Conventional Medical System Research Articles

Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system

ABSTRACTComplementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

Identifying sources, pathways and risk drivers in ecosystems of Japanese Encephalitis in an epidemic-prone north Indian district.

Japanese Encephalitis (JE) has caused repeated outbreaks in endemic pockets of India. This study was conducted in Kushinagar, a highly endemic district, to understand the human-animal-ecosystem interactions, and the drivers that influence disease transmission. Utilizing the ecosystems approach, a cross-sectional, descriptive study, employing mixed methods design was employed. Four villages (two with pig-rearing and two without) were randomly selected from a high, a medium and a low burden (based on case counts) block of Kushinagar. Children, pigs and vectors were sampled from these villages. A qualitative arm was incorporated to explain the findings from the quantitative surveys. All human serum samples were screened for JE-specific IgM using MAC ELISA and negative samples for JE RNA by rRT-PCR in peripheral blood mononuclear cells. In pigs, IgG ELISA and rRT-PCR for viral RNA were used. Of the 242 children tested, 24 tested positive by either rRT-PCR or MAC ELISA; in pigs, 38 out of the 51 pigs were positive. Of the known vectors, Culex vishnui was most commonly isolated across all biotopes. Analysis of 15 blood meals revealed human blood in 10 samples. Univariable analysis showed that gender, religion, lack of indoor residual spraying of insecticides in the past year, indoor vector density (all species), and not being vaccinated against JE in children were significantly associated with JE positivity. In multivariate analysis, only male gender remained as a significant risk factor. Based on previous estimates of symptomatic: asymptomatic cases of JE, we estimate that there should have been 618 cases from Kushinagar, although only 139 were reported. Vaccination of children and vector control measures emerged as major control activities; they had very poor coverage in the studied villages. In addition, lack of awareness about the cause of JE, lack of faith in the conventional medical healthcare system and multiple referral levels causing delay in diagnosis and treatment emerged as factors likely to result in adverse clinical outcomes.

Contexts and Opportunities of e-Health Technology in Medical Care

Keeping up with a sound health is a fundamental right for the human beings. It also acts as an indicator of the socio-economic development of a country. However, nowadays keeping sound health is challenging because of rapidly increasing non-communicable diseases. Concurrently, we are on the edge of very fast technological advancement which includes usage of cellular technology, high-speed internet and wireless communications. These technologies and their unique applications are creating lots of new dimensions in health care system which is known as e-Health. The medical call centers, emergency toll-free telephone services are being used in all over the world. The newly developed electronic health system can play a vital role in the remote regions of emerging and developing countries although sometimes it seems difficult due to the lack of communication infrastructure. E-Health can be a promising aspect for providing public health benefits if it integrates with the conventional medical system. More strategic approaches are necessary for the planning, development, and evaluation of e-Health. This article is written to depict the existing and future opportunities of e-Health in health support system.

Contexts and Opportunities of e-Health Technology in Medical Care

Keeping up with a sound health is a fundamental right for the human beings. It also acts as an indicator of the socio-economic development of a country. However, nowadays keeping sound health is challenging because of rapidly increasing non-communicable diseases. Concurrently, we are on the edge of very fast technological advancement which includes usage of cellular technology, high-speed internet and wireless communications. These technologies and their unique applications are creating lots of new dimensions in health care system which is known as e-Health. The medical call centers, emergency toll-free telephone services are being used in all over the world. The newly developed electronic health system can play a vital role in the remote regions of emerging and developing countries although sometimes it seems difficult due to the lack of communication infrastructure. E-Health can be a promising aspect for providing public health benefits if it integrates with the conventional medical system. More strategic approaches are necessary for the planning, development, and evaluation of e-Health. This article is written to depict the existing and future opportunities of e-Health in health support system.

Various Medical Aspects of Liver Transplantation and its Survival Prediction using Machine Learning Techniques

Objective: Prognosis models play a significant role in forecasting the patient's survival in Organ transplantation. To review the impact of machine learning methods in predicting the of survival of patients who undergoes Liver Transplantation using a Multilayer Perceptron Artificial Neural Network model with an extensive discussion of all the medical aspects is the key objective of this paper. Methods/Analysis: Medical practitioners studied various parameters during pretransplantation for predicting the survival of a patient. This study considered those parameters and reviewed whether these parameters have any vital part in the survival rate of a patient after Liver Transplantation (LT). This study also compared various scores including Model for End Stage Liver Disease (MELD) score, Emory score and Child score that are used in survival prediction. Currently the medicinal specialists estimate the outcome of LT with MELD score. We employed a detailed learning about the health aspects of LT and various machine learning techniques used in this area. In order to perform the experimentation, the dataset was congregated from the United Network for Organ Sharing transplant database (n = 65534). With the three layer architecture, the model trains the attributes of donors, recipient and transplantation using back propagation algorithm. 10-fold cross validation was applied in each training and test set before training. During the training process, the appropriate donor-recipient pairs were found out and obtained the best liver patient survival in transplantation. Findings: We conducted a comprehensive study about LT for the liver patient survival prediction. We proposed a Multilayer Perceptron Artificial Neural Network model to predict the survival rate after LT with 99.74% accuracy using United Network Organ Sharing registry. We also compared the performance of proposed model with existing models and proved that proposed model produced more accuracy than other models. Novelty/Improvement: The multilayer perceptron model succeeded clinical scores in terms of high accuracy, sensitivity and specificity. Machine learning techniques show better performance than conservative numerical methods in donor, recipient and transplantation attributes which are used to predict the survival. Due to less expensive and producing reliable solutions with rich datasets, machine learning techniques have been succeeded the conventional statistical methods and medical scoring systems. The proposed model predicts a promising accuracy for the prediction of best survival rates after.

Initial basal cell carcinomas diagnosed in the National Campaign for Skin Cancer Prevention are smaller than those identified by the conventional medical referral system.

BACKGROUNDBasal cell carcinoma is the malignant tumor most often diagnosed in the National Campaign for Skin Cancer Prevention (NCSCP). Little is known about the profile of these lesions compared to the profile of lesions diagnosed by conventional routes of public dermatological care.OBJECTIVETo identify if basal cell carcinomas identified in prevention campaigns and referred to surgery are smaller than those routinely removed in a same medical institution.METHODSCross-sectional study including tumors routed from 2011-2014 campaigns and 84 anatomopathological reports of outpatients.RESULTSThe campaigns identified 223 individuals with suspicious lesions among 2,531 examinations (9%), with 116 basal cell carcinomas removed. Anatomopathological examinations revealed that the primary lesions identified in the national campaigns were smaller than those referred to surgery by the conventional routes of public health care (28 [13-50] x 38 [20-113] mm2, p <0.01). On the other hand, after a mean follow-up of 15.6 ± 10.3 months, 31% of cases identified in campaigns showed new basal cell carcinoma lesions.STUDY LIMITATIONSRetrospective study and inaccuracies in the measurements of the lesions.CONCLUSIONSThe NCSCP promotes an earlier treatment of basal cell carcinomas compared to patients referred to surgery by the conventional routes of public health care, which can result in lower morbidity rates and better prognosis.

A Review of Swertia chirayita (Gentianaceae) as a Traditional Medicinal Plant.

Swertia chirayita (Gentianaceae), a popular medicinal herb indigenous to the temperate Himalayas is used in traditional medicine to treat numerous ailments such as liver disorders, malaria, and diabetes and are reported to have a wide spectrum of pharmacological properties. Its medicinal usage is well-documented in Indian pharmaceutical codex, the British, and the American pharmacopeias and in different traditional medicine such as the Ayurveda, Unani, Siddha, and other conventional medical systems. This ethnomedicinal herb is known mostly for its bitter taste caused by the presence of different bioactive compounds that are directly associated with human health welfare. The increasing high usage of Swertia chirayita, mostly the underground tissues, as well as the illegal overharvesting combined with habitat destruction resulted in a drastic reduction of its populations and has brought this plant to the verge of extinction. The increasing national and international demand for Swertia chirayita has led to unscrupulous collection from the wild and adulteration of supplies. The aim of this review is to provide a synthesis of the current state of scientific knowledge on the medicinal uses, phytochemistry, pharmacological activities, safety evaluation as well as the potential role of plant biotechnology in the conservation of Swertia chirayita and to highlight its future prospects. Pharmacological data reported in literature suggest that Swertia chirayita shows a beneficial effect in the treatment of several ailments. However, there is lack of adequate information on the safety evaluation of the plant. The pharmacological usefulness of Swertia chirayita requires the need for conservation-friendly approaches in its utilization. Providing high-quality genetically uniform clones for sustainable use and thereby saving the genetic diversity of this species in nature is important. In this regard, plant biotechnological applications such as micropropagation, synthetic seed production, and hairy root technology can play a significant role in a holistic conservation strategy. In addition to micropropagation, storage of these valuable genetic resources is equally important for germplasm preservation. However, more advanced research is warranted to determine the activities of bioactive compounds in vitro and in vivo, establish their underlying mechanisms of action and commence the process of clinical research.

Bridging the Gap between Community and Cardiologists

Cardiovascular diseases are an emerging cause of morbidity and mortality in India. India produces less than 150 cardiologists annually leading to a gap between the need and availability of trained professionals. Three years cardiology training programme is available for post graduate doctors in conventional medical education system. Majority of the people living in rural/small town/district town of the country do not have any access to cardiac care because trained cardiologists are mostly concentrated in the metro or capital cities. To address this issue Indira Gandhi National Open University has designed and developed a two-year full time training programme in the area of non-invasive cardiology named Post Graduate Diploma in Clinical Cardiology for medical graduates which is being offered through the open and distance learning mode. The objective of the programme is to train large number of medical graduates effectively to enable early recognition, management and prevention of common cardiovascular diseases. Learners have been given opportunity to train in different departments and posted in various areas like management of common cardiovascular diseases (6 months), ECG and Stress Testing (3 months), Echocardiography (3 months), ICU/CCU management (6 months), Paediatrics Cardiology (3 months), preventive cardiology (3 months) in this programme. Self learning materials, 33 video programmes (1260 minutes) and monthly live interactive teleconference (90 minutes) has been incorporated in this programme. Beside these, 50 theory counselling sessions, 25 guest lectures, seminars, journal club and case discussion has been taken care in every training center. Hands on skills training is provided to every learner as prescribed in this programme. The 72 credits programme is divided into 7 theory and 6 practical courses. Students need to pass in each course independently both in internal examination and term end examination. Minimum teacher-student ratio has been maintained strictly in both training and term end practical examination. The top most cardiac institutes/hospitals across the country have been identified as training centers as per the norms of the University. This programme has begun with 116 students in 16 training centers in 2006. 443 students have been enrolled in 67 training centres in 2013. More than 320 cardiologists are involved as academic counselors in this training programme. A total 1006 candidates have successfully completed their training and a many of them are providing services in small or district town of the country.

Knowledge, attitude and practice of complementary and alternative medicine: A patient′s perspective

Background: Complementary and alternative medicine (CAM), includes a wide range of approaches such as herbal medicine, traditional therapies, mind-body intervention, etc. Although CAM is a common practice in India, it is not being integrated into the conventional medical system. There is a paucity of data regarding the usage and acceptance of CAM by patients. Objective: The aim was to determine the knowledge, attitudes, and practice toward CAM among patients and to correlate these findings with their demographic and professional characteristics. Materials and Methods: A cross-sectional, questionnaire-based survey conducted in 100 patients attending out-patient department of a tertiary care teaching hospital. Results: Among the respondents, 79.0% were aware of CAM and 46.0 used it. Most common system used was Ayurveda (71.73%), and most common ailment for which it is used was arthritis (30.43%). Majority consulted quacks (43.47%); physicians (23.91%), friends and relatives (19.56%), and 15.21% took CAM as a self-medication. Thirty percent felt that CAM was based on scientific evidence, 25% felt it was safer than modern medicine that is significantly more in women when compared to men. Twenty-five percentage opined that CAM is more efficacious than modern medicine that is significantly more in respondents >40 years age. The most common advantages reported were complete cure, easy availability and no side-effects, whereas disadvantages include food restriction, expensive medication, symptomatic relief and effective for limited diseases. Conclusion: Majority of patients use CAM along with modern medicine without physician's advice. Hence, healthcare professionals should be aware of this while taking clinical history and treating patients that may reduce drug interactions due to use of CAM particularly in the elderly population.

Managing acute alcohol withdrawal with Homoeopathy: A prospective, observational, multicentre exploratory study

Background: Alcohol dependence is a common social problem which may be associated with other risk factors and co-morbidities. Abrupt cessation of alcohol intake may provoke an acute alcohol withdrawal phase with varying degrees of signs and symptoms. In conventional medical system, specific pharmacological interventions are used for management of Acute Alcohol Withdrawal (AAW). There exists a need to explore safe and holistic treatment of AAW. The present work reports the results of a prospective, observational, exploratory, multicentre trial (2008-2011) to assess the role of Homoeopathy in AAW. Materials and Methods: Individualised Homoeopathy was given to 112 patients reporting with AAW. The clinical assessment was done for 05 days using Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar). Post-withdrawal phase, quality of life of patients was assessed at end of 01 st , 03 rd and 06 th month using World Health Organisation quality of life (WHOQOL)- BREF. Results and Analysis: There was a significant decrease in CIWA-Ar mean scores and increase in quality of life score (P < 0.001). The most common remedies used were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica and Pulsatilla. Conclusion: The results of current observational pilot study suggest the promising use of Homoeopathy in the management of acute alcohol withdrawal. Further studies with large sample size and rigorous design are warranted.

What does integrative medicine mean to the physician and the ministry of health and welfare?

Our aging society, rapid growth of diseases resulting from unhealty habits, frequent occurrences of sickness, and variations in the awareness of health by patients, the worldwide need for integrative medicine, which means the incorporation and integration of complementary and alternative medicine (CAM) into conventional medical systems, is growing rapidly. The most widely available forms of CAM in the treatment of diseases in the U.S. and Europe are acupuncture, chiropractic, phytomedicine (western herbal medicine), mind-body therapies, and nutrition therapy. The well-known hospitals in the U.S. and in Europe (e.g., Harvard, Memorial SloanKettering Cancer Center, Duke, Maryland, Essen, and Humboldt) are offering integrative medicine. The clinical practices as well as the education on CAM of medical schools is becoming more widespread in Korea. It is critical for us as physicians to be aware that the role of CAM is to support and complement conventional medicine, not to substitute for it. To manage chronic diseases effectively, it is imperative for physicians to incorporate and integrate Korean oriental medicine as well as CAM into the conventional medical systems. It is the duty of the medical universities and hospitals to integrate care delivery proven by CAM therapies into the conventional medicine and to develop the standard curriculum for integrative medicine at the undergraduate and graduate levels. To globalize Korean oriental medicine and to scientifically prove the efficiency of CAM, the role of integrative medicine is critical. One of the most important roles of the Ministry of Health and Welfare is to support the hospitals in which integrative medicine is systematically practiced and financially supported. In order to successfully accomplish integrative medicine in Korea, it is important to not only establish an integrative medicine center, but to also develop the contents and clinical pathway along with legal systems regarding integrative medicine with the support of the specialists in the field of integrative medicine.

The market: A dive into the Afro-Brazilian sacred universe?

Candomble terreiros (plots of land) are intended as spaces to preserve African religious traditions within the Brazilian diaspora. In addition, they serve as multifunctional spaces for the purpose of integrating, autonomously or by means of governmental or international partnerships, the agenda of social actions aimed at developing a model of health care structured on values and norms. The aim is to rationally engage the conventional medical system, thus setting the stage for health care possibilities based on different cultural models. This model is associated with an understanding of the knowledge and practices developed and performed by Candomble as a therapeutic system that might enable collaboration with local health systems and their specificities based on the system’s significant use of plants for therapeutic purposes. Therefore, these religious therapeutic practices are addressed as a mechanism for opening communication channels with social spaces, particularly the public market, which is the preferred locus for Afro-Brazilian sacred consumption and presents an issue related to public policies and programs for natural and complementary medicines and/or medicinal plants and phytotherapic agents.

Mercado: uma imersão no universo sacro afro-brasileiro

Candomble terreiros (plots of land) are intended as spaces to preserve African religious traditions within the Brazilian diaspora. In addition, they serve as multifunctional spaces for the purpose of integrating, autonomously or by means of governmental or international partnerships, the agenda of social actions aimed at developing a model of health care structured on values and norms. The aim is to rationally engage the conventional medical system, thus setting the stage for health care possibilities based on different cultural models. This model is associated with an understanding of the knowledge and practices developed and performed by Candomble as a therapeutic system that might enable collaboration with local health systems and their specificities based on the system’s significant use of plants for therapeutic purposes. Therefore, these religious therapeutic practices are addressed as a mechanism for opening communication channels with social spaces, particularly the public market, which is the preferred locus for Afro-Brazilian sacred consumption and presents an issue related to public policies and programs for natural and complementary medicines and/or medicinal plants and phytotherapic agents.

Mercado: uma imersão no universo sacro afro-brasileiro

Candomblé terreiros (plots of land) are intended as spaces to preserve African religious traditions within the Brazilian diaspora. In addition, they serve as multifunctional spaces for the purpose of integrating, autonomously or by means of governmental or international partnerships, the agenda of social actions aimed at developing a model of health care structured on values and norms. The aim is to rationally engage the conventional medical system, thus setting the stage for health care possibilities based on different cultural models. This model is associated with an understanding of the knowledge and practices developed and performed by Candomblé as a therapeutic system that might enable collaboration with local health systems and their specificities based on the system’s significant use of plants for therapeutic purposes. Therefore, these religious therapeutic practices are addressed as a mechanism for opening communication channels with social spaces, particularly the public market, which is the preferred locus for Afro-Brazilian sacred consumption and presents an issue related to public policies and programs for natural and complementary medicines and/or medicinal plants and phytotherapic agents.

Folk medicine should be integrated into the conventional medical healthcare system in the Caribbean

To argue for the integration of folk medicine into theconventional medical healthcare system in the Carib-bean is an interesting debate; interesting because‘folk’ medicine used to be the ‘mainstream’ medicineso, if anything, it should be an argument for reinte-gration. So first, what do these two terms mean, howdid the different medical paradigms get separated andhow, if at all, can they be reintegrated to make a morewholesome, affordable and integrated healthcaresystem in the Caribbean?Before Europeans arrived in the Caribbean, itsplants were being used for healing and maintaininghealth. Historical research has shown that the Taino,a West Indian Arawak tribe who inhabited theCaribbean from ~900 AD, used many plants forhealing purposes.

Economic Evaluations of the Effects of Longevity on Telemedicine and Conventional Healthcare Provision

Providing healthcare for the elderly is one of the expectations of a telemedicine system to reduce the isolation of the aging and enhance the quality of long-term care for the elderly. Based on the experiences in Taiwan, this research aimed at investigating the influences of longevity on the demand for health services through telecommunications and conventional face-to-face methods and to note the relationship between telemedicine and conventional health services. Multiple regression analysis was undertaken. The sample covers the period from 1995 to 2004. Our results indicate that a 1% increase in the proportion of elderly relative to the population significantly increases the quantity demanded of telehealth by 305.73 and the quantity demanded of face-to-face health services by 1.99 × 10⁷. On the relationship between longevity and telemedicine, the society begins to request telehealth when the elderly proportion is >2.06%. With current 9.5% elderly proportion, there is a potential to provide 2,274.86 telemedicine health services that are currently provided at only 954.9 and underprovided by 1.38 times. On the relationship between longevity and conventional health services, when the elderly proportion is >0.56%, the needs for face-to-face health services increase in the elderly percentage. With 9.5% elderly proportion, the estimated volume of health services via conventional medical care system is 1.54 × 10⁸. The current quantity of such services is 1.11×10⁸ and underprovided by 38%. Estimation results reveal that online and conventional health services are complementary for enhancing health status in an aging society.

The Role of Cost in Telemedicine Evaluation

This study examined how health service provision via telemedicine and conventional medical systems affected a population's health status and whether the costs of health services play a deterministic role in allocating medical resources. Using the health indicator of the life expectancy at birth and applying the generalized methods of moments estimators in version 10.0 of the statistical software STATA by blending statistics and data with the survey data, the panel datasets of observations were covered over the period 1995-2004 for the Taiwan experience. Empirical evidence indicated that a 10% increase in the cost of each conventional health service increased the population life expectancy at birth by 0.12%. A 10% increase in gross domestic product per capita or the income level of the country increased the population's life expectancy at birth by 0.0023%. A 10% increase in population increased the population's life expectancy at birth by 0.0004%. A 10% increase in the ratio of telehealth services relative to conventional medical services increased the population's life expectancy at birth by 0.00019%. Interestingly, the cost of each telehealth service does not influence the population's health status. Furthermore, to reach the longevity at 76.25 years that is the current population's life expectancy at birth, an increase in health services via the telecommunications system of 243 times is able to reduce the cost of conventional health services by 69.5%. Accordingly, the cost of telehealth services does not play a deterministic role for guiding medical resource allocation and the provision of telemedicine is able to effectively save medical resources.

Micro flexible ultrasound imaging array systems.

Medical ultrasonography has continued to be an important biomedical imaging modality for its various advantages. Conventional medical ultrasound systems typically utilize a rigid transceiver phase array, with a relatively small transceiver contact area. A micro conformal system increases observation aperture by using a large, flexible transducer array that conforms to curved body surfaces, providing increased angular coverage and 3‐D imagery. In addition, the frequency‐modulated continuous wave (FMCW) signaling format requires lower peak power than pulse‐echo systems and exhibit more favorable receiver noise characteristics. This paper provides an overview of the hardware development of the micro flexible ultrasound array system. The image formation procedure is first presented in the form of pulse‐echo imaging modality. Subsequently, image reconstruction algorithms are formulated for the FMCW imaging format. In addition, the equivalence between the pulse‐echo and FMCW imaging modes is developed. This enables us to conduct image reconstruction process in both space as well as spatial‐frequency domain. The presentation includes theoretical analysis, image formation algorithms, and laboratory experiments. [This research project was supported by the Telemedicine and Advanced Technology Research Center (TATRC), Department of Defense under award numbers W81XWH‐07‐1‐0672 and W81XWH‐07‐1‐0668.]

Community-Based Organizations Are Critical Partners in Providing Complete Cancer Care

In Canada people affected by cancer access psychosocial care and support from two systems. In the conventional medical system, psychosocial professionals focus mainly on screening for and treating those most distressed by their diagnosis. Many patients and family members go beyond this step to find information and support provided by community-based organizations (CBOS). This article outlines the components of complete cancer care effectively provided by CBOS and why the integration of the two systems of care is critical in delivering seamless high-quality psychosocial care for all.

Are ‘complementary and alternative medicines’ alternative to conventional medical system? An economic evaluation

The availability of conventional medical services (i.e., allopathy) is the basic need for a modern day living. Though this clause is easily met in the developed countries, but in the developing countries it is very difficult to accomplish. Hence in the developing countries a dearth is often created, which is filled to some extent by complementary and alternative medicines (CAM). In India this phenomenon is acutely noticied. In this regard, a study is highly needed to understand why do people go for complementary and alternative medicines? Is it for the very concept that the alternative medicines involve low cost, and/or are they equally or more effective than the familiar allopathic tretment? So, this study is an approach to (i) the determination of the socio-economic factors that influence the choice of complementary and alternative medical services by health purchasers, and also (ii) the estimation of the cost-effectiveness of these medical services.