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Non-conventional medical practices that make use of dietary supplements, herbal extracts, physical manipulations, and other practices typically associated with folk and Traditional Medicine are increasingly becoming popular in Western Countries. These practices are commonly referred to by the generic, all-inclusive term “Complementary and Alternative Medicine.” Scientists, practitioners, and medical institutions bear the responsibility of testing and proving the effectiveness of these non-conventional medical practices in the interest of patients. In this context, the number of peer-reviewed journals and published articles on this topic has greatly increased in the recent decades. In this editorial article, we illustrate the policy of the Journal of Traditional and Complementary Medicine for publishing solid and scientifically sound papers in the field of Traditional and Complementary Medicine.

Simple Summary: Complementary and alternative medicine (CAM) therapies include a wide range of procedures and products that are often used by cancer patients to directly combat cancer and to protect normal cells from the toxic effects of conventional therapies. Most often, their use is self-prescribed based on a collection of scattered information from websites and advice from relatives or friends. In this paper, we examined the potential known benefits and harms associated with the most commonly used alternative treatments to provide a practical guide for caregivers and patients. CAM is used by about 40% of cancer patients in Western Countries, with peaks of 80% for breast cancer patients. Cancer patients use CAM to boost immune function, to control cancer symptoms and treatment-related side effects, and to improve health-related quality of life (HR-QoL) and survival. Unfortunately, self-prescription of natural remedies in cancer patients can lead to unexpected toxicities and can reduce the effectiveness of cancer therapy. Although CAM usually refers to all the "natural or organic" products/methods that are generally considered less toxic, there are concerns about drug interactions, especially in patients participating in clinical trials with experimental agents. Despite the claims of the promising and potential benefits made by prescribers, many CAMs lack clear scientific evidence of their safety and efficacy. Given the widespread use of CAM—both clearly declared and overt—in this review, we focused on the most important known data on the risk of interactions between biologics and oncology drugs with the goal of opening up CAM in accordance with the meaning of integrative medicine. [ABSTRACT FROM AUTHOR]

Copyright of Ethnologia Polona is the property of Instytut Archeologii I Etnologii Polskiej Akademii Nauk and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Despite substantial progress in the treatment of hepatitis C through the use of direct-acting antivirals which have been shown to cure the disease, complementary and alternative medicines (CAM) are popular among patients as a substitute or complement of allopathic medicines. This study aimed to explore the perspectives of patients and CAM practitioners on the use of CAM for the treatment of hepatitis C in Pakistan. Methods. A cross-sectional design was adopted. Participants (CAM practitioners and patients) were recruited from the capital and two provinces: Khyber Pakhtunkhwa and Punjab of Pakistan. A survey using paper-based questionnaires, each specific for patients and CAM practitioners, was conducted to gather information pertaining to demography, disease status, treatment history, and participants' perspectives (about the disease, reasons to switch to CAM, and referring source). Results. A total of 417 respondents (n = 284 patients, n = 133 practitioners) were recruited. Of the total patients, 170 (59.9%) had started CAM during the previous three months. There were 168 (59.2%) of the total patients who had used allopathic treatments for hepatitis C prior to their use of CAM. The confidence in CAM (24.6%), high cost (19%), and unbearable side effects (52.1%) of allopathic medicines were the main reasons to switch to CAM treatment. Majority (49.3%) of the patients were referred to CAM on the recommendations of relatives or care givers (17.3%) whereas only 9.5% were referred by health care professionals. Out of 133 practitioners, 48 (36.1%) were practicing herbal medicines. From practitioners' perspectives, club-moss (Lycopodium clavatum) was the best treatment option for hepatitis C. The majority, 73 (54.9%), of the patients had chosen to use CAM because of the side effects of allopathic medicines. Patients who had previous "good experience" with CAM were the most common referral source (56.4%) for CAM use in hepatitis C. Conclusions. Patients' beliefs in CAM, side effects of allopathic therapy, high cost of allopathic medicines, and referrals from previous CAM users are key factors in the switching of hepatitis C patients to CAM. [ABSTRACT FROM AUTHOR]

Background: Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM. Methods: A systematic search of the literature was carried out. A two-stage selection process with predetermined inclusion/exclusion criteria identified studies using a theoretical framework depicting the interaction of psychological factors involved in the CAM decision process. Papers were critically appraised and findings summarised. Results: Twenty two studies using a theoretical model to predict CAM use were included in the final review; only one examined child use. Seven different models were identified. The most commonly used and successful model was Andersen's Sociobehavioural Model (SBM). Two papers proposed modifications to the SBM for CAM use. Six qualitative studies developed their own model. Conclusion: The SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and policy. [ABSTRACT FROM AUTHOR]

Through ethnographic research at the Graduate School of East-West Medical Science (GSM) at Kyung Hee University in South Korea, this paper examines how a hybrid research team translates Korean medicine (KM) into scientific languages through the mobilization of laboratory science in a global knowledge-making field. Paying attention to the asymmetric power relationship between KM and science, I show that the richness and liveliness of KM is truncated as it enters the global scientific field. This lab study examines: (1) KM's double approach to local KM and global scientific fields; (2) the lab's political function in relation to biomedicine and science; and (3) the identity crisis and reconstruction of KM caused by its scientific translation. [ABSTRACT FROM AUTHOR]

Background: Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney. Methods: We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns. Results and Discussion: First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement. Conclusion: In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases are chronic and progressive inflammatory diseases of the gastrointestinal tract. Patients suffering from these diseases, especially if the standard treatment does not bring satisfactory results, more and more often turn to unconventional methods (complementary and alternative medicine). These methods are not only ineffective but also unsafe for the patient. For many of them, there is not enough scientific research. For this reason, the planning of such a method of therapy by the patient should be consulted with his or her doctor. The physician should discuss the potential benefits and risks of non-standard treatment with the patient and advise the patient not to stop conventional therapy. [ABSTRACT FROM AUTHOR]

Objectives: To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. Methods: A literature search was performed on Pubmed, ScienceDirect and EMBASE. Keywords: 'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage. Results: 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05). Conclusions: Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) consist of a broad group of restorative resources often linked to existing local cultures and established health care systems and are also increasingly used in children with some serious illnesses. In this narrative review, we examine the epidemiology of the use, efficacy, and safety of complementary and alternative medicine in pediatric oncology, neurology, and hepatology. We searched for relevant articles published in Pubmed evaluating CAM use and its efficacy in safety in children affected by oncologic, neurologic and liver diseases. CAM is used to improve the success of conventional therapies, but also to alleviate the pain, discomfort, and suffering resulting from the diseases and their treatment, which are often associated with a significant burden of adverse effects. CAM use must be evaluated in children with neurological, oncological and liver diseases. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Surgery & Clinical Research is the property of Master Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC). Methods: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users. Results: Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression. Conclusion: The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this evergrowing field. [ABSTRACT FROM AUTHOR]

Background: Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). Methods/design: Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. Discussion: The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis. [ABSTRACT FROM AUTHOR]

Prior studies exploring the effectiveness of traditional Korean medicine (TKM) treatment for facial palsy have mainly focused on Bell's palsy, and there are few studies on the effectiveness of TKM treatments for traumatic facial palsy following mandibular fracture. The patient was a 24-year-old Korean man with left-sided facial paralysis following a left mandibular fracture. Surgery was performed for the fracture and the facial palsy was treated using conventional medicine (CM) treatments for approximately 3 months, but there was no improvement observed in the patient's condition. Subsequently, the patient underwent an integrative Korean medicine treatment regimen consisting of acupuncture, pharmacopuncture, cupping, moxibustion, and herbal medication for a duration of 2 months. After 2 months of treatments, the House–Brackmann facial grading scale changed from Ⅴ to II and Yanagihara's unweighted grading score increased from 9 to 34. This case presentation and previous studies of traumatic facial palsy using TKM treatment show that TKM treatment may be considered a complementary or alternative treatment method to CM treatment in patients with traumatic facial palsy. PROSPERO registration number: CRD42023445051. [ABSTRACT FROM AUTHOR]

Introduction and purpose: Many people worldwide suffer from chronic pain. It is a very inconvenient condition on its own, not only an accompanying symptom of other diseases. Conventional drug treatment may be insufficient in some cases or may even cause serious side effects in the long term. In response to this, we aim to demonstrate the diversity of alternative pain management techniques in this review and identify conditions where such techniques may be beneficial to patients. State of knowledge: This paper evaluates some of the most common alternative pain management methods (acupuncture, massage, chiropractic, mind body therapies, herbal medicine, music therapy) and their application in specific cases of chronic pain. We also describe the possible mechanisms of action involved in the effectiveness of these techniques, based on contemporary studies. Summary: In conclusion, there are conditions where alternative medicine may be beneficial for patients suffering from chronic pain. The studies taken into account showed the best effects for chronic musculoskeletal pain treated with methods such as acupuncture and massage. Mind-body therapies may reduce stress levels and symptoms of depression associated with chronic pain, consequently improving the quality of patients' lives. However, alternative methods should not yet be considered as replacements for conventional drug therapy. More studies are needed to evaluate whether alternative therapies will play a significant role in chronic pain management in the future.

Medicine is one of the most fully represented disciplines in the Philosophical Transactions (PT), particularly in the materials dating from before the establishment of medical societies and of specialized journals. Medical events were recorded and described, data were collected, interpreted, and discussed. The need for a faster communication among professionals brought about new written forms. Shorter texts were adopted to exchange up-to-date information. This investigation focuses on a selected number of texts to verify the origin and the nature of any rhetorical and stylistic changes which may have occurred in the PT during the eighteenth century. The selection of extracts constitutes the basis for a detailed discussion of rhetorical and stylistic issues. Between 1702 and 1801 medical writing in the PT undergoes major changes: these are gradual shifts along a continuum highlighting an essentially author-centered approach at the outset of the century and an object-centered perspective at the end of the period. [ABSTRACT FROM AUTHOR]

Background and Objective. Several treatments are used to attain good control of symptoms and to reduce asthmatic exacerbations. The survey was designed to compare different systems of treatments for asthma and to explore the most preferred treatment in terms of efficacy, side effects, long-term use, and satisfaction. Materials and Methods. The cross-sectional survey was conducted; primary data were collected from asthmatic patients in different hospitals and clinics of allopathic, homeopathic, and herbal practitioners in Karachi, Pakistan. The study duration was from January 2020 to December 2020. Asthmatic patients aged over 13 years were selected for the study. A written informed consent was taken from the patients before the interview. Collected data were analyzed by the Statistical Package of Social Sciences (SPSS) 22. Result. Among 255 asthmatic patients; 51.4% (n = 131) were male and 48.6% (n = 124) were female. For control of acute attacks of asthma 88.2% (p = 0.0001) of patients significantly preferred allopathic treatment while 6.3% (p = 0.008) used homeopathic treatment and 5.5% chose herbal treatment. For maintenance of asthma, 78.8% (p = 0.0001) patients used allopathic treatment while 12.4% (p = 0.0001) homeopathic and 8.8% (p = 0.0001) patients used herbal treatment. About 63.4% (p = 0.0001) of the asthmatic patients used short-acting β-2 agonists for managing acute asthmatic episodes while long-acting β-2 agonists (p = 0.0001) and inhaled corticosteroids (p = 0.0001) were found to be the preferred medicines for maintenance therapy. Effectiveness of treatment (p = 0.004) and cost effectiveness (p = 0.0001) significantly act as contributing factors for the selection of the treatment. The majority of the patients were satisfied with their chosen treatments for control of asthmatic symptoms. Conclusion. Most asthmatic patients preferred allopathic treatment for the management of acute episodes and control of asthmatic symptoms. It was found that the major factors for selecting a specific treatment include effectiveness, cost, and minimal side effects. [ABSTRACT FROM AUTHOR]

Background: Bioresonance therapy is a holistic physical method used in the treatment of various diseases. Aim of the study: The aim of the present paper was to evaluate the effect of bioresonance therapy in patients with recurrent major depressive disorder and with mild or moderate depressive episodes, respectively, without any other pharmacological, psychological, or other type of treatment. Methods: We selected 40 patients diagnosed with recurrent depressive disorder and bioresonance therapy as the only treatment. Assessment of the level of depression was achieved by measuring the biorhythm with the bioresonance device and by applying the Hamilton Depression Inventory questionnaire, with 17 items, at the beginning and the end of five weeks of treatment. Results: We identified a statistically significant decrease in depression levels as quantified by the HAM-D 17 scale, between the initial and final phase of therapy (p = 0.0001). Conclusions: Our results suggest that bioresonance therapy can decrease the level of depression in patients with recurrent depressive disorder, with mild and moderate depressive episodes.

Four phases of trial are widely used in testing drugs, surgery, and diagnosis in Western medicine (WM). The staged testing process helps protect patients from unnecessary harms and control costs while assessing safety and efficacy. In this paper we adapt the four phase trials for traditional Chinese medicine (TCM). As TCM has been used in humans for thousands of years and there has been good preliminary clinical evidence on safety and efficacy for many of its therapies, in most cases its evaluation can start directly in humans, and preclinical laboratory research can be conducted in phase 4 trials after the efficacy is firmly demonstrated. Furthermore, unlike investigational drugs, TCM therapies are various in the certainty of their safety and efficacy and thus should not enter the evaluation process at the same stage. Unlike in WM, clarifying and refining PICO (patients, intervention, comparator, and outcome) are an important part of evaluation of newly designed TCM therapies. The incommensurability between WM and TCM causes additional difficulties in TCM trials regarding defining and choosing PICO, for which some suggestions are made. Observational studies seem to have a greater role in evaluation for TCM although the efficacy must be confirmed with randomized trials. [ABSTRACT FROM AUTHOR]

This paper examines a sequence of investigations in parasitology, botany, pharmacology, psychometrics and ethnopsychology focused on Kenyan village children's knowledge of medicinal herbs. We follow this work of making and ordering of knowledge, showing that the different disciplinary perspectives on bodies, medicines, knowledges, children and cultures produced by this research all sought the foundation of knowledge in reference to objective reality, and that they aimed to make the world known in the specific form of distinct and comparable entities with individual properties and capacities. Based on subsequent ethnographic observations of healing in the same village, we outline a different, contrasting modality of knowing, which places ontology above epistemology. Medicinal knowledge and its transformational capacity are here not located within entities but between them; not in objective reality but in effects; 'to know' means 'to come together' with the implication of having an effect on one another. We use this ethnographic sketch of a different form of knowing as a foil against which to contrast the imaginary that had shaped our previous research. Beyond the stark contrast between herbal village healing and pharmacological laboratory analysis, we expand our argument by moving from natural science to social science, from studies of plants and substances to those of humans, minds and cultures; from laboratories to ethno-psychological tests, cultural models, and eventually econometrics. We suggest that by reiterating a particular scientific imaginary, remaking humans (and non-human beings) as known things, a specific notion of man and a related political economy of knowledge is naturalized. Looking back at our involvement with this sequence of research, we realize that, contrary to our intentions, our inclusion as 'social scientists' into a multidisciplinary scientific project may have exacerbated rather than mitigated its potentially problematic effects. [ABSTRACT FROM AUTHOR]

In the early 1920s, the Manitoba medical profession reached a pinnacle in its opposition to alternative medicine, waging an aggressive four-year campaign against chiropractic and osteopathy to ‘protect’ the public from the dangers of alternative forms of healing and prevent ‘irregulars’ from establishing their practices. It was during these same years that the Manitoba medical profession was able to successfully overcome many internal problems of consensus and external problems of legitimacy. Examining the years leading up to, during, and following the campaign, this paper demonstrates how the Manitoba medical profession's militant reaction to osteopathy and chiropractic during these years helped strengthen and differentiate orthodox practitioners as a group, thus reinforcing their authority within the public realm. [ABSTRACT FROM AUTHOR]

Sanguinaria canadesis, Chelidonium majus and Macleya cordata have been used for centuries as alternative medicines. Currently the extracts from these medicinal plants are components of veterinary and human phytopreparations, and of oral-hygiene agents. Sanguinarine and chelerythrine (SA/CHE) are biologically active components of these extracts. They display distinct antibacterial and anti-inflammatory properties, but, on the other hand, they have been reported as having adverse effects — genotoxicity and hepatotoxicity. This paper is aimed at evaluation of the effects of daily administration of the extract from Macleya cordata (2 mg and 100 mg in 1 kg feed, sanguinarine:chelerythrine 3:1) in the diet on the health status of swine. After 90-day administration, alkaloids were retained to a different extent in tissues. The highest SA/CHE retention was detected in the gingiva (0.55 μg/g) and liver (0.15 μg/g), no SA/CHE were detected in muscles. Plasma SA levels attained 0.11 μg/ml. Treated animals did not display any results of hematological, biochemical or histological assay different from controls. A 32P-postlabeling assay proved that no DNA-adducts with SA/CHE were detected in pig livers. We did not observe any symptom linked to epidemic dropsy syndrome often attributed to sanguinarine. In conclusion, an average daily oral dose of alkaloids up to 5 mg per 1 kg animal body weight proved to be safe. [Copyright &y& Elsevier]

Introduction: This report describes the organization and launch of one of the first evidence-based, complementary and alternative medicine (CAM) oriented journal club programs integrated into a professional CAM curriculum, designed to teach essential evidence-based practice (EBP) skills and behaviors. Methods: Journal clubs were structured as required clinical hours for all DC students in a clinical internship during the 9th and 10th trimesters. Faculty, staff, and supervising clinicians were assigned mentoring roles. An information specialist videotaped presentations, distributed copies of papers, and organized electronic resources and archives. Students, separated into teams, defined patient scenarios, developed a clinical question performed a literature search, and selected, appraised, presented, and discussed a research paper as a team project, self-assigning roles. An assessment was administered at the beginning and end of the program. Instructional resources covered essential EBP concepts, searching skills and resources, and critical appraisal. Results: Twenty-seven student-led journal clubs produced over three trimesters were attended by at least one librarian, one research faculty, and one supervising clinician in addition to the instructor and interns. Participation increased each trimester. All 27 articles were from peer-reviewed journals and focused on chiropractic, acupuncture, nutrition, emerging technologies, general medicine, and musculoskeletal or metabolic topics. Randomized controlled trials, cohort studies, systematic reviews, and case studies were among study designs selected. At least 24% of the discussions supported or initiated new therapies in the clinic. Twenty-two percent (22%) of graduating students expressed interest in participating in a postgraduate journal club, and 30% commented that the journal club course added value to their clinical experience. Conclusion: The initial organization and launch of the evidence-based, CAM-oriented, internship-integrated journal club was successful. Interns' attitudes toward using EBP skills as part of their clinical decision making became more positive after two trimesters of participation. Funding was provided by NIH/NCCAM #1R25AT002872. [ABSTRACT FROM AUTHOR]

Background The World Health Organization advocates integration of traditional and complementary medicine (T&CM) into the conventional health services delivery system. Integrating quality services in a patient-centred manner faces substantial challenges when T&CM is delivered within a health system dominated by conventional medicine. This review has synthesized international experiences of integration strategies across different contexts. Sources of data Publications describing international experiences of delivering T&CM service in conventional healthcare settings were searched. Backward and forward citation chasing was also conducted. Areas of agreement Capable leaders are crucial in seeking endorsement from stakeholders within the conventional medicine hierarchy and regulatory bodies. However, patient demands for integrative care can be successful as demonstrated by cases included in this review, as can the promotion of the use of T&CM for filling effectiveness gaps in conventional medicine. Safeguarding quality and safety of the services is a priority. Areas of controversy Different referral mechanisms between conventional and T&CM practitioners suit different contexts, but at a minimum, general guideline on responsibilities across the two professionals is required. Evidence-based condition-specific referral protocols with detailed integrative treatment planning are gaining in popularity. Growing points Interprofessional education is critical to establishing mutual trust and understanding between conventional clinicians and T&CM practitioners. Interprofessional communication is key to a successful collaboration, which can be strengthened by patient chart sharing, instant information exchange, and dedicated time for face-to-face interactions. Areas timely for developing research Research is needed on the optimal methods for financing integrated care to ensure equitable access, as well as in remuneration of T&CM practitioners working in integrative healthcare. [ABSTRACT FROM AUTHOR]

Background. Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods. To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results. Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion. The research strategy extends to and complements the prevailing hierarchical system by introducing a broad "evidence house" approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile. Discussion: Many of the arguments raised against EBM within the CAM community are based on a caricature radically at odds with established, accepted and published principles of EBM practice. Contrary to what has sometimes been argued, EBM is not cookbook medicine that ignores individual needs. Neither does EBM mandate that only proven therapies should be used. Before EBM, decisions on health care tended to be based on tradition, power and influence. Such modes usually act to the disadvantage of marginal groups. Conclusion: By placing CAM on an equal footing with conventional medicine - what matters for both is evidence of effectiveness - EBM provides an opportunity for CAM to find an appropriate and just place in health care. [ABSTRACT FROM AUTHOR]

Amid persistent interest in and concerns about traditional, complementary and alternative medicine (TCAM) in low-, middle- and high-income countries, the global community of healthcare is in need of learning ways to institutionalize TCAM with biomedicine. By investigating how traditional East Asian medicine (TEAM), one of the most popular forms of TCAM in the world, is institutionalized in China, Korea and Japan, this study finds three different ways of instituting a plural medical system in which TCAM and biomedicine intersect with each other. In the interpenetrative pluralism in China and the exclusionary pluralism in Korea, TEAM and biomedicine are institutionalized as independent and equivalent systems of medical practices. However, TEAM and biomedicine are conditioned to cross over into each other unconditionally in practice in the former, whereas the two exclude each other very strictly in the latter. In the subjugatory pluralism in Japan, the crisscrossing of TEAM and biomedicine is allowed, yet in an asymmetrical way whereby the practice of TEAM is dependent upon and subordinated into biomedicine. The practice of various TEAM modalities is overseen by TEAM doctors, biomedicine doctors or integrative TEAM-biomedicine doctors in interpenetrative pluralism, by TEAM doctors only in exclusionary pluralism, and by biomedicine doctors only in subjugatory pluralism. These varying characteristics demonstrate a variety of plural medical systems. They also provide useful cues in accounting for the varying behaviours of medical service providers and users who encounter TCAM as well as biomedicine in their everyday practices. In addition, the growing literature about the outcomes of TCAM and plural medical systems can take advantage of these findings. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate whether students at German medical schools participating in elective courses on acupuncture and homeopathy differ from an unselected group of students regarding attitudes and personality traits. Methods: Elective courses on acupuncture and homeopathy in the academic half-year 2013/14 all over Germany were identified and participants invited to fill in a questionnaire including nineteen questions on attitudes towards Complementary and Alternative Medicine (CAM), orientation towards science, care and status orientation, and a short validated instrument (Big-Five-Inventory-10) to measure personality traits (extraversion, neuroticism, openness, conscientiousness, and agreeableness). Participants of a mandatory family medicine course at one university served as unselected control group. Results: Two hundred twenty and 113 students from elective courses on acupuncture and homeopathy, respectively, and 315 control students participated (response rate 93%). Students participating in elective courses had much more positive attitudes towards CAM, somewhat lower science and status orientation, and somewhat higher care orientation than control group students (all p-values for three-group comparisons < 0.001). There were no differences between the three groups regarding personality traits with the exception of lower values for agreeableness in controls (p=0.009). Conclusions: The findings of this study show that attitudes of students participating in elective courses on acupuncture or homeopathy at German medical schools differ to a considerable degree from the attitudes of unselected students. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to describe and discuss the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a rigorous diagnosis-based clinical decision rule. Methods: A prospective observational cohort of consecutive patients with PRLP participated in the study. Data on 73 consecutive patients were collected at baseline and at the end of the active treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ). Pain intensity was measured using the numerical rating scale for pain (NRS). Patients were also asked to self-rate their improvement. Results: Complete outcome data were available in 73 patients. Fifty-three patients (72.5%) reported their improvement as either "Excellent" or "Good." The mean patient-rated improvement was 60%. The mean improvement in BDQ was 16.7 points. The mean percent improvement in BDQ was 37.2% and the median was 43%. Mean improvement in pain was 2.6 points. Thirty-five (48%) of the patients in this cohort experienced clinically significant improvement in disability and 47 (63.5%) patients in this cohort experienced clinically significant improvement in pain. Patients were seen an average 6.8 visits. Conclusion: The management strategy studied here yielded favorable outcomes in this patient population and appears to be a safe option for patients with PRLP. However, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized, controlled trials are necessary to distinguish treatment effects from the natural history of PRLP. [ABSTRACT FROM AUTHOR]

Flooding causes significant public health issues. The Mekong Delta has been considered the region to be the most vulnerable to flooding in Vietnam. This study assessed the spatial vulnerability of the health impacts of flooding in the Mekong Delta region, Vietnam. This study applied a vulnerability assessment framework which was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity. The indicators for each dimension were derived from the relevant literature, consultations with experts, and data availability. An analytic hierarchy process (AHP) and a principal component analysis (PCA) were used to determine the weight of indicators. Vulnerability indexes (VIs) were then computed for each province. A total of 29 indicators (sensitivity index, 14; adaptive capacity index, 13; and exposure index, 2) were employed to evaluate the vulnerability to the health impacts of flooding at a provincial level. The results of AHP revealed that the highest VIs were found in the Dong Thap and An Giang provinces (VI, 1.948 and 1.574, respectively). VIs were distributed with higher indexes in upstream provinces close to a river than in coastal provinces. PCA generated three components from the 29 indicators, and the VIs computed from the PCA method are in substantial agreement with the AHP method (ICC = 0.71, p < 0.05). The vulnerability to the health impacts of flooding varies from province to province in the Mekong Delta region in Vietnam. Individual plans for health preparedness and adaption to flooding should be developed for each province in the Mekong Delta region. [ABSTRACT FROM AUTHOR]

The impact of strong cultural beliefs on specific reasons for traditional medicine (TRM) use among individuals and populations has long been advanced in health care and spatio-medical literature. Yet, little has been done in Ghana and the Ashanti Region in particular to bring out the precise "pull" and "push" relative influences on TRM utilization. With a qualitative research approach involving rural and urban character, the study explored health beliefs and motivations for TRM use in Kumasi Metropolis and Sekyere South District, Ghana. The study draws on data from 36 in-depth interviews with adults, selected through theoretical sampling. We used the a posteriori inductive reduction model to derive broad themes and subthemes. The "pull factors"--perceived benefits in TRM use vis-à-vis the "push factors"--perceived poor services of the biomedical treatments contributed to the growing trends in TRM use. The result however indicates that the "pull factors," viz.--personal health beliefs, desire to take control of one's health, perceived efficacy, and safety of various modalities of TRM--were stronger in shaping TRM use. Poor access to conventional medicine accounted for the differences in TRM use between rural and urban areas. Understanding the treatment and health-seeking behaviour of a cultural-related group is critical for developing and sustaining traditional therapy in Ghana. [ABSTRACT FROM AUTHOR]

Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in contributing to evidence-basedmedicine. Recent developments in Koreanmedicine have not been as well disseminated as traditional Chinese medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidence-based Koreanmedicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing conventional and complementary approaches. [ABSTRACT FROM AUTHOR]

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or 'allopathic' (disease as 'other' or 'outsider') practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such 'world medicine' as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice. [ABSTRACT FROM AUTHOR]

Giardiasis, a gastrointestinal disease caused by Giardia duodenalis, is currently treated mainly with nitroimidazoles, primarily metronidazole (MTZ). Treatment failure rates of up to 20 percent reflect the compelling need for alternative treatment options. Here, we investigated whether orlistat, a drug approved to treat obesity, represents a potential therapeutic agent against giardiasis. We compared the growth inhibitory effects of orlistat and MTZ on a long-term in vitro culture adapted G. duodenalis strain, WB-C6, and on a new isolate, 14-03/F7, from a patient refractory to MTZ treatment using a resazurin assay. The giardiacidal concentration of the drugs and their combined in vitro efficacy was determined by median-effect analysis. Morphological changes after treatment were analysed by light and electron microscopy. Orlistat inhibited the in vitro growth of G. duodenalis at low micromolar concentrations, with isolate 14-03/F7 (IC5024h = 2.8 µM) being more sensitive than WB-C6 (IC5024h = 6.2 µM). The effect was significantly more potent compared to MTZ (IC5024h = 4.3 µM and 11.0 µM, respectively) and led to specific undulated morphological alterations on the parasite surface. The giardiacidal concentration of orlistat was >14 µM for 14-03/F7 and >43 µM for WB-C6, respectively. Importantly, the combination of both drugs revealed no interaction on their inhibitory effects. We demonstrate that orlistat is a potent inhibitor of G. duodenalis growth in vitro and kills parasites at concentrations achievable in the gut by approved treatment regimens for obesity. We therefore propose to investigate orlistat in controlled clinical studies as a new drug in giardiasis. [ABSTRACT FROM AUTHOR]

Introduction: Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. Methods: We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. Results: The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0–0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0–0.71), a 35% increase (p = 0.046). A median HIV knowledge score of 67% (IQR: 59–78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74–89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. Discussion: We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected. [ABSTRACT FROM AUTHOR]