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Objectives: The degree to which the effects of acupuncture treatment vary between acupuncturists is unknown. We used a large individual patient dataset of trials of acupuncture for chronic pain to assess practitioner heterogeneity. Methods: Individual patient data linked to identifiable acupuncturists were drawn from a dataset of 39 high-quality trials of acupuncture, where the comparators were either sham acupuncture or non-acupuncture controls, such as standard care or waitlist. Heterogeneity among acupuncturists was assessed by meta-analysis. Results: A total of 1206 acupuncturists in 13 trials were included. Statistically significant heterogeneity was found in trials with sham-control groups (p Discussion: Although differences in effects between acupuncturists were greater than expected by chance, the degree of variation was small. This suggests that most chronic pain patients in clinical practice would have similar results to those reported in high-quality trials; comparably, we did not find evidence to suggest that greater standardization of acupuncture practice would improve outcomes. Further research needs to be conducted exploring variability using a sample of acupuncturists with a broader range of practice styles, training and experience.

Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis. Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. Methods: The study design was an interdisciplinary consensus process based on a systematic literature search. Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.

Background: Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. Objectives: The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. Method: In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. Results: With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Conclusion: Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.

Background: There is currently no effective treatment against coronavirus disease 2019 (COVID-19). The optimal selection of interventions targeting the virus is unknown. Therefore, evidence from randomized controlled trials (RCTs) to support specific treatment against COVID-19 is urgently needed. The use of Chinese herbal medicines (CHMs) might have a role in the treatment and symptomatic management of patients with COVID-19. It was aimed at providing an overview of the available evidence and ongoing trials concerning the effects of CHMs for the treatment of COVID-19. Methods: This is a narrative review of relevant studies. Searches were conducted to identify documents published till April 22, 2020. Electronic databases, evidence-based collections, websites of relevant organizations, and trial registries were consulted. Results: A total of 25 guidelines on the treatment of patients with COVID-19 were identified. Four guidelines provided recommendations on the use of CHMs; these guidelines were developed in China and South Korea and were based on the consensus of experts exclusively. The remaining 21 guidelines provided no guidance on CHMs. No finished RCTs of CHMs for the treatment of patients with COVID-19 was found. According to the evidence evaluated in this review, a Cochrane review of CHMs for severe acute respiratory syndrome and five uncontrolled observational studies of the effects of CHMs in patients with COVID-19, the effects of CHMs for COVID-19 are unknown. A total of 52 ongoing clinical trials of CHM interventions for the treatment of COVID-19 were found. These trials will be carried out mostly in China (n = 51). Forty (77%) of the ongoing trials will be randomized, whereas 12 (23%) have an unclear sequence generation procedure. Forty-seven trials (90%) will have a sample size

The German Cancer Aid set up a priority research programme with the intention to generate high-quality information based on evidence and to make this information easily accessible for health-care professionals and advisors, researchers, patients, and the general public.The Kompetenznetz Komplementärmedizin in der Onkologie (KOKON) received 2 funding periods within this programme. During the first funding period, KOKON assessed patients' and health-care professionals' informational needs, developed a consulting manual for physicians, developed an education programme for self-help groups, set up a knowledge database, and developed a pilot information website for patients. Funding period 2 continues with work that allows cancer patients and health-care professionals to make informed decisions about complementary and alternative medicine (CAM). For this aim, KOKON evaluates training programmes for physicians (oncology physicians, paediatric oncologists, and general practitioners) and for self-help groups. All training programmes integrate results from an analysis of the ethical, psychological, and medical challenges of CAM in the medical encounter, and the knowledge database is being extended with issues related to CAM for supportive and palliative care. Key Message: A Germany-wide collaborative research project to identify needs, provide information, foster communication, and support decision-making about CAM in oncology is being set up.Hintergrund: Die Deutsche Krebshilfe hatte ein sogenanntes “Priority Research Programme” ausgeschrieben, in dem evidenzbasierte Informationen von höchster Qua­lität für Angehörige von Gesundheitsberufen und für Berater, Forscher, Patienten und die Öffentlichkeit zu­gänglich gemacht werden sollten. Zusammenfassung: Das Kompetenznetz Komplementärmedizin in der Onko­logie (KOKON) konnte Fördergelder für zwei Förderperioden innerhalb dieses Programms akquirieren. KOKON untersuchte in der ersten Förderperiode den Bedarf von Patienten und Angehörigen von Gesundheitsberufen sowie Informationsbedürfnisse, entwickelte ein Konsultationsmanual für Ärzte, ein Trainingsprogramm für Selbst­hilfegruppen, baute eine Wissensdatenbank auf und entwickelte eine Pilot-Informations-Webseite für Patienten. In Förderperiode 2 wurde diese Arbeit insofern fortgesetzt, als dass Patienten und Angehörige von Gesundheitsberufen in die Lage versetzt werden sollten, infor­mierte Entscheidungen zu treffen. Zu diesem Zweck evaluiert KOKON Trainingsprogramme für Ärzte (aus der Onkologie, Kinderonkologen und Hausärzte) und für Selbsthilfe-Gruppen. Alle Trainingsprogramme integrieren Ergebnisse von Analysen der ethischen, psychologischen und medizinischen Herausforderungen von Komplementärmedizin in der medizinischen Versorgung, und die Wissensdatenbank wird um Themen der Supportiv- und der Palliativ-Therapie erweitert. Schlussfolgerung: Ein deutschlandweiter Forschungsverbund konnte eta­bliert werden, um den Bedarf bezüglich Komplementärmedizin in der Onkologie zu identifizieren, entsprechende Informationen zur Verfügung zu stellen sowie Kommunikation und Entscheidungsfindung zu fördern.

Background Chinese eye acupuncture, focuses on treating different diseases by applying needle stimulation around the orbit of the eye. Since 1970, it has been used in China for the management of pain-related disorders. This scoping review systematically collected clinical studies on the use of eye acupuncture to treat pain conditions and identify any adverse events. Methods Six databases including PubMed, the Cochrane Library, CNKI, VIP, Wan Fang Data and SinoMed were searched from 1970 to March 2019. Randomized controlled trials (RCTs), clinical controlled trials (CCTs) and case series on eye-acupuncture for pain conditions meeting the inclusion criteria were identified. Data were extracted on patients, interventions, details of eye acupuncture, control treatments and outcomes. Results Searches identified 81 clinical studies and a trend demonstrating an increasing number of published studies. All studies were conducted in China and published in Chinese. These included, 45 (55.6%) RCTs, 5 (6.2%) CCTs, and 31 (38.3%) case series, treating 7113 patients with 44 different pain-related diseases or symptoms. The most frequently reported conditions were headache (18, 16.2%), acute lumbar pain (7, 6.3%) and lumbar disc herniation (7, 6.3%). Treatment using small needles (φ0.25 × 13 mm), retained ≤30 min, needling the horizontal outer orbital edge and the avoidance of manipulation during treatment were the most frequent descriptions of the interventions used. Eye acupuncture was used alone in about half of the studies and of the remaining studies it was combined with other treatment. All studies suggested some beneficial effects including: pain relief, improved quality of life and mental health, and 18 (22.2%) adverse events. Conclusion Eye acupuncture, predominantly studied in China, may be a promising intervention for managing diverse pain conditions. However, given the variety of study designs and reported treatment outcomes, conclusions about the evidence for eye acupuncture for specific conditions are not possible at this stage.

Editor's Note: This column takes our series from the Society for Acupuncture Research (SAR) in a new direction. Recently, the U.S. government's Center for Medicare and Medicaid Services (CMS) issued a call for public comment related to the government's exploration of inclusion of acupuncture and licensed acupuncturists in federal payment schemes. The decision of SAR's research leaders to engage with policymakers is forward thinking, especially as much dialogue and many research needs related to acupuncture and other integrative health practices and practitioners are shifting toward implementation concerns. SAR's engagement in this arena is also reflected in the organization's 2019 conference June 27–29, 2019 in Burlington, Vermont: “Acupuncture Research, Health Care Policy, & Community Health…Closing the Loop.” The author team includes the entire SAR Board, led by president-elect Jun J. Mao, MD, and current copresidents Robert T. Davis, MS, LAc, and Richard Harris, PhD. This is also a moment to congratulate Harris on his selection to the U.S. National Institutes of Health National Advisory Council on Complementary and Integrative Health.—John Weeks, Editor-in-Chief

Background: In a randomized controlled trial, compared with standard care alone in breast cancer, acupuncture as a prophylactic treatment did not show better quality of life or fewer side effects of chemotherapy (NCT01727362 [clinicaltrials.gov]). The aim of the qualitative part of this mixed methods study was to better understand the subjective perspectives of the patients regarding quality of life during chemotherapy and the perceived effects of acupuncture. Methods: In a nested retrospective qualitative study, semi-structured telephone interviews were conducted with 5 responders and 5 non-responders (defined by the outcome of the primary parameter FACT-B) who were randomly selected from both study arms. The interviews were digitally recorded, pseudonymized, transcribed, and then deductively and inductively analyzed according to Qualitative Content Analysis using MAXQDA® software. Results: A total of 20 patients were included in the qualitative part of the study. In both groups, most women stated that their quality of life was surprisingly better than what they had expected before starting the chemotherapy. All patients of the acupuncture group experienced the acupuncture treatments as relaxing and beneficial, mentioning a friendly setting, and empathic attitude of the therapist. Most of these patients stated that the acupuncture treatment reduced chemotherapy-induced side effects. The patients reported that acupuncture was supportive for coping with the disease in a salutogenic way. For all patients, finding strategies to cope with life-threatening cancer and the side effects of chemotherapy was essential, for example, keeping a positive attitude toward life, selecting social contacts, and staying active as much as possible. Conclusions: Patients in the acupuncture group reported positive effects on psychological and physical well-being after receiving the study intervention. For all patients, having coping strategies for cancer seemed to be more important than reducing side effects. Therefore, further studies should focus more on coping strategies and reducing acute side effects.

Background: The aims of this pilot study were to observe perceived outcomes of spiritual healing in Germany. Patients and Methods: In this prospective case study, we performed qualitative interviews with clients and healers about perceived outcomes of spiritual healing treatments. A directed qualitative content analysis was used. In addition, we applied questionnaires (WHOQOL-BREF, General Self-Efficacy Scale, Sense of Coherence 13, SpREUK-15, intensity of complaints on visual analogue scale) at baseline and after week 1, month 2 and month 6 which were analysed descriptively. Results: Seven healers and 7 clients participated, 42 interviews were analysed. In the interviews, the clients described positive body sensations, greater relaxation and well-being as short-term effects of healing treatments. Perceived longer-term effects were related to making significant life changes, creating new meanings, activating resources and improving social relationships. Patients in pain described a reduction of pain intensity. In the questionnaires, the clients reported improvements in quality of life and self-efficacy, to a smaller extent improvements of intensity of complaints and sense of coherence. Conclusion: The results from this pilot study could be useful to choose outcomes of future prospective studies with a larger sample: qualitative assessments combined with global and broad quantitative outcomes such as quality of life, self-efficacy and intensity of complaints could be applied., Hintergrund: Ziel dieser Pilotstudie war es, subjektiv wahrgenommene Effekte des spirituellen Heilens quali­tativ und quantitativ zu erfassen. Patienten und Metho­den: In dieser prospektiven Pilotstudie wurden über 6 Monate qualitative Interviews mit Klienten und Heilern über wahrgenommene Effekte spiritueller Heilbehandlungen geführt und auf Basis einer qualitativen Inhaltsanalyse ausgewertet. Ergebnisse wurden zusätzlich mit Fragebögen (WHOQOL-BREF, General Self-Efficacy Scale, Sense of Coherence 13, SpREUK-15, Beschwerdeintensität auf visueller Analogskala) zu Studienbeginn und nach der Woche 1, Monat 2 und Monat 6 erfasst. Ergebnisse: Sieben Heiler und 7 Klienten nahmen an dieser Studie teil, 42 ­Interviews wurden analysiert. Klienten beschrieben als kurzfristige Effekte der Heilbehandlungen positive Körperempfindungen, mehr Entspannung und Wohlbefinden. Die längerfristig wahrgenommenen Effekte standen im Zusammenhang mit signifikanten Veränderungen des Lebens, neuen Deutungen, Ressourcenaktivierung und der Verbesserung sozialer Beziehungen durch die Klien­ten. Klienten mit Schmerzen beschrieben eine Verringe­rung der Schmerzintensität. In den Fragebögen zeigten sich Verbesserungen der Lebensqualität und der Selbstwirksamkeit, zu einem geringeren Ausmaß Verbesserungen der Beschwerdeintensität und des Kohärenzgefühls. Schlussfolgerung: Die Ergebnisse dieser Pilotstudie könnten nützlich sein, um Endpunkte für künftige pros­pektive Studien mit einem größeren Stichprobenumfang zu wählen: qualitative Analysen in Kombination mit Fragebögen, die globale und umfassende Aspekte wie Lebensqualität, Selbstwirksamkeit und Intensität der ­Beschwerden erfassen, sind unserer Ansicht nach am besten geeignet.

Background We aimed to compare patients’ and physicians’ safety reporting using data from large acupuncture trials (44,818 patients) and to determine associations between patient characteristics and reporting of adverse reactions. Methods Six pragmatic randomized trials with an additional non-randomized study arm that included those patients who refused randomization were evaluated. Patients received acupuncture treatment for osteoarthritis of the hip or knee, chronic neck pain, chronic low back pain, chronic headache, dysmenorrhea, or allergic rhinitis or asthma. Safety outcomes were evaluated by questionnaires from both the physicians and the patients. To determine level of agreement between physicians and patients on the prevalence of adverse reactions, Cohen’s kappa was used. With multilevel models associations between patient characteristics and reporting of adverse reactions were assessed. Results Patients reported on average three times more adverse reactions than the study physicians: for bleeding/haematoma, 6.7% of patients (n = 2458) vs. 0.6% of physicians (n = 255) and for pain, 1.7% of patients (n = 636) vs. 0.5% of physicians (n = 207). We found only minor agreements between patients and physicians (maximum Cohen’s kappa: 0.50, 95% confidence interval [0.49;0.51] for depressive mood). Being a female and participation in the randomization were associated with higher odds of reporting an adverse reaction. Conclusions In our study, patients’ and physicians’ reports on adverse reactions of acupuncture differed substantially, possibly due to differences in patients’ and physicians’ questionnaires and definitions. For the assessment of safety, we strongly support the inclusion of patients’ and physicians’ reports while ensuring standardization of data collection and definitions. Electronic supplementary material The online version of this article (10.1186/s12906-019-2638-x) contains supplementary material, which is available to authorized users.

To address the needs of cancer patients, two things are important: (1) oncology physicians and other health professionals in cancer care should receive training so that they can guide their patients through the maze of available offers in complementary and integrative medicine (CIM), and (2) more CIM providers should possess competencies to provide evidence-informed CIM treatments to cancer patients.

Objectives: Chronic low-back pain (CLBP) is burdensome and costly, and a common condition for which adults use integrative therapies. The effectiveness of multidisciplinary integrative approaches has not been well studied. The purpose of this observational study was to compare characteristics and outcomes of CLBP patients treated at the Osher Clinical Center (OCC) versus other clinics at Brigham and Women's Hospital. Design: Observational comparative effectiveness study. Setting: Tertiary care hospital. Subjects: Patients ≥21 years with 3+ months of CLBP or 6+ months of intermittent low-back pain. Intervention: All patients were observed for 12 months. OCC patients received care at the integrative clinic (7.3 visits on average over 13 weeks); non-OCC patients received usual care at other clinics of the same hospital. Outcome measures: Primary outcomes: change from baseline to 6 months in functional status (Roland Disability Questionnaire [RDQ]) and bothersomeness of pain (BOP). Secondary outcomes: change in RDQ and BOP at 3 and 12 months, percentages of patients with clinically meaningful (≥30%) improvements. Results: One hundred fifty-six OCC and 153 non-OCC participants were enrolled; follow-up was 90.4 and 98.0%, respectively, at 12 months. There were substantial differences in baseline characteristics between groups. For RDQ, the adjusted mean group difference was nonsignificant at 6 months; for BOP, the differences were significant, but clinically small. At 12 months, the observed benefit on RDQ was significant and clinically meaningful; for BOP, there were significant, but clinically small differences. Percentages of patients with ≥30% improvements in RDQ were significantly greater in the OCC group only at 12 months, and both 6 and 12 months for BOP. Conclusions: Baseline characteristics can differ between those who select different sources of healthcare for CLBP. While benefits seen in the OCC versus non-OCC clinics were not large, further evaluation through randomized trials might be warranted to provide a more definitive evaluation.

Research into acupuncture has had ripple effects beyond the field of acupuncture. This paper identifies five exemplars to illustrate that there is tangible evidence of the way insights gleaned from acupuncture research have informed biomedical research, practice, or policy. The first exemplar documents how early research into acupuncture analgesia has expanded into neuroimaging research, broadening physiologic understanding and treatment of chronic pain. The second describes how the acupuncture needle has become a tool to enhance biomedical knowledge of connective tissue. The third exemplar, which illustrates use of a modified acupuncture needle as a sham device, focuses on emergent understanding of placebo effects and, in turn, on insights into therapeutic encounters in treatments unrelated to acupuncture. The fourth exemplar documents that two medical devices now in widespread use were inspired by acupuncture: transcutaneous electrical nerve stimulators for pain control and antinausea wrist bands. The final exemplar describes how pragmatic clinical trial designs applied in acupuncture research have informed current general interest in comparative effectiveness research. In conclusion, these exemplars of unanticipated outcomes of acupuncture research comprise an additional rationale for continued support of basic and clinical research evaluating acupuncture and other under-researched therapies.

Die franziskanische Ordensschwester Pauline Felder (1925-2007) ist eine der bekanntesten schweizerischen Naturheilkundlerinnen der jüngsten Vergangenheit. An ihrem Beispiel wird exemplarisch aufgezeigt, dass die schweizerische Volksmedizin eine lebende Tradition ist, die komplementär zu naturwissenschaftlichen Methoden der Biomedizin einen wichtigen Beitrag zur ganzheitlichen Gesundheitsversorgung der lokalen Bevölkerung beiträgt. Dieser Artikel beleuchtet Schwester Paulines familiäre und religiöse Sozialisation, ihre berufliche Ausbildung zur Hebamme, ihr gewähltes Leben als Nonne sowie ihren Werdegang zur Naturheilpraktikerin. Ihre therapeutischen Anwendungen basierten vornehmlich auf mündlich tradiertem phytotherapeutischen Wissen, welches ihr als integraler Teil der Gesundheitsversorgung während ihrer Kindheit und Jugend vermittelt worden war, weiter auf ihrer medizinischen Fachausbildung in den 1940er-Jahren, die nach wie vor naturheilkundliche Pflegeanwendungen lehrte, sowie literarischen und praktischen Fortbildungen. Ab den 1980er-Jahren erweiterte sie ihre phyto- und hydrotherapeutische Arbeitsweise mit zum Teil unorthodoxen Methoden. In zahlreichen Vorträgen, Kursen, Interviews, schriftlichen Erzeugnissen sowie als Mentorin von Praktikantinnen und Praktikanten verbreitete sie ihr Wissen und trug damit zur Erhaltung der schweizerischen Volksmedizin bei. Ihre jährlich selbst zubereiteten Heilmittel, die sie mittels traditioneller Sammel- und Verarbeitungsregeln herstellte, hatten bei ihrer Kundschaft die Reputation, von besonders guter Qualität zu sein. Der langjährige Erfolg ihrer Gesundheitsberatungsstelle zeigt beispielhaft, dass parallel zur Schulmedizin Heilmittel der Traditionellen Europäischen Medizin bei Patientinnen und Patienten erwünscht sind. Er illustriert auch, dass psychosoziale Aspekte für eine erfolgreiche Behandlung von elementarer Bedeutung sind.

Acupuncture is increasingly used in patients with allergic asthma, but there is a lack of evidence on the cost-benefit relationship of this treatment. The aim of this study was to assess economic aspects of additional acupuncture treatment in patients with allergic bronchial asthma compared to patients receiving routine care alone. DESIGN, SUBJECTS, INTERVENTION, OUTCOME MEASURES: In a randomized controlled trial, patients with allergic bronchial asthma were either allocated to a group receiving acupuncture immediately or a waiting-list control group. Both groups were free to use routine care treatment. The resource consumption, costs, and health-related quality of life were evaluated at baseline, and after 3 and 6 months by using statutory health insurance information and standardized questionnaires. Main economic outcome parameters were direct and indirect cost differences during the study period and the incremental cost-effectiveness ratio (ICER) of acupuncture treatment.Three hundred and six (306) patients (159 acupuncture; 147 controls) were included (mean age 46.5±13.11 years, female 57.2%) and were comparable at baseline. Acupuncture treatment was associated with significantly higher costs compared to control patients (overall costs: €860.76 [95% confidence interval (CI) 705.04-1016.47] versus €518.80 [95% CI 356.66-680.93]; p=0.003; asthma-related costs: €517.52 [95% CI 485.63-549.40] versus €144.87 [95% CI 111.70-178.05]; p0.001). These additional costs seem essentially driven by acupuncture costs themselves (€378.40 [95% CI 367.10-389.69]). However, acupuncture was associated with superior effectiveness in terms of quality-adjusted life years (QALYs). Resulting ICER lay between €23,231 (overall) and €25,315 (diagnosis-specific) per additional QALY. When using German acupuncture prices of year 2012, the ICER would improve to €12.810 (overall) versus €14,911 (diagnosis-specific) per QALY gained.Treating patients who have allergic bronchial asthma with acupuncture in addition to routine care resulted in additional costs and better effects in terms of patients' quality of life. Acupuncture therefore seems to be a useful and cost-effective add-on treatment.

Das Spektrum universitärer Forschung in der Naturheilkunde/Komplementärmedizin wird anhand klinischer Phytotherapie bei Patienten mit chronischen Erkrankungen aufgezeigt. Methoden der Evidenzbasierten Medizin (EbM) werden angewandt (Metaanalyse, randomisierte kontrollierte Studie (RCT), Beobachtungsstudie), um sowohl die Wirksamkeit und Sicherheit pflanzlicher Extrakte als auch die Kombinationsbegründung und Konfounder in Studien zu pflanzlichen Arzneimitteln zu untersuchen: Zwei Metaanalysen zeigen - bei der Reanalyse der Rohdaten nach Intention-to-treat-Prinzip - eine signifikante und klinisch relevante Reduktion, zum einen gastrointestinaler Symptome durch das Kombinationspräparat STW5 bei 273 Patienten mit funktioneller Dyspepsie und zum anderen der krankheitsspezifischen Mortalität bei 602 Patienten mit alkoholtoxischer Leberzirrhose durch das Monopräparat Silymarin - jeweils im Vergleich zu Placebo. Zwei RCTs zeigten i) bei 204 Patienten mit Fingergelenkspolyarthrose unter topischer Anwendung eines Arnika-Gels keine signifikante Unterlegenheit im Vergleich zu einem nichtsteroidalen Antirheumatikum bezüglich Schmerz sowie Handfunktion und ii) bei 182 Patienten mit somatoformen Störungen mit der Behandlung durch das Kombinationspräparat Ze 185 (4 Pflanzenextrakte) im Vergleich zur 3er-Kombination und Placebo eine signifikante Reduktion depressiver und ängstlicher Symptome. Eine Beobachtungsstudie mit 1541 ambulanten Patienten mit unipolaren leicht- bis mittelgradigen depressiven Episoden ergab, ähnlich wie bei synthetischen Antidepressiva, eine negative Assoziation zwischen Erkrankungsdauer, Symptomstärke und Erkrankungsalter mit dem Outcome. Je nach klinischer Fragestellung eignen sich verschiedene Methoden der EbM zur Untersuchung pflanzlicher Extrakte hinsichtlich der eingangs erwähnten Aspekte.

Fragestellung: Im Zusammenhang mit der Einführung ambulanter KM-Sprechstunden am Regionalspital Burgdorf wurde die ärztliche Einstellung zu Komplementärmedizin (KM) untersucht. Weiterhin wurden der Anteil der Ärzte mit KM-Angeboten im Versorgungsgebiet des Regionalspitals, deren KM-Erfahrungen sowie der Einfluss dieser Erfahrungen auf die Einstellung gegenüber KM untersucht. Material und Methoden: Alle Ärzte jeglicher Fachrichtung (n = 170) im Versorgungsgebiet wurden 2011 und 2012 schriftlich zu ihrer Einstellung gegenüber KM (Befürwortung/Ablehnung und Ambivalenz), ihrem KM-Angebot und ihren KM-Erfahrungen befragt (Rücklaufquote 45% bzw. 36%). Ergebnisse: Die Einstellung gegenüber KM war im Durchschnitt neutral (M = 2,47, Standardabweichung (SD) = 0,61; Befürwortung von KM von 1 = «stimme völlig zu» bis 4 = «stimme überhaupt nicht zu») und klar (M = 1,59, SD = 0,46; Einstellungsambivalenz von 1 = «habe klare Meinung» bis 4 = «bin mir sehr unsicher in meiner Meinung»). Die höchste Zustimmung erhielten die Forderungen nach wissenschaftlicher Untersuchung der KM (M = 2,10, SD = 0,95) und nach zertifizierter ärztlicher KM in der Grundversicherung (M = 2,53, SD = 1,15). Knapp ein Drittel der Ärzte bot KM an, und 77% bzw. 69% überwiesen Patienten zu KM-Behandlungen. Die wichtigsten Prädiktoren der KM-Befürwortung waren eine zertifizierte KM-Ausbildung und unerwartete positive bzw. negative Verläufe unter einer KM-Behandlung (R22011 = 0,44, p < 0,001). 25% der Ärzte hatten Erfahrungen mit der neuen KM-Sprechstunde, die überwiegend positiv waren. Schlussfolgerung: Die teilnehmenden Ärzte aus einer ländlichen Region der Schweiz zeigten im Durchschnitt eine neutrale und klare Einstellung zur KM, die sich im eigenen KM-Angebot bzw. in der Überweisungspraxis spiegelte.

Background/Objectives: Unhealthy lifestyle is often related to overweight and obesity and thus to chronic diseases. Web-based programs might be an option for a comprehensive approach to improving long-term weight management. Data from a randomized controlled trial (RCT) evaluating the impact of a lifestyle program on weight reduction were used for a secondary analysis. The objectives were (a) to identify potential predictors for marked weight loss, (b) to explore associations of weight reduction with changes in health-related variables, and (c) to evaluate whether self-monitoring of the daily lifestyle is associated with weight loss. Methods: 67 subjects with a body mass index of 28-35 who underwent the 1-year ‘Individual Health Management' (IHM) program were included in the analysis (mean age 49.8 years, 79% female). Two subgroups (high response: ≥7.5% weight reduction vs. low response: Results: 70% of the subjects fulfilled the criterion of high response. There were no statistically significant differences between the two subgroups with respect to sociodemographic and baseline data. Regression analysis failed to identify any predictors for the amount of weight reduction. Subjects with high response showed a more distinct improvement in life satisfaction and neurovegetative stability. The findings indicated an association between the level of self-monitoring and weight loss. Conclusions: More research is needed to establish optimal strategies for maximizing the longer-term maintenance of weight loss and prevention effects. For weight reduction, support strategies like feedback learning through self-monitoring, reporting systems, and self-performance measurement with questionnaires might ameliorate high-intensity lifestyle modification programs.

Hintergrund: Das Tibetische Arzneimittel Padma Lax ist seit über 40 Jahren in der Schweiz bei Obstipation und Blähungen zugelassen. In dieser Studie wurden Daten zur Anwendung im Praxisumfeld und zur Wirksamkeit bei verschiedenen obstipationsbedingten Beschwerden sowie zu Sicherheit und Verträglichkeit erhoben und bewertet. Material und Methoden: In der Schweiz praktizierende Ärztinnen und Ärzte dokumentierten retrospektiv den Behandlungsverlauf bei chronischer Obstipation mittels eines eigens entwickelten Fragebogens. Neben der Stuhlfrequenz wurde unter anderem auch die Intensität von 12 spezifischen Verstopfungssymptomen erhoben. Ergebnisse: 17 teilnehmende Ärzte lieferten Daten von insgesamt 174 Patientenfällen, wobei rund 30% aus der gynäkologischen Praxis stammten. Als Obstipationsursachen wurden unter anderem Lifestyle-Faktoren und verschiedene Grunderkrankungen angegeben, z.B. neurologische oder hormonelle Störungen. Sicherheit und Verträglichkeit wurden als sehr gut beurteilt, es wurde nur 1 unerwünschtes Ereignis (eine Verschlechterung der Flatulenz) angegeben. Die Stuhlfrequenz stieg im Behandlungsverlauf deutlich, 97% erreichten eine Frequenz von >2 pro Woche. Durchschnittlich verringerten sich die Häufigkeit und die Intensität aller Symptome, mit Ausnahme des Symptoms weicher/dünner Stuhl, das sich bei ebenso vielen Patienten erhöhte wie erniedrigte. Die Gesamtintensität über alle Symptome sank von durchschnittlich 15,8 um 63% auf 5,8. Der Anteil der Patienten mit starken Beschwerden (Gesamtscore >20) sank von 20,1% auf 1,7%, was in der Folge die Gruppe mit «kaum Beschwerden» (Gesamtscore ≤5) von 1,2% auf 57% ansteigen ließ. 86% der Ärzte und der Patienten beurteilten die Wirksamkeit als gut. Schlussfolgerungen: Padma Lax wurde bei Verstopfung unterschiedlicher Ursache bei einem breiten Patientenspektrum eingesetzt. Die Einschätzung der Wirksamkeit und Verträglichkeit war gut oder sehr gut. Trotz der Limitierung durch den retrospektiven Studientyp weisen die Daten darauf hin, dass Padma Lax bei chronischer Verstopfung unterschiedlicher Ursache, insbesondere auch in der gynäkologischen Praxis, bei geriatrischen Patienten und bei Patienten mit neurogener Obstipation, eine wirksame und verträgliche Therapieoption darstellt.

Ayurveda is playing a growing part in Europe. Questions regarding the role of religion and spirituality within Ayurveda are discussed widely. Yet, there is little data on the influence of religious and spiritual aspects on its European diffusion. Methods. A survey was conducted with a new questionnaire. It was analysed by calculating frequency variables and testing differences in distributions with the chi(2)-Test. Principal Component Analyses with Varimax Rotation were performed. Results. 140 questionnaires were analysed. Researchers found that individual religious and spiritual backgrounds influence attitudes and expectations towards Ayurveda. Statistical relationships were found between religious/spiritual backgrounds and decisions to offer/access Ayurveda. Accessing Ayurveda did not exclude the simultaneous use of modern medicine and CAM. From the majority's perspective Ayurveda is simultaneously a science, medicine, and a spiritual approach. Conclusion. Ayurveda seems to be able to satisfy the individual needs of therapists and patients, despite worldview differences. Ayurvedic concepts are based on anthropologic assumptions including different levels of existence in healing approaches. Thereby, Ayurveda can be seen in accordance with the prerequisites for a Whole Medical System. As a result of this, intimate and individual therapist-patient relationships can emerge. Larger surveys involving bigger participant numbers with fully validated questionnaires are warranted to support these results.

Background: Quality profiling is practiced at the TCM hospital Bad Kötzting since its establishment 25 years ago. The profiling comprises assessment of treatment effectiveness andsafety, structural features, staff qualification as well as diagnostic and therapeutic processes. Findings regarding patients, intervention and outcome profiles are presented by appropriate examples. Methods: Data of each in-patient were systematically collected by physicians and via self-reports at admission, discharge and follow-up. Over the years the system was adjusted several times resulting in a data pool of about 19,000 in-patients by end of 2014. Results: Patients are 52 years old on average, 70% are female, and suffering from the main complaint since 7 years (median). The diagnostic spectrum changed over the years according to the development towards a psychosomatic focus. For TCM acupuncture therapy 222 different acupoints were used in 7.7 different localisations on average per individual treatment. The mean intensity of the main complaint decreased clinically relevant (Cohen's d = 1.11 at discharge and 0.93 at follow-up). After the hospital stay the number of days of sick leave declined from 51.3 days by 40% per patient and year. Depressive disorders as most common mental illness decreased significantly decreased significantly at discharge (ICD symptom rating; Cohen's d = -1.01). 29.8% of patients met the criteria for a metabolic syndrome diagnosis according to the International Diabetes Federation (IDF). In this group of cases, triglycerides, cholesterol and blood glucose improved markedly at discharge. Discussion: The presented quality control measures clearly contribute to an enhanced transparency in terms of a comprehensive quality profile. The findings from various outcome parameters indicate that patients benefit from the treatment.

Background: Epidemiological data shows globally increasing numbers of obesity and stress-related diseases. In this article, a comprehensive medical lifestyle modification programme - called Individual Health Management (IHM) - is described in detail and discussed as a promising tool to individually manage and reverse such negative health trends in patients. Methods: The IHM programme is based on a blended learning concept. It comprises a 12-week basic training phase, followed by a 9-month maintenance phase, and includes the following key features: 1) web-based and physician-led health screenings; 2) a structured 12-week basic training with a core curriculum providing tuition in behavioural self-management strategies for weight loss and stress reduction; 3) weekly supervised group sessions during the core curriculum; 4) tailoring of materials, strategies and lifestyle goals; 5) continuous self-monitoring and feedback of the achieved progress; 6) regular contact with physicians or health professionals based on either face-to-face or distant lifestyle counselling; 7) recurrent one-day health seminars to ensure the sustainability of obtained results. Conclusions: IHM is a multi-component lifestyle intervention programme to increase physical activity, to reduce calorie intake and to practice both self and stress management. Individual care, group support and a tailored web-based programme blend to achieve the desired goals. A randomised control study to evaluate IHM's effects on weight control is currently being conducted.

Die Wirkstoffe pflanzlicher Arznei- und Heilmittel sind pleiotrope Vielstoffgemische mit Multi-Target Eigenschaften einschlieβlich antiinflammatorischer Wirkungen. Eine pleiotrope Entzundungshemmung konnte bei tumorkranken Menschen als Versuch der Verhinderung bzw. Verzogerung der Metastasierung eine bedeutsame Rolle spielen. Zahlreiche experimentelle Daten fur europaische wie auch auβereuropaische Pflanzen und verschiedene phytotherapeutische Kombinationen weisen auf eine solche Moglichkeit hin. Trotz der bislang nur geringen Anzahl klinischer Untersuchungen konnten derartige phytotherapeutische Behandlungsversuche vertretbar erscheinen, wenn fur solche Arznei- und Heilpflanzen aus Anwendungsbereichen bei nicht tumorkranken Menschen gesicherte Daten uber Qualitat und Sicherheit dokumentiert sind und eine Ubertragung solcher Daten auf die Situation tumorkranker Menschen unter kritischer Abwagung moglich erscheint. Phytotherapeutika spielen zudem in der Supportivtherapie eine zunehmende Rolle, wobei zahlreiche dieser Phytotherapeutika neben ihrer symptomatischen supportiven Wirksamkeit auch antiinflammatorische Wirkungen zeigen. Die gezielte Auswahl von supportiv wirksamen Phytotherapeutika mit zusatzlichen antiinflammatorischen Effekten konnte fur tumorkranke Menschen neben der Symptomlinderung simultan die Moglichkeit einer antiinflammatorischen antitumoralen Wirksamkeit bieten als eine Art personalisierter Phytotherapie. Zurzeit besteht diesbezuglich noch ein groβer Bedarf an therapeutisch orientierter klinischer Forschung.

Maligner Aszites ist eine haufige Komplikation im Verlauf onkologischer Erkrankungen. Standardtherapien sind fur keinen Primartumor definiert. Wir berichten uber den Fall einer zum Zeitpunkt der Erstdiagnose 49-jahrigen Patientin, die uber einen langeren Zeitraum an rezidivierendem Aszites aufgrund eines hepatogen metastasierenden Mammakarzinoms litt. Aufgrund positiver Berichte in der Literatur sowie guter Vorerfahrungen in der eigenen Klinik wurden parallel zu einer Polychemotherapie wiederholt hochdosiert intraperitoneal Mistelextraktlosungen im Rahmen von Entlastungspunktionen instilliert. Der Langzeitverlauf verweist auf einen wesentlichen Anteil der Misteltherapie an der erzielten Symptomkontrolle, die zu einer wesentlich gebesserten Lebensqualitat fuhrte. Die Vertraglichkeit war gut. Als Wirkmechanismus werden neben den bekannten immunmodulierenden auch unmittelbar zytotoxische sowie adjuvante Wirkungen zur Chemotherapie mit Carboplatin/Paclitaxel diskutiert.

Hintergrund und Fragestellung: Die Zungenbeurteilung ist ein zentrales diagnostisches Verfahren der traditionellen chinesischen Medizin. In der vorliegenden Studienserie wurde untersucht, inwieweit unterschiedliche Beurteiler bei der morphologischen Beschreibung von Zungenmerkmalen übereinstimmen. Methoden: In zwei Pilotstudien (jeweils n = 15 Patienten) und einer größeren Untersuchung (Hauptstudie; n = 101) wurden Digitalfotografien der Zungenbefunde von Klinikpatienten durch zwei bzw. drei erfahrene Beurteiler mithilfe von Formularen verblindet bewertet. Das wichtigste Zielkriterium war die Übereinstimmung über die erwartete zufällige Übereinstimmung hinaus (Cohens Kappa). Ergebnisse: In der ersten Pilotstudie wurden in hohem Maße variable Kappa-Werte beobachtet (–0,15 bis 0,76). Bei zahlreichen Merkmalen zeigten sich jedoch nur geringe bis mäßige Übereinstimmungen. In der zweiten, mit einer verbesserten Methode durchgeführten Pilotstudie zeigten sich zwar wiederum in hohem Maße variable Kappa-Werte (–0,10 bis 1,00), bei 7 der 18 erhobenen Merkmale war die überzufällige Übereinstimmung jedoch sehr gut (Kappa ≥0,75). In der Hauptstudie lagen die Kappa-Werte zwischen 0,15 und 0,83. Diskussion: In den vorliegenden Studien wurden erste Schritte hin zu einer systematischen Untersuchung der Reliabilität der Zungendiagnose im Rahmen der traditionellen chinesischen Medizin unternommen. Die Ergebnisse deuten darauf hin, dass die Beurteilung morphologischer Merkmale eine befriedigende Reliabilität haben dürfte.

Zusammenfassung Hintergrund und Ziel Im Rahmen des Modellvorhabens der Ersatzkassen wurden Wirksamkeit und Vertraglichkeit der Akupunktur bei der Behandlung von Patienten mit chronischen Schmerzen untersucht. In der vorliegenden Arbeit berichten wir uber die Ergebnisse einer grosen Beobachtungsstudie im Rahmen des Modellvorhabens zur Sicherheit und Vertraglichkeit. Methoden Aspekte der Sicherheit und Vertraglichkeit wurden auf dreierlei Weise untersucht: Bei allen 503.397 zwischen Juli 2001 und Juni 2003 dokumentierten Behandlungsfallen sollten die Arzte eine globale Vertraglichkeitsbewertung abgeben und aufgetretene unerwunschte Wirkungen benennen. Schwerwiegende unerwunschte Wirkungen sollten bis Ende 2004 der begleitenden Forschungseinrichtung gemeldet werden. Auserdem wurden 6.140 Patienten direkt zu Nebenwirkungen befragt. Ergebnisse Die Arzte berichteten in 7,8% der Falle uber unerwunschte Wirkungen; die am haufigsten genannte unerwunschte Wirkung war Nadelungsschmerz. Insgesamt 17 Falle von schwerwiegenden unerwunschten Wirkungen wurden gemeldet; das am haufigsten genannte Ereignis war hierbei ein Pneumothorax (5 Falle). 9,3% der Patienten bejahten die Frage nach Nebenwirkungen; in einem Viertel der Falle wurden diese als stark beeintrachtigend bewertet. Die von Patienten am haufigsten genannten Nebenwirkungen waren Schmerzen, Mudigkeit und Kreislaufbeschwerden. Schlussfolgerung Schwerwiegende unerwunschte Wirkungen der Akupunktur sind sehr selten, leichtere Nebenwirkungen werden dagegen haufig von Patienten angegeben. Insgesamt ist Akupunktur bei arztlicher Anwendung als vergleichsweise sichere Methode anzusehen.

The potential benefit of silymarin (special extract from the fruits of Silybum marianum) in the treatment of liver diseases remains a controversial issue.For this systematic review electronic databases identified 65 papers for the search terms silymarin, silibinin, silicristin or milk thistle and clinical trial. Only 19 complied with the criteria'double-' or 'single-blind'. These publications were analysed from a clinical point of view and meta-analytic calculations were performed.The clinical evidence ofa therapeutic effect of silymarin in toxic liver diseases is scarce. There is no evidence of a favourable influence on the evolution of viral hepatitis, particularly hepatitis C. In alcoholic liver disease, comparing with placebo, aspartate aminotransferase was reduced in the silymarin-treated groups (p = 0.01) while alkaline phosphatase was not. In liver cirrhosis, mostly alcoholic, total mortality was 16.1% with silymarin vs. 20.5% with placebo (n.s.); liver-related mortality was 10.0% with silymarin vs. 17.3% with placebo(p = 0.01).Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child 'A') liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome.

Background. The high prevalence of chronic neck pain in high income countries impacts quality of life and the social and work-related activities of those afflicted. We aimed to understand how mind-body therapies and exercise therapy may influence the experience of pain among patients with chronic neck pain.Methods. This qualitative interview study investigated how patients with chronic neck pain experienced the effects of exercise or qigong therapy at two time points: during an intervention at three months and after the intervention at six months. Interviews were analysed thematically across interviews and within person-cases. Based on other qualitative studies, a sample size of 20 participants was deemed appropriate.Results. The sample (n=20) consisted of 16 women and four men (age range: 29 to 59). Patients’ experiences differed according to the therapies’ philosophies. Exercise therapy group interviewees described a focus on correct posture and muscle tension release. Qigong group interviewees discussed calming and relaxing effects. Maintaining regular exercise was easier to achieve with exercise therapy.Conclusions. The findings of this study may help health care providers when counselling chronic pain patients on self-help interventions by informing them of different bodily and emotional experiences of mind-body interventions compared to exercise therapy.

Vor rund 20 Jahren begann mit der Akademisierung von Komplemen­ tarmedizin und Naturheilkunde an Universitaten in Europa ein entschei­ dender wissenschaftlicher Emanzipa­ tions­ und Professionalisierungspro­ zess [1]. War vorher jahrhundertealtes Erfahrungswissen vor allem durch experimentelle und klinische Studien fur die medizinische Alltagspraxis gepruft worden, ging es nun um die wissenschaftliche Integration von Komplementarmedizin und Natur­ heilkunde an Universitatskliniken und Lehrkrankenhausern. Die Phyto­ therapie spielte dabei eine wichtige Rolle, da ihre Forschungen aufgrund der methodischen Nahe zur kli­ nischen Pharmakologie besonders geeignet schienen, traditionsreiche Empirie durch klinische Studien zu analysieren [2, 3]. Zu diesem Prozess trug entschieden die Orientierung vieler komplementarmedizinisch For­ schender an der Methodik der evi­ denzbasierten Medizin (EbM) bei [4]. Durch die in der Folge gewonnene Evidenz entwickelte sich die wissen­ schaftliche Akzeptanz fur viele Inter­ ventionen aus traditionellen Medizin­ systemen. So stellt sich heute – auf der Grund­ lage einer mittlerweile breiten klini­ schen Evidenz, beispielsweise auf dem Gebiet der Phytotherapie – fur unter­ schiedliche medizinische Fachberei­ che (z.B. Innere Medizin, Onkologie, Psychiatrie) die Frage, welche Be­ handlungen in der klinischen Praxis geeignet sind und aufgenommen wer­ den konnen [5, 6]. Schweizerische Zeitschrift fur Ganzheitsmedizin Swiss Journal of Integrative Medicine

Background: The terms used for defining complementary and alternative medicine (CAM) including the methods, procedures and therapies vary greatly. The task of the CAMbrella working group on terminology was to explore the existing CAM terminologies and to develop a pragmatic definition of CAM that is acceptable Europewide. This can then be used to systematically research, e.g., its prevalence and legal status and to investigate the citizens’ demands on CAM and the perspectives of providers of CAM in Europe. Methods: Terms and definitions were collected from both scientific and non-scientific sources. The terms and definitions identified were analysed and discussed among the CAMbrella working group participants on several occasions with the aim of arriving at a consensus. Results: We developed a proposal for a pragmatic European definition of CAM: ‘Complementary and alternative medicine (CAM) utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM has been mainly used outside conventional health care, but in some countries certain treatments are being adopted or adapted by conventional health care.’ Conclusion: Developing a uniform, pragmatic pan-European definition of CAM was complicated by a number of factors. These included the vast diversity of existing definitions, systems, disciplines, procedures, methods and therapies available within the EU.

Background: Herbal medicine is a popular part of primary health care in Switzerland. Following an ethnobotanical approach, in this study we seek to identify Swiss herbalists with broad, empirical medicinal plant knowledge and use. We aim to consider different areas of the medicinal landscape including biomedicine, complementary and alternative medicine, and self-medication. Material and Methods: A total of 61 expert interviews were conducted from February 2010 to November 2011. The transfer of knowledge was analyzed according to a Switzerland-related selection of historical and recent popular as well as scientific herbal books. Results: A total of 254 medicinal plant species, belonging to 218 genera and 87 families, were recorded in 934 use reports. Predominantly leaves and flowers are used for the treatment of dermatological, respiratory, nervous, and gastrointestinal problems. Recent to historical herbal books are an important source of plant knowledge. Conclusions: Medicinal plants are used for self-medication and professional health care and despite different underlying medicinal concepts and philosophies, herbalists largely agree on the most important medicinal plant species.

Background Today, the increasing demand for complementary medicine encourages health care providers to adapt and create integrative medicine departments or services within clinics. However, because of their differing philosophies, historical development, and settings, merging the partners (conventional and complementary medicine) is often difficult. It is necessary to understand the similarities and differences in both cultures to support a successful and sustainable integration. The aim of this project was to develop a theoretical model and practical steps that are based on theories from mergers in business to facilitate the implementation of an integrative medicine department. Methods Based on a literature search and expert discussions, the cultures were described and model domains were developed. These were applied to two case studies to develop the final model. Furthermore, a checklist with practical steps was devised. Results Conventional medicine and complementary medicine have developed different corporate cultures. The final model, which should help to foster integration by bridging between these cultures, is based on four overall aspects: culture, strategy, organizational tools and outcomes. Each culture is represented by three dimensions in the model: corporate philosophy (core and identity of the medicine and the clinic), patient (all characteristics of the professional team’s contact with the patient), and professional team (the characteristics of the interactions within the professional team). Conclusion Overall, corporate culture differs between conventional and complementary medicine; when planning the implementation of an integrative medicine department, the developed model and the checklist can support better integration. Electronic supplementary material The online version of this article (doi:10.1186/s12906-015-0696-2) contains supplementary material, which is available to authorized users.