable. Traditional Chinese medicine (TCM) as an option of CVDs management As an important part of Chinese culture, TCM has a history of more than 2000 years. Based on theories about Qi and restoring the balance between Yin and Yang, TCM has been widely applied in clinical practice in Asia and is gaining worldwide acceptance, which is evidenced by the inclusion of TCM diagnosis in the International Classification of Diseases-11 published by the World Health Organization. The role of TCM in preventing and treating CVDs has been explicit as more and more evidence becomes available. Basic researches exploring the pharmacological mechanism of TCM has proved that some bioactive ingredients have cardiovascular benefits such as lipid-modulation, immune-modulation, anti-oxidation, anti-inflammation, blood pressure lowering, and endothelial protection.[24] Practitioners are increasingly looking for proof of efficacy and safety of TCM in clinical trials. In a systematical analysis that includes 56 randomized clinical trials on TCM, Zhang et al[25] concluded that TCM might be a complementary and alternative approach to the primary and secondary prevention of CVDs including hypertension, dyslipidemia, and heart failure. Besides, TCM emphasizes a balanced lifestyle as well as a harmonic physiological and mental state, which is consistent with the modern concept of integrative medicine and may facilitate the rehabilitation of CVDs. With the standardization and modernization of TCM, it is expected that TCM will play a more important role in the management of CVDs. In summary, CVD research and practice are changing drastically, and with it comes the unlimited opportunities and possibilities for even-better care to the CVDs patients in the post-COVID pandemic era. Funding None. Conflicts of Interest None.

Gynecologists\u2019 attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany

PurposeDespite patients’ widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals’ current implementation of it in clinical routine. A national survey was conducted to assess gynecologists’ attitudes to and implementation of complementary and integrative treatment approaches.MethodsThe Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email.ResultsQuestionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016).ConclusionsThere is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.

Patient perspectives on supportive care in cancer: Results of the Calista 2 study

Over recent decades, supportive care and patient quality of life, advocated by dedicated guidelines, have become a core focus of the concept of integrative medicine. The Calista 2 survey was conducted in France between September 2016 and October 2017 among oncologists and their patients being treated for early breast cancer, adjuvant colorectal cancer or advanced lung cancer. The present analysis sought to ascertain, understand and rank the expectations of cancer patients with regard to supportive care. Data were collected from 467 questionnaires from patients recruited by 82 oncologists. Inclusion criteria were patients already on treatment for breast cancer, colorectal cancer or lung cancer. Most supportive care facilities were available at the point of care. Physicians were mainly seen to offer management of adverse events (81%), and pain (72%), psychological support (56%), and advice on diet/nutrition (49%). Patient uptake of supportive care related essentially to management of adverse events (72%) and pain (61%), diet/nutrition (34%), and self-image improvement techniques (31%). The main unmet needs voiced by patients were information on complementary medicines (28%), management of fatigue (27%), and relaxation techniques (24%). Supportive care was essentially seen to satisfy patient requirements with regard to the management of adverse events and pain. However, patients highlighted the need for a wider access to fatigue management and information on complementary medicine and relaxation techniques.

Training concept of integrative medicine in Hungary based on international models

Integrative medicine is a new approach in the 21st century healthcare system, which integrates conventional medicine and evidence-based, safe and efficient complementary therapies into a unified biomedicine. Medical doctors and complementary therapists work together in partnership with patients to help them recover and live a whole life. Equally important is the maintenance and enhancement of health and well-being in which therapists become role-models. In this article, the authors introduce a proposal for the concept and major elements of a two-year integrative medicine postgraduate training for specialist doctors in Hungary and summarize international progress in the field. Orv Hetil. 2020; 161(27): 1122-1130.

Prevalence and Predictors for Nonuse of Complementary Medicine among Breast and Gynecological Cancer Patients

Background: Complementary and alternative medicine (CAM) use is common among cancer patients. Data indicated that CAM use correlates with younger age, higher education levels, higher income, and less physician consultations. However, non-CAM use and predictors for non-CAM use are less clear among breast and gynecological cancer patients. Objectives: The purpose of this study was to determine the prevalence of non-CAM use and to investigate factors that might influence non-CAM use. Methods: The survey was conducted in breast cancer patients from January to May 2013 and in gynecological cancer patients from January to May 2014 with 2 pseudoanonymous questionnaires: one for CAM users (109 questions) and one for non-CAM users (85 questions). The survey was conducted via a telephone interview with 333 patients. Eligible participants were women with breast cancer (n = 285) and gynecological cancer (n = 291) who had undergone surgery at the Department of Gynecology and Obstetrics at the Technical University Munich, Germany, in the years 2012 (breast cancer) and 2011–2013 (gynecological cancer). Descriptive statistics were generated to determine patterns of non-CAM use. Univariable analysis was used to detect patient characteristics associated with noninterest in the different CAM therapies. Results: A total of 333 of 576 patients participated in the survey (58%). Fifty-eight percent (n = 192/333) were diagnosed with breast cancer and 42% (n = 141/333) with gynecological cancer. The overall prevalence of non-CAM use was 42% (n = 139/333). Eighty-one percent (n = 112/139) of the non-CAM users stated to have received no recommendation for CAM use, although 53% (n = 73/139) would have liked to receive information from their physician. As reasons for the nonuse of CAM therapies, 76% (n = 106/139) nonusers declared that they did not believe CAM use was necessary since the conventional therapy was considered sufficient, 44% (n = 61/139) reported a lack of information, 31% (n = 43/139) a fear of fraud, and 22% (n = 31/139) a fear of interactions and side effects of CAM. Sixty-eight percent (n = 95/139) of the patients stated that they would resort to CAM if the disease progressed while only 27% (n = 37/139) would still not use any CAM with progression of disease. Five percent (7/139) did not give any information regarding possible future CAM use with disease progression. Seventy-three percent (n = 102/139) would both welcome more physicians with qualifications in complementary medicine and supported an integration of CAM into our health care system. Furthermore, statistically significant correlations between patients’ sociodemographic characteristics and their nonuse of complementary therapies were identified. Conclusions: Our data demonstrate a high overall interest in CAM even in non-CAM users. Health care professionals should be aware of this in order to be able to better address patients’ needs. It is necessary to explore the use of CAM with cancer patients, educate them about potentially beneficial therapies even in the light of the limited available evidence, and work towards an integrated model of health care. Therefore, we implemented a counseling service as an outpatient program (ZIGG) for integrative medicine concepts and evidence-based complementary treatments to discuss integrative health approaches proactively with cancer patients in our cancer center in 2013.

Homeopathy and Pluralism of Theories in Medicine Arguments Put Forward to Remove Homeopathic Products from Pharmacies Contradict Actual Scientific Evidence and Suggest Deliberate Misinformation

Founded in 2000 by renowned physicians and researchers on the initiative of Professor Dr. med. Dr. h.c. Jörg-Dietrich Hoppe, then president of the German Medical Association, the Dialogue Forum Pluralism in Medicine (DPM) aims to overcome the traditional partisan bias between conventional medicine and complementary medicine by way of continued critical and objective dialogue between acknowledged representatives of different theoretical and practical approaches, in favour of an Integrative Medicine. The article describes the initiative in Germany as linking up with the concept of Integrative Medicine which originated from the United States and today is spreading across the world. The DPM strives to assess divergent paradigms in medicine for their potential to complement each other. Current DPM members are established proponents of mainstream medicine, anthroposophical medicine, homeopathy, classical naturopathy and Chinese Medicine (TCM). It has become fashionable to belittle homeopathy as being ineffective, using inaccurate statements on the state of research. On behalf of the DPM members as well as numerous medical organisations and renowned physicians and researchers, this article comments on such unjustified claims by means of specific examples. The idea is to establish Integrative Medicine in a spirit of critical but unbiased collaboration between mainstream medicine and selected complementary approaches as a precondition for a fully orchestrated healthcare system that meets the individually varying needs and preferences of the population. In this context, reference is made to a position paper on medical professionalism signed by all DPM members which underlined that conventional and complementary medicine alike are obliged to adhere to scientific standards. Ludwig Fleck and Thomas Kuhn already described tendencies among proponents of specific paradigms to claim privileges for their own paradigm via legislation. However, under Basic Law (German constitution) Article 5 Paragraph 3, the state is generally forbidden to pass judgment on scientific matters in the sense of advocacy of one specific paradigm. It should also be noted that attempts to monopolize a single paradigm favour the emergence of totalitarian thought patterns. In a final vote, the signatories – established medical organisations and numerous physicians and scientists of renown – reject all efforts to pursue totalitarian thought patterns in our healthcare system which are irreconcilable with constitutional law.

Use of biologically-based complementary medicine in breast and gynecological cancer patients during systemic therapy

BackgroundBiologically-based complementary medicines (BB-CAM) including herbs and nutritional supplements are frequently taken by breast- and gynecological cancer patients undergoing systemic therapy. The aim of this study was to analyze the use of these natural CAM methods under systemic therapy.MethodsFrom September 2014 to December 2014 and February 2017 to May 2017 all patients (n= 717) undergoing systemic therapy at the day care unit, Department of Gynecology and Obstetrics, Technical University Munich, Germany, with breast- and/or gynecological cancer were included in this survey.The self-administered 8-item questionnaire was developed to obtain information on complementary medication intake during systemic therapy.ResultsAmong 448 respondents 74.1% reported to use complementary medication simultaneous to their systemic therapy. The most frequently applied methods during therapy were vitamins and minerals supplements (72.3%), medicinal teas (46.7%), phytotherapy (30.1%), and mistletoe (25.3%).The analysis showed that various patients-, disease- and therapy characteristics like receiving chemotherapy (p= 0.002), and younger age (younger than 60 years; p=0.017) are significantly associated with BB-CAM use.ConclusionsOur data suggest that female cancer patients undergoing systemic therapy frequently use BB-CAM medicine. Therefore, it is indispensable to implement counseling and evidence-based complementary treatments into clinical routine of cancer centers. A counseling service for integrative medicine concepts and an outpatient program (ZIGG) was therefore implemented in our cancer center in 2013. Further research on the CAM intake of cancer patients is needed in order to verify drug interactions and implement specific guidelines for integrative medication concepts.

Integrative Approach to Psoriasis Vulgaris.

In this article, we present a literature review of the most popular and commonly used therapeutic procedures belonging to complementary and alternative medicine, which is part of the modern concept of integrative medicine, used in the treatment of psoriasis. Psoriasis is a chronic, systemic, inflammatory disease wherein skin changes are the most visible sign. It occurs in approximately 1% to 3% of the world population, and the National Psoriasis Foundation of the United States estimates the number of patients in the whole world at about 125 million. Psoriasis primarily affects the skin, burdening patients with inflamed, pruritic, and sometimes painful lesions covered with whitish scales that last for years. Because of its prevalence in the general population, diversity of the clinical picture (from minimal and localized lesions without subjective symptoms to life-threatening conditions), and disease duration (practically a lifetime), psoriasis is a disease that has become a focus of modern medicine, and therapeutic options for the treatment of psoriasis are currently very numerous and diverse. Conventional treatment of psoriasis is guided by the so-called principle of "steps," where treatment options are applied according to the severity of illness assessed by a physician. Apart from the official therapy for psoriasis, as it is defined and understood in modern developed societies, there exists in parallel a great number of traditional, complementary, and alternative psoriasis treatments, which are based on the beliefs, experiences, and theories inherent to different cultures; in this article, we have analyzed the literature related to some of these procedures.

Implementation of an Integrative Oncological Concept in the Daily Care of a German Certified Breast Cancer Center

Background: In recent decades the concept of integrative medicine has attracted growing interest in patients and professionals. At the Gemeinschaftskrankenhaus Havelhöhe (GKH), a hospital specialized in anthroposophical medicine, a breast cancer center (BCC) has been successfully certified for more than 5 years. The objective of the present study was to analyze how integrative strategies were implemented in the daily care of primary breast cancer patients. Methods: Clinical, demographic, and follow-up data as well as information on non-pharmacological interventions were analyzed. In addition, BCC quality measures were compared with data of the National Breast Cancer Benchmarking Report 2016. Results: Between 2011 and 2016, 741 primary breast cancer patients (median age 57.4 years) were treated at the GKH BCC. 91.5% of the patients showed Union for International Cancer Control (UICC) stage 0, I, II, or III and 8.2% were in UICC stage IV. 97% of the patients underwent surgery, 53% radiation, 38% had hormone therapy, and 25% received cytostatic drugs. 96% of the patients received non-pharmacological interventions and 32% received Viscum album L. therapy. Follow-up was performed in up to 93% of the patients 2 years after first diagnosis. Compared to nationwide benchmarking BCCs, the GKH BCC met the requirements in central items. Conclusions: The results of the present study show that integrative therapies offered by the concept of anthroposophical medicine can be implemented in the daily care and treatment of a certified BCC. However, as national guidelines on integrative concepts in oncology are missing, further studies are needed for a systematic evaluation of integrative treatment and care concepts in this field.

Impacto en la salud pública colombiana de los departamentos de medicina preventiva y salud pública de las facultades de medicina

En este artículo se exponen los resultados de una investigación que tuvo por objetivo presentar las diversas orientaciones de los departamentos de medicina preventiva en las décadas del 50 y 60 y su influencia en la educación superior colombiana. La metodología consistió en un estudio histórico basado en un análisis a partir del concepto de medicina integral. Entre sus resultados se destaca que si bien es cierto que Abraham Flexner le daba mucha importancia a los aspectos sociales de la medicina, en la implantación de su modelo en los EE.UU se siguió un enfoque fundamentalmente biologista, sin embargo en Colombia al introducir la modernización preconizada por él, la cual siguió el ejemplo de las Facultades de Medicina norteamericanas, en las que se formaron nuestros líderes en este campo, los Departamentos de Medicina Preventiva fueron un distintivo fundamental. Hecho que significó una gran modificación del modelo. Con la investigación se pudo concluir que tres Facultades de Medicina crearon modelos de desarrollo específicos para estas reparticiones, los cuales por servir de patrones, tuvieron un gran impacto en la educación médica colombiana primero, en la universidad como un todo después, en el Sistema Nacional de Salud posteriormente y a nivel internacional fueron ejemplo no solo en Latinoamérica sino para muchos otros países del mundo.

Attitudes, beliefs, and practices of integrative medicine among nurses in the Netherlands.

This study assessed the attitude, beliefs, and practices of integrative medicine (IM) among nurses in the Netherlands. Subscribers of a Dutch nursing journal were asked to fill in an anonymous, structured, online survey related to the topic under study. A total of 355 people responded, of which 37% were familiar with the concept of IM in advance. On completion of the survey, the majority (83%) considered IM as a (very) important innovation in health care. Familiarity (odds ratio = 3.20; 95% confidence interval [1.48, 6.94]) and organization (nursing home compared to hospital (odds ratio = 5.98; 95% confidence interval [1.36, 26.23]) were characteristics associated with a positive attitude toward IM. Between 23% and 46% of respondents encountered obstacles regarding implementation of IM. The main obstacles were lack of support (69% to 78%), means (57% to 85%), and time (63% to 70%). Dutch nurses seem to have relatively positive attitudes and beliefs regarding IM. The outcome of this survey may contribute an increased awareness of the key role that nurses can play in the development and implementation of IM.

Whole-Systems Research in Integrative Inpatient Treatment

In the last years, medicine has seen a shift from a depersonalized towards a patient-centered individualized medicine. This, on the one hand, is based on the achievements in the field of genetics and molecular science fostering an individually designed drug therapy and treatment tailoring [1]. On the other hand, research on patient-practitioner interaction, psychosocial and behavioral conditions of chronic diseases, and a patient-centered treatment approach has revealed that nonpharmacological factors such as empathy might be essential parameters for the outcome of the patient [2]. Moreover, complementary therapies as traditional whole-medical systems (Ayurveda, traditional Chinese medicine a.o.) or homeopathy, which according to their definition are individualized, have attained increasing interest for improving the patient care, for example, in the treatment of chronic diseases and pains syndromes. More recently, the combination of conventional medicine, complementary medicine, and patient-centered approaches has been put into the conceptional frame of “integrative medicine” which covers these topics adequately [3]. The most common and comprehensive definition up to now has been given by the Consortium of Integrative Medicine in 2005. It describes integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing” [4]. It therefore joins the latest scientific advances with the profound insights of traditional healing systems and individualized patient care in complementary medicine to regain and preserve health and to enhance self-efficacy and patient's own capacities to recover from illness and to maintain health. In the last decades, several hospitals have adopted this concept of integrative medicine for the treatment of chronic and acute states of illnesses in an inpatient treatment. For instance, Sendelbach et al. (2003) describe the development of an inpatient integrative therapies program in a cardiovascular tertiary care center [5]. Ernst and Ferrer (2009) also reflect on the implementation of a 7-year integrative hospital program in a cardiac hospital center from the viewpoint of the nursing staff [6]. In almost all cases, these hospitals have integrated one or more complementary disciplines as naturopathy, anthroposophical medicine, homeopathy, or traditional Chinese medicine. While, in the USA integrative medicine has emerged towards a marker for innovative quality patient care within the last two decades, other countries have a longer tradition in this field [7]. In Germany, for instance, the amendment to the German Drug Law in 1976 has recognized anthroposophic medicine, homeopathy, and phytotherapy as “Specific Therapeutic Systems” [8]. As a consequence, inpatient treatment opportunities for integrative medicine increased, and specialized hospitals and hospital departments started to evaluate their programs also with respect to comparative cost scenarios [9] which are nowadays still seen as a major goal [10]. Thus, several approaches have already entered the platform of in-patient care in integrative medicine. A current study of Kligler et al. (2011) found a decrease in the use of medications resulting in substantial cost savings in the care of oncology patients treated with an integrative in-patient approach including yoga therapy, holistic nursing, and healing environment [11]. Unfortunately, due to heterogeneity of the approaches and evaluations, the meta-analyses and systematic reviews of such evaluations in most cases suffer from a lack of comparability of outcome parameters within these evaluations so far. Of note, whole-systems evaluation of integrative in-patient treatment might also benefit from a systematic analysis of the patient characteristics of clinical pathways and flow processes between in- and outpatient treatments, which has been described [12]. Finally, concepts of combining education, teaching, and in-patient integrative treatment can be seen as an important milestone for the development of integrative medicine. If only students are able to discover and get some first insight into the potential different perspectives of medicine and healing, they might be able to argue open-mindedly about the best fitting therapeutic strategy for the individual patient to regain his optimal health [13]. Despite these current achievements, evaluations of the approach of integrative medicine as a whole system and its interactions with other services of patient care have only been seen marginally. Thus, the cutting edge for the future development of integrative medicine now is to close the “evidence gap” [4] and to summarize and communicate these findings of research to the public, the stakeholders, and policy makers of healthcare authorities [14]. This special issue tries to step into this direction by bringing together evidence from different perspectives. Apart from whole-systems evaluations of hospital programs, cost studies, and findings on educational aspects of integrative medicine, this issue also covers historical aspects of the development of integrative medicine and presents the meta-analyses of integrative approaches. Hopefully, science-driven implementation of integrative medicine into hospitals and patient care can improve the 21st century medicine. Thomas Ostermann Andre-Michael Beer Vassya Bankova Andreas Michalsen

The Effects of Integrative In-Patient Treatment on Patients’ Quality of Life: A Meta-Analysis

Background. In the last decades, several hospitals have adopted this concept of integrative medicine for the treatment of chronic and acute states of illnesses in in-patient treatment. The aim of this paper was to summarize the current evidence for a possible effectiveness of integrative on-patient treatment in patients' quality of life by means of a meta-analysis. Material and Methods. The databases MEDLINE, EMBASE, AMED, PsycInfo, PsycLit CCMED, and CAMbase were screened to find articles. We also screened publisher databases to find relevant information. Articles were included if patients were treated in a hospital. To guarantee comparability SF-36 was the predefined outcome measure for patients' quality of life. Data of pre/posteffects on the mental and physical scores of the SF-36 were extracted and effect sizes were calculated and entered into a random effect meta-analysis. Results. Eight articles published between 2003 and 2010 were included in the final meta-analysis. Random effect meta-analysis of the eight studies revealed an overall effect size of 0.37 (95% CI: [0.28; 0.45]) in the physical score and 0.38 (95% CI: [0.30; 0.45]) in the mental score of the SF-36. I 2 statistics indicate a high heterogeneity in the effects in both the physical and mental scores of the SF-36 (I 2 = 91.8%, P < 0.001, resp.; I 2 = 86.7%, P < 0.001). Discussion. This meta-analysis might help to rediscover the importance of integrative in-patient treatment for patients, physicians, and stakeholders.

Integrative medicine — Traditional Chinese medicine, A model ?

The paper explores the concept of integrative medicine (IM) in relation to complementary and alternative medicine (CAM). It contrasts IM available in China to its availability in the West. The second part of the paper highlights tools which could facilitate opportunities for IM. The paper concludes with a plea to ensure and maintain the integrity of traditional Chinese medical practice, and to continue to increase developing the evidence base through a funded European Coordination Action between EU member states and China.

The model of western integrative medicine: The role of Chinese medicine

The basic concept of integrative medicine (IM) is that by combining mainstream (biomedicine) with complementary and alternative medicine (CAM), synergistic therapeutic effects can be attained. When the methods of mind/body medicine (MBM) are added to this combination, as in Western countries, a new concept emerges that drastically changes the approach toward illness.It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples' Republic of China preceded the Western model of IM by almost 50 years. Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM, and Chinese medicine has played and continues to play an important role in advancing IM. However, one of the major differences between the Chinese and the Western models of IM today, besides MBM and some other treatment options, is that Western integrative medicine (WIM) strictly requires its CAM methods to be supported by scientific evidence.The therapeutic methods of IM and their applications are many and varied. However, they are most frequently employed to treat chronic medical conditions, e.g., bronchial asthma, rheumatic disease, chronic inflammatory bowel disorder and chronic pain. Other fields in which IM may be applied are internal medicine (inflammatory bowel diseases and cardiovascular diseases), musculoskeletal disorders, oncology (chemotherapy-induced side effects), obstetrics and gynecology (dysmenorrhea, endometriosis, infertility and menopausal complaints), pediatrics, geriatrics, neurology (migraine and chronic headache), and psychiatry (anxiety and depression).The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.

Developing a Complementary, Alternative, and Integrative Medicine Course: One Medical School's Experience

There is significant overlap with many concepts emphasized in integrative medicine and current educational priorities within medical school education such as cultural sensitivity, doctor-patient relationship, and physician self-care. Although the concept of Integrative Medicine is just beginning to gain recognition in academic medical institutions, the recognition of Complementary and Alternative Medicine's (CAM) growing popularity has led to increased incorporation of CAM content into U.S. medical school education. The present article describes the evolution of a complementary, alternative, and integrative medicine course within the New Jersey Medical School at the University of Medicine and Dentistry over the last 3 years, and critically evaluates its successes and challenges.

Uncontrolled therapeutic observations in complementary medicine—What is the benefit?

Objective A considerable part of articles about complementary therapies focus on uncontrolled interventions administered in the context of clinical practice. According to the therapy-related hierarchy of scientific evidence 〈 http://www.cebm.net/index.aspx?o=1025 〉, however, such publications are associated with a very low evidence level. Since a perceived positive therapeutic result gained after an uncontrolled intervention may be due to at least seven factors, six of which are unspecific [2] , no conclusion can be drawn regarding a specific therapeutic effect (i.e., post hoc ergo propter hoc ). Does that mean that such reports do not have any benefit? Method A systematic search was carried out in electronic databases as well as in current textbooks on evidence-based medicine and complementary medicine. The reference lists of all relevant articles were perused. Results The identified contributions suggest that the (anecdotal) information gained in uncontrolled therapeutic interventions may indeed be valuable, particularly in (but no limited to) the following cases: • detection of possible side effect, potential new therapeutic indications, and/or problems regarding compliance [1] ; • generation of new hypotheses [3] . Discussion Vandenbroucke [3] suggested differentiating between two hierarchies of study design: one for intended effects of therapy ( cf ., 〈 http://www.cebm.net/index.aspx?o=1025 〉) and another one for discovery and studying new explanations. In the latter hierarchy, the traditional ranking of the levels of evidence is reversed: uncontrolled interventions administered in the context of clinical practice (as well as findings in patient or laboratory data and in the literature) are given the greatest importance because they may serve as catalysts for follow-up research (using the traditional hierarchy), which in turn might lead to new knowledge regarding diagnosis, therapy, and/or prevention. This double strategy may open another door towards the concept of integrative medicine.