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Simple Summary: A significant proportion of people with cancer use forms of complementary medicine. Many factors contribute to cancer including some which are modifiable by the patient, such as stress, poor nutrition, vitamin D deficiency, poor sleep and lack of physical activity. This paper discusses why it is important that oncologists help cancer patients to address such factors, and why an integrative approach which combines evidence-based complementary medicines or therapies with orthodox treatment might lead to better outcomes for cancer patients. A significant proportion of cancer patients use forms of complementary medicine or therapies. An integrative approach to cancer management combines conventional medicine with evidence-based complementary medicines/therapies and lifestyle interventions, for the treatment and prevention of disease and the optimisation of health. Its basis is a holistic one; to treat the whole person, not just the disease. It makes use of adjunct technologies which may assist the clinician in diagnosis of early carcinogenesis and monitoring of treatment effectiveness. Many factors contribute to the development of cancer including some which are largely modifiable by the patient and which oncologists may be in a position to advise on, such as stress, poor nutrition, lack of physical activity, poor sleep, and Vitamin D deficiency. An integrative approach to addressing these factors may contribute to better overall health of the patient and better outcomes. Evidence-based complementary medicine approaches include the use of supplements, herbal medicine, various practices that reduce stress, and physical therapies. Individualised to the patient, these can also help address the symptoms and signs associated with cancer and its orthodox treatment. [ABSTRACT FROM AUTHOR]

Tics and compulsions in comorbid Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD) are associated with chronic hyperactivity of parallel cortico/amygdalo-striato-thalamo-cortical (CSTC) loop circuits. Comorbid TS- & OCD-like behaviors have likewise been observed in D1CT-7 mice, in which an artificial neuropotentiating transgene encoding the cAMP-elevating intracellular subunit of cholera toxin (CT) is chronically expressed selectively in somatosensory cortical & amygdalar dopamine (DA) D1 receptor-expressing neurons that activate cortico/amygdalo-striatal glutamate (GLU) output. We’ve now examined in D1CT-7 mice whether the chronic GLU output from their potentiated cortical/limbic CSTC subcircuit afferents associated with TS- & OCD-like behaviors elicits desensitizing neurochemical changes in the striatum (STR). Microdialysis-capillary electrophoresis and in situ hybridization reveal that the mice’s chronic GLU-excited STR exhibits pharmacodynamic changes in three independently GLU-regulated measures of output neuron activation, co-excitation, and desensitization, signifying hyperactive striatal CSTC output and compensatory striatal glial and neuronal desensitization: 1) Striatal GABA, an output neurotransmitter induced by afferent GLU, is increased. 2) Striatal d -serine, a glial excitatory co-transmitter inhibited by afferent GLU, is decreased. 3) Striatal Period1 (Per1), which plays a non-circadian role in the STR as a GLU + DA D1- (cAMP-) dependent repressor thought to feedback-inhibit GLU + DA- triggered ultradian urges and motions, is transcriptionally abolished. These data imply that chronic cortical/limbic GLU excitation of the STR desensitizes its co-excitatory d -serine & DA inputs while freezing its GABA output in an active state to mediate chronic tics and compulsions − possibly in part by abolishing striatal Per1-dependent ultradian extinction of urges and motions. [ABSTRACT FROM AUTHOR]

Chronic insomnia affects a significant proportion of the general population worldwide, and is associated with several serious medical conditions. From the Western scientific literature, hyper-arousal (on the cognitive- emotional, behavioral, autonomic, or central nervous system level) is a final common pathway involved in its pathogenesis. However, from a Chinese medicine (CM) perspective, it is the Heart, capitalized to denote the functional system as described in CM theory, that is the key organ involved in insomnia due to its role as the "seat of consciousness." This article explores how insomnia is understood from the CM perspective, in particular the role of the Heart, and some of the neurophysiological evidence that supports these ancient theoretical understandings. The potential role of the vagus nerve and its relationship with the (biomedical) heart and CM Heart is also examined. Finally, some of the evidence in association with mechanisms of action of acupuncture in insomnia, in particular its impact on cardiovascular variables associated with insomnia, is presented, along with findings of systematic reviews. [ABSTRACT FROM AUTHOR]

Simple Summary: Cannabidiol (CBD) is one of the main constituents of the plant Cannabis sativa. Surveys suggest that medicinal cannabis is popular amongst people diagnosed with cancer. CBD is one of the key constituents of cannabis, and does not have the potentially intoxicating effects that tetrahydrocannabinol (THC), the other key phytocannabinoid has. Research indicates the CBD may have potential for the treatment of cancer, including the symptoms and signs associated with cancer and its treatment. Preclinical research suggests CBD may address many of the pathways involved in the pathogenesis of cancers. Preclinical and clinical research also suggests some evidence of efficacy, alone or in some cases in conjunction with tetrahydrocannabinol (THC, the other key phytocannabinoid in cannabis), in treating cancer-associated pain, anxiety and depression, sleep problems, nausea and vomiting, and oral mucositis that are associated with cancer and/or its treatment. Studies also suggest that CBD may enhance orthodox treatments with chemotherapeutic agents and radiation therapy and protect against neural and organ damage. CBD shows promise as part of an integrative approach to the management of cancer. The plant Cannabis sativa has been in use medicinally for several thousand years. It has over 540 metabolites thought to be responsible for its therapeutic effects. Two of the key phytocannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC). Unlike THC, CBD does not have potentially intoxicating effects. Preclinical and clinical research indicates that CBD has a wide range of therapeutic effects, and many of them are relevant to the management of cancer. In this article, we explore some of the potential mechanisms of action of CBD in cancer, and evidence of its efficacy in the integrative management of cancer including the side effects associated with its treatment, demonstrating its potential for integration with orthodox cancer care. [ABSTRACT FROM AUTHOR]

Background: The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it. Objectives: An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt 'somewhat' prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree. Methods: A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey. Results: There were a small number of responses ( n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement. Conclusions: Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice. [ABSTRACT FROM AUTHOR]

Circulating adhesion molecules (CAMs), surface proteins expressed in the vascular endothelium, have emerged as risk factors for cardiovascular disease (CVD). CAMs are involved in intercellular communication that are believed to play a role in atherosclerosis. A Chinese medicine, the "Dantonic Pill" (DP) (also known as the "Cardiotonic Pill"), containing three Chinese herbal material medica, Radix Salviae Miltiorrhizae, Radix Notoginseng and Borneolum Syntheticum, has been used in China for the prevention and management of CVD. Previous laboratory and animal studies have suggested that this preparation reduces both atherogenesis and adhesion molecule expression. A parallel double blind randomized placebo-controlled study was conducted to assess the effects of the DP on three species of CAM (intercellular cell adhesionmolecule-1 (ICAM-1), vascular cell adhesionmolecule-1 and endothelial cell selectin (E-selectin)) in participants with mild-moderate hypercholesterolemia. Secondary endpoints included biochemical and hematological variables and clinical effects. Forty participants were randomized to either treatment or control for 12 weeks. Treatment with DP was associated with a statistically significant decrease in ICAM-1 (9% decrease, P = .03) and E-Selectin (15% decrease, P = .004). There was no significant change in renal function tests, liver function tests, glucose, lipids or C-reactive protein levels and clinical adverse effects did not differ between the active and the control groups. There were no relevant changes in participants receiving placebo. These results suggest that this herbal medicine may contribute to the development of a novel approach to cardiovascular risk reduction. [ABSTRACT FROM AUTHOR]

Treatment of cardiovascular disease, albeit under the auspices of other clinical descriptors to those described in western biomedicine, has a long history in China. Chinese Medicine (CM) is guided by unique philosophical underpinnings and theories. There are differences in how the heart is conceptualised traditionally in CM compared to biomedicine. This paper focusses on how hypercholesterolemia is understood from within the Chinese medical paradigm, including its aetiology, pathogenesis, and treatment. A brief overview of the key characteristics and theories of CM is given to provide context. Modern science has demonstrated that many Chinese herbs have cholesterol-lowering properties. Examples of research into individual herbs and medicinal formulae, combinations of herbs are presented. At a more sophisticated level, some researchers are challenging some of the very assumptions upon which CM is based, including applicability of CM theory to modern clinical entities such as hypercholesterolemia, and are seeking intersections of knowledge between CM and biomedicine that may extend CM theory. [ABSTRACT FROM AUTHOR]

Background: Toyohari meridian therapy (TMT) is a Japanese system of acupuncture. Acupoint selection follows diagnosis of the primary and secondary patterns of disharmony ( sho) and disturbances in the yang channels. Pulse diagnosis and abdominal palpation diagnosis are the two main diagnostic methods used. Little is known about the reliability of pulse, abdominal, and pattern diagnosis in TMT. This is important since diagnosis of the sho determines acupoint treatment. If diagnosis is unreliable, there can be less confidence that the patient will receive optimal treatment. Objective: The objective of this study is to assess the level of agreement between two TMT practitioners on pulse diagnosis, abdominal diagnosis, and diagnosis of the primary and secondary sho. Methods: An inter-rater reliability study was conducted. Two (2) TMT practitioners separately conducted a TMT examination and completed an assessment form, choosing from a range of possible responses relating to pulse characteristics, abdominal diagnosis, and diagnosis of primary sho and secondary sho. The κ coefficient was used as a measure of inter-rater reliability of the outcome variables. Results: Sixty-two (62) Australians (22 males, 40 females) aged 20–65 years participated (mean age 49.2 ± 12.2 years). Level of agreement for pulse diagnosis was 57%, 61%, and 77% for pulse depth, speed, and strength, respectively. For abdominal diagnosis, the level of agreement for involvement of the Lung, Kidney, Spleen, and Liver abdominal regions was 58%, 53%, 35%, and 10%, respectively. The overall level of agreement on primary sho diagnosis was 48% and for secondary sho diagnosis, 44%. Conclusions: Overall, there was a reasonable level of agreement on basic pulse characteristics and on abdominal diagnosis for two of the abdominal regions. Level of agreement on primary and secondary sho diagnosis suggests room for improvement. Further studies are required in order to gain a greater understanding of the reliability of diagnosis in TMT. [ABSTRACT FROM AUTHOR]

The question of the objectivity of the clinical examination has been raised in relation to Western and non-Western medical systems. Western practitioners are often skeptical about Traditional Chinese Medicine (TCM), on the basis that its diagnostic variables and subcategories of disease appear subjective and not repeatable. We conducted a study investigating the reproducibility of individual diagnostic observations within three of the four diagnostic methods used in a TCM examination: inspection, palpation, and auscultation. Three TCM practitioners participated in the study, and examined 45 adults who had mild-to-moderate hypercholesterolemia but were otherwise healthy. Results indicated that while there are certain features of the TCM system that are highly objective and repeatable, such as detection of the presence of shen, character of breath sounds, and pulse speed, there are other features that are subjective and unreliable, such as color under the eyes and tongue body color. This poses a challenge for TCM practitioners to improve their clinical practice and demonstrates to Western medical practitioners that TCM does in part rest on a rigorous and objective empirical basis. [ABSTRACT FROM AUTHOR]

Background: In the practice of forms of traditional East Asian medicine (TEAM) such as Traditional Chinese Medicine and Japanese meridian therapy, treatment follows identification of underlying “patterns of disharmony.” However, little is known in an objective sense of the consistency or reliability of diagnosis within TEAM. This is important: If diagnosis is not reliable, there can be less confidence that optimal treatment is received. TEAM systems have their own diagnostic endpoints that are used as evidence of change. If these are to be incorporated into clinical studies, a prerequisite is that they are reliable. Few studies have assessed the reliability of diagnostic data collected during a TEAM examination. The majority have investigated reliability of pulse diagnosis, with results ranging from low to a very good level of agreement. Studies of reliability of tongue diagnosis and other diagnostic data collected in a Chinese Medicine examination suggest considerable variability. In general, studies of reliability of pattern diagnosis and treatment in a range of disorders have not found a high level of reliability. A range of factors may affect reliability. Objectives: This paper reviews the current knowledge of reliability of TEAM diagnoses, including limitations of studies, and discusses the implications for practice and research and how to improve the current situation. [ABSTRACT FROM AUTHOR]

Background: Chinese medicine distinguishes itself from Western medicine in the differentiation of diseases according to underlying patterns of disharmony, or Chinese medicine (CM) syndromes. CM has its own clinical endpoints that are used as evidence of change in the body. Yet, relatively little is known about the reliability of CM diagnostic techniques, the final diagnosis of a CM syndrome, or the organizing principles used to reach a CM diagnosis such as the Eight Guiding Principles. Information about reliability of CM diagnosis has important implications for clinical practice and research, particularly if CM diagnostic variables or CM syndromes are to be incorporated into study designs. Design: An inter-rater reliability study was conducted with three CM practitioners to investigate the reproducibility of CM diagnosis according to the Eight Guiding Principles and Zang-Fu Theory. Forty-five (45) adults with mild hypercholesterolemia but who were otherwise healthy participated in the study. Results: Our results suggest that there is a reasonably good level of agreement between at least two practitioners on the dimensions of the Eight Guiding Principles. Level of agreement between at least two practitioners on CM syndrome diagnosis according to Zang-Fu Theory was very good for one syndrome only, that of Spleen qi deficiency. Conclusions: Further investigations are needed into the reliability of the CM diagnostic processes from the initial stage of data collection to the final CM syndrome diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Uptake of the neuromodulator d-serine by isolated larval tiger salamander (Ambystoma tigrinum) retinas was measured using capillary electrophoresis (CE). Excised retinas were incubated in Ringer''s solution in the presence of 5μM d-serine. The supernatant was removed after 30min, mixed with 4-fluoro-7-nitrobenz-2-oxa-1,3-diazole (NBD-F) to fluorescently label amines and analyzed using CE. Significant d-serine uptake was observed over a period of 1.5h. This is the first observation of d-serine uptake by an intact retinal tissue. d-Serine uptake in the retina was Na+-dependent and blocked by l-alanine, l-threonine, and l-cysteine. This pharmacology is consistent with the sodium dependent heteroexchange expected of system ASC-type transporters. [Copyright &y& Elsevier]

Release of neurotransmitters and other primary amine-containing analytes from intact, isolated larval salamander (Ambystoma tigrinum) retinas maintained in a 6.5-μL perfusion chamber was monitored using online microdialysis-capillary electrophoresis with laser-induced fluorescence detection (CE-LIF). Primary amines were derivatized online with o-phthaldialdehyde (OPA) and beta-mercaptoethanol. With the use of overlapping injections, the perfusate was sampled every ∼ 10 s. Although separation conditions were optimized using 20 mM hydroxypropyl-γ-cyclodextrin (HP-γ-CD) for a number of important neuromessengers including d- and l-serine, d- and l-asparate, glutamate, GABA, serotonin, dopamine, norepinephrine, and taurine, only glutamate (0.48 ± 0.27 μM), GABA (0.25 ± 0.12 μM), taurine (5.5 ± 2.1 μM), and l-serine (2.8 ± 1.0 μM) were identified in the perfusate. Elevated levels of glutamate, GABA, and taurine were detected during stimulation with 60 mM K+. This method is the first to directly sample multiple neurotransmitters from perfused, isolated retinas and to observe changes in efflux of these neurotransmitters as a result of pharmacological stimulation. [ABSTRACT FROM AUTHOR]

Cell extraction and further sample preparation for nucleotide pool analysis using capillary electrophoresis was faster and simpler using volatile extraction solvents (e.g. organic solvents and de-ionized water) compared to the commonly applied acids dissolved in water (e.g. perchloric acid and trichloracetic acid). Temperature had to be controlled during the whole sample preparation process to prevent degradation, and extracts had to be cleaned from proteins and other large molecules prior to capillary electrophoretic analysis to improve reproducibility. Capillary electrophoresis using borate and cyclodextrins in the background electrolyte was used for determining 11 cellular nucleotides simultaneously. In order to optimize the assay, 0–100% acetonitrile, 0–100% ethanol, and 0–100% methanol in de-ionized water were applied to extract nucleotides from mouse lymphoma cells, and nucleotide yields, recovery, and reproducibility were compared. The assay met the commonly accepted validation limits for biological fluids, if 20–80% acetonitrile in water and 40–60% ethanol in water were used as extraction solvents. [Copyright &y& Elsevier]

The conspicuity of road traffic signs and signals for a group of observers with the color vision defect of deuteranopia is compared with that for a control group of observers with normal color vision. Conspicuity was measured by the proportion of reports of target objects detected in 300-ms presentations of projected slides of road scenes. There were two instructions, one designed to measure attention conspicuity and the other, search conspicuity. The attention conspicuity of red, orange, and green color-coded traffic control devices was significantly less for deuteranopes than for the observers with normal color vision, but this was not true for yellow and blue color-coded signs. This result is consistent with our understanding of the color perceptions of deuteranopes. The reduction of conspicuity was not so great for the search conspicuity condition. We conclude that redundant color coding does contribute to the conspicuity of signs and signals and that deuteranopes--and probably those with other severe forms of defective color vision--have a significantly reduced ability to notice colored targets, such as road signs and signals, in complex visual environments. The actual and potential application of this work is in the design of signs so they are conspicuous, especially when the user group includes people with defective color vision. [ABSTRACT FROM AUTHOR]

Objectives: Chinese medicine is a complex domain of theoretical and practical approaches that is being increasingly put under the research spotlight. The "Chinese Medicine in Australia"research project attempted to capture the clinical features of practitioners of Chinese medicine. Participants and Interventions: The project involved a national survey of Chinese medicine professional association members and registered practitioners in the state of Victoria, Australia (n = 655; response rate, 42%-55%) completed in 2012-2013. Design: The content and face validated survey was developed using new and previous workforce survey questions. Results: This paper reports on the workforce and practice characteristics of the survey respondents. Chinese medicine practitioners are highly educated, come from diverse backgrounds, and have chosen to practice predominantly in sole or multipractitioner private practice settings. An interest in the philosophy of Chinese medicine and previous experiences contributed to practitioners' decisions to study and practice Chinese medicine. Incorporating a variety of techniques, practitioners describe themselves as practicing predominantly Chinese acupuncture and herbal medicine. Conclusions: The results from this survey contribute to the understanding of the nature and description of Chinese medicine practice in Australia. [ABSTRACT FROM AUTHOR]

Childhood cancer survivors (CCS), of whom there are about 500,000 living in Europe, are at an increased risk of developing health problems [1–6] and require lifelong Survivorship Care. There are information and knowledge gaps among CCS and healthcare providers (HCPs) about requirements for Survivorship Care [7–9] that can be addressed by the Survivorship Passport (SurPass), a digital tool providing CCS and HCPs with a comprehensive summary of past treatment and tailored recommendations for Survivorship Care. The potential of the SurPass to improve person-centred Survivorship Care has been demonstrated previously [10,11]. The EU-funded PanCareSurPass project will develop an updated version (v2.0) of the SurPass allowing for semi-automated data entry and implement it in six European countries (Austria, Belgium, Germany, Italy, Lithuania and Spain), representative of three infrastructure healthcare scenarios typically found in Europe. The implementation study will investigate the impact on person-centred care, as well as costs and processes of scaling up the SurPass. Interoperability between electronic health record systems and SurPass v2.0 will be addressed using the Health Level Seven (HL7) International interoperability standards. PanCareSurPass will deliver an interoperable digital SurPass with comprehensive evidence on person-centred outcomes, technical feasibility and health economics impacts. An Implementation Toolkit will be developed and freely shared to promote and support the future implementation of SurPass across Europe. PanCareSurPass is a novel European collaboration that will improve person-centred Survivorship Care for CCS across Europe through a robust assessment of the implementation of SurPass v2.0 in different healthcare settings. • SurPass addressing knowledge gaps regarding Survivorship Care requirements. • SurPass v2.0 will improve person-centred Survivorship Care for CCS across Europe. • SurPass v2.0 as an interoperable digital tool. • Generating evidence on person-centred outcomes, feasibility and health economics. • Promoting uptake of the SurPass via freely available Implementation Toolkit. [ABSTRACT FROM AUTHOR]

Background: Little is known about how prepared Chinese medicine (CM) students perceive themselves to enter the workforce. Objective: The objective of this study was to investigate perceptions of preparedness for clinical practice of final-year CM students in Australia. Design: The study design consisted of a written survey focusing on eight dimensions relating to practice: Interpersonal Skills, Confidence/Coping Skills, Professional Networks, Professional Practice Management, Professional Patient Management, Prevention, Holistic Care, and Self-Directed Learning. Part 1 of the survey required participants to choose from six possible responses on how well they believe their CM course has prepared them in relation to 41 statements about aspects of practice (1 = very inadequately through to 6 = very adequately). Part 2 consisted of nine open-ended questions. Study participants: The study participants were final-year Bachelor degree CM and acupuncture students from Australian universities and privately operated educational institutions. Analysis and main outcome measures: Part 1 of survey: mean scores on the eight dimensions of practice. Part 2 of survey: transcribed responses were imported into NVivo8. Each part of the questions was analyzed and grouped into broad themes. Results: Seventy-one (71) of one hundred and seven (71/107) invited students (average age 29.4 years ± 7.4 years) participated in the survey conducted in 2008. Mean scores on eight dimensions of clinical practice were as follows: Interpersonal Skills 3.9 (±1.1), Confidence/Coping Skills 4.0 (±0.8), Professional Networks 4.2 (±0.8), Professional Practice Management 4.2 (±0.8), Professional Patient Management 4.7 (±0.7), Prevention 4.6 (±0.7), Holistic Care 4.4 (±0.7), and Self-Directed Learning 4.6 (±0.6). There was no significant difference in mean scores across gender. Responses to Part 2 indicated a range of suggestions on the strengths of educational courses and how transition to clinical practice could be facilitated. Conclusions: In general, CM students perceived themselves to be “somewhat adequately” or “adequately” prepared for various aspects of clinical practice. Survey results may help inform CM educators about how to better prepare students for entry into the workforce. [ABSTRACT FROM AUTHOR]

The majority of childhood cancer survivors are at risk of treatment-related adverse health outcomes. Survivorship care to mitigate these late effects is endorsed, but it is not available for many adult survivors of childhood cancer in Europe. The PanCareFollowUp project was initiated to improve their health and quality of life (QoL) by facilitating person-centred survivorship care. The PanCareFollowUp consortium was established in 2018, consisting of 14 project partners from ten European countries, including survivor representatives. The consortium will develop two PanCareFollowUp Interventions, including a person-centred guideline–based model of care (Care Intervention) and eHealth lifestyle coaching (Lifestyle Intervention). Their development will be informed by several qualitative studies and systematic reviews on barriers and facilitators for implementation and needs and preferences of healthcare providers (HCPs) and survivors. Implementation of the PanCareFollowUp Care Intervention as usual care will be evaluated prospectively among 800 survivors from Belgium, Czech Republic, Italy and Sweden for survivor empowerment, detection of adverse health conditions, satisfaction among survivors and HCPs, cost-effectiveness and feasibility. The feasibility of the PanCareFollowUp Lifestyle Intervention will be evaluated in the Netherlands among 60 survivors. Replication manuals, allowing for replication of the PanCareFollowUp Care and Lifestyle Intervention, will be published and made freely available after the project. Moreover, results of the corresponding studies are expected within the next five years. The PanCareFollowUp project is a novel European collaboration aiming to improve the health and QoL of all survivors across Europe by developing and prospectively evaluating the person-centred PanCareFollowUp Care and Lifestyle Interventions. • Survivorship care may improve survivors' health and quality of life. • Many adult childhood cancer survivors do not receive optimal survivorship care. • PanCareFollowUp facilitates the implementation of survivorship care across Europe. • Harmonised recommendations for long-term follow-up care will be developed. • Models for survivorship care and lifestyle coaching will be developed and evaluated. [ABSTRACT FROM AUTHOR]

Abstract Aims Survival after cancer diagnosed during childhood or adolescence continues to improve with new treatments and supportive therapies. Optimal long-term care requires that risks to vulnerable organs are clearly defined and translated into guidelines that are implemented into practice. PanCareLIFE is a pan-European consortium that addresses survivorship issues comprising fertility, hearing impairment and quality of life. This article describes the scientific basis of PanCareLIFE's studies. Methods PanCareLIFE involves 17 partner institutions from eight European countries, with additional 11 data providers from five other countries. Study designs and methods include molecular genetic, cohort and case-control studies, a longitudinal study and an intervention study. Ethics and data protection issues have been taken into account from the beginning. Results PanCareLIFE will investigate the way that treatment impairs female fertility, by evaluating anti-Müllerian hormone levels and the underlying genetic susceptibility to loss of fertility. For our fertility studies, more than 6000 survivors have completed questionnaires, more than 1500 provided serum samples and more than 400 case-control triads have been identified. Fertility preservation guidelines for boys and girls will be developed. More than 2000 survivors have contributed audiograms for the ototoxicity study. Almost 1000 samples were sent for genetic analysis related to ototoxicity and gonadal reserve. The SF-36 questionnaire will measure quality of life in more than 10,000 survivors. Conclusions The large number of subjects enrolled in PanCareLIFE and the detailed information accumulated will allow in-depth evaluation of important outcomes. Fertility preservation guidelines will help patients and their families make informed decisions and contribute to their long-term well-being. Highlights • PanCareLIFE is a large pan-European study on late effects after childhood cancer. • Studies of hearing loss, fertility impairment and quality of life are included. • Clinical and genetic methods with new guidelines will lead to improved health. [ABSTRACT FROM AUTHOR]

Background: Chinese medicine (CM) has its own diagnostic indicators that are used as evidence of change in a patient's condition. The majority of studies investigating efficacy of Chinese herbal medicine (CHM) have utilized biomedical diagnostic endpoints. For CM clinical diagnostic variables to be incorporated into clinical trial designs, there would need to be evidence that these diagnostic variables are reliable. Previous studies have indicated that the reliability of CM syndrome diagnosis is variable. Little information is known about where the variability stems from--the basic data collection level or the synthesis of diagnostic data, or both. No previous studies have investigated systematically the reliability of all four diagnostic methods used in the CM diagnostic process (Inquiry, Inspection, Auscultation/Olfaction, and Palpation). Objectives: The objective of this study was to assess the inter-rater reliability of data collected using the four diagnostic methods of CM in Australian patients with knee osteoarthritis (OA), in order to investigate if CM variables could be used with confidence as diagnostic endpoints in a clinical trial investigating the efficacy of a CHM in treating OA. Methods: An inter-rater reliability study was conducted as a substudy of a clinical trial investigating the treatment of knee OA with Chinese herbal medicine. Two (2) experienced CM practitioners conducted a CM examination separately, within 2 hours of each other, in 40 participants. A CM assessment form was utilized to record the diagnostic data. Cohen's κ coefficient was used as a measure of the level of agreement between 2 practitioners. Results: There was a relatively good level of agreement for Inquiry and Auscultation variables, and, in general, a low level of agreement for (visual) Inspection and Palpation variables. Conclusions: There was variation in the level of agreement between 2 practitioners on clinical information collected using the Four Diagnostic Methods of a CM examination. Some aspects of CM diagnosis appear to be reliable, while others are not. Based on these results, it was inappropriate to use CM diagnostic variables as diagnostic endpoints in the main study, which was an investigation of efficacy of CHM treatment of knee OA. [ABSTRACT FROM AUTHOR]