Introduction
I1 World Congress for Integrative Medicine & Health 2017 - A global forum for exploring
the future of comprehensive patient care
Benno Brinkhaus1, Torkel Falkenberg2,3, Aviad Haramati4,5, and Stefan N. Willich1
1Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin
Berlin, Berlin, Germany; 2Department of Neurobiology Care Sciences and Society, Division
of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden;
3I C – The Integrative Care Science Center, Järna, Sweden; 4Department of Biochemistry,
Molecular and Cellular Biology, Georgetown University, Medical Center, Washington,
DC, USA; 5Department of Medicine, Georgetown University Medical Center, Washington,
DC, USA
We are excited to present the abstracts of the keynote speakers, parallel sessions
and oral and poster presentations of the World Congress on Integrative Medicine &
Health (WCIMH 2017; http://www.ecim-iccmr.org/2017/) to be held in Berlin on May 3-5,
2017, which will be jointly convened by the European Society of Integrative Medicine
(ESIM) and the International Society for Complementary Medicine Research (ISCMR).
The Congress will take place in association with a number of national and international
organizations from North America and other continents. Consequently, the congress
will provide the most comprehensive global forum and perspective in the field of Complementary
and Integrative Medicine in 2017.
The congress goal is reflected in its tag line: The Future of Comprehensive Patient
Care - Strengthening the Alliance of Researchers, Educators and Providers. We believe
that by bringing together researchers, educators and providers, who are addressing
various aspects of Integrative Medicine and health, we can build on the evidence obtained
through research to inform clinical education and practice and thereby create a better
platform for comprehensive patient care.
The main themes of the Congress are:
Clinical care: The practice of Integrative Medicine should be based on distinct definitions,
should be informed by evidence and evolve from guidelines that are developed by experts
from conventional and complementary medicine.
Education: Academic leaders and health officials have called for future clinicians
to possess the knowledge and skills to understand how Integrative Medicine can be
incorporated into conventional care to improve the health of the public. Therefore,
it is essential to share best practices in how to create robust curricular opportunities
for medical students to experience systematic teaching of the principles, strengths
and limitations of Integrative Medicine.
Research: Within this Congress scientists will showcase the highest quality research
worldwide in this field and will provide the state-of-the-science evidence base through
plenary lectures, symposia and abstract presentations.
Traditional healing systems (THS): Traditional healing practices and practitioners
are an important and often underestimated part of health care. THS is found in almost
every country in the world and the demand for its services is increasing. Research
contributing to evidence informed decision making is imperative to develop a cohesive
and integrative approach to health care that allows governments, health care practitioners
and, most importantly, those who use health care services, to access THS in a safe,
respectful, cost-efficient and effective manner.
Arts and medicine: For the first time at a research congress, this theme will explore
the important contributions of the arts (music, visual arts, dancing, etc,) for integrative
therapeutic interventions to achieve optimal health and healing.
Given the ambitious scope of this worldwide international congress, the four authors
of the present editorial serve as co-presidents and they are guided by the International
Organizing Committee consisting of many experts from around the world including Myeong
S. Lee, Jianping Liu, Kenji Watanabe (from Far East Asia), Renee Street (Africa),
Amie. Steel (Australia), Paulo Arturo Caceres Guido, Chin An Lin (South America),
Heather Boon, Josephine Briggs, John Weeks (North America) and Abdullah Al-Bedah,
Mohamed Khalil, Elad Schiff (Middle East and Israel).
The programming for each of the five themes is directed by WCIMH 2017 theme subcommittees
involving some of the most highly regarded clinicians, educators and researchers in
the world in this field (in alphabetic order): Linda Balneaves, Lesley Braun, Eva
Bojner Horwitz, Gustav Dobos, Jeffery Dusik, David Eisenberg, Iva Fattorini, Eckhart
G. Hahn, Suzanne B. Hanser, Frederick Hecht, George Lewith, Harald Matthes, Andreas
Michalsen, Judy Rollins, Volker Scheid, Michael Teut, Robert Saper, Claudia M. Witt,
Merlin Wilcox and Darong Wu. The Local Organizing Board is coordinated by M. Cree.
We are very grateful to all organisations and individuals working diligently to making
this first World Congress for Integrative Medicine & Health in 2017 a great success.
We are also pleased to announce that the opening welcome will include the Director
General for the World Health Organization, Dr Margaret Chan (on video). All plenary
speakers are internationally recognized experts in the field of Complementary and
Integrative Medicine such as Josephine B Briggs (US) and Merlin Willcox (UK) as keynote
speakers for the theme traditional healing systems; Klaus Linde (Ger) and Michael
Moore (UK) for the research theme; Lisa M Wong (US) and Töres Theorell (Sweden) will
address the theme of arts and medicine; Darong Wu (China) and Jeffery A Dusek (US)
are presenting on the theme of clinical care; and Aviad Haramati and David Eisenberg
(both US) will close the Congress with presentations on education.
In addition, more than 100 oral presentations in over 40 parallel sessions will be
in the program to provide newly emerging data from recent research projects, experiences
from new treatment aspects in clinical care, descriptions of new models of education
in medicine, information about integration of traditional healing systems in health
care systems and new aspects on the integration of arts in medicine. In addition,
more than 400 posters will be presented in guided poster sessions during the three
days of the Congress.
To translate the congress goals and objectives into a tangible action for the field,
a Berlin Agreement is being developed. With the title ‘Social and Self-responsibility
in practicing and fostering Integrate Health and Medicine Globally,’ this document
is meant to help shape the future of comprehensive patient care in Integrative Medicine,
and addresses the responsibilities of all participants, including patients and citizens,
physicians and all colleagues working in the healthcare system. The Berlin Agreement
has been developed by the WCIMH 2017 congress presidents and the International Organizing
Committee to create a document for further distribution to the scientific and clinical
community and to health care stakeholders, decision makers, and politicians. We anticipate
having the final version of the Berlin Agreement endorsed by a number of organizations
prior to the Congress and also soliciting the support of congress at the WCIMH 2017
in Berlin. Our hope is that this document will provide an important impetus for further
engagement world-wide after the Congress has concluded.
Immediately before the start of WCIMH 2017 on Wednesday May 3rd 2017 there will be
several high-quality pre-conference workshops covering all congress topics. Reflecting
the political situation in recent years, especially in Europe, we have arranged for
a unique half-day workshop on the topic: “Refugees with Chronic Diseases between the
Middle-East and Europe: The Role of Traditional and Integrative Medicine in Bridging
Gaps”, The speakers are all from the Middle East and Europe and will address how Integrative
Medicine may serve as an important element to overcome the problematic health situation
of refugees around the world.
We are convinced that the field of Complementary and Integrative Medicine, including
traditional healing systems and medicine and the arts, will benefit from The 2017
World Congress on Integrative Medicine & Health—a preeminent scientific international
forum that is focused on highlighting advances in these thematic areas. We invite
all practitioners, educators and researchers in the field of Integrative Medicine
to come together, participate and engage together to make this Congress an exciting
meeting for the successful advancement of Integrative Medicine across the globe.
I2 The Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering
Integrative Medicine and Health Globally
April 5, 2017
Introduction
Faced by multiple challenges, including the rise of chronic, lifestyle related diseases,
and grossly inequitable access to healthcare, we are committed to achieving the Sustainable
Development Goals 2030 to foster healthy lives and promote well-being for all ages.
We are part of a global movement to orient care, and the education, research and policy
that support it, toward a model that draws on biomedical, complementary and traditional
medicine practices and respects multiple philosophies. This approach to medicine and
healthcare:
“ … reaffirms the importance of the relationship between practitioner and patient,
focuses on the whole person, is informed by evidence, and makes use of all appropriate
therapeutic and lifestyle approaches, healthcare professionals and disciplines to
achieve optimal health and healing.”1
Our work stands on that advanced in 1978 at the Alma-Ata Conference that mobilized
a movement for primary healthcare for all and officially declared the importance of
integration of effective traditional practices to promote global health. Today, the
World Health Organization (WHO) advocates universal health coverage and integration
of safe and effective traditional providers and complementary services into health
service delivery, as well as self- care practices. These are key objectives of the
WHO’s traditional medicine strategy 2014-2023. We also affirm our alignment with the
declarations from Beijing in 2008 and Stuttgart in 2016 and fully support calls on
governments and non-governmental agencies to adopt, support, fund, research and promote
activities that advance evidence informed integrative care models.
With this Berlin Agreement we call on ourselves as individuals to engage, to the best
of our abilities, in the following:
Model Health
Recognizing that our ability to impart and enhance health and well-being is not only
performed by a social and professional health practice, but is also informed by our
own self-care and resilience, we strive to model personal engagement in health-creating
practices.
Engage Patients
Knowing that the most important strategy for fostering health is to engage patients
in better lifestyle choices, we seek to develop our skills to activate patients to
be self-responsible, to strengthen their resilience, and become captains of their
own healing processes.
In respect for the importance of natural processes as guides for enhancing well-being,
we educate and stimulate patient understanding of, and participation in, efforts to
protect and sustain the natural environment.
Promote Interprofessionalism and Team Care
Knowing that no single type of practitioner has all the answers that can be useful
to a given patient, we individually seek to develop quality relationships with members
of other disciplines and professions to guarantee that we can quickly connect patients
to the right services from the right practitioners and right professions at the right
time;
Aware that such care may be provided via knowledge or practitioners from multiple
global healing traditions, we personally commit to continuously broadening our understanding,
awareness and engagement with other fields and resources.
Recognise the importance of traditional medicine in global healthcare
Given that traditional medical products, practices and practitioners are the main
access to healthcare in most regions of the world, we highlight the importance of
global investment to systematically develop best practices in these diverse systems
that supports their safe and effective use and integration with biomedical practices.
Commit to Evidence-Informed Dialogue and Practice
Aware that a substantial portion of what is done in medicine and healthcare lacks
a quality evidence base, we personally seek ever more effective ways to end polarizing
dialogue and to stimulate collaboration in our collective ability to research, create
and operationalize optimal evidence informed integrative care.
Foster Whole Systems Research
Committed to practices that respect the whole human being through use of diverse modalities
and often through teams of practitioners, we personally champion development of methods,
funding, and dissemination of research that address chronic diseases from multiple
etiologies and treatments that often are best resolved through whole person and whole
systems approaches.
Aware that questions related to cost are often an obstacle to the system-wide implementation
of these models and thus access to these services, we will personally endeavor to
support heightened focus on research that includes the economic dimensions of integrative
models of care.
Stimulate Collaboration
Given the limitations and harm that can emanate for professions and stakeholders operating
in isolation, we challenge ourselves individually, and within our own professional
organizations and institutions, to commit to programs and projects that stimulate
increased respect, collaboration and understanding across disciplines, traditions,
professions, and stakeholders.
Bridge Clinical Care with Prevention, Community and Public Health
Knowing that clinical medical interventions represent but 10%–20% of the factors that
shape the health of a community, we actively engage in creative methods to deepen
the preventive and lifestyle dimensions of our individual practices while also connecting
our practices and patients to community and public health resources.
Engage as Change Agents
Recognizing that imbalances in social, environmental, economic and political structures
are major influences in the health of citizens, we seek to foster more equitable communities
and societies.
To better empower our own work, we seek to expand our abilities to work closer and
more constructively with other professions, government agencies, non-governmental
organizations, private and not for profit businesses, patients and other stakeholders
in advancing integrative health and medicine.
Through engaging these personal and social responsibilities, we will improve individual
patient care and positively influence the preconditions of healthcare systems, locally
and globally, to achieve optimal health and healing in the individuals, communities
and planet we serve.
1Definition of Integrative Medicine and Health. Academic Consortium for Integrative
Medicine and Health (www.imconsortium.org)
This agreement was developed by the Congress Presidents (B. Brinkhaus (Germany), A.
Haramati (USA), T. Falkenberg (Sweden) and S.N. Willich (Germany) with J. Weeks (USA)
and the other members of the International Organizing Committee (A.M.N. Al-Bedah (Saudi
Arabia), H. Boon (Canada), P.A. Caceres Guido (Argentina), M. Khalil (Saudi Arabia),
M.S. Lee, (Korea), C.A. Lin (Brazil), J. Liu (China), E. Schiff (Israel), A. Steel
(Australia), R. Street (South Africa) and K. Watanabe (Japan) of the World Congress
on Integrative Medicine and Health 2017 in Berlin and is supported by several societies
such as the e.g.
European Society of Integrative Medicine (EU)
Academic Collaborative for Integrative Health (USA)
Integrative Health Policy Consortium (USA)
Academy of Integrative Health and Medicine (USA)
Umbrella Association of Austrian Doctors for Holistic Medicine (AUT)
Association of Anthroposophic Physicians in Germany (Germany)
Interprofessional Organization for Anthroposophic Medicine (Germany)
German Physicians Society of Osteopathy (Germany)
International Society for Chinese Medicine (Germany)
German Physicians' Association for Ayurvedic Medicine (Germany)
The Society of Complementary Medicine in Israel (Israel)
German Association of Homeopathic Physicians (Germany)
Latin American Society of Phytomedicine (Latin America)
Argentine Council of Osteopaths - Registry of Osteopaths (Argentina)
First Ayurveda Health Foundation (Argentina)
Spanish Federation of Integrative Medicine (Spain)
as well as individual clinicians, researchers, educators and policy-makers.
Plenaries
Plenary session I
S1 The lessons from integrative medicine: sometimes less really is more
Josephine P Briggs
NCCIH, NIH, Bethesda, MD, USA
It is widely recognized that our health care system does too much of some things,
and too little of others. Learning what actually works and for whom – finding the
true balance between benefit and harm - is the charge to the biomedical research enterprise.
Negative findings are as important a product of evidence-based medicine as the positives.
Three examples will be explored: cancer screening, pain management, and end-of life
care. Critical examination of common health care practices in these areas is yielding
surprises; careful examination of data from observational studies and large scale
randomized trials is frequently finding less benefit than expected (or even harm)
of some drugs, widely used screening strategies, and other health interventions; and
in some cases a more favorable benefit to harm ratio of gentle ‘old-fashioned’ approaches
that come from outside the mainstream.
Nevertheless, translation of evidence into good care remains problematic. Increasingly
it is understood that the answers will lie in part with greater patient engagement
and shared decision making. Integrative medicine practitioners are defining an innovative
style of practice that provides a model for greater openness to the patient’s voice.
Health care decision making needs to more effectively marry the insights that come
from evidence-based medicine with the individual values of each patient. Integrative
practitioners tap into an interest of patients in greater involvement and often in
less use of technology. While the input and expertise of the health care practitioner
is essential for good care, so is an active, partnership with the patient and the
flexibility to adapt to the patient’s concerns.
S2 Traditional medicine and primary healthcare in Africa
Merlin Willcox (Merlin.willcox@phc.ox.ac.uk)
Department of Primary Care and Population Sciences, University of Southampton, Aldermoor
Health Centre, Coxford Rd, Southampton 2016 5ST, UK
Background
It is often stated that 80% of the world’s population relies on traditional medicine
for their primary health care [1]. However very few countries in Africa have attempted
to integrate traditional and modern healing systems for the benefit of patients. On
the contrary, traditional medicine has been widely discouraged and some practices
even banned. We set out to investigate ways in which traditional and modern medical
systems could better collaborate, for the benefit of patients.
Methods
Surveys were undertaken in Mali, Uganda and Ethiopia of treatments used by patients
for febrile illnesses, and associated outcomes. In Mali, we selected the plant associated
with the best outcomes for further clinical research using a “reverse pharmacology”
approach [2], in order to develop an improved traditional medicine. In Mali and Uganda,
the “confidential enquiry” methodology was used to investigate maternal, perinatal
and child deaths in a total of 10 subdistricts over 3 years. Local panels analysed
how deaths could have been avoided by improvements in both traditional and modern
medical systems, and made recommendations to this effect.
Results
Prevalence of use of traditional medicine for febrile illnesses varied widely, from
0% in the Apac district of Uganda, to 60% in the Sikasso area of Mali [3]. Of 66 plants
traditionally used in Mali, Argemone mexicana was the only one systematically associated
with clinical recovery. This was further investigated in a dose-escalating trial [4],
and then in a randomised controlled trial [5]. Its use has since increased. The confidential
enquiry revealed that traditional healers and traditional birth attendants had been
involved in the care of 15% of children who had died (ranging from 5% to 36% in different
districts), whereas official health centres and hospitals had been involved in 58%
of cases in Mali and 49% in Uganda. The majority of children who had consulted a traditional
healer had not been referred in a timely manner. Training courses were organised to
improve recognition and referral of severe illnesses.
Conclusions
In Africa, usage of traditional medicine in primary care is still prevalent, at least
for febrile illness in children, including illnesses which are eventually fatal. The
“reverse pharmacology” approach facilitated the development of an evidence-based improved
traditional medicine in Mali, which became more widely used. The “confidential enquiry”
approach engaged both traditional and modern practitioners together in a discussion
of what could be done to reduce childhood deaths.
References
1. Bannerman R, Burton J, Wen-Chieh C. Traditional Medicine and Health Care Coverage.
Geneva: World Health Organisation; 1983.
2. Willcox M, Graz B, Falquet J, Diakite C, Giani S, Diallo D. A "reverse pharmacology"
approach for developing an anti-malarial phytomedicine. Malaria Journal. 2011;10(Suppl
1):S8.
3. Diallo D, Graz B, Falquet J, Traore AK, Giani S, Mounkoro PP, et al. Malaria treatment
in remote areas of Mali: use of modern and traditional medicines, patient outcome.
Trans R Soc Trop Med Hyg. 2006;100(6):515-20.
4. Willcox ML, Graz B, Falquet J, Sidibe O, Forster M, Diallo D. Argemone mexicana
decoction for the treatment of uncomplicated falciparum malaria. Trans R Soc Trop
Med Hyg. 2007;101(12):1190-8.
5. Graz B, Willcox ML, Diakite C, Falquet J, Dackuo F, Sidibe O, et al. Argemone mexicana
decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy
and public-health implications. Trans R Soc Trop Med Hyg. 2010;104(1):33-41.
Plenary session II
S3 Evidence of effectiveness but not efficacy - why many complementary therapies are
so hard to accept for biomedicine
Klaus Linde (klaus.linde@tum.de)
Institute of General Practice, Technical University Munich, Munich, Germany
While the integration of complementary therapies into health care practice continues
to progress in many countries, the scientific and academic debate on many of these
therapies seems to heat up again in the last decade after a period of relative openness.
Interestingly, both those attacking and defending complementary medicine claim that
their view is evidence-based. In my presentation I will try to analyze important reasons
why there is so much, often fierce debate.
Using acupuncture and homeopathy as examples I will show how the same evidence is
sometimes interpreted completely different. The more controversial the topic, the
more interpretation is shaped by the influence of prior beliefs, personal preference
of different types of evidences, previous knowledge and experience. The main problem
for the acceptance of many complementary therapies is not the lack of evidence that
patients benefit but weak theoretical foundations (leading again to stronger demand
of proof of specificity). I will explain why “specificity” is such a crucial tool
for demarcation of the unacceptable, both for science and the medical profession.
At the same time, many of these “intellectual” problems do not seem to be relevant
in the pragmatic reality of everyday practice.
In my view there are two important consequences of these considerations: 1) a public
debate is needed whether “scientific nonsense” could be effective in practice – and
if so, whether it should be reimbursed by public health insurance; 2) there is a strong
need for more research on how complementary therapies work, but this research should
not take the often naïve and mechanistic theoretical concepts of these therapies as
granted.
Plenary session III
S4 Arts in health promotion
Töres Theorell1,2
1Department of Neuroscience, Karolinska Institute, Stockholm, Sweden; 2Stress Research
Institute, Stockholm University, Stockholm, Sweden
Arts (music, writing, dance, visual arts and theatre) have a strong potential in health
promotion. Health can be defined in many ways, ranging from strict absence of medical
conditions to well-being in a wide social sense [1]. When we discuss musical experiences,
flow is potentially a central concept in health promotion. The flow concept is particularly
applicable to music performance. When a subject has practiced a difficult music piece
and is finally able to perform it well, a high level of arousal and at the same time
a high degree of elation arises. Our own experiments indicate that this state is associated
with a concomitant activation of the sympathetic and parasympathetic systems. A subject
who is allowed to have these rare experiences repeatedly collects flow experiences
which add to a high quality of life. This would correspond to life-long flow capital.
Flow experiences can arise in several domains, in sports, while performing theatre,
while giving a lecture etc. According to our theory flow experiences add importantly
to quality of life.
Alexithymia, inability to differentiate, describe and communicate feelings, is a central
concept in psychosomatic medicine. Our research has shown that competence in arts
is associated with a good ability to handle emotions. Each one of the artistic skills
(see above) adds statistically to emotional ability and there are also additive effects.
Since alexithymia has an established role in early stages of hypertension, burnout
syndrome and abuse of alcohol these relationships are of importance to health promotion.
However, our twin research has shown that a large part of the relationship between
musical practice and alexithymia is genetically determined [2,3]. Therefore relatively
large controlled intervention studies are required in order to establish health effects
of musical experiences. An RCT study, the Culture Palette study, performed on health
care centres in Stockholm, showed that cultural activities organized for women with
burnout syndrome for three months twice a week were followed by improved burnout and
alexithymia scores which were not seen in the control group [4]. The alexithymia changes
were even more pronounced three months after the cultural intervention than immediately
after the end, findings which may indicate that health promotion processes have started.
Efforts to stimulate cultural activities should start in childhood [5].
References
1. Theorell T: Psychological Health Effects of Musical Experiences: Theories, Studies,
and Reflections in Music Health Science Dordrecht, Netherlands: Springer, 2014
2. Theorell TP, Lennartsson AK, Mosing MA, Ullén F. Musical activity and emotional
competence - a twin study. Front Psychol. 2014 Jul 16;5:774. doi: 10.3389/fpsyg.2014.00774.
3. Lennartsson AK, Bojner Horwitz E, Theorell T and Ullén F (2017) Lack of creative
artistic achievement (writing, music, dance, theatre, visual arts) is related to alexithymia.
Creativity Research Journal. In press 2017
4. Grape Viding C, Osika W, Theorell T, Kowalski J, Hallqvist J and Bojner Horwitz
E (2015) ”The Culture Palette” a randomized intervention study for women with burnout
symptoms in Sweden. Brit J Med Practitioners 2015; 8(2):a813
5. Theorell T, Lennartsson AK, Madison G, Mosing MA, Ullén F. Predictors of continued
playing or singing--from childhood and adolescence to adult years. Acta Paediatr.
2015 Mar;104(3):274-84. doi: 10.1111/apa.12870
S5 Healing the community through the arts: framing and reflections
Lisa M. Wong (lisamwong@gmail.com)
Arts and Humanities Initiative, Harvard Medical School, Boston, MA 02115, USA
The arts are an essential element of human life that foster health, wellness and balance.
Through the arts, the relationship between practitioner and patient can be affirmed
and deepened. The arts in medicine focus on the whole person, making use of several
therapeutic approaches: through dance, individuals living with movement disorders
enhance their flexibility with grace and confidence; through mask-making, wounded
veterans find a voice as they struggle with PTSD.
Integrating the arts into the practice of medicine presents an exciting new intersection
of fields. Important new questions emerge. What is the role of the physician musician?
How can the experience and knowledge of music therapist, neuroscientist and physician
best be utilized to institute a personalized care plan for the patient? What does
evidence-based practice look like through the lens of the artist in healthcare settings?
Caregivers and healthcare providers in training also benefit from the integration
of the arts into their practice. Narrative medicine encourages healthcare providers
to understand their own story, as well as the patient’s story, beyond the diagnosis.
Looking deeply at art in the museum enhances observation skills, critical thinking,
and communication. Analyzing, playing and listening to music invites deeper reflection
and analysis of complex diagnoses.
Join the growing number of physicians, musicians, therapists, neuroscientists, and
patients who are embracing the arts as a critical aspect of integrative medicine.
Together we will pave the way forward, discover new parallels, learn from each other,
and ultimately improve the way we care for our patients and each other.
Plenary session IV
S6 Integrating complementary and integrative health therapies into US hospitals –
the role of practice based research in guiding the field
Jeffrey Dusek
Psychosomatic medicine, Neuropsychology, Allina Health, Minneapolis, MN, USA
Consumer demand for complementary and integrative health (CIH) therapies continues
to grow in the United States (US). As a result, about 15 years ago, several US health
systems were early adopters in the inclusion of CIH therapies into hospital settings.
Several randomized controlled trials provided initial evidence that specific CIH therapies
(e.g., acupuncture) were efficacious for relief of symptoms (e.g., pain) in certain
hospitalized patient populations (e.g., post-surgery). Additional studies suggested
that the CIH therapies were safe for these patients. While results of the randomized
trials were important, translation of these results into clinical practice has been
challenging due to the fact that neither health care administrators, nor clinical
providers are aware of which CIH therapy would be most effective for specific condition
relief in specific patient populations. An important question being asked is: can
the right patient be provided the right CIH therapy for the right symptom relief outcome?
This presentation will include a description of the development and evolution of one
early adopter model for the integration of CIH therapies services into a US hospital
setting. The presentation will also include results from a large National Institutes
of Health practice based research evaluation in the early adopter model to explore
the effectiveness of different CIH therapies on pain in varied clinical populations.
The presentation will detail lessons learned from these experiences that will provide
health care system administrators and clinical providers with guidance for efficient
delivery of CIH therapies in US hospital settings and perhaps across the world.
S7 Integrating CAM into hospital care: prospectives from China (Abstract ID 220)
Darong Wu
2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
Objective
The integration of traditional Chinese medicine(TCM)and western medicine in China
was initiated more than a century ago. Since early 1950s, TCM as one of the important
component of complementary and alternative medicine (CAM), has been integrated into
hospital care, including inpatients"medical services, due to several practical reasons,
e.g. China"s health policy, Chinese traditions, patient"s promises and claims, etc.
Methods
There are mainly two types of model in terms of integration TCM into inpatient/hospital
settings in China, (1) Disease-based model, which has been adopted in most of the
western medicine hospitals, especially in the departments of cardiovascular disease,
tumor disease, or other rehabilitation related diseases, or virus infection diseases;
(2) Pattern diagnose-based model, usually is applied in the hospitals of integrative
medicine or TCM medicine. Despite the types of model, more and more physicians and
other health care professionals realize that it is important to help the patients
to make informed health care decision during the integration procedure. And it shall
combine the management methods which have been successfully applied in hospital operation,
including clinical pathways and lean management.
Results
Clinical pathways has been adopted to efficient the progress of integrating TCM into
inpatient services since 2002 in China. Researches found that it might help to reduce
the length of stay, to maintain the cost within a reasonable range, and would still
keep the quality of medical services in the same or even higher levels. The ideas
of evidence-based practice, patient-informed decision,etc, have been embodied, while
we would not ignore any "unexpected" outcomes from clinical practiceswhichmight be
"new" ideas for further researches orfuture evidences.
Discussion
ntegrating TCM into inpatient services has six-decade history in China, any further
development in this area may face both opportunities and challenges ahead.
Keywords: Integration, Complementary and Alternative Medicine (CAM), Traditional Chinese
Medicine (TCM), Hospital Care, China
Plenary session V
S8 Nutrition and lifestyle education in an era of obesity and diabetes – might “Teaching
Kitchens” serve as catalysts of personal and societal transformation?
David Eisenberg
Department of Nutrition, Harvard University T H Chan School of Public Health, Boston,
MA 02115, USA
To address dramatic global increases in obesity, diabetes and other lifestyle-related
diseases, the medical establishment must invent and experiment with novel approaches
whereby patients – and caregivers as role models – learn to eat, cook, move and think
differently.
As a result of this presentation, participants will:
Review trends in obesity, diabetes and other lifestyle-related chronic diseases in
the US and globally
Be introduced to the conceptual construct of a “Teaching Kitchen”. This includes educational
approaches which combine: (1) nutrition education, (2) hands-on culinary instruction,
(3) mindfulness training, (4) enhanced movement and exercise, and (5) optimal behavior
change strategies including health coaching
Appreciate the unique role played by mindfulness in these curricula
Learn about Teaching Kitchen prototypes being developed and evaluated at universities,
medical schools, hospitals, corporate workplaces, colleges, K-12 schools and community
settings across the US, Europe and Asia
Envision future models of medical education and healthcare delivery which focus on
both: (a) “salutogenesis”, the creation and maintenance of health and wellness, in
combination with (b) “pathogenesis”, which typically focuses on disease diagnosis
and treatment, in an effort to enhance public health and reduce total healthcare related
expenditures
Be introduced to the recently established “Teaching Kitchen Collaborative” which includes
more than 30 institutions with Teaching Kitchens, all of whom are committed to (a)
establishing best practices; (b) developing shared research strategies; and (c) participating
in multi-site studies to assess the clinical and financial impact of these emerging
models
S9 Addressing chronic stress and burnout in health professionals: the educational
imperative for incorporating mindfulness for self-care
Aviad Haramati
School of Medicine, Georgetown University, Washington D.C., United States
Recent reports suggest that chronic stress and burnout among physicians are pervasive
problems and cause for concern. More than half of all physicians in the United States
experience some element of burnout, and this can lead to changes in the patient-provider
relationship and adversely impact on the quality of care. In some specialties, the
rates are even higher. This trend may begin earlier with the observed decline in empathy
during medical student training and the alarming rates of burnout in medical and other
students in the health professions. In response, various groups are developing interventions
with medical students, residents and faculty to address the rise in burnout and the
decline in professional resiliency. Keys to this work are themes of self-awareness,
mindfulness and exploring domains of control and meaning in the clinical encounter.
In this plenary presentation, Dr. Haramati will review published outcomes on interventions
using mindfulness approaches to reduce stress and burnout and improve wellbeing. A
physiologic framework will be provided to explain why mindfulness appears to be effective.
He will also share his perspective on why it is essential to incorporate mind-body
techniques into the training curriculum for all health professionals—something that
will require both skill and courage.
Pre-workshops
Research
A1 Qualitative research methods in complementary and integrative medicine
Bettina Berger (bettina.berger@uni-wh.de)
Department of Health, University of Witten/Herdecke, Witten/Herdecke, Germany
This workshop will give an insight in qualitative research methods for complementary
and integrative medicine, teach how to reflect quality criteria of qualitative research
methodology and try different ways to interpret data to know more about the diversity
of qualitative methodologies.
A2 Getting your work published – tips from editors
Kathi Kemper (kathi.kemper.md@gmail.com)
OSU, Blacklick, OH, United States
This will be an interactive session led by three editors from prominent CAM journals
– BMC CAM, Complementary Therapies in Medicine, and Journal of Alternative and Complementary
Medicine. The pros and cons of submitting to different journals, the availability
and recommended use of writing guidelines from the EQUATOR network will be reviewed
and the participants will be offered a simple, hands on approach to writing a journal
article without getting bogged down in writer’s block.
A3 Horizon 2020 – networking and creating working groups
Beate Stock-Schröer1, Hedda Sützl-Klein2
1Carstens-Foundation and FORUM, D-45276 Essen, Germany; 2ESIHR (European Society for
Integrative Health Care), A-1070 Vienna, Austria
Correspondence: Hedda Sützl-Klein (hedda.suetzl-klein@aon.at)
During the preconference of 12th WCIMH (World Congress Integrative Medicine & Health
2017)/10th ECIM (European Congress of Integrative Medicine) a Horizon 2020-Networking
Workshop will offer researchers and potential participants of Horizon 2020-projects
the opportunity to network, share information and create working groups for research
proposals involving integrative medicine and multimodal approaches. The workshop was
initiated by DDr. Hedda Suetzl-Klein and Dr. Beate Stock-Schröer with support from
researchers of the FORUM research network (Forum universitärer Arbeitsgruppen für
Naturheilverfahren und Komplementärmedizin: http://www.uniforum-naturheilkunde.de).
Background and goals
Complementary and integrative medicine is supposed to provide opportunities for highly
personalised medicine and other challenges of the specific programme „Health,
Demographic Change and Well-being” of Horizon 2020, the “EU Framework Programme for
Research and Innovation” from 2014 – 2020. The goals of this pre-conference workshop
are to analyse the current (and upcoming) work programme, to discuss potential topics
of research and to build working groups for Horizon 2020 proposals. As well as defining
topics, networking is a major aim, in order to form appropriate teams to formulate
research proposals and increase the number of promising EU-projects (Horizon 2020-research
projects) involving integrative medicine issues and multimodal approaches.
Speakers and working group leaders
Dr. Wolfgang Weidenhammer (KOKONAT-TU Munich, CAMbrella project coordinator) will
analyse work programmes and current developments, Dr. Pierre Madl (University of Salzburg,
participant in 3 FP7 research projects: CATO, Bridge, NanoValid) will share experience
and lessons learned from former applications and successful EU-research projects.
To build working groups for Horizon 2020 applications, the researchers are supported
by Prof. Dr. Jost Langhorst (University of Duisburg-Essen, Department of Internal
and Integrative Medicine, Kliniken Essen-Mitte), Dr. Wolfgang Weidenhammer (KOKONAT-TU
Munich), Prof. Dr. Roman Huber (University of Freiburg, Center for Complementary Medicine,
Institute for Environmental Health Sciences and Hospital Infection Control, focussing
on: prevention and treatment of chronic diseases), PD Dr. Kristjan Plaetzer (University
of Salzburg: AMR and antimicrobial strategies based on natural resources), Doz. Dr.
Alexander Haslberger (University of Vienna: Epigenetically active nutrition in integrative
medicine therapies and prevention) and Dr. Pierre Madl (University of Salzburg: Integrative
medicine, health & biophysics).
Clinical care
A4 Integrated Cchronic Care Model and diabetes: the project as implemented within
the Center of Integrated Medicine of the Hospital of Pitigliano
Rosaria Ferreri (tyvvf@tin.it)
Hospital Centre of Integrated Medicine, Hospital of Pitiglian,o ASL SudEst Toscana,
Grosseto, Italy
The care of people with diabetes is, all over the developed world, and now, even in
countries in the developing world, one of the main problems of organization of systems
of health protection. This goes far beyond the meaning of the care of a single disease,
but rather is almost a paradigm of the Chronic Care Model, which, in most companies
in the world, it is epidemiologically prevalent today. The challenge of this project
is to develop an integrated protocol including Homeopathy and Phytotherapy to evaluate
how, where and when it is possible to introduce the integrated protocol in the course
of the CCM Diabetes. Proposals has been accepted by the chief of Medicine Department
of the Hospital of Pitigliano. We are going to study different categories of diabetic
patients included in the project:
Patients that have high value of emoglobina glicata, despite their anti diabetic oral
therapy;
Patients that suffer from comorbidities (that could have influenced their metabolic
status and the course of their diabetes)
We have approached the patients, collecting their informed consent, and establishing
the integrated protocol to be adopted in each of the two categories. The protocols
include:
an homeopathic remedy
a phytotherapy compound, made of two plants extracts
A group of 20 diabetic patients have been enrolled, ten of them were affected by diabetes
and other ten have comorbidities; for each of them, we have collected data related
to: blood sugar level, glycated haemoglobin, renal and hepatic function, blood pressure,
(other parameters that will be included in a second phase of the project). To each
of them we have given: a Questionnary (as SF12) for the quality of life and ADL skills
for daily ability; we have also used EDMONTON scales for the assessment of symptoms
and a CARD for the consumption of conventional drugs, to monitoring the use of antidiabetic
drugs.
Results and discussion
We describe:
A new organisational model, which includes new roles and new functions.
A new common pathway.
How to identify proactive patient using risk stratification tools.
How we have improved hospital infrastructure, which supports sharing information and
patient monitoring.
A common set of shared objectives and indicators linked to health outcomes and process
improvement have been adepte and we"ll show the results in terms of:
Ameliorating QoL: from 68 to 85% of them declare improvements in the general health
feelings
Improving HB glycate value : in 12 weeks have been improved about - 10%-
Reducing use of conventional drugs: preliminary data will be shown
A5 Phyto-nutrition and diabetes
Rosaria Ferreri (tyvvf@tin.it)
Hospital Centre of Integrated Medicine, Hospital of Pitigliano, ASL SudEst Toscana,
Grosseto, Italy
Introduction
Managing blood glucose and preventing complications in diabetes care are important
goals for anyone with this chronic disease. Nutrients present in various foods play
an important role in maintaining the normal functions of the human body and some phytonutrients
help to lower blood glucose. Others protect insulin-producing cells in the pancreas
from oxidative damage. But where can we get these nutrients? The best challenge is
to have them through a studied diet, not only based upon calories and nutrients, but
also taking in account the so called phyto-nutrients. That also why, recently, vegeterian
regimen has been proposed to be the best to cope with diabetes.
Materials and methods
Phytonutrients are the plant nutrients with specific biological activities that support
human health. Due to the fact that some of these nutrients have a great and recognized
role in the help of chronic conditions, as diabetes is, we have tried to include them
in the composition of an ideal diet, not based upon the energetic values but on phytonutrients
and their ORAC value.
Discussion
Well show the composition of an ideal diet for patients with diabetes, that could
be more helpful in the control of hyper insulinism and also in the control of oxidation
process. We propose our rationale for the choice of foods and their distribution during
the day, based upon the best research in the field of plant-derived preparations,
such as pomegranate seed oil[1], grape skin extract [2], blood orange extract [3]
barley b-glucan [4], anthocyanins from cherries [5], and green tea (2)-epigallocatechin-3
[6]. We also show that this strategy is also comparatively cheap, easy to be used
by aged people and could significantly reduce health care costs.
Bibliography
1. Vroegrijk, I.O et al. -2011- Pomegranate seed oil, a rich source of punicic acid,
prevents dietinduced obesity and insulin resistance in mice. Food Chem. Toxicol. 49:
1426–1430
2. Hogan, S. et al - 2011-. Dietary supplementation of grape skin extract improves
glycemia and inflammation in diet-induced obese mice fed a Western high fat diet.
J. Agric. Food Chem. 59: 3035–3041
3. Titta, L., et al. -2010-. Blood orange juice inhibits fat accumulation in mice.
Int. J. Obes. (Lond.) 34: 578–588
4. Choi, J.S et al – 2010- Consumption of barley beta-glucan ameliorates fatty liver
and insulin resistance in mice fed a high-fat diet. Mol. Nutr. Food Res. 54: 1004–1013
5. Jayaprakasam, B. et al - 2006- Amelioration of obesity and glucose intolerance
in highfat-fed C57BL/6 mice by anthocyanins and ursolic acid in Cornelian cherry (Cornus
mas). J. Agric. Food Chem. 54: 243–248
6. Lee, M.S et al – 2009 - Green tea (-)-epigallocatechin- 3-gallate reduces body
weight with regulation of multiple genes expression in adipose tissue of diet-induced
obese mice. Ann. Nutr. Metab. 54: 151–157
A6 A comprehensive integrative approach to the management of chronic pain
Gary Kaplan
The Kaplan Center for Integrative Medicine, Georgetown University, McLean, VA, United
States
“Chronic pain” and “depression” are not actionable diagnoses; they are, instead, symptoms
of a neuroinflammatory disease of multiple and compounding aetiologies. Exploring
the proposal that accepted medical practices often fail to help chronic pain sufferers
because they have been based on a fundamental misunderstanding of the illness itself,
the goal of this workshop is to understand the pathophysiology of chronic pain and
depression according to a neuroinflammatory model as well as the multiple aetiologies
of neuroinflammation.
The participants will learn how to take a comprehensive, chronic-pain history according
to the neuroinflammatory model of chronic pain and, based on that, create an integrative
treatment.
A7 Visit of Gemeinschaftskrankenhaus Havelhoehe: Anthroposophic medicine in workaday
life for patient centred care in a capital town (8.30-12.00 a.m, half day)
Harald Matthes
Hospital Havelhöhe, Berlin, Germany
On this excursion the participants will experience the concept of the Anthroposophic
Clinic “Havelhoehe” and get to know practical integrative concepts. The program includes
a guided Visit in different (optional) fields: a) From the intracardiac catheter to
the Heart school (life style modification) b) Integrative Oncology in a certified
oncology centre (OnkoZert) c) Integrative Pain Unit d) Integrative Psychosomatic Medicine
e) Integrative Concepts of functional diseases (IBS) f) The Self-Governing Concept
of the Clinic.
Time: 8.30 am - 12.15 pm (including bus transfer)
A8 Introduction to osteopathic medicine – a hands-on workshop
Gabriele Rotter (gabriele.rotter@charite.de)
Institute for Social Medicine, Epidemiology and Health Economics, Charité University
Hospital, Berlin, Germany
This workshop offers an introduction to osteopathic medicine and is intended for medical
students and medical doctors with few or no knowledge in osteopathic medicine. The
participants should learn basic osteopathic principles, their indication and contraindication
as well as the integration of osteopathy into the overall treatment strategy of a
patient. During the hands-on part of the workshop participants are given a practical
demonstration of basic examination procedure with special emphasis on palpation, as
well as selected treatment techniques.
Education
A9 Implementing skills from hypnosis and touch therapies to improve doctor-patient
communication
Elad Schiff1, Zahi Arnon2,3
1Internal medicine and Complementary medicine service, Bnai Zion Medical Center, Haifa,
Israel; 2Complementary-Integrative Surgery Service, Bnai Zion Medical Center, Haifa,
Israel; 3The Emek Yezreel Academic College, Yezreel Valley, Israel
Correspondence: Elad Schiff
Currently, education toward optimal physician-patient communication does not take
into account the impact of positive and negative suggestions on health and disease.
Moreover, there is vast evidence in the medical literature that such suggestions can
trigger placebo, or nocebo effects respectively. As an example, saying to a patient
"here are your pain pills" implies that the patient owns the pain (nocebo), whereas
"here are medications that will help you reduce pain, and increase your comfort" activate
patient empowerment and control over pain (placebo). Implementing fundamentals of
hypnosis to suggestions embedded in communication with patients can tremendously improve
the outcomes of such encounters.
Hypnosis is a mind-body technique aimed to activate innate healing forces by using
words with positive suggestions as well as non-verbal communication such as touch.
The effect of hypnosis is thought to occur best in a "trance state" where the sub-conscious
mind is more receptive to suggestions, which are conveyed to the nervous & immune
systems. In contrast to the common belief that hypnosis requires patients to be calm
and relaxed, hypnotic trance due to stressful health conditions is very common. Actually,
patients are in spontaneous trance state during most encounters with physicians. Hypnotic
trance places patients in a state-of-mind where they are highly influenced by suggestions-
for the good (placebo), and for the bad (nocebo). Consequently, physicians could learn
how to activate patient's healing forces by using the correct suggestions in verbal
and non-verbal communication (i.e. touch and body gestures), based on fundamentals
of hypnosis. The workshop will introduce health-providers and medical students to
hypnotic based communication that potentiates the healing capacity of patients. Videos
of real patient-physician encounters as well and vivid demonstrations, and hands on
techniques to improve physical exam skills, are built in the workshop.
A10 Developing pre-residency core entrustable professional activities in integrative
medicine: a skills-based workshop for medical educators and students
Eckhard Hahn (eckhart.hahn@uk-erlangen.de)
Medicine I, University Hospital Erlangen, Erlangen, 90154, Germany
The goal of this workshop is to provide the participants with a hands-on opportunity
to create core Entrustable Professional Activities (EPAs) in integrative medicine
for trainees entering residency and post-graduate training. EPAs are becoming an important
part of outcomes based education and are increasingly looked at being essential in
preparing students for graduate medical training. This workshop will build on precourse
assignments, start with an interactive summary of this knowledge and will then shift
to experiential as we create the opportunity for participants to work in groups and
develop team-based core EPAs in integrative medicine that include interprofessional
practice.
Outline of Workshop
Participants introduce themselves 5 min.
Workshop Activity: 20 min. Q&A 5 min
How to develop a team-based EPA – interactive summary of precourse assigment.
3.
Work in small groups with facilitator: Creating a blueprint for team-based EPAs in
Integrative Medicine. 30 min.
4.
First patient encounter
5.
Self-care
6.
Treatment plan (a patient with breast cancer)
Coffee break 15 min.
4.
Experiential learning of IM-EPAs: team-based practice. 30 min.
5.
A simulated IM patient encounter
6.
A simulated self-care session (patient with breast cancer)
7.
A simulated assessment session of IM-EPA (treatment plan for patient with breast cancer).
8.
Debriefing – later letters. 15 min
Total time 120 minutes
Precourse assignment:
Integrative Medicine in the Continuum of Medical Education;
Entrustable Professional Activities (EPAs) - especially core EPAs for entering residency;
Interprofessional aspects of Integrative Medicine (the team-based approach).
A11 Differentiating the psychological and physiological mechanisms of relaxation versus
mindfulness: an experiential workshop and clinical implications
Christina M. Luberto (cluberto@mgh.harvard.edu)
Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
Mind-body therapies, used to treat a variety of stress and pain-related conditions,
often include the use of both relaxation techniques and mindfulness exercises. Relaxation
techniques are interventions such as progressive muscle relaxation and diaphragmatic
breathing that are intended to alter physiological and emotional states by eliciting
the relaxation response. Mindfulness techniques, which can be taught using stand-alone
exercises (e.g., mindful breathing, mindful sitting) or formal mindfulness-based interventions
(e.g., Mindfulness-Based Stress Reduction), are intended to promote present moment
awareness and acceptance as a way of enhancing self-regulation. Thus, there is a distinct
difference in both the intention and, ultimately, the psychological and physiological
mechanisms associated with these two approaches - which have important implications
for informing clinical practice. Unfortunately, over time, the term “mind-body therapies”
has become synonymous with both the use of relaxation therapies and mindfulness techniques,
thereby obscuring these critical differences.
Therefore, the primary purpose of this workshop is to provide participants with a
deeper understanding of the differences in the psychological and physiological mechanisms
associated with relaxation versus mindfulness techniques, using a combination of experiential
exercises and brief didactics. Four relaxation and mindfulness exercises (20-30 minutes
each) will be used throughout the workshop to allow participants to experientially
learn the difference between these two approaches. Each exercise will be followed
by paired and/or group discussions to provide opportunities for processing and reflection.
Three didactics will be interspersed throughout the workshop in order to supplement
the experiential exercises: (1) theoretical/conceptual similarities and differences
between relaxation and mindfulness approaches; (2) extant research documenting differences
in psychological and physiological mechanisms and outcomes between these approaches;
and (3) implications for clinical practice and research settings. Case examples will
be used to exemplify when relaxation versus mindfulness training would be most clinically
indicated based on evidence-based recommendations. This session deserves to be included
in the program because it provides a depth of theoretical and practical knowledge
that can help clinicians and researchers alike more accurately differentiate between
types of mind-body practices to select interventions best suited to their clients’
needs. This level of nuance, comparing and contrasting specific mind-body approaches,
is also an important next step for moving the field of mind-body medicine forward.
A13 Meditation and medicine – investigating the underlying laws and forces
David Martin, Silke Schwarz
Children’s Hospital, University of Tübingen, Tübingen, 72076, Germany
Correspondence: David Martin (david.martin@med.uni-tuebingen.de)
Meditation is increasingly becoming a relevant health factor: What do students and
physicians need to know? What are the underlying factors and „natural laws“? What
actually happens during meditation? This experiential workshop focuses on the different
types of meditation and what they can do for students, physicians, medical personnel
and patients.
A14 Developing clinical clerkships in Integrative medicine
Diethard Tauschel
Integrated Curriculum for Anthroposophic Medicine, Faculty of Health, University of
Witten/Herdecke, Herdecke, Germany
In this workshop the participants will discover possibilities and problems in establishing,
conducting and sustainably developing clinical clerkships in Integrative Medicine
(IM). This will include aspects of curriculum development like needs assessment, finding
and setting adequate goals, learning objectives and the use of feedback and evaluation.
Participants will be given an overview about the opportunities and challenges of IM
clerkships, examples from 12 years of experiences of establishing and conducting IM
Clerkships within the Integrated Curriculum for Anthroposophic Medicine.
Traditional healing systems
A15 Herbal medicine research: from margins to mainstream
Andrew Flower
University of Southampton, Southampton, SO16 5ST, United Kingdom
This pre-congress-workshop allows the participant to explore different research methods
used to investigate herbal medicines as done at the University of Southampton.
The key domains of herbal medicine research such as quality control, batch consistency,
the importance of stabilising levels of known active compounds, interactions with
pharmaceuticals, model validity, and herbal pharmacokinetics will be considered.
Besides, the idea is to develop a model for future research into herbal medicines
that can incorporate a properly phased, iterative programme of research that will
optimise both pragmatic rigour and the clinical relevance of these investigations.
A16 Cost and health benefits from integrating new age Ayurveda into European health
systems
Harsha Gramminger1,2
1Euroved GmbH, Bell, Germany; 2European Ayurveda Association, Bell, Germany
General Health Costs are spiraling in all developed and developing nations of the
world. In 2013, Germany spent almost € 315 billion on health. This was an increase
of about € 12,1 billion compared to 2012 : 3910,00 € in 2013 vs. 3770,00 € in 2012
per inhabitant.
Type 2 Diabetes, Obesity, Hyperlipidemia, Hypertension & Other “civilization” diseases
are the main factors for these costs. With over 8 million sufferers (in 2009 and growing),
Diabetes Mellitus is one of the most widespread diseases in Germany. Serious “secondary
complications” and “associated diseases”/co-morbidities include heart attack, stroke,
athlete’s foot etc. Total costs € 3.817.00 includes three components: Direct - disease
(), Indirect () & associated complication () Obesity is another new global epidemic
and set to become the “number one health problem globally” by the year 2025. In 2013
52% of all Germans were overweight, which is about 42.02 Million people! The associated
conditions include: Type 2 Diabetes, Hypertension, Vascular diseases, Stroke, Coronary
heart disease, Gall stones, Cancer, Sleep Apnea Syndrome, Diseases of the joints and
of the skin and more. Clinical and practical experience is proven, that Ayurveda is
able to improve the condition of both Type 2 diabetes and Obesity. Furthermore it
is able by its lifestyle guidance and preventive holistic approach, to reduce and
avoid follow – up diseases and costs. The presentation will show with facts and figures
how the wisdom of Ayurveda can be followed for the New Age to prevent, manage and
cure such diseases. Figures for savings to the European Health care costs will be
presented and discussed. The presentation will show with facts and figures how the
wisdom of Ayurveda can be followed for the New Age to prevent, manage and cure such
diseases. Figures for savings to the European Health care costs will be presented
and discussed.
A17 Ayurvedic herbs in modern times
Hedwig H Gupta (info@dr-gupta.de)
Private Medical Practice, Ludwigsburg, 71638, Germany
Ayurveda is an Asian Medical System with a history of more than three thousand years.
Through the centuries, as documented by ayurvedic texts, the materia medica kept changing
slightly as new plants were described and added. But all in all the system stayed
stable as the population using ayurvedic herbs grew only slowly and the usage of ayurvedic
plants was confined mainly to southern Asia.
With the globalization of medical systems and the development of modern life Ayurveda
faces tremendous changes which give rise to many questions that will be discussed
in this presentation as: How can Ayurveda be practiced if more and more people use
its herbs? Many classically described herbs are grown in the Himalayans or other areas
of a very specific climate. Is it feasable and sensible for the whole world to use
these plants? What effects do environmental changes, industrial agriculture of herbs
and pollution have on the quality of herbs? How can locally grown plants be understood
and integrated in a modern and ecologically correct ayurvedic therapy?
A18 West meets east - differences in general attitudes between European and Indian
Ayurveda-patients
SN Gupta1,2 (guptayurveda@yahoo.com)
1Kayacikitsa (PG) Department, J. S. Ayurveda college & P.D. Patel Ayurveda Hospital,
Nadiad (Gujarat), India; 2Academic advisory board, European Academy of Ayurveda, Birstein,
Germany
Human behavior is always influenced by sociocultural environments. This is applicable
also for patients, particularly regarding their attitude towards their disease, its
treatment, their health service providers and co-patients. With a growing popularity
of Ayurveda, contacts of European patients with Ayurvedic doctors are also growing.
Socio-cultural differences may cause bilateral difficulties, often in the form of
a cultural shock. To develop a physician-patient rapport, it is essential for the
physician to understand these aspects, in which European patients differ from their
Indian counterparts.
The article is not based on a scientific research, but on a 20 years’ observation
in treating a great number of European patients in India and in Germany.
Faith and evidence
For Indians faith in the system is prime. For them the tradition of thousands of years
is not challengeable. While in the West, an evidence based rational approach is the
dominant factor. Decisions and actions are less emotionally driven as in Indians.
Religious and spiritual beliefs play important roles in the context of healing for
Indian patients, while Europeans expect scientifically evaluated therapies.
Individuality and relationship
Familial and social bonds in India are very strong therefore family members or close
friends of a patient take care of the basic needs even a decision about treatment.
While In the West, since the individuality is dominating, usually patient has to look
after himself together with a decision about the treatment.
Disclosing ability
Western patients are very good in disclosing and explaining their problems, which
is helpful for the physician. While in India, certain aspects of life, though very
important e.g. sex, are still taboos.
Privacy
If European patients tend to respect other patients’ privacy and not embarras them
by intervening while Indians, when upset, generally value people showing concern.
Accuracy
Europeans expect accuracy in everything. These features are seldom seen in Indian
patients.
The mentioned differences still can be observed in most parts of India. But a few
westernized islands already exist in India, too, mainly in urban Indian centers, where
the differences are not as obvious.
A19 Home remedies from all over the world – evaluation and education
Annette Kerckhoff
Naturopathy, Charité University Hospital, Berlin, Germany
This workshop focuses on the evaluation of traditional folk remedies from all over
the world. The top ten ingredients for home remedies will be examined closer; relevant
data from food pharmacology and clinical trials will be presented to understand the
active principle. Reliable and safe simple interventions are presented and advice
for education is given.
These evaluated interventions using easy-to-get, worldwide spread and cheap ingredients
can support health and self-efficacy.
A20 Ayurveda in Europe– what’s needed when healing tradition travels abroad?
Christian S Kessler1,2, Andreas Michalsen1,2
1Institute of Social Medicine, Epidemiology and Health Economics, Charité University,
Berlin, Germany; 2Department for Complementary Medicine, Immanuel Hospital Berlin,
Berlin, Germany
Correspondence: Christian S Kessler (c.kessler@immanuel.de)
Ayurveda is one of the oldest codified traditional systems of medicine worldwide.
During the last decades an increasing usage and acceptance of Ayurveda in countries
outside of its original context, particularly in European countries and North America,
has been observed. Notably, Ayurveda has developed quite heterogeneously during this
journey by interacting with other concepts of healing and philosophy. Depending on
where and by whom it is being practiced and called upon, it has taken different shapes
to different degrees depending on a significant number of cultural, political, economic,
geographical and other factors. Due to this complexity, interdisciplinary Ayurveda
research and networking is required in all related fields, e.g. medicine, anthropology,
philosophy, Indology, religious sciences and health economics, in order to further
clarify Ayurveda’s current statuses in Western countries and its health care potentials
in countries outside of South Asia. This pre-conference workshop invites (1) leading
scientists in the field to present their research work related to Ayurveda as practiced
outside of South Asia, (2) senior clinicians with long standing expertise in treating
patients with Ayurvedic medicine in Western contexts to share their experience, and
(3) board members of the leading Western therapists’ associations for Ayurveda (DÄGAM,VEAT,
AFGIM, EUAA, EURAMA, DGA and others) to highlight crucial aspects related to national/supranational
health care economics and policy making. This session deserves to be included in the
program because Ayurveda is one of the fastest growing traditional systems of medicine
in Western countries, however, it is still lacking acceptance as a whole system of
medicine in conventional mainstream medicine. This session aims to develop strategies
for a long-term inclusion of evidence-based Ayurvedic therapies into reimbursable
Western health care delivery and health education in countries outside of South Asia.
6 interconnected short presentations (10 + 3 min.) will be followed by a 40 min. round
table discussion to conclude the 120 min. session.
A21 Clinical trials on Ayurveda in western countries: implications for future projects
Christian S Kessler1,2 (c.kessler@immanuel.de)
1Institute for Social Medicine, Epidemiology and Health Economics, Charité University,
Berlin, Germany; 2Immanuel Hospital Berlin, Department for Complementary Medicine,
Berlin, Germany
Clinical research on traditional systems of medicine like Ayurveda should not just
be doing research on unconventional therapies by using conventional methodology. Several
issues have to be taken into account in order to facilitate a successful implementation
of clinical trials that should simultaneously fulfill quality criteria of modern research
methodology and internal criteria of complex whole systems approaches like Ayurveda.
Moreover, within international collaboration projects cultural-, context- and setting-aspects
as well as clear research communication between partners have to be taken into account
in order to guarantee fruitful research cooperation. Experiences from clinical trials
on Ayurveda in Germany will be presented, outlining chances, challenges, obstacles
and pitfalls.
A22 Integrative Korean medicine treatment for the management of pregnant women’s health:
Korean medicine approach
Eun S. Kim1, Eun H. Jang2, Rana Kim3, Sae B. Jan1
1Gynecology in Korean Medicine, You and Green Korean Medical Clinic, Daejeon, 35262,
South Korea; 2Acupuncture, You and Green Korean Medical Clinic, Daejeon, 35262, South
Korea; 3Obstetrics and Gynecology, You and Green Korean Medical Clinic, Daejeon, 35262,
South Korea
Correspondence: Eun S. Kim (greenmiz@naver.com)
During the process of treating diseases and enhancing the health of pregnant women,
Korean Medical Treatment increases rate of success of other medical treatments, at
the same time as reducing any complications to help maintain pregnancy and induce
term delivery. Under the binary medical system, separated as western and Korean Medicine
Systems, there are various treatment modules for the improvement of pregnant women
and the management of diseases during pregnancy.
In this respect, we suggest Korean Medical Treatment including acupuncture, moxibustion,
hip steam bath, and traditional medicine as an effective adjuvant tool, could help
reduce any complication caused by other medical treatments and even help improve health
of patients overall. As the title of this year’s conference means, for the comprehensive
patient care, introduction of integrative Korean Medicine Treatment would give a safe
and effective way to reduce complications and, later improve overall health of patients
psychologically and physically.
On the whole, Korean gynecology, based on the theory of traditional Korean Medicine,
encompasses the disciplines of physiology and pathology of pregnant women from conception
till delivery. Emesis gravidarum or cold is a common complication that occurs during
early pregnancy period. It is possible to treat common cold with proper management
of symptom such as prevention of pathogenic factors. Abortions such as threatened
abortion can be prevented with inducing hemostasis and speeding up the absorption
of hematoma.
There might be preterm labor associated with development of the fetus during the mid-pregnancy
because of plummeting bearing capacity of uterine lining. This can be improved by
increasing blood flow to uttering lining. Even in case of placenta previa, increasing
blood flow to placenta would prevent abruption of placenta and slow down placenta
previa. Amniotic fluid is interrelated with nutrition supply to fetus, so oligohydramnios
can be partially improved just by increasing blood flow to the fetus. Growth of the
fetus gives strain on your waist and causes musculoskeletal pain. Once the blood flow
to the fetus naturally increases, muscles and ligaments supporting musculoskeletal
system weaken. Consequently, musculoskeletal pain occurs in spite of little movement.
This can be improved by applying acupuncture, moxibustion, Korean physical therapy.
Delivery can be completed by the contraction of uterus. In Korean medicine, natural
delivery does not mean reducing the pain, but shortening the pain interval. Thus,
maximizing blood flow to uterine lining would shorten pain interval to achieve natural
delivery.
A23 Ayurveda and salutogenesis
Martin Mittwede (martin.mittwede@ayurveda-akademie.org)
Director, Faculty of Ayurvedic Medicine, European Academy of Ayurveda, Birstein, Germany
Since more than 2500 years Ayurveda is based on concepts that were developed from
a combination of philosophy and clinical practice. From a modern perspective we have
to ask whether Ayurveda is more than a philosophy of life or a knowledge system. Traditional
systems of medicine have a strong focus on health, wellbeing and prevention.
Ayurveda does not only include medicine and therapy, but is also a teaching of balanced
life. On the basis of knowing oneself and knowing what is really strengthening or
weakening in life, right decisions can be made which are the basis of action in everyday
life and lead to good habits.
In this sense, knowledge of life also includes profound self-knowledge and healthoriented
action. Inner and outer reality are connected to one another and give an integrated
feeling of life (sense of coherence in the sense of salutogenesis)
Through scientific research, not only the successes of Ayurvedic therapies can be
examined, but also the beneficial effects of a balanced life. It is important that
the research approaches reflect the complex nature of the ayurvedic system and the
multifactorial genesis of health as well.
By comparing Ayurveda with concepts of Salutogenesis deeper insights in traditional
medical systems can be reached; and these can inspire new lines of empirical research.
A24 Introducing Ayurveda in a GP practice
Wiebke Mohme (mohme@gmx.net)
Ayurveda and naturopathy, General Practice, Hamburg Eimsbüttel, Germany
A large percentage of patients asking for Ayurveda in my GP practice suffer from stress-related
and psychosomatic diseases. Ayurvedic concepts of lifestyle changes, diet, physical
therapies and phytotherapy tailored to the individual state and constitution offer
a perspective towards healing. Due to limited resources in terms of time, finances
and availability of remedies and therapies practical approaches have to be chosen
to translate these concepts into practical steps that fit into patients’ everyday
life. To talk with the patients and explaining everything in a way they can relate
to becomes crucible. The inclusion of yoga practice, breathing techniques, relaxation
and meditation have proven useful and effective. The focus is on supporting the patient's
motivation to change their condition, and exploring the patient's resources, skills
and potential. If a condition cannot be changed it is important to foster acceptance
of what is. Since most of the success of a treatment depends on the patient's cooperation
and homework, anything that is offered has to add a sense of joy and satisfaction
to their life.
Various topics
A25 Refugees with chronic diseases between the Middle-East and Europe: the role of
traditional and integrative medicine in bridging gaps
Eran Ben-Arye1,2, Massimo Bonucci3, Bashar Saad4, Thomas Breitkreuz5,6, Elio Rossi7,8,
Rejin Kebudi9, Michel Daher10, Samaher Razaq11, Nahla Gafer12, Omar Nimri13, Mohamed
Hablas14, Gunver Sophia Kienle15, Noah Samuels16, Michael Silbermann17
1Integrative Oncology Program, Lin Medical center, Clalit Health Services, Haifa,
Israel; 2Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;
3The Association for Integrative Oncologic Therapies Research (A.R.T.O.I.), Rome,
Italy; 4Al-Qasemi Academy, Baqa El-Gharbia, Israel; 5Die Filderklinik, Stuttgart,
Germany; 6Paracelsus-Krankenhaus Unterlengenhardt, Bad Liebenzell, Germany; 7ASL Tuscany
North West, Lucca, Italy; 8Tuscan Network for Integrative Oncology, Florence, Italy;
9Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey; 10St. George Hospital,
Balamand University, Beirut, Lebanon; 11Children’s Welfare Teaching Hospital, Baghdad,
Iraq; 12Radiation & Isotope Centre, Khartoum, Sudan; 13Ministry of Health, Amman,
Jordan; 14Palliative Care Services, Gharbiya Cancer Society, Al Gharbiya, Egypt; 15University
of Witten/Herdecke, Freiburg, Germany; 16Tal Center for Integrative Oncology, Institute
of Oncology, Sheba Medical Center, Ramat Gan, Israel; 17Middle East Cancer Consortium,
Haifa, Israel
Correspondence: Eran Ben-Arye (eranben@netvision.net.il)
The recent wave of immigration from the Middle-East to Europe has intensified the
need to find a model for supportive care which is tailored to the dominant paradigm
of health belief among refugees, with its high affinity for complementary and traditional
(CTM) medicine. The Middle-Eastern context of health care contrasts significantly
from that of integrative medicine research and clinical practice which is prevalent
in Europe and other developed nations, where complementary medicine is typically used
by patients from the upper socio-economic and educational level of society. The goal
of the workshop will be to address the cross-cultural health conflicts experienced
by refugees from the Middle East who have fled to Europe. The workshop will be comprised
of integrative physicians from Middle Eastern countries invited by the Middle-East
Cancer Consortium, as well as leading European figures from the field of integrative
medicine. This workshop reflects the commitment of clinicians and researchers from
Europe and the Middle East to bridge cross-cultural gaps experienced by refugees and
health care providers by the use of an integrative bio-psycho-social-spiritual approach.
Young people in integrative healthcare – workshops
Y1 Open dialogue with experts - Integrative Medicine: A Conversation with Experts
Lena Bandelin, Anna-Lena Lang
Institute for Social Medicine, Epidemiology and Health Economics, Charité University
Hospital, Berlin, Germany
This workshop will provide a space for conversation between students, young doctors,
practitioners, and experts in the field of integrative medicine. This meeting will
be casual in nature, where general questions that represent the diverse perspective
may be asked to explore issues related to pursuing a career in integrative medicine.
This session is for people who may ponder: What does integrative medicine mean to
me? What does a holistic approach to patient care mean? Where do I see myself in the
medical health system of the future? How will I get there? What integrative medicine
resources are available to me to inform and improve medical practice? Hearing perspective
from experts in various fields of integrative medicine whose work ranges from research
to patient care, inpatient to outpatient practice, and public to private practice
will help the attendee of this session have a better understanding of how to navigate
their journey in integrative medicine. Possible experts that may serve on this panel
include: Michalsen (Naturopathic medicine), Stange (Naturopathic medicine), Kessler
(Ayurveda), Chris von Scheid (MBM), Haramati (Mindfulness), Brinkhaus (TCM), Girke
(Anthroposophic Medicine)
Y2 Integrative medicine hands on workshop
Eva Wartner
Naturopathy, Immanuel Hospital Berlin-Wannsee, Berlin, Germany
90 minutes of Integrative Medicine/CAM practice! Discover elements of different IM
disciplines through hands-on experience. Join us for cupping massage, sound therapy,
phytotherapy, wet packs, yoga, dietary and mind body medicine. Leave with new knowledge
and skills that you can immediately incorporate into your practice.
Y3 Integrative medicine online
Christoph Holtermann
Pediatrics, Filderklinik, Filderstadt, Germany
How does integrative medicine relate to the Internet? How do people interested in
integrated medicine network and access information? This workshop will explore these
questions using online networking and information tools like Facebook, mailing lists,
and Wikipedia as case studies. The focus will be on how we are both affecting the
medium and being shaped by the medium. How can we best utilize these resources to
effectively communicate with one another? How can we further utilize these tools to
address the questions and tasks necessary for integrative medicine’s development and
success in the future?
Y4 Comparing medical student integrative medicine curricula from around the world
Maxwell Binstock
University of California, Berkeley, CA 94720-4206, USA
This event will explore the various integrative medicine curricula available to undergraduate
medical students in different countries. Our panel will have medical student representatives
from a diverse array of countries. They will share the student experience of integrative
medicine education, including, but not limited to accessibility, topics, and curriculum
design. We will compare and contrast programs from different countries and explore
facilitators and barriers to undergraduate medical student learning and practice of
integrative medicine. Ample time will be left for additional perspectives from other
students in the audience as well as questions. The purpose of this session is to give
students and educators additional insight, inspiration, and ideas of how to improve
integrative medicine education for their country's undergraduate medical student.
This workshop is meant for students, educators, practitioners, and researchers.
Y5 Composing the moment
Robert Riebau, Edin Mujkanovic
Institute for Music Scieneces and Music Pedagogy, University of Osnabrück, 49074 Osnabrück,
Germany
Music may give one access to inspiring experiences of the moment. In our workshop
we will explore unconventional techniques to get in touch with our creative energy.
It is not about being "right" or "wrong," but rather learning how to have an open
mind. We will have fun communicating and improvising through various instruments and
sound making objects. Come on out and play!
Symposia
Research
X1 Yoga in therapy and prevention: the current state of the science on utilization,
efficacy and safety
Holger Cramer1, Romy Lauche2, Andres Michalsen3, Lesley Ward4
1University of Duisburg-Essen, Essen, Germany; 2University of Technology Sydney, Sydney,
Australia; 3Charité – University Medical Centre, Berlin, Germany; 4Oxford University,
Oxford, UK
Correspondence: Holger Cramer (h.cramer@kliniken-essen-mitte.de)
As yoga is gaining increased popularity as a therapeutic practice, it has become one
of the therapies with the most rapid increase in prevalence. Accordingly, yoga’s potential
as a preventive or therapeutic means has been explored in a growing number of clinical
trials to date. The purpose of this symposium is to present a comprehensive overview
on the state of the science on the application of yoga in therapy and prevention.
Presenters will review scientific research on utilization, efficacy, and safety of
yoga for the general population as well as for selected patient samples with specific
mental or physical conditions. Dr. Lauche will present data on the association between
yoga and weight control from clinical trials, systematic reviews and current cross-sectional
analyses. Dr. Michalsen’s presentation will cover the current state of knowledge on
yoga for stress reduction and include results of a new study on yoga for stress reduction
in schools. Dr. Ward will present data on yoga for pregnancy, and for neurological
conditions; and discuss the content of yoga interventions which have been developed
for these conditions. Dr. Cramer’s presentation will cover the current state of knowledge
on the safety of yoga both in clinical care and in everyday use. Presenters will also
describe highlights of their own ongoing yoga research initiatives to further illustrate
these concepts and approaches; and recent trends, developments and future directions
for this field of research.
Given its relatively low costs, yoga could easily be implemented worldwide as a preventive
or therapeutic means for a variety of important health conditions. As such, health-care
providers are increasingly presented with patients using, or interested in trying,
yoga for the management of their medical conditions. This increased use of yoga raises
the issue of the efficacy and safety of yoga as a prevention strategy and therapy.
The symposium will present up-to-date scientific evidence on the prevalence and patterns
of yoga use as well as on the efficacy and safety of yoga for health conditions of
global medical and socioeconomic importance. This information will promote evidence-based
decision making on the clinical application of preventive or therapeutic yoga interventions.
Gaps and open question in current research and implications for further studies will
also be highlighted. The symposium thus aims to improve both clinical decision making
and research quality on one of the most prevalent complementary therapies used for
the prevention and therapy of chronic health conditions.
X2 The safety of yoga – a comprehensive review of clinical and epidemiological data
Holger Cramer
Department of Internal and Integrative Medicine, University of Duisburg-Essen, Essen,
45276, Germany
While yoga has long been viewed as a cure without harm, this view has been challenged
in recent years. Mainly based on anecdotal evidence, the safety of yoga has been questioned
in a number of lay-press articles. These publications seem to have led to a general
uncertainty among yoga practitioners and those interested in starting practice.
To address this issue from a scientific perspective, the results of a systematic review
of case reports on yoga-associated injuries and other adverse events are presented.
Systematic reviews as well as own studies on epidemiological data will also be reported,
assessing data from more than 10,000 yoga practitioners. Large population-based surveys
on associations of yoga practice with falls, injuries, and joint problems will be
covered. Further, clinical data will be presented in a meta-analysis on all available
randomized trials on yoga reporting on safety-related data. In total, 94 trials with
more than 8,400 participants were analyzed.
The available evidence shows that just as any other mental or physical practice, yoga
is indeed associated with certain risks of injuries and other adverse events. However,
yoga appears just as safe as other forms of exercise. Between one in four and one
third of yoga practitioners have been injured or suffered another adverse event due
to their yoga practice; however most were mild and transient. Given that yoga has
been shown effective for a number of conditions and risk constellations, there no
need to discourage yoga practice for healthy people or those with underlying physical
or mental ailments.
X3 Effects of integrative medicine on purinergic signalling and on the autonomous
nervous system - implications for the treatment of anxiety and pain
Dominik Irnich1, Wolfram Stör2, Geoffrey Burnstock3, Hans-Georg Schaible4, Thomas
Ots5
1Department of Anesthesiology, Multidisciplinary Pain Centre, University of Munich,
Munich, Germany; 2German Medical Association for Acupuncture (DÄGfA), Munich, Germany;
3Autonomic Neuroscience Centre, University College Medical School, London, NW3 2PF,
United Kingdom; 4Institute of Physiology, University of Jena, Jena, Germany; 5Private
practice, Graz, Austria
Correspondence: Dominik Irnich (dominik.irnich@med.uni-muenchen.de)
This session presents the scientific underpinnings of the mind–body connection documenting
the numerous interactions of the peripheral, autonomous and central nervous system.
First, this session will provide important background information about how these
systems profoundly impact human functioning, and how this can be modulated on different
levels by techniques like acupuncture, neuraltherapy, meditation, relaxation techniques
and movement therapies.
Second, it will be assessed how this knowledge can be translated into daily practice
to achieve long term effects in chronic pain and anxiety disorders.
Strategies using a patient-centered approach will be presented for group treatment
as well as in an individualized setting. Speakers will demonstrate that desensitization,
somatic awareness, understanding, respect, discipline, empathy and patience are the
basic principles of a successful treatment.
X4 Integrative gastroenterology
Jost Langhorst (j.langhorst@kliniken-essen-mitte.de)
Kliniken Essen-Mitte, University of Duisburg-Essen, Duisburg, Germany
Expertise
I have serious experiences regarding conference’ and session’ organizing and have
chaired and held sessions at several conferences, in the field of complementary medicine
as well as in gastroenterology and internal medicine. I have published numerous articles
in the field of gastroenterology, conventional and complementary. Integrative gastroenterology
can be considered my field of expertise, witnessed by several trials and publications.
I am the director of the department for integrative gastroenterology with special
focus on patient care and clinical as well as basic research. I am the expert in the
field for complementary and alternative medicine (CAM) and psychosomatic medicine
in Inflammatory bowel diseases for the German Society of Gastroenterology (DGVS).
I am capable of organizing this session in an intelligent and forward fashion. The
invited speakers demonstrate outstanding experience in high quality research in integrative
gastroenterology on an international level. They have all been attending or organizing
conferences in the past and are well recognized and leading experts in the field of
integrative gastroenterology. We expect this session to be a success.
Synospis
There is a huge interest of the public in an integrative approach implementing complementary
treatment approaches into gastroenterology; however evidence for the efficacy and
safety of complementary therapies is still sparse or of lower quality in various fields
leading to dissatisfaction among patients and practitioners. During the past years
several trials and reviews have been conducted increasing the evidence base for integrative
gastroenterology. Chinese Medicine has a long history in the treatment of digestive
disease and with faecal microbiota transfer an old therapy strategy with a long history
in medicine is gaining more and more attention at the moment. This is based on the
enormous interest in the scientific field of the microbiome where fascinating interactions
between the mind and the microbiome have been proposed.
The purpose of this symposium is to present recent clinical trials, systematic reviews
and basic research on complementary and alternative therapies with the focus on Chinese
Medicine, faecal microbial transfer and the mind-gut axis. The presenters, coming
from three different continents, will not only provide the most recent developments
in the field of integrative gastroenterology, but also point out blind spots of current
research in order to direct future research for the best possible patient care. The
presenters will further describe highlights of their own ongoing research initiatives
in the field of integrative gastroenterology. The session will consist of three talks.
X5 Yoga for weight loss and weight control – a critical review of research findings
Romy Lauche
Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University
of Technology Sydney, Ultimo, 2007, Australia
The rates of overweight and obesity have reached epidemic proportions worldwide, with
nearly two in three people in Germany, Australia and the United States classified
as overweight or obese. A large percentage of complementary medicine interventions
specifically target overweight and obesity, and as such it is not surprising that
weight loss is one of the most frequently stated reasons for many CM practices including
yoga. Yoga is in fact regularly advertised as the magic remedy for weight management
in public yet a lack of quality research has been identified to fully understand the
role of yoga in weight management, from public health and clinical perspectives.
The aim of this presentation is to evaluate latest research on the associations of
yoga with dietary patterns, body weight, body image and eating disorders, and methods
to lose or control weight; to summarize findings from clinical trials and systematic
reviews; and to discuss directions for future research needed to establish a scientific
foundation for the use of yoga in overweight and obesity.
X6 Evidence-based assessment of integrated care for pain – how do we best integrate
different outcomes, to understand the effects of integrated care?
Tobias Sundberg, Torkel Falkenberg
IC –The Integrative Care Science Center, Stockholm, Sweden
Correspondence: Tobias Sundberg (tobias.sundberg@integrativecare.se)
Brief summary
The overall aim of this session is to present and inform international stakeholder
perspectives and expert opinions on integrating different outcomes in the evaluation
of integrated care, i.e. the evidencebased assessment of integrated healthcare interventions
for pain.
Timeline (90 minutes)
A panel of researchers and stakeholders will share their expert perspectives, experiences
and opinions about the integration of outcomes in the assessment of integrated pain
rehabilitation interventions. (45 min)
The audience is invited to contribute to the discussion sharing their views of integrated
outcomes for integrated care via a panel dialogue, possibly complemented by means
of small group participatory "think tanks". (30 min)
The session will finish by summarizing the proposed "best" outcomes to be integrated
and used in the evaluation of integrated care for pain. (15 min)
Why this session deserves to be in the program
The impact of bringing together expert opinions from key stakeholders including research
and industry leaders to summarize scientific outcomes for evidence-based assessment
of integrated pain rehabilitation is anticipated to be of high importance contributing
to improved understanding of the use of integrated outcomes in integrated care for
pain in clinical practice and research. Additionally, it is the organizers' intention
that this session will contribute with information and outcomes to inform a subsequent
report. Importantly, together with data from a literature review, this session may
contribute with information to a proposed "toolbox", i.e. a document that can be used
by different stakeholders for informing relevant evidence-based assessments of healthcare
interventions with a special emphasis on integrating multiple outcomes in the evaluation
of integrated care for pain.
The audience will
Gain international stakeholder perspectives and expert opinions on the integration
of outcomes in the evaluation of integrated care for pain.
Gain knowledge about clinical and research based outcomes for evidence-based assessment
of integrated care for pain.
Take home ideas and hypothesis with relevance for clinical practice and future research
in the area of integrated care for pain.
Clinical care
X7 Implementation of integrative medicine in a german pediatric hospital setting –
clinical realization of complementary and alternative treatment approaches
Catherina Amarell
Kinderkrankenhaus St. Marien, Landshut, Germany
Complementary and alternative medicine (CAM) can support and amplify traditional therapies,
especially in children. However, they are barely being used in in-patient treatment.
The children’s hospital St. Marien initialized a responsible use of CAM as part of
a model project.
Over the past years, CAM methods were integrated into routine pediatric care of the
hospital in in-house and outpatient treatments. Complementary treatments are not only
provided for acute illness like upper airway nfections, headache or abdominal pain
but are also offered as a supportive treatment to children with chronic illnesses.
The clinical implementation of these treatments was undertaken in close collaboration
of all healthcare professionals (nurses, physiotherapists, doctors, etc).
Different modalities were implemented, using methods of acupressure, relaxation techniques,
herbal medicine, wraps and poultices and aromatherapy.
Regular in-house trainings led to broad knowledge and embedding of different techniques
in all therapeutic areas.
One important pillar of implementation is the education of parents. Parents are regularly
involved in the implementation process, receiving guidance on how to apply CAM and
also receiving informational material informing them of possible complementary treatments
as well as recommended life style changes for their children.
X8 Update on pediatric integrative medicine – three main topics – upper airway infections
Catherina Amarell
Kinderkrankenhaus St. Marien, Landshut, Germany
Upper respiratory tract infections (URI) are very common among children and account
for a majority of visits to pediatric clinics. A small child suffers from about 6-10
URIs per year. They are usually mild, 90% viral and self-limiting, however the symptoms
can cause irritability, fever and great discomfort- both for the child and the parents.
Antibiotic treatment is not necessary in uncomplicated URI episodes. Over the counter
medicines („conventional”and complementary products) are widely used, but many of
them are not effective (or: evidenced based) and can even cause a variety of side
effects, particularly in very young children.
In this part of the symposium an update will be given on integrative approaches of
treatment strategies for URIs by taking into account not only current evidenced based
treatments to shorten the duration and reduce symptoms, but also taking a closer look
at home remedies, dietary changes, supplements and lifestyle changes.
X9 Update on pediatric integrative medicine – three main topics - chronic headaches
Melanie Anheyer
Elisabeth Krankenhaus Essen, Essen, Germany
Headaches are one of the most common pain conditions in children. The worldwide prevalence
is estimated about 58.4%, with an increasing incidence during the last years. The
classification of headache for children and adolescents as well as for adults is defined
by the International headache Society and published in the International Classification
of Headache Disorders III (ICHD-3). The most common headache types in childhood are
migraine and tension-type headaches. Both types are generally associated with a reduction
of overall quality of live and a high frequency of school absence.
This part of the session will give an overview of the current evidence for integrative
treatment options of primary chronic headaches in children and adolescents. On this
occasion especially mind body therapies, acupuncture, herbal medicine and nutritional
supplements will be taken into account.
X10 Implementation of integrative medicine in a german pediatric hospital setting–
development of a concept and steps towards realization
Marion Eckert (dr-eckert@t-online.de)
Kinderkrankenhaus St. Marien, Landshut, Germany
Complementary and Alternative Medicine (CAM) has not been systematically institutionalized
in the pediatric care so far. Therefore it is often used without the knowledge of
the attending pediatrician and compartmentalized mostly into the outpatient care.
For the responsible implementation and systematic evaluation of complementary medicine
in pediatric care a model project “Integrative Pediatrics – implementation of naturopathic
and complementary medicine in pediatrics” was initialized in 3 different pediatric
hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” Landshut.
Within this project we started to implement CAM Methods in the pediatric routine care
of the hospital and the outpatient setting. A concept of the implementation process
has been developed based on clinical care, teaching and scientific evaluation. The
concept and the main steps which lead to successful implementation will be presented
and individual speakers will introduce the audience into selected treatment modalities
implemented and scientifically evaluated over the period of one year.
X11 Update on pediatric integrative medicine - three main topics - functional abdominal
pain
Marion Eckert1, Mercedes Ogal2
1Kinderkrankenhaus St. Marien, Landshut, Germany; 2Arztpraxis für Kinder und Jugendliche,
Brunnen, Switzerland
Correspondence: Marion Eckert (dr-eckert@t-online.de)
Abdominal pain is a common complaint of many children. According to the KiGGS study
up to 69% of all 3- to10-year old children and about 60% of all children age 11-17-years
complain about abdominal pain over the period of 3 months. The entity of functional
abdominal pain is considerd to make for about 8% percent of abdominal pain episodes
in children. It is characterized and defined as ROME III criteria and many times difficult
to diagnose and treat.
Many children undergo numerous diagnostic tests and sometimes painful procedures before
the diagnosis functional abdominal pain is made. The ROME III criteria were developed
to avoid unnecessary diagnostic tests and help facilitate the diagnosis.
It still is challenging to treat and give the children strategies to deal with their
pain.
In this part of the symposium we will focus on giving an update on the current evidenced
based treatment strategies in „conventional medicine“ and also focus on evidenced
based integrative approaches for functionel abdominal pain in different treatment
settings.
X12 Implementation of integrative medicine in a german pediatric hospital setting
– concept and realization using the example of the Kinderkrankenhaus St. Marien, Landshut
Marion Eckert1, Catherina Amarell1, Annette Schönauer1, Birgit Reisenberger1, Bernhard
Brand1, Dennis Anheyer2, Gustav Dobos2
1 Kinderkrankenhaus St. Marien, Landshut, Germany; 2Klinik für Naturheilkunde und
Integrative Medizin, Knappschafts-Krankenhaus, Kliniken Essen-Mitte, Essen, Germany
Correspondence: Marion Eckert (dr-eckert@t-online.de)
Complementary and Alternative Medicine (CAM) has not been systematically institutionalized
in the pediatric care so far. Therefore it is often used without the knowledge of
the attending pediatrician. The growing interest amongst users as well as therapists
leads to an increasing need of information about safety and efficacy for the CAM methods
used.
For the responsible implementation and systematic evaluation of complementary medicine
in pediatric care a model project Integrative Pediatrics – implementation of naturopathic
and complementary medicine in pediatrics was initialized in 3 different pediatric
hospitals in Germany, one of them being the Kinderkrankenhaus St. Marien Landshut.
Within this project we started to implement CAM Methods in the pediatric routine care
of the hospital and the outpatient setting. A concept of the implementation process
has been developed based on clinical care, teaching and scientific evaluation. The
main steps which lead to successful implementation will be presented and individual
speakers will introduce the audience into selected treatment modalities implemented
over the period of one year. The modalities presented will be methods of TCM, relaxation
techniques, foot reflexology, wraps and poultices, aromatherapy and homeopathy. Other
modalities implemented are yoga and herbal medicine. To evaluate the implementation
process a survey of expectations, knowledge and usage of CAM among patients and the
medical staff was performed at the onset of this project. Also qualitative and quantitative
data of this survey will be presented to the audience.
X13 The anthroposophic-medical approach to the treatment of insomnia, other stress-related
complaints and ADHD
Matthias Kroez1, David Martin2, Harald Matthes3, Aldo Ammendola4
1Interdisciplinary Oncology, Hospital Havelhöhe, Berlin, Germany; 2Pediatrics, University
of Tübingen, Tübingen, Germany; 3Hospital Havelhöhe, Berlin, Germany; 4Weleda AG,
Arlesheim/CH, Arlesheim, Switzerland
Anthroposophic medicine (AM) is an integrative multimodal treatment system based on
a holistic understanding of disease and treatment. It is building on a concept of
four levels of formative forces in nature and on the model of a three-fold human constitution.
AM is practiced by conventionally-trained physicians, therapists and nurses who have
undergone additional, specialized training, learning to apply a broad array of effective
natural medicines. This whole-person approach also incorporates art, music, movement
(eurythmy), and massage therapies as elements of a multidisciplinary health care.
More than forty percent of all adults suffer adverse health effects from perceived
stress, e.g. insomnia; about seventy-five percent of all doctor's office visits are
for stress-related complaints. Stress playing also a role in problems such as headaches,
high blood pressure, diabetes, asthma, arthritis, depression and anxiety is mainly
a hazard of the workplace which costs the industries worldwide several hundreds of
billions Euro annually.
Attention deficit hyperactivity disorder (ADHD) is a mental disorder characterized
by problems paying attention, excessive activity, or disruptive behavior. Despite
being the most commonly studied mental disorder in children, the exact cause is unknown
in the majority of cases. ADHD treatment varies by country and usually involves some
combination of counseling or behavioral therapy, lifestyle changes, and medications.
The anthroposophic-medical approach to stress-related complaints, exemplified in this
symposium by insomnia and other diseases, include counseling with regard to behavioral
changes (daytime and sleep hygiene adapting to an individual circadian rhythm, inner
spiritual sleep preparation e.g. with a review of the day, meditation or prayer),
external applications (lower leg and foot embrocation) e.g. with lavender oil or cuprum
ointment, and anthroposophic medications such as Bryophyllum pinnatum, potentized
Phosphorus, Avena sativa combinations, or possibly also medications such as Neurodoron®
or Cardiodoron® from Weleda AG. Similar approaches to the management of ADHD will
also be presented and discussed.
X14 Advancing the science and care of integrative oncology around the world
Jun J Mao1, Claudia Witt2, Yufei Yang3, Gustav Dobos4
1Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA;
2Institute for Complementary and Integrative Medicine, University Hospital Zurich,
Zurich, Switzerland; 3Clinical Cancer Center in Xiyuan Hospital, China Academy of
Chinese Medical Sciences, Beijing, China; 4Complementary and Integrative Medicine,
Clinic for Internal and Integrative Medicine, University of Duisburg-Essen, Essen,
Germany
Correspondence: Jun J Mao
Advances have been made in research to develop evidence and improve clinical delivery
of integrative onoclogy care. In this international symposium, the speakers will discuss
the current status of clinical care delivery in North America, Europe, and Asia. In
addition, this international group of physician scientists will discuss their own
research in the areas of acupuncture, mind-body medicine, and herbal medicine for
cancer care. Following their talks, they will engage the audience to discuss how to
increase collaboration to advance the science and care of integrative oncology around
the world.
X15 From communication to integration – consultations about complementary medicine
in cancer care
Miriam Oritz1, Markus Horneber2, Petra Voiß3
1Institute for Social Medicine, Epidemiology and Healthe Economics, Charité University,
Berlin, Germany; 2Oncology, Klinikum Nürnberg, Nürnberg, Germany; 3Naturopathy and
Integrative Medicine, University of Duisburg-Essen, Essen, Germany
Correspondence: Miriam Oritz (Miriam.oritz@charite.de)
This session will give an overview about how to effectively communicate with patients
(and relatives) about complementary medicine in routine oncological care. Four talks
will be provided on:
Needs and expectations: a patient’s perspective
Tasks and topics for the health professionals: case presentations
Consultation service: results of a collaborative research project
Implementation strategies: international perspective on consultation models
After the session the audience will
Be able to understandthe oncological patients`perspective
Know about special communication skills in integrative oncology
Know about models for implementing integrative oncology in practice
X16 Implementation of integrative medicine in a german pediatric hospital setting–
integration of foot reflexology as one pillar of an integrative treatment approach
for hospitalized children
Birgit Reisenberger
Kinderkrankenhaus St. Marien, Landshut, Germany
Direct involvement of parents in the treatment of their sick child is very important
for the wellbeing of the child, the parents, as well as for the staff involved in
treating the child. Foot reflexology is a great means to accomplish this goal and
an effective way to provide fast alleviation of symptoms in many cases. Out of the
many indications for the application of foot reflexology we chose two common ailments
in children for which we offer this additional treatment modality: abdominal pain
and lung affections such as bronchitis.
The parents are given teachings by physiotherapists and nurses apply certain techniques
whilst caring for the children. Additionally handouts explaining the technique are
provided. The aim is to offer parents and caretakers of the children a practical and
easy way to alleviate symptoms and activate self-regulating mechanisms in their children
in the hospital and at home.
For scientific evaluation a study was initiated to investigate the effects of the
treatment. Questionnaires were developped to be filled in by the parents before and
2 weeks after the initiation of the intervention. Certain aspects of the parent’s
stress level resulting from their child’s illness, as well as practicability, comprehension
and effectivity of the techniques used are assessed.
So far there has been a very positive feedback and openness to the study and foot
reflexology. It is perceived as an efficient help for the children and also as an
emotional relief for the parents by lowering their own stress levels.
X17 Up-date on integrative pediatrics
Alexandra von Rosenstiel1, Marion Eckert2, Mercedes Ogal3, Catharina Amarell2, Melanie
Anheyer4
1Pediatrics, Rijnstate Hospital, Arnhem, the Netherlands; 2Pediatrics, Kinderkrankenhaus
St. Marien, Landshut, Germany; 3Integrative pediatrics, medical office, Brunnen, Switzerland;
4Pediatrics, Elisabeth Krankenhaus, Essen, Germany
Correspondence: Alexandra von Rosenstiel (Ivonrosenstiel@rijnstate.nl)
The aim of this 90 minute symposium is to equip individual clinicians and multidisciplinary
teams with up-to-date knowledge of an integrative approach to manage common problems
in pediatrics.
For three pediatric key domains (1) chronic headache (2) functional abdominal pain
and (3) upper airway infections the latest scientific research and clinical expertise
on integrative therapies in various age groups will be discussed by pioneers from
3 European countries.
Culture-sensitive concepts and frameworks relevant for informed, shared decision making
with families will be provided.
This session also highlights successful strategies for incorporating integrative pediatrics
into conventional medicine set ups across Europe.
X18 Integrative oncology in anthroposophic medicine - concept, research and clinical
practice
Friedemann Schad1,3*, Marc Schläppi2, Matthias Kröz1,3,4, Arndt Büssing5, Gil Bar-Sela6,
Harald Matthes1,3
1Community Hospital Havelhöhe, 14089 Berlin, Germany; 2Center of Integrative Medicine,
Hospital St. Gallen, 9000 St. Gallen, Switzerland; 3Research Institute Havelhöhe,
14089 Berlin, Germany; 4Institut for Social Medicine, Epidemiology and Health Economics,
Charité University Medicine, 10117 Berlin, Germany; 5Institute for Integrative Medicine,
Faculty of Health, Witten/Herdecke University, 58313, Herdecke, Germany; 6Rambam Health
Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technology Institute
of Israel, 3525433 Haifa, Israel
Correspondence: Friedemann Schad
Background
For decades Anthroposophic Medicine (AM) has provided integrative concepts in cancer
care. In hospitals as well as ambulant settings multimodal integrative oncology (IO)
treatment options have been developed combining high quality provision of conventional
cancer treatment with art therapies, movement therapies, eurythmy therapy and mind
body interventions. In addition, therapeutic nursing interventions, rhythmical massage,
psycho-oncology and mistletoe treatment complement daily care. Based on guideline
orientated medicine, central aspects are the individualized approach, the relationship
between professionals and patients, health related quality of life and patient orientation.
Further development of academic structures and research and exchange with other integrative
concepts are future challenges. The World Congress of Integrative Medicine and Health
2017 (WCIMH) in Berlin, Germany provides the necessary platform to address these aspects
of IO.
Methods
Individual aspects, concepts and clinical practice of IO in Anthroposophic healthcare
will be subsequently deepened in a first WCIMH discussion panel consisting of physicians
from European healthcare institutions which have successfully implemented and exercised
IO concepts.
Results
The panel provides recent data from various fields of IO and AM: clinical outcome
of advanced and metastatic pancreatic cancer treated with standard and IO concepts
in a certified cancer center, multimodal treatment concepts and perspectives of chronic
fatigue in breast cancer patients, and spiritual needs of oncological patients. Furthermore,
research and clinical approaches of IO through the example of Swiss, Israeli and German
hospitals and the implementation in AM concepts will be introduced and discussed.
Conclusion
Addressing academization and implementation of IO concepts in Anthroposophic healthcare
a discussion panel of the WCIMH world congress 2017 was set up to deepen and discuss
results of actual studies, individual approaches, concepts and clinical practice in
this field.
X19 An integrative approach to understanding & managing procedural anxiety - a 3600
perspective
Elad Schiff1,2, Eran Ben-Arye3,4, Zahi Arnon5, David Avshalomov6, Samuel Attias2,7
1Internal Medicine, Bnai Zion Medical Centre, Haifa, Israel; 2Complementary Medicine
Service, Bnai Zion Medical Centre, Haifa, Israel; 3Integrative Oncology Program and
Western Galilee Oncology Service, Lin Medical Center, Clalit Health Services, Haifa,
Israel; 4Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa,
Israel; 5Psychology & Mind-Body therapies, Complementary Medicine Servive, Bnai Zion
Medical Centre, Haifa, Israel; 6Chinese Medicine, Bnai Zion Medical Center, Haifa,
Israel; 7School of Public Health, University of Haifa, Haifa, Israel
Correspondence: Elad Schiff (elad.schiff@b-zion.org.il)
Pre-Operative Anxiety (POA) is associated with a negative patient experience, increased
morbidity, and even mortality. Conventional management of POA is suboptimal and relies
on anxiolytics. Complementary and Integrative Medicine (CIM) therapies have been shown
to reduce POA. In the session, we will present:
Patient’s and health care providers’ perceptions of POA and its impact on patient-provider
communication. We will contemplate at anxiety within the broader bio-psycho-social-spiritual
context of the patient’s health belief model.
We will also present a variety of CIM therapeutic perspectives on POA: Traditional
Chinese Medicine (the "Shen" concept), Reflexology (4 elements theory), Hypnotherapy
(fear of death, and nocebo effects). A hands-on experience will be given for each
modality, so that participants will be able to apply simple techniques for relieving
anxiety.
In addition, we will present findings from state-of-the-art research on CIM for POA
related to obstetric, general surgery/anesthesia, and gastroenterology procedures.
Finally we will share our experience with thousands of patients at Bnai Zion Medical
Center in preventing & treating POA.
Q&A
Session will be interactive with audience mainly during the segment on therapeutic
approaches.
X20 Implementation of integrative medicine in a german pediatric hospital setting
– homeopathy as one pillar of an integrative treatment approach for hospitalized children
Annette Schönauer
Kinderkrankenhaus St. Marien, Landshut, Germany
Over the course of many years, there has been an increasing interest in the homeopathic
treatment of children suffering from various ailments. Not only cough and the common
cold, but also acute diseases such as pneumonia or severe chronic illnesses like rheumatism,
asthma, etc. have been targets for a homeopathic supportive therapy.
For more than 10 years we have been offering a consult service for the homeopathic
complementary treatment for various different diseases in the „Kinderkrankenhaus St.
Marien, Landshut“ with great success. The patients are treated with classical allopathic
and evidence based treatment modalities and additionally a consult service conducted
by a highly experienced homoepathic doctor is offered 24 hours a day. Inhouse teachings
are given on a regular basis to the staff and treatment policies are provided on the
intranet of the hospital.
Patients and families as well as the medical staff highly welcome this additional
possibility of treatment for the children. In a study performed in 2016, 80% oft he
parents who have been offered the additional homeopathic treatment for their child
accepted this option readily. For the staff a more comprehensive treatment of the
whole child is made possible this way.
An overview over the concept for the homepathic care, financing strategies and benefits
for the treatment of hospitalized children will be given during this session.
Education
X21 Challenges, outcomes and lessons learned from implementing a mind-body,edicine
program into the health professions curriculum
Aviad Haramati1, Claudia Witt2, Benno Brinkhaus3, Sian Cotton4, Miek Jong5, Mats Jong6
1School of Medicine, Georgetown University, Washington, DC, United States; 2Institute
for Complementary and Integrative Medicine, University and University Hospital Zurich,
Zurich, Switzerland; 3Institute for Social Medicine, Epidemiology and Health Economics,
Charité - University, Berlin, 10117, Germany; 4Centre for Integrative Health and Wellness,
UC College of Medicine, Cincinnati, OH 45267, USA; 5Louis Bolk Institute, Driebergen,
3972LA, Netherlands; 6Department of Nursing, Mid Sweden University, Sundsvall, Sweden
Correspondence: Aviad Haramati (haramati@georgetown.edu)
Reports from many countries suggest that burnout among physicians and other health
professionals is a pervasive problem and a cause for concern. More than half of all
physicians in practice in the US, and residents in training in Canada, experience
burnout, and this can lead to changes in the patient-provider relationship and can
adversely impact on the quality of care. Some believe that this process begins with
the decline in empathy and rise in cynicism seen during medical school and post-graduate
training. In response, there is increased interest among faculty, adminstrators and
policy makers to develop interventions with medical students, residents and faculty
and provide them with tools to address the rise in chronic stress and burnout and
the decline in resiliency. Keys to this work are themes of self-awareness and mindfulness
and exploring domains of self-care and finding meaning in one’s work. At Georgetown
University School of Medicine, a mind-body medicine skills course was developed to
provide opportunities for students, residents and faculty to experience various mind-body
techniques in a safe, confidential group setting. The program has now been adapted
by a number of other institutions in the US and Europe.
In this 90-minute session, representatives from 6 institutions (Germany, Netherlands,
Sweden, Switzerland and the US) who have implemented mind-body programs will share
perspectives on the challenges they faced, the strategies they used to implement the
program into the curriculum, the outcomes they obtained, and the lessons learned.
The symposium will involve short (10) minute presentations, which will enable at least
a 30 minute discussion with the audience participants.
By the end of the session, participants will be able to:
Describe of the challenges and barriers to implementation of a mind-body medicine
program into the curriculum
Understand the strategies that facilitated the successful curricular implementation
of mind body medicine programs
Delineate some of the outcomes that programs have reported in their students and faculty
X22 Promoting development in one self and others: educating for self-care and leadership
in integrative health care
Christian Scheffer1, Aviad Haramati2, Diethard Tauschel1,3, Friedrich Edelhäuser1,3
1Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke,
Witten Herdecke, Germany; 2School of Medicine, Georgetown University, Washington,
DC, United States; 3Faculty of Health, University of Witten/Herdecke, Witten, Germany
Correspondence: Christian Scheffer (Christian.scheffer@posteo.de)
Integrative Medicine and Health Care focuses on individual preferences, needs and
values of patients. Fast changing health care systems with progressive economization,
with a digital-technologic transformation and with global interdependencies ask for
increased capabilities of health care professionals, especially leadership and self
care. Based on educational research and educational experiences at Georgetown University
in the US and at Witten/Herdecke University in Germany we will present contemporary
learner centered educational tools to meet these challenges.
Adi Haramati will introduce the symposium by outlining the Principles of Mindful Leadership
and then describing how the Mind-Body-Medicine program at Georgetown University School
of Medicine has been effective to foster self-care, self awareness, and professional
identity formation among faculty.
Diethard Tauschel will present successful tools of Self-Directed Learning to Promote
Leadership in Self-Development. Friedrich Edelhäuser will address the topic: Becoming
a Change Agent: Fostering Student Engagement and Transformational Learning. Christian
Scheffer will give the final presentation on the topic: „Responsibility Drives Learning
- Leadership and Self-Care during Active Participation in Patient Care. The latter
three presenters will describe essentials of their educational experiences with the
Integrated Curriculum for Anthroposphice Medicine at Witten Herdecke University. This
90 minute session will include 4 short (15 minute) presentations followed by 30 minutes
of audience participation and discussion,
Participants will be able to:
Understand the basis for self-awareness and self-care as key elements that form the
basis of mindful leadership and also of learner-centered education
Distinguish among various approaches that foster self-awareness
Describe different educational methods to foster leadership in integrative medical
education.
Traditional healing systems
X23 Wet cupping: evidence, guidelines and policy
Abdullah AlBedah1, Myeong Soo Lee2, Mohamed Khalil1
1National Centre for Complementary and Alternative Medicine, MOH, Riyadh, Saudi Arabia;
2Korean Institute of Oriental Medicine, Daejeon, Korea
Correspondence: Abdullah AlBedah (aalbedah33@yahoo.com)
Wet cupping is a leading traditional therapy in Asia and Middle East as a part of
traditional healing systems or as a complementary therapy. The session will give an
overview of taking wet cupping therapy beyond research stages and discuss the experience
of developing guidelines and policy in complementary and integrative medicine. During
the session, Dr AlBedah will highlight the Saudi Governmental experience in regulating
and integrating wet-cupping in the conventional health care. Dr Lee will give a talk
on Cupping therapy in Korean medicine clinical practice guideline, then Dr Khalil
will present a model for evaluating wet cupping evidence and the reality of policy
makings.
Objectives
Policy and regulation of wet cupping in Saudi Arabia, obstacles and opportunities
Developing clinical guidelines in Korea
The scientific evidence and reality of policy making: Model of using wet cupping in
low back pain
X24 Kampo medicine (traditional Japanese medicine) for cancer care under integrated
universal health care coverage in Japan
Keiko Ogawa1, Yoshiharu Motoo1, Junsuke Arimitsu2, Masao Ogawa1, Genki Shimizu3
1Kanazawa University Hospital, Kanazawa, Japan; 2Clinical Immunology, Osaka University,
Suita, Osaka, Japan; 3Departement of East Asian Traditional Medicine, Ehime Prefectural
Central Hospital, Matsuyama, Japan
Correspondence: Keiko Ogawa (ikkandoo@gmail.com)
The effectiveness of traditional Japanese herbal (Kampo) medicine in cancer care is
attracting more and more attention in medical system in Japan.
Kampo is the most frequently used alternative and complementary medicine in Japan.
The aim of Kampo therapy is to improve patients condition whatever their diseases
are. Kampo therapy is unique because its focus is patients condition not their disease.
Therefore, Kampo Medicine plays more and more important roles in closing the gap between
modern modern medicine and demand of patients. It can be also used easily for cancer
patient because it is operated under integrated universal health care by Japanese
government. Patients are diagnosed from both viewpoints of modern and Kampo medicine,
and they are treated with the appropriate combination of both therapies. This characteristic
suggests an ideal form of integrated medicine, where scientific and analytical approach
of western medicine is integrated with holistic approach of Kampo Medicine. Though
its origin was in ancient China, Kampo Medicine has been developed under the influence
of Japanese nature and culture, and nowadays is working as an independent medical
system significantly different from Traditional Chinese Medicine (TCM). We would like
to discuss on the advantage and disadvantage of Kampo medicine for cancer patients
through some clinical researches and reports.
According to four key objectives of WHO strategy, policy to integrate TM within national
health care systems, establishment of the safety, efficacy and quality of TM, and
preservation of the right of patients to access TM. Japanese medical system might
be a good example for countries where traditional medicines are used.
Provide some information on Kampo medicine through some clinical researches and case
reports.
Discuss on the efficacy of Kampo medicine, Japanese medical system, and usage of Kampo
medicine in cancer care.
X25 Phytotherapy in therapy and prevention: current state of science and regulation
and perspectives of future uses
Rainer Stange1,2, Karin Kraft3, Kenny Kuchta4
1Immanuel Krankenhaus, Berlin, Germany; 2Charité University Medical Centre, Berlin,
Germany; 3University of Rostock, Rostock, Germany; 4National Institute of Health Sciences,
Tokyo, Japan
Correspondence: Rainer Stange (r.stange@immanuel.de)
Phytotherapy has been the basis of almost any Traditional Medicine for ages. Appr.
after 1850 and beginning in Europe, there has been increasing use of botanical, pharmaceutical
and later pharmacological scientific efforts to guarantee delivery of phytotherapeutical
products of highest quality and to evaluate their use in therapy as well as to a smaller
part also in preventive medicine for a variety of medical conditions. Today, phytotherapy
is well regulated in countries with Western standards of drug regulation. We overlook
a number of clinical trials of any type as well as reviews and systematic reviews.
Traditional use of phytotherapy esp. as teas or decocts, still is around.
The purpose of this symposium is to present different dimensions on the state of the
science on the application of phytotherapy in therapy and prevention. Presenters will
review scientific research on utilization, efficacy, and safety of phytotherapy for
the general population as well as for selected patient samples with specific mental
or physical conditions. One example will be the current state of knowledge on the
use of phytotherapy for therapy and prevention of infectious diseases, esp. urinary
tract in and airways infections.
Kampo medicine in Japan is a very good case to study its implementation into the Japanese
public health system. Presently, freeze-dried granules of 148 traditional prescriptions
are covered by public health insurance in Japan. One of these is Yokukansan, a novel
phytotherapeutic preparation for the treatment of neuronal disorders on the basis
of traditional Japanese Kampo medicine.
Given its relatively low costs, phytotherapy could easily be implemented worldwide
as a preventive or therapeutic means for a variety of important health conditions.
As such, health-care providers are increasingly presented with patients using, or
interested in trying, phytotherapy for the management of their medical conditions.
This increased use of phytotherapy raises the issue of the efficacy and safety of
phytotherapy as a prevention strategy and therapy.
Gaps and open question in current research and implications for further studies will
also be highlighted. The symposium thus aims to improve both clinical decision making
and research quality on one of the most prevalent complementary therapies used for
the prevention and therapy of chronic health conditions.
Given its relatively low costs and so far good safety records, phytotherapy should
be implemented on a wider sale, as is also suggested by WHO with its quest for broader
acceptance and understanding of Traditional Medicines.
X26 Globalization of traditional healing systems
Kenji Watanabe (watanabekenji@keio.jp)
Keio University, Tokyo, Japan
International classification of diseases (ICD) is an international platform for health
statistics of mortality and morbidity since 1900. In 2018, ICD-11 will be launched
and traditional healing system will be incorporated at the first time in the long
history of ICD. First Traditional healing system features the Asian Traditional Medicine
originating from ancitne China. Other modalities such as Ayurveda or Unani are expected
to follow in future. This session will spotlight the meaning of the globalization
of traditional healing system.
Medicine and arts
X27 Therapeutic recitation in anthroposophic therapeutic speech: physiological and
psychological interactions of respiration, pulse and well-being
D Bonin
GTM, Anthroposophic Therapeutic Speech, Bern, Switzerland
Objectives
In two studies we investigated cardiorespiratory synchronization in healthy subjects
during (simultaneous effects) and after (immediate effects) recitation of ancient
verse (Hexameter, H/Alitteration A), controlled and spontaneous breathing (C and S)
as well as random conversation (R). Cardiorespiratory synchronization was analyzed
with respect to the oscillations in heart rate induced by respiration, i.e. respiratory
sinus arrhythmia (RSA) and a respiratory trace. Ancient verse (e.g. Hexameter) is
used frequently in Anthroposophic Speech Therapy ATS, and effects of stress reduction
and improved breathing have been attributed to its therapeutic application.
Methods
Simultaneous effects study
20 healthy subjects were included in the study. Each subject had to perform three
different exercises in the following sequence: 15 min. sitting - 20 min. walking and
exercise - 15 min. sitting. The exercises were: Hexameter exercise (H), Controlled
breathing (C), Spontaneous breathing (S).
Immediate effects study
7 healthy subjects were included in the study. Each subject had to perform three different
exercises in the following sequence: 15 min. sitting (S1) - 30 min. walking and exercise
- 15 min. sitting (S2). To ensure comparable levels of physical activity during the
exercises, the subjects walked at a pace of 50 steps/min. The exercises performed
were: Hexameter exercise (H), Alitterative verse (A), Random conversation (R). The
participants were asked to comment on mood-changes in free text.
Results
Simultaneous efffects study [1]
In total 180 recordings were analysed. All exercises showed an increase in heart rate,
whereas heart rate always decreased after exercise as compared to baseline. The hexameter
exercise showed the highest heart rate (mean 82.9/min.). Cardiorespiratory synchronisation
was high after hexameter recitation (γ = 0.70), less after controlled breathing (γ = 0.57)
and desynchronized after spontaneous breathing (γ = 0.15).
Immediate effects study [2]
In total 105 recordings were analyzed. The overall binary pattern predominance (PP)
as well as the frequency of predominant and cyclically recurrent cardiorespiratory
phase locking patterns were calculated. Furthermore the changes of low and high frequency
heart rate variability. ATS provoked alterations in heart rate dynamics which were
different from those after control exercises and which persisted at least during 15 minutes
following exercise.
References
1. Cysarz D, et al. Oscillations of heart rate and respiration synchronize during
poetry recitation. Am J Physiol Heart Circ Physiol. 2004;287:H579 - H587
2. Bettermann H, et al. Effects of speech therapy with poetry on heart rate and cardiorespiratory
coordination. International Journal of Cardiology. 2002;84/1:77-88
X28 Eurythmy therapy – effects observed in clinical studies
Arndt Büssing
Witten/Herdecke University, Witten/Herdecke, Germany
Eurythmy Therapy (EYT) is a non-pharmacological mindfulness-oriented movement therapy
of Anthroposophic Medicine. It focuses on the relationship and regulation of spirit
and soul with the physical body and life forces. EYT expresses sound and rhythm which
are transformed in specific movements. It is used for several quite heterogeneous
indications, which underlines the importance to examine more closely its effectiveness.
So far there are two systematic reviews on EYT effects in clinical settings. The 2008
review from Büssing et al., published in BMC Complementary and Alternative Medicine,
referred to 8 citations which met the inclusion criteria and indicated that EYT is
a “potentially relevant add-on in a therapeutical concept”. In 2015 Lötzke et al.
published an updated systematic review in the Journal of Integrative Medicine and
referred to 11 studies published since 2008. Most of these studies described positives
treatment effects with effect sizes ranging from small to large. The studies were
heterogeneous according to the indications, study design, methodological quality,
and outcome measures.
A recent randomized clinical study by Büssing, Michalsen, Krötz et al., which was
not included in the 2015 review, compared the efficacy of three active interventions,
i.e., EYT, yoga and physiotherapeutic exercises (PhyE) in a group 270 persons suffering
from chronic low back pain. The study had an eight week intervention and an eight
week follow-up phase. All three interventions were similar effective to significantly
decrease patients’ physical disability and pain perception, while SF-12’s mental health
component increased. Here, EYT had a significant benefit compared to PhyE. Moreover,
there were significant improvements of stress perception, life satisfaction and mood
for yoga and EYT, which were not seen for patients receiving PhyE. Significant improvements
of patients’ self-efficacy expectation were observed within the active intervention
period only in the EYT group. Thus, with respect to the different ‘levels’ of the
human being, all three interventions were effective on the physiological level (pain
and associated disability), yoga and EYT on the emotional level (psychological quality
of life components), and EYT on the level of the ‘inner self’ (self-efficacy). This
larger study showed that EYT can be a therapeutic option for patients with chronic
low back pain comparable to the ‘gold standard‘ PhyE - and similarly effective as
Yoga which is already implemented in the US guidelines.
In summary, EYT is an important and promising intervention already established in
Anthroposophic Medicine, and worth of further research in conventional settings.
X29 Arts therapies within anthroposophic medicine – one essential modul of holisitic
medical approach
Harald Gruber (Harald.gruber@alanus.edu)
Alanus University of Arts and Social Sciences, Alfter, Germany
Anthroposophic medicine is based on science and includes the whole range of conventional
therapies. It furthermore aims to strengthen the whole constitution of the patient
by taking into account the vital, emotional, mental, spiritual and social dimension
as seriously as the physical one. Arts Therapies as sculpture-, painting-, music-,
speech-, and eurythmie therapy are well established and appreciated in Anthroposophic
Medicine since decades. They can directly influence emotions and psychophysiological
parameters one the one side and can help nonverbal selfexpression and self-realisation
on the other side. Within Anthroposophic Medicine Arts Therapies are therefore more
than only a “nice to have”. The different applied Arts Therapies are based on traditional
approaches and modified by anthroposophically enhanced perspectives. Research results
from speech therapy, music therapy, and eurythmie therapy give evidence for the effectiveness
of these special therapeutic approaches in Anthroposophic Medicine. Basic research
studies and randomised controlled trials are accumulating, documenting the effectiveness
of Arts Therapies for various patient groups. More comprehensive research is necessary
but the first findings are promising.
X30 Research in arts therapies
Sabine Koch1, Harald Gruber1, Urs Pohlmann1, Christine Caldwell2, Barbara Krantz3,
Ria Kortum1, Lily Martin1
1Research Institute for Creative Arts Therapy, Alanus University Alfter/Bonn, Alfter/Bonn,
Germany; 2Naropa University, Boulder, CO; 3Hoogeschool Nijmegen, Nijmegen, Netherlands
Correspondence: Sabine Koch (sabine.koch@alanus.edu)
Art Therapy, Music Therapy, Dance Movement Therapy, Drama Therapy and Poetry Therapy
together form the field of Creative Arts Therapies (CATs) and are mainly applied in
mental health contexts. Recently they have also expanded into work and research on
neurological and cardiovascular diseases as well as prevention, where they have been
found to significantly reduce stress and to enhance the parent-infant relationship.
In palliative care, art, music and dance movement therapy have been shown to reduce
pain, anxiety and depression for cancer patients; for patients suffering from Parkinson’s
disease they have been shown to increase quality of life. Yet in many areas, research
needs to be expanded, enhanced and deepened as to what specifically works in arts
therapies. How can we investigate active factors and mechanisms? How can we apply
psychophysiological measures for the benefit of the field? This symposium provides
an overview of existing empirical evidence, research findings, and directions in Creative
Arts Therapies.
(4 presentations; 90 Minutes)
Arts Therapies: Dr. Christine Caldwell, Naropa University, Boulder, CO, USA: Measuring
synchronization of physiological parameters in arts therapies – Ideas and first results
Art Therapy: Dr. Ria Kortum & Prof. Dr. Harald Gruber, Alanus University, Germany;
Effects and Active Factors in Art Therapy: An overview for the field of palliative
care
Music Therapy: Barbara Krantz, M.A., Nijmegen: Parent-infant Music Therapy: Effects,
efficacy and practice - A research overview
Dance Movement Therapy: Prof. Dr. Sabine C. Koch/Lily Martin, Alanus University/SRH
University, Heidelberg: Dance movement therapy research: Efficacy of DMT and therapeutic
factors across the arts therapies
Workshops
Research
W1 The Cochrane risk of bias tool - how to use the updated tool for assessing clinical
trial evidence
Lisa S Wieland1, Ben Kligler2, Susan Gould-Fogerite3,4
1Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore,
MD, USA; 2Department of Family and Community Medicine, Icahn School of Medicine at
Mount Sinai, Brooklyn, New York, NY, United States; 3ICAM, Rutgers School of Health
Professions, Newark, New Jersey, USA; 4Clinical Laboratory Sciences and Primary Care,
Rutgers School of Health Professions, Newark, New Jersey, USA
Correspondence: Lisa S Wieland (lswieland@gmail.com)
Cochrane systematic reviews are considered the gold standard for evaluating the clinical
trials evidence for a given therapeutic approach. However many clinicians still find
Cochrane reviews intimidating and difficult to translate into the setting of clinical
decision-making. One reason for this gap is a lack of clear understanding among health
care providers of the specific methodology and tools that Cochrane reviews rely on
to arrive at their conclusions. In particular, the Cochrane tool for assessing risk
of bias—which forms the core of the Cochrane strategy for assessing the methodological
quality of clinical trials included in a review, and contributes to the overall assessment
of the quality of the evidence stemming from the review —is not well understood by
most clinicians, educators and even researchers. The Cochrane risk of bias tool has
been updated by Cochrane methodologists and will be presented to the Cochrane community
in late 2016. This workshop provides an opportunity to bring the latest methodological
advances in this area to integrative medicine clinicians, educators, and researchers.
This hands-on workshop will provide an overview of the risk of bias tool, followed
by a supervised practice session in which participants will work through the process
of evaluating an article using the tool. This first-hand experience in utilizing the
risk of bias tool will equip participants to feel more confident in understanding
and using Cochrane reviews, and demonstrate how they themselves could participate
as a Cochrane reviewer if they are interested.
The workshop will consist of two parts:
1) Presentation
We will introduce the participants to the Cochrane review process and how the risk
of bias tool is used in Cochrane reviews. We will describe the components of the updated
tool and how each domain of risk of bias is to be assessed.
2) Hands-on experience
We will supervise the participants in working through an article describing an integrative
medicine clinical trial, and applying the risk of bias tool to the trial. At the end
of the hands-on session, we will review the risk of bias assessments and answer any
questions about the concepts or their application.
W2 How to develop clinical practice guidelines for integrative medicine part 1: assessing
the quality of the evidence used to inform a recommendation
Yuqing Zhang1,2,3, Lisa S Wieland4, John J Riva5,6
1Clinical Epidemiology and Biostatistics department, McMaster University, Hamilton,
Canada; 2Michael G. DeGroote National Pain center, McMaster University, Hamilton,
Canada; 3Quality, Methodology and Innovation (QMI), Doctor Evidence, Santa Monica,
USA; 4Center for Integrative Medicine, University of Maryland School of Medicine,
Baltimore, MD, USA; 5Department of Family Medicine, McMaster University, Hamilton,
Ontario, Canada; 6Department of Health Research Methods, Evidence and Impact, McMaster
University, Hamilton, Ontario, Canada
Correspondence: Yuqing Zhang (madisonz1220@gmail.com)
Clinical practice guidelines (CPG) have become increasingly important to guide optimal
clinical practice. They play the crucial role of translating research findings into
succinct clinically relevant recommendations to facilitate clinicians, patients and
caregivers in making clinical decisions. When developing evidence-based CPGs, trials,
systematic reviews and meta-analyses are some of the most common sources of evidence
to inform evidence-based recommendations.
Clinicians want to get a sense of how much they should trust underlying evidence.
However, the quality of the evidence depends upon many factors including the availability,
biases, precision, and consistency of the underlying evidence. The quality of the
evidence obtained influences the confidence in effect estimates for each outcome underpinning
CPG recommendations. The Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) approach is a systematic and transparent method for summarizing the quality
of evidence for an outcome into simple phrasing for clinicians. The formulation of
evidence-based CPGs relies upon GRADE assessments of the evidence, and it is therefore
important for CPG developers to understand how to use this approach. GRADE also allows
clinicians, policy makers, and consumers to use reviews’ results and recommendations
efficiently and reliably.
This workshop will have two main components:
1) A learning component;
We will introduce the participants to the GRADE approach for quality appraisal developed
by the GRADE working group in McMaster University, Hamilton, Canada. We will describe
why it is important to evaluate the quality of the evidence in the context of integrative
medicine Cochrane systematic reviews, the relevance of the GRADE approach to clinicians,
researchers and policy makers, GRADE’s objectives, and the five domains that are used
to assess the quality of the evidence.
2) A hands-on component
We will provide an example based on an evidence profile of a research question of
interest in integrative medicine. The participants will work in small groups, applying
the concepts presented in the learning section to this evidence.
Participants will obtain the introductory skills to assess the quality of evidence
for estimates from integrative medicine Cochrane systematic reviews. This skill is
important for understanding the conclusions of a Cochrane-style systematic review,
and essential for those who may be considering carrying out a Cochrane-style systematic
review. Participants will also master one of the crucial steps in developing evidence-based
CPGs to make evidence-based integrative medicine related recommendations.
Education
W3 Understanding and learning the skills to manage stress in hospital residents and
medical faculty
Michael Lumpkin1, Emily Ratner2
1Georgetown University School of Medicine, Washington DC, USA; 2Medstar Health, Columbia,
Maryland, USA
Correspondence: Michael Lumpkin (mlumpk01@georgetown.edu)
Numerous studies show that hospital residents and medical/healthcare faculty suffer
from excess stress, burnout, and loss of empathy. To address the challenge of healing
these healers so that they may better serve their patients and themselves, we will
briefly highlight the current knowledge about the physiology of the stress response
in the context of the mind-body connection and describe the pathophysiological consequences
of chronic stress on residents and faculty. Having defined the problem, participants
will learn through experiential practice how to more effectively manage their own
stress through the use of several mind-body medicine techniques including guided imagery,
meditation, and autogenic biofeedback. To enhance the impact and meaning of the experiential
activity, a real-time, non-invasive monitoring device will be provided to measure
the result of mindfulness practice.
Timeline: Introduction and Goals-5 min; Physiology and Pathophysiology of Stress-20 min;
Guided Imagery Experiential-15 min; Constructing a Program for Residents and Faculty
to Adress Stress and Burnout-15 min; Experiential Session with Meditation and Biofeedback
with Monitoring Device-25 min; Processing and Discussion-10 min.
The importance of such a session to the program is to promote the long-term health
and well-being of healthcare providers so that they may more effectively and reliably
provide comprehensive healthcare to patients into the future.
W4 Concepts of TCM education in China and Europe - what can we learn from each other
Liu Ping1, Pei Jian1, Gesa-Meyer Hamme2, Xiaosong Mao2, Han Chouping3, Sven Schröder2
1Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China;
2HanseMerkur Center for TCM at the UKE, Hamburg-Eppendorf, Germany; 3International
Education College, Shanghai University of TCM, Shanghai, China
Correspondence: Sven Schröder (schroeder@tcm-am-uke.de)
In China full academic education in TCM started 60 years ago is now available throughout
the country at universities and colleges on all levels including bachelor, master
and PHD programs. After receiving their bachelor degree, students usually choose a
specialization, either acupuncture/tuina or internal (herbal) medicine for their further
studies.
In Europe TCM is seen as an additive to Western medicine after graduation. Education
programs started in the 1950th but are mainly non-academical and organized by societies
of physicians and practitioners. In Germany medical doctors can reach a postgraduate
specialization degree for acupuncture, education on Chinese herbal medicine is not
regulated. Non-medical practitioners can receive a limited allowance for treatment.
However, a few academical programs at non-medical universities have been introduced
recently in Europe.
Based on 30 years of sistercityship the TCM University Shanghai and the HanseMerkur
Center for TCM at the University Medical Center Hamburg Eppendorf cultivated an active
exchange on all aspects of TCM with frequent reciprocal visits, cooperative research
projects, co-organized symposiums and reciprocal training for many years.
Nowadays, many textbooks and classical texts are available in English language. Furthermore,
chinese scientific articles increasingly provide an english abstract and more and
more research on TCM is performed in western countries. Main differences in education
can be found in didactic concepts. In China lectures are mainly teacher oriented with
less interactive elements. In western countries, students demand modern teaching material,
problem oriented learning and discussions. Chinese teachers expect exact repetition
of textbook contents, while western didactics pronounce context oriented learning
and transferal of information. However, transferal of information is only possible,
if there is a basic understanding of facts and terms. One further difference is the
evaluation of the PHD education. In China, PHD studies are seen as a combination of
further qualification in the specific field and the scientific thesis. In western
countries more impact is put on the experiments, thesis and the following scientific
publication. For the internationalization of TCM education, both educational systems
have to be taken into account. Furthermore, transfer of knowledge, exchange of teachers,
harmonization of curricula and cooperative international projects are mandatory.
To approve an educational academic cooperation in practice, Shanghai and Hamburg are
planing an academization of TCM education at a western medical university. The concept
includes common teaching by chinese and german specialist in Hamburg as well as in
Shanghai; and common research projects for master and PHD theses.
Traditional healing systems
W5 Treatment of allergic rhinitis and asthma with Chinese Medicine
Josef Hummelsberger1, Michael Wullinger2
1SMS, Munich, Germany; 2Medical Practice, Rosenheim, Germany
Correspondence: Josef Hummelsberger
According to actual trials Acupuncture and CHM seem to be a alternative method to
help patients with Allergic rhiniits. Decicisve in TCM is a correct pattern differentiation.
Aim of this workshop is to help the physican to give hi a clear and practical help
and guideline to use TCM in this disease effectively.
Medicine and arts
W6 Performing arts medicine: preventing injuries and restoring resiliency in musicians
Marc Brodzky1,2,3, Christoff Zalpour3,4
1Center for Integrative Medicine and Wellness, Stamford Hospital, Connecticut, USA;
2Columbia University, New York, USA; 3Performing Arts Medicine Association (PAMA),
Englewood, USA; 4INAP/O, Institute of Applied Physiotherapy and Osteopathy, University
of Osnabrück, Osnabrück, Germany
Correspondence: Marc Brodzky
INAP/O, Institut für angewandte Physiotherapie und Osteopathie; Hochschule Osnabrück,
Osnabrück, Deutschland
Performing Arts Medicine (PAM) is the study of the prevalence, etiology and management
of playing-related disorders. Similar to Integrative Medicine, PAM embodies relief
of suffering from pain, nutrition and other lifestyle recommendations, and mind-body
stress reduction strategies to help people overcome anxieties that may hinder performance
during high pressure situations.
Musicians are predisposed to certain injuries such as musculoskeletal overuse, nerve
entrapment conditions, and focal dystonia. They may also experience stress-related
psychological conditions. Barriers to care include affordability, access, and attitudes.
This workshop/case conference session will introduce the audience to the unique health
needs of performing artists. Thorough history taking and pertinent physical exam may
identify potential or existing performing-related conditions. Preventing injury and
restoring resiliency may optimize a sense of well-being and performance in musicians
and other artists.
W7 Using art to enhance observation skills and improve patient care and provider communication
Julia Langley (Julia.langley@georgetown.edu)
Arts and Humanities Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown
University, Washington, D.C., USA
Keen observation and communication skills are critical to patient care. The ways in
which we see, understand and respond to patients, caregivers and colleagues are complex
and often ineffective due to missed cues, distractions and time constraints. If each
individual and every situation is unique, how can we be certain that we convey the
nuances of each case with clarity and precision? Especially when time is of the essence?
This workshop uses the analysis of artworks, active sketching and expressive writing
to teach participants how to look carefully, describe precisely and communicate directly
– skills which transfer directly from the classroom to the clinic.
References
1. Herman, Amy H. Visual Intelligence: Sharpen Your Perception, Change Your Life,
Boston: Houghton Mifflin Harcort, 2016.
2. Wellbery C. The value of medical uncertainty, The Lancet. 2010; 375(9727):1686-1687.
Discussions
Research
D1 Planning for and successfully conducting pragmatic trials of complementary and
integrative interventions
Wendy Weber1, Lanay M Mudd1, Peter Wayne2, Clauda Witt3,4
1Division of Extramural Research, National Center of Complementary and Integrative
Health, National Instititutes of Health, Bethesda, MD, USA;
2
Osher Center for Integrative Medicine, Brigham and Womens Hospital, Boston, MA 02215,
United States; 3Institute for Social Medicine, Epidemiology and Health Economics,
Charité University Medicine, Berlin, 10117, Germany; 4University of Zurich, Zurich,
Switzerland
Correspondence: Wendy Weber
In the last few years there has been a growing interest by the public and the scientific
community in pragmatic clinical trials that test research hypotheses, which will directly
inform the health care system. This interest has been driven by a number of factors
including the high cost of traditional efficacy studies and the exclusion of many
individuals from efficacy trials resulting in results that do not generalize to many
patients. The proposed discussion session will include presentations that will provide
definitions of pragmatic trials; how feasibility studies can inform design of large
scale pragmatic trials and how they differ from explanatory trial feasibility studies;
and provide resources for planning and conducting pragmatic trials. Dr. Mudd will
highlight an overview of pragmatic trials and how to plan feasibility studies to inform
design of pragmatic trials. Dr. Wayne will present results of feasibility studies
of a community delivered tai chi program in preparation for larger scale studies.
Dr. Witt will provide an overview two full scale pragmatic trial she has recently
published. Presenters will discuss an overview of the challenges encountered in conducting
these studies and how they have overcome these challenges. Dr. Weber will provide
highlights of a pragmatic trials that are ongoing in the field of complementary health
and a final summary of resources developed by the NIH Health Care System Research
Collaboratory for investigators who are planning and conducting pragmatic trials (www.nihcollaboratory.org).
The session will close with a panel discussion with all presenters to answer questions
from the audience.
This session will provide attendees with a strong overview of how to conduct pilot
studies to plan for successful conduct of pragmatic trials. Attendees will also be
informed of resources and tools available to help them better understand the complexity
of pragmatic trials.
D2 The future of collaborative research on complementary medicine in Europe
Wolfgang Weidenhammer1, Vinjar Fønnebø2, Heather Boon3
1Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der
Isar, TU München, Munich, Germany; 2NAFKAM, Tromsø, Norway; 3University of Toronto,
Toronto, Canada
Correspondence: Wolfgang Weidenhammer (Wolfgang.weidenhammer@tum.de)
Since finishing the EU-funded CAMbrella project – defined as a coordination action
– no convincing organizational structure could be established yet to continue and
further develop the network of European CAM/IM research groups. The discussion should
disclose the reasons for this development and compile new ideas for a modified strategy
taking into account the needs and specific conditions of the research groups. The
discussion should be fuelled by 3 short inputs: i) history of ISCMR European chapter
(Weidenhammer), ii) experiences from the Canadian chapter (Boon), iii) organizational
framework for networking provided by ISCMR (Fønnebø).
This international meeting is an ideal platform to sort out the current situation,
the need for networking and ideas for future strategies to facilitate international
collaborative CAM/IM research.
Education
D3 Development of a framework to support critical enquiry in complementary and integrative
medicine education programs: a collaborative discussion
Amie Steel1,2, Andrea Bugarcic3, Melisa Rangitakatu1
1Endeavour College of Natural Health, Brisbane City, Australia; 2University of Technology
Sydney, Ultimo, Australia; 3University of Queensland, Brisbane, Australia
Correspondence: Amie Steel (amie.steel@endeavour.edu.au)
Complementary and integrative medicine practitioners face unique challenges when drawing
upon relevant information sources to inform clinical decision-making and as such require
specific skills in critical enquiry to navigate the available evidence. This session
will provide an overview of the current challenges facing educators within CIM practitioner
education programs regarding the development of critical enquiry skills in their students
and provide the foundation for future progress in this topic. The speakers will present
current research, initiatives and insights from the context of CIM education which
relates to critical enquiry. Dr Steel will present original research from CM education
institutions exploring the challenges associated with the inclusion of both traditional
knowledge and scientific research within the curriculum (Approx. 15 minutes). Dr Bugarcic
will overview a novel approach to engendering skills in critical enquiry amongst students
of CIM practitioner programs (Approx. 15 minutes). Dr Rangitakatu will discuss the
role of reflectivity in critical enquiry and practitioner competence (Approx. 15 minutes).
Attendees will then to contribute to a discussion about key elements which could be
included in a critical enquiry framework for CIM practitioners (Approx. 30 minutes).
The outcomes of this discussion will provide a platform to inform the advancement
of meaningful and relevant critical enquiry in CIM education. The international audience
of the conference will strengthen the diversity of the discussion, and ensure the
outcomes are appropriate and relevant to the wider international CIM community.
D4 The Practitioner Research and Collaboration Initiative: establishment and baseline
data for the world’s largest practice-based research network in complementary healthcare
Amie Steel1, Jon Adams1, David Sibbritt1, Jon Wardle1, Matthew Leach1, Janet Schloss2,
Helene Dieze2
1University of Technology Sydney, Ultimo, Australia; 2Office of Research, Endeavour
College of Natural Health, Fortitude Valley, Brisbane City, 4006, Australia
Correspondence: Amie Steel
Purpose
Practice-based research networks (PBRNs) are an accepted infrastructure which supports
pragmatic research drawn from real-life clinical environments. There has been a strong
growth in PBRNs in recent years encompassing a wide range of health professions including
integrative medicine. The Practitioner Research and Collaboration Initiative (PRACI)
is the largest PBRN within complementary healthcare in that it encompasses fourteen
(14) different complementary medicine health professions.
Methods
All CM practitioners with qualifications in the professional groups included in PRACI
were invited to complete a workforce survey. Those interested in joining PRACI were
asked to provide contact details to link their results to a PRACI ID number. This
data was used to form the foundation of the PRACI membership database.
Results
764 CM practitioners joined PRACI with the highest number of practitioners reporting
qualifications in massage therapy (n = 447; 58.5%), naturopathy (n = 202; 26.4%),
nutrition (n = 110; 14.4%), and reflexology (n = 102; 13.4%). The largest number of
PRACI members have a practice based in Victoria (34.7%), Queensland (24.6%) and New
South Wales (22.8%) although members are also represented in all other States and
Territories. The PRACI members reported diverse practice interest areas.
Conclusions
PRACI is a PBRN which affords the potential to support diverse research projects due
to its innovative sub-study design. As a result, PRACI offers significant opportunity
to facilitate economies of scale and growth in CM research across a broad range of
research areas.
Traditional healing systems
D5 Statutory regulation of traditional and complementary medicine professionals: operationalizing
the World Health Organization guidelines
Heather Boon, Nadine Ijaz
University of Toronto, Toronto, Canada
Correspondence: Heather Boon (Heather.boon@utoronto.ca)
The World Health Organization has called upon states to regulate practitioners of
traditional and complementary medicine (TCAM) systems and therapies, and an increasing
number of jurisdictions are taking steps to do so. However, to date, scholarship that
addresses the distinct complexities of TCAM professional regulation has been scant.
The objectives of this project were: 1) To explore the factors that distinguish TCAM
professional regulation from that of biomedical health providers; and 2) to develop
a public interest framework to guide TCAM professional regulation. Data collection
included an extensive review of literatures reporting various jurisdictions" approaches
to and experiences with regulating TCAM providers; and re-analysis of our research
team"s fifteen-year study of TCAM professionalization in Ontario, Canada which has
included a multiple sets of qualitative interviews with front line TCAM practitioners
and leaders, as well as a survey of all Chinese medicine, naturopathy and homeopathy
practitioners in the Province (n = 1047). We found several features that differentiate
TCAM professional regulation from that of biomedical professionals, including: contrasting
epistemic frameworks and conceptualizations of evidence; traditional medicine"s concurrent
clinical and cultural importance; the internal diversity of traditional health care
systems; and historically-situated, differential power relations between TCAM and
biomedicine. Applying critical theories of the professions as well as post-coloniality,
we propose a principle-based framework for guiding TCAM professional regulation across
jurisdictions. Underpinned by the principle of regulatory equity, our framework prioritizes
traditional knowledge protection alongside patient safety, quality of care, and accessibility.
We discuss how these principles may be diversely interpreted and applied across contexts,
with respect to such specific issues as: professional standards, linguistic regulatory
requirements, and biomedical professionals" increasing adoption of TCAM practices.
D6 How to prioritise traditional treatments for further research, including clinical
trials
Merlin Willcox, Michael Heinrich, George Lewith, Andrew Flower, Bertrand Graz
University of Southhampton, Southhampton, United Kingdom
Correspondence: Merlin Willcox (Merlin.willcox@phc.ox.ac.uk)
There are tens of thousands of traditional treatments used throughout the world, and
limited resources for their evaluation, especially in clinical trials. To date, there
have been no scientific guidelines on how to prioritise which treatments should be
researched in depth, including for clinical trials. We propose to present several
ideas from different viewpoints, and to engage the audience in discussing how these
ideas could be developed into guidelines to improve the efficiency of research on
traditional medicines.
Specifically we will have short presentations on the following approaches:
The need for consolidated standards on reporting ethnopharmacological research – Prof
Michael Heinrich
Ethnopharmacological studies with diverging expections: why a consensus? – Dr Bertrand
Graz
Novel methods for prioritising plants for further research – the “RITAM score”; and
the “Retrospective Treatment Outcome study” – Dr Merlin Willcox
The “5-phase model” to define good practice – Dr Andrew Flower and Prof George Lewith
Orals
Research
O1 Impact of acupuncture on medication use in patients suffering seasonal allergic
rhinitis – results of the ACUSAR trial
Daniela Adam, Linus Grabenhenrich, Miriam Ortiz, Sylvia Binting, Thomas Reinhold,
Benno Brinkhaus
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin
Berlin, Berlin, 10117, Germany
Correspondence: Daniela Adam (daniela.adam@charite.de)
Background
Seasonal allergic rhinitis (SAR) is a common disease with diminishing effects on quality
of life (Qol). An estimated 18% of the patients try to alleviate their symptoms through
acupuncture. The ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) study assessed
the impact of acupuncture on SAR and showed significant improvements in rhinitis specific
Qol (RQoL), SAR symptoms and the use of rescue medication (RM). We investigated patients
use for antihistamines into more detail.
Methods
Patients were randomised into three study groups: acupuncture plus RM, sham acupuncture
plus RM and RM alone. They documented their medication use before and during the intervention
period (8 weeks). Main outcome were the days of antihistamine used. Statistical analyses
were conducted using parametric and non-parametric tests. Robustness of the results
was tested by sensitivity analyses.
Results
Data of 414 patients were analysed. Following results were determined for the intervention
period: The acupuncture group used antihistamines on significantly fewer days than
the other groups (acupuncture vs. sham acupuncture: mean difference = -4.49 days,
p = 0.01; acupuncture vs. RM: mean difference = -9.15 days, p < 0.001). About 38%
of the acupuncture group did not use any antihistamine compared to only 16% in the
RM group. Acupuncture patients did not need to increase the days of antihistamine
use to handle their symptoms in contrast to patients who used RM alone.
Conclusions
Besides improving RQoL and SAR symptoms, acupuncture significantly reduces the use
of antihistamines and can therefore be considered as a valuable treatment option for
SAR patients.
O2 Measuring existential qualities of patients' health and suffering – the first stages
of instrument development
Susanne Andermo1,2, Tobias Sundberg1,2, Torkel Falkenberg1,2, Johanna Hök Nordberg1,2,
Maria Arman1,2
1Division of nursing, Karolinska Institutet, Huddinge, 14183, Sweden; 2I C – The Integrative
care science center, Järna, Sweden
Correspondence: Tobias Sundberg (tobias.sundberg@ki.se)
Purpose
Patients may appreciate integrative care by its whole person and existential approaches.
However, such caring qualities can be difficult to measure. The aim of this Swedish
study was to develop a first version of an instrument measuring patients’ experiences
of health and suffering with an existential focus.
Methods
A methodological design with three phases for instrument development was used. First;
an item pool was developed based on qualitative interviews (n = 64) from patients
receiving integrative care. Subsequently the relevance of the items was explored in
2 iterative rounds of cognitive patient interviews (n = 5 and n = 3). Finally expert
stakeholder consultations (n = 5), were used to further refine the instrument.
Results
The first phase development of the instrument resulted in two interrelated dimensions:
existential qualities of "health" and "suffering", characterized by 5 domains; "Life
passion and energy", "Personal freedom", "Present in life" "Relations" and "Meaning".
Instrument items were formulated as word pairs on a semantic differential scale representing
opposite ends of a continuum. The cognitive patient interviews and expert opinions
helped to refine items and domains, but did not change the overall instrument construct.
Conclusions
The dimensions and domains of this first version of the instrument, developed from
a contemporary use of language, resemble well with theories in caring science focusing
on existential qualities of health and suffering as integral to human life. The instrument
is anticipated to be of value for evaluations in research, development of integrative
and conventional health care practice as well as for theory development in caring
science.
O3 Epigenetics alterations associated with short-term relaxation response training
in healthy subjects
Manoj Bhasin1,2, Xueyi Fan2, Towia Libermann1,2, Gregory Fricchione3,4, John Denninger3,4,
Herbert Benson3,4
1Benson-Henry Institute for Mind Body Medicine, BIDMC, Harvard Medical School, Medicine,
Boston, MA, United States; 2Genomics, Proteomics, Bioinformatics and Systems Biology
Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of Interdisciplinary Medicine and Biotechnology, and Division of
Interdisciplinary Medicine and Biotechnology, Boston, MA, United States; 3Benson-Henry
Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, United
States; 4Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
Correspondence: Manoj Bhasin (mbhasin@bidmc.harvard.edu)
Background
The relaxation response (RR) is the physiological and psychological opposite of the
fight-or-flight or stress response. The RR has been reported to be effective in a
number of disorders that are believed to be caused or exacerbated by stress. We had
performed multiple genomics and systems biology studies in healthy and disease conditions
to understand the molecular mechanism of RR. Our studies provided compelling evidence
that the RR elicits specific gene expression changes linked to upregulation of energy
production and insulin secretion, and downregulation of NF-kB mediated inflammation.
Methods
To explore further whether the beneficial effects of RR are associated with upstream
epigenetic modifications (specifically, changes in DNA methylation), we now report
a pilot study on 6 healthy subjects before and after 8 weeks of RR training. To identify
RR-associated epigenetic changes, we performed genome-wide bisulfite sequencing to
measure methylation changes. We also carried out integrated analysis of methylation
and transcriptome data to identify molecular alterations which affect both regulatory
and transcriptional genomic spaces.
Results
Comparison of pre- and post- RR methylation data identified 18,979 significantly hypo-
or hyper- methylated regions (Adjusted P value < .01), corresponding to hyper- and
hypo- methylation of 1,033 and 1,587 genes, respectively. Pathway enrichment analysis
revealed significant hypo-methylation of genes linked to: neuron and muscle cell differentiation
and development; lipid metabolism; mRNA processing and MAPK signaling. A similar analysis
revealed hyper-methylation of multiple pathways, including: interferon gamma response;
cell cycle regulation; and systemic lupus erythematosus.
We also performed an integrated analysis of our epigenetic and gene expression data
from a previous study of healthy subjects (n = 19). The comparison identified multiple
pathways that significantly impacted both at the transcriptional and epigenetics levels:
Electron transport chain signaling pathways had significant hypo-methylation and up-regulation
at the gene expression levels, indicating a positive effect of RR on energy production,
mRNA processing, GPCR ligand Binding and Epithelial Cell Differentiation pathways.
Further regulatory analysis of epigenetics and transcriptional data showed activation
of INSR, a key molecule in insulin signaling, indicating that RR may have a positive
effect on glucose metabolism. Similarly, the analysis indicated inhibition of the
expression of IL6, a key cytokine associated with chronic inflammation, supporting
the role of RR in downregulating inflammation.
Conclusion
This pilot study provides a unique insight into how the RR effects DNA methylation
and gene expression of energy production, glucose metabolism and immune response pathways.
O4 Prolonged fasting in T1DM – case study from patient perspective
Bettina Berger1, Rainer Stange 2, Andreas Michalsen 2, David D Martin 3,4
1University Witten/Herdecke, Health, Herdecke, Germany; 2Immanuel Hospital, Berlin,
Germany; 3Hospital of Children, University, Tuebingen, Germany; 4Hospital of Children,
Filderstadt, Germany
Correspondence: Bettina Berger (bettina.berger@uni-wh.de)
Background
Fasting as a medical treatment has been proven to be a valuable therapeutic method
for chronic diseases like rheumatoid arthritis, hypertension, and metabolic syndrome
[1]. For patients with Type 1 Diabetes mellitus (T1DM), fasting therapies has neither
been recommended nor excluded by fasting guidelines [2] and most fasting clinics do
not accept people with T1DM for fear of ketoacidosis. The literature on fasting in
T1DM is scarce and limited to fasting during Ramadan [3].
AIMS: Report on a single case study of prolonged fasting in a T1DM patient for about
seven days.
Methods
A femal patient (age 49 y) suffering from T1DM for 39 years, decided to fast on her
own. Fasting during 7 days scheduled a reduction of insulin dosage from around 36
units short acting insulin and 18 units basal insulin/d to basal insulin only (18
units/d). The faster took water, tea, and vegetable broth only. She measured blood
sugar level daily 10-12 times and took carbohydrates in case of blood sugar level
below 60 mg/dl. She decided to measure ketone body daily and to take carbohydrate
in case of uncertanty.
Results
Fasting was performed during 7 days without any carbohydrate intake. Only two times
a mild hypoglycemia (treated with two units of carbohydrates) and two times a mild
hyperglycemia (treated with four units of short acting insulin) but no serious hypoglycemia
or hyperglycemia, not ketoacidosis occurred. Glucose profil were balanced between
60 and 180 mg/dl, av. 150 mg/dl during the whole time. The patient felt very well.
Conclusion
To the best of our knowledge, this is the first case report on prolonged complete
fasting in T1DM. It indicates that persons with Type 1 diabetes can participate safely
in prolonged fasts provided they reduce their usual insulin dose and carefully supervise
their blood sugar level. Interventional studies are needed on the effects of fasting
on metabolism, quality of life and longevity.
Literatur
1. Michalsen A, Li C. Fasting therapy for treating and preventing disease - current
state of evidence. Forsch Komplementmed. 2013;20(6):444-53.
2. Wilhelmi de Toledo F, Buchinger A, Burggrabe H, Holz G, Kuhn C, Lischka E, et al.
Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch
Komplementmed. 2013;20(6):434-43.
3. Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control
in insulin dependent diabetic patients: A literature review. Diabetes & metabolic
syndrome. 2016.#
O5 Hypnotherapy or transcendental meditation versus regular relaxation exercises in
the treatment of children with primary headaches: a multi-centre, pragmatic, randomized
clinical study
Inge Boers1, Arine Vlieger2, Miek Jong1
1Louis Bolk Institute, Driebergen, 3972LA, Netherlands; 2Antonius Hospital, Nieuwegein,
Netherlands
Correspondence: Inge Boers (i.boers@louisbolk.nl)
Questions
To investigate the effectiveness of hypnotherapy or transcendental meditation (TM)
versus regular relaxation exercises added to usual medical treatment of paediatric
primary headaches.
Methods
A pragmatic, randomized controlled trial was carried out in six hospitals in de Netherlands.
Children (age 9-18 years) with primary headache and headache attack frequency of ≥2
times per month were randomized to receive either hypnotherapy or TM or regular relaxation
exercises (control group), in addition to usual medical treatment. Primary outcome
were mean frequency of primary headache attacks and clinically relevant (>50%) reduction
in headache frequency, after three months of intervention. Secondary outcome was subjective
improvement in symptoms (adequate relief).
Results
112 children were included: hypnotherapy (N = 39), TM group (N = 36) and control group
(N = 37). Mean age was 13.3 years and 77% was female. Preliminary analysis were performed
and showed that headache frequency was significantly reduced after 3 months for all
groups from 18 to 13 days with headache per month (p = 0.0001). No significant differences
were found between the groups (p = 0.95). The percentage of children with clinically
relevant reduction in headache attacks was 38% and did not significantly differ between
the three groups. Subjective improvement after intervention (adequate relief) was
reported by 30% of children, with no significant difference between groups, although
there was a positive trend for hypnotherapy (38,5% versus 25% in TM and control group,
p = 0.34). No adverse events were reported.
Conclusions
Final analysis and conclusions with respect to the effects of hypnotherapy or meditation
versus regular relaxation techniques on primary headaches in children will be completed
before the start of the conference and presented there.
O6 Cupping in chronic low backpain – a randomized three-armed partly-blinded clinical
trial
Benno Brinkhaus, Michael Teut, Alexander Ullmann, Miriam Ortiz, Gabriele Rotter, Sylvia
Binting, Fabian Lotz, Stephanie Roll
Institute for Social Medicine, Epidemiology and Health Economics, Charité University,
Berlin, 10117, Germany
Correspondence: Benno Brinkhaus (benno.brinkhaus@charite.de)
Background
Cupping is used frequently in chronic low back pain (cLBP) although its effectiveness
is not clear. The study aim was to investigate the effectiveness of pulsatile cupping
in cLBP.
Methods
cLBP patients were randomly allocated to 1) pulsatile cupping (8 treatments), 2) minimal
cupping (8 treatments) or 3) a control group. All groups received paracetamol on demand.
Patients in both cupping groups were blinded in regard to which cupping they received.
Primary outcome was the pain intensity measured with the VAS (0-100 mm) after 4 weeks.
Secondary outcomes included back function measured with the Funktionsfragebogen Hannover
Rücken (FFbH-R) and paracetamol intake.
Results
A total of 110 patients were randomized to pulsatile cupping (n = 37), minimal cupping
(n = 36) and control group (n = 37). The mean adjusted (for baseline values) VAS pain
intensity after 4 weeks for the pulsatile cupping group was 34.9 (95% CI: 28.7;41.2),
40.4 (34.2;46.7) for minimal cupping and 56.1 (49.8;62.4) for control group (group
differences: cupping vs. control (p < 0.001); minimal cupping vs. control (p = 0.001);
pulsatile cupping vs. minimal cupping (p = 0.225)). After 12 weeks VAS pain intensity
was significantly lower for pulsatile cupping vs. control (-15.1 (3.1;27.1); p = 0.014),
but not for minimal cupping vs. control (-11.5 (-0.44;23.4), p = 0.059) and pulsatile
cupping vs. minimal cupping (3.7 (-8.6;15.9); p = 0.554). Pulsatile cupping was better
than (p = 0.045) control for back function after 4 weeks, but not after 12 weeks (p = 0.088).
Minimal cupping was not significant better than control after 4 and 12 weeks. Paracetamol
intake did not differ significantly between the groups.
Conclusion
Both forms of cupping were efficacious in patients with cLBP after 4 weeks. However
only pulsatile cupping showed significant effects compared to control in some outcomes
after 12 weeks.
O7 Developing an integrative treatment program for cancer-related fatigue with stakeholder
engagement
Claudia Canella1, Michael Mikolasek1, Matthias Rostock1, Jörg Beyer2, Matthias Guckenberger3,
Josef Jenewein4, Esther Linka2, Claudia Six5, Sarah Stoll6, Roger Stupp2, Claudia
M Witt1
1Institute for Complemetary and Integrative Medicine, University Hospital Zurich,
Zurich, Switzerland; 2Department of oncology, University Hospital Zurich, Zurich,
Switzerland; 3Department of radiation oncology, University Hospital Zurich, Zurich,
Switzerland; 4Department of Psychiatry and Psychotherapy, University Hospital Zurich,
Zurich, Switzerland; 5Patient and member of the stakeholder advisory board, University
Hospital Zurich, Zurich, Switzerland; 6Cancer League Ostschweiz, St. Gallen, Switzerland
Correspondence: Claudia Canella (claudia.canella@usz.ch)
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 (CM) interventions seems 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 by stakeholder engagement.
Objectives
The aim of the study was to develop an integrative CRF treatment program using stakeholder
engagement and comparing it to an expert's version.
Method
In a qualitative study a total of 22 stakeholders (4 oncologists, 1 psycho-oncologist,
1 radiation-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member,
1 representative of the Swiss Cancer League) were interviewed either in a face-to-face
or in a focus group setting. For data collection and data analyses the method of qualitative
content analyses was used.
Results
The stakeholder engagement resulted in an adjustment to the individual and real-life
situations and in a request for highlighting interventions where patients can be active.
Compared to the expert's version which had all intervention options on the same level,
the stakeholder engagement resulted in a program with 3 different levels. The first
level includes non-pharmacological mandatory interventions, the second non pharmacological
choice based interventions and the third pharmacological interventions for severe
CRF.
Conclusion
By adopting the approach of stakeholder engagement, 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 with a higher
potential to be sustainable in a usual care setting.
O8 Patient perceptions of group and individual acupuncture in an urban, underserved,
primary care setting
Elisabeth Chuang1,2, Ben Kligler1, Melissa D McKee1,2
1Icahn School of Medicine at Mount Sinai, Department of Family and Community Medicine,
Brooklyn, New York, NY, United States; 2Albert Einstein College of Medicine, Family
and Social Medicine, Bronx, New York, NY, United States
Correspondence: Ben Kligler (benkligler@gmail.com)
Question
What are the perceptions of patients from an ethnically diverse, urban, underserved
population on the experience of acupuncture for pain in the individual setting vs.
the group setting?
Background
In March 2015, the Acupuncture Approaches to Decrease Disparities in Pain Treatment
(AADDOPT-2) trial, a two-arm comparative effectiveness trial, was launched to assess
whether acupuncture for chronic pain delivered in a group setting is as effective
as individual acupuncture in an underserved and ethnically diverse patient population
at risk for health disparities. The trial has recruited 512 of a projected 700 patients
and will conclude in late 2017. A second objective of the AADDOPT-2 trial was to use
qualitative analysis to better understand the patient experience of both individual
and group acupuncture.
Methods
Semi-structured open-ended interviews were conducted with 20 participants in each
study arm. The interview guide was created through interactive process including research
team members and patient stakeholders. Questions aimed to elicit patients’ pain narrative;
experience of acupuncture during sessions and social interactions; and perceptions
of the outcomes of acupuncture. The sample was purposely selected for representation
of both genders, all study sites and patients with good and poor functional status.
Interviews were conducted by phone, audiotaped and transcribed verbatim. Material
was coded using Dedoose software and analyzed using a constant comparison technique
Results
Patients in both study arms valued the pain relief, holistic approach and relaxation
experienced during acupuncture. The relationship with the acupuncturist was described
positively by patients in both arms, but with greater richness by patients in the
individual arm. A minority of patients in both arms cited concerns about privacy and
receiving acupuncture in mixed gender groups, however, patients who were assigned
to group acupuncture noted that being allowed to wear street clothing and acupuncturist
efforts to maintain privacy assuaged their concerns. A small number of patients assigned
to group acupuncture noted an ongoing feeling of vulnerability around being in pain
due to needling in a public setting. A few patients assigned to group acupuncture
expressed that non-clinical physical environment gave them initial misgivings about
the legitimacy of acupuncture treatments. Group dynamics varied; some groups fostered
a supportive, therapeutic interaction between patients, while others were more reserved
Conclusions
There were important differences in the experience of acupuncture in the group vs.
individual setting. Patients in both arms valued their acupuncture experience. and
group patients reported both positives and negatives regarding the group experience.
O9 Yoga for women diagnosed with breast cancer – a systematic review and meta-analysis
Holger Cramer1,2, Romy Lauche2, Petra Klose1, Silke Lange1, Jost Langhorst1, Gustav
Dobos1
1Department of Internal and Integrative Medicine, University of Duisburg-Essen, Essen,
45276, Germany; 2Research Center in Complementary and Integrative Medicine, University
of Technology Sydney, Sydney, Australia
Correspondence: Holger Cramer (h.cramer@kliniken-essen-mitte.de)
Question
What are the effects of yoga on health-related quality of life, mental health, and
cancer-related symptoms in women diagnosed with breast cancer?
Methods
This abstract is based on a draft and pre-peer review version of a Cochrane Review.
Upon completion and approval, the final version is expected to be published in the
Cochrane Database of Systematic Reviews (www.cochranelibrary.com). The Cochrane Breast
Cancer Group Specialised Register, MEDLINE, EMBASE, IndMED, and CENTRAL were searched
through February 2016 for randomized controlled trials (RCTs) assessing the effects
of yoga on health-related quality of life, depression, anxiety, fatigue, or sleep
disturbances in women diagnosed with breast cancer. For each outcome, standardized
mean differences (SMD) and 95% confidence intervals (CI) were calculated. The quality
of evidence was assessed using the Cochrane risk of bias tool and the GRADE recommendations.
Results
Twenty-four RCTs on 2,166 women were included. Compared to no therapy, moderate quality
evidence for short-term effects of yoga was found for health-related quality of life
(SMD = 0.22; 95%CI = 0.04,0.40; I2 = 19%), fatigue (SMD = -0.48; 95%CI = -0.75,-0.20;
I2 = 72%), and sleep disturbances (SMD = -0.25; 95%CI = -0.40,-0.09; I2 = 0%). Compared
to psychosocial/educational interventions, moderate quality evidence for short-term
effects on depression (SMD = -2.29; 95%CI = -3.97,-0.61; I2 = 96%), anxiety (SMD = -2.21;
95%CI = -3.90,-0.52; I2 = 95%), and fatigue (SMD = -0.90; 95%CI = -1.31,-0.53; I2 = 0%)
was revealed. No group difference compared to exercise occured. No serious adverse
events were reported.
Conclusions
Moderate quality evidence supports the recommendation of yoga as a supportive intervention
for women diagnosed with breast cancer. Very low quality evidence suggests that yoga
might be equally effective as other exercise interventions.
O10 Acupuncture and related therapies for treating irritable bowel syndrome: overview
of systematic reviews and network meta-analysis
Vincent CH Chung1, Hoi LC Wong2, Xin Y Wu1, Grace YG Wen1, Robin ST Ho1, Jessica YL
Ching1, Justin CY Wu1
1Jockey Club School of Public Health and Primary Care, The Chinese University of Hong
Kong, Shatin, 999077 Hong Kong; 2Department of Medicine and Therapeutics, The Chinese
University of Hong Kong, Shatin, 999077 Hong Kong
Correspondence: Vincent CH Chung (vchung@cuhk.edu.hk)
Purpose
Recent clinical evidence has shown the effectiveness of acupuncture and related therapies
for improving irritable bowel syndrome (IBS) symptoms. However, the relative performance
among different types of acupuncture and related therapies is unknown. This network
meta-analyses (NMA) was conducted to evaluate comparative effectiveness of various
acupuncture and related therapies.
Methods
Eight electronic databases were searched for SRs focusing on randomized controlled
trials (RCTs) which investigated acupuncture and related therapies among IBS patients.
Data from RCTs were extracted for pair-wise meta-analyses. NMA was used to explore
the most effective treatment option.
Results
From 8 SRs, 132 RCTs (n = 10,694) assessing acupuncture and related therapies were
included. Result from pair-wise meta-analyses showed that acupuncture did not have
significant beneficial effect on treating pain and diarrhoea symptoms among IBS patients
when compared with Pinaverium Bromide (an oral western medication). Three trials comparing
moxibustion, electroacupuncture and catgut embedding with Pinaverium Bromide demonstrated
beneficial effects of various types of acupuncture on treating IBS overall symptoms
(RR = 1.35, 95%CI: 1.09 to 1.67, moxibustion; RR = 1.55, 95%CI: 1.11 to 2.17, electroacupuncture;
RR = 1.55, 95%CI: 1.13 to 2.13, catgut embedding). Results from NMA of seven RCTS
showed no differences on the comparative effectiveness among five types of acupuncture
and related therapies, but moxibustion had the highest probability (68.2%) of being
the best option for improving IBS overall symptoms.
Conclusion
The effectiveness of all acupuncture and relative therapies reviewed on treating IBS
symptoms appeared to be similar, with moxibustion showing the highest probability
of being the best treatment on IBS. To confirm the effectiveness of moxibustion, well
conducted, adequately powered trials are needed in the future.
O11 The experience of a pet therapy visit on patients in an acute care setting
Amanda Coakley1, Jane Flanagan1,2, Christine Annese1, Joanne Empoliti1
1Nursing, Massachusetts General Hospital, Boston, MA, United States; 2Boston College,
Chestnut Hill, MA, United States
Correspondence: Amanda Coakley (abcoakley@partners.org)
Background
Limited research supports pet therapy for people who are hospitalized. Findings from
one study indicated that pet therapy was beneficial to patients post-vascular surgery
(Coakley & Mahoney, 2009). Earlier research indicated that following pet therapy visits,
patients reported feeling happier calmer and less alone (Cole & Gawlinski, 1995).
Another study with patients on general care units found that they reported feeling
comforted, satisfied, relaxed, attached, and peaceful after dog visits (Coakley 2003).
Specific Aims/Question
To explore the outcomes related to well-being, stress, and comfort in patients who
participate in the dog pet therapy program at Massachusetts General Hospital (MGH):
Methods
This study employed a descriptive non-experimental design and a convenience sample
to explore the experience of dog pet therapy program on well-defined outcome measures
pre - and post a pet therapy visit. The sample included patients on four inpatient
surgical units. Measures included: vital signs, visual analog scale (VAS) of comfort
and well-being, the Spielberger state anxiety and salivary cortisol levels. Demographic
variables related to the sample were also captured.
Results
Preliminary results show that there is significant improvement in pulse, respirations,
level of comfort and well being following a pet therapy visit.
Conclusion
A dog pet therapy program in the hospital setting is beneficial to patients in regards
to their level of comfort and well-being. Further research is needed to determine
if this program is beneficial to patients across other settings.
O12 Acupuncture at acupoints may prevent risks of cardiovascular diseases in migraine
patients by reversing plasma glutamate and APOB ratio
Zishan Gao1, Xugang Liu2, Shuguang Yu2, Xianzhong Yan3, Fanrong Liang2
1Helmholtz Zentrum München, Research Unit of Molecular Epidemiology (AME), Munich,
Germany; 2Chengdu university of Tranditional Chinese Medicine, Chengdu, China; 3National
Center of Biomedical Analysis, Beijing, China
Correspondence: Zishan Gao (zishan.gao@helmholtz-muenchen.de)
Question
The efficacy difference between acupuncture and sham acupuncture arise great debate
in evidence-based medicine. The aim of the current study was to investigate the metabolomic
evidence for the efficacy difference between acupuncture and sham acupuncture in treating
migraine by using 1H nuclear magnetic resonance (NMR)-based metabolomic technology.
Methods
We recruited 60 migraine patients and 10 health adults. First, 1H-NMR experiment and
multivariate analysis were conducted to characterize metabolic profiling of migraine
and potential biomarkers for migraine patients. Second, migraine patients were randomly
assigned to special acupoints group and non-acupoints group. Acupuncture treatment
were accordingly practiced on these groups lasted for two sessions. 1H-NMR experiment
was conducted, multivariate analysis and Ingenuity Pathway and network analysis (IPA)
was used to identify function change and metabolic pathway difference between acupuncture
at acupoints and acupuncture at non-acupoint in predicted protein-metabolomic network
model of migraine.
Results
We found that metabolic profiling of acupuncture at acupoints group change very similar
to health adults as acupuncture treatment session increases. 6 metabolites including
citrate, acetone, pyruvate, glutamate, creatine, LDL were significant reversed after
2 session of acupuncture treatment. In contrast, metabolic profiling of non-acupoints
group was clearly separated from health adults as treatment session increases. Only
glutamate, a classic migraine biomarker, was significantly reversed after 2 session
of treatment in acupuncture at non-acupoints group. Particularly, acupuncture at acupoints
could reverse novel cardiovascular biomarker- APOB ratios in predicted protein- metabolomic
network model, and also could significantly activate lipid metabolism function and
decrease amino acids metabolism function in predicted bio-function migraine model.
However, acupuncture at acupoints did not exhibit such effect in the predicted protein-metabolic
migraine model.
Conclusions
Our data suggest acupuncture might exhibit non-specific effect on both acupoints and
non-acupoints by decreasing plasma glutamate therefore reliving migraine attack. However,
acupuncture at acupoints may exhibit sustained effect on migraine by gradually reverse
the metabolic profiling of migraine patients compared with acupuncture at non-acupoints.
In particular, acupuncture at acupoint but not non-acupoints may prevent risks of
cardiovascular diseases in migraine patients by reversing both plasma glutamate and
APOB ratio.
O13 Effectiveness of leech therapy in treatment of chronic low back pain - a randomized
controlled clinical study
Christoph D Hohmann1, Nico Steckhan1, Thomas Ostermann2, Arion Paetow3, Evelyn Hoff3,
Andreas Michalsen1
1Internal and Complementary Medicine, Charité University, Berlin, Germany; 2Department
of Psychology and Psychotherapy, University of Witten/Herdecke, Witten/Herdecke, Germany;
3KPW Garbsen, Garbsen, Germany
Correspondence: Christoph D Hohmann (christoph.hohmann@charite.de)
Question
Low back pain has a high relevance in means of prevalence and socioeconomic burden.
This paper presents a clinical trial assessing the effectiveness of medical leech
therapyin chronic low back pain.
Methods
We aimed to investigate the effectiveness of leech therapy in chronic low back pain.
Forty-fourpatients with chronic low back pain who scored > 40 mm since at least 3 months
on a 100 mm VAS pain scale were randomized to a single treatment with 4-7 locally
applied leeches (leech group) or a 28 day course with back exercise once a week for
one hour led by a physiotherapist. Primary outcome measure was change of overall pain
on the 100 mm VAS from baseline to day 28. Secondary outcomes were overall impairment
(bothersomeness) by pain (100 mm VAS), disability (Roland Morris Disability Scale,
Funktionsfragebogen Hannover), quality of life (SF-36), and pain perception (SES).
Patients were examined baseline and at days 28 and 56 after treatment.
Results
Overall pain score at day 28 was reduced from 61.23/-15.6 to 33.74/-22.7 in the leech
group (n = 25) and from 61.55/-14.76 to 60.44/- 17.52 in back exercise group (n = 19)
(mean group difference -25.23; 95%CI -41.01 to -9.45; p = 0.0018). Significant treatment
effects were also observed for bothersomeness, disability, quality of life and pain
perception. Results were not affected by outcome expectation.
Conclusions
A single course of leech therapy is effective in relieving pain, improving disability
and quality of life for at least 2 months. Leech therapy is an effective option in
the treatment of chronic low back pain.
The study is registerd at german clinical trials register under identifier DRKS00004871.
O14 Andrographis paniculata for symptomatic relief of acute respiratory tract infections:
a systematic review and meta-analysis
Xiao-Yang Hu1, Ruo-Han Wu2, Martin Logue1, Clara Blonde3, Lily Y Lai 1, Beth Stuart1,
Andrew Flower1, Yu-Tong Fei2, Michael Moore1, Jian-Ping Liu2, George Lewith1
1University of Southampton, Southampton, SO16 5ST, United Kingdom; 2Centre for Evidence-Based
Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China; 3AgroParisTech,
Paris Institute of Technology for Life, Food and Environmental Sciences, Paris, France
Correspondence: Xiao-Yang Hu (x.hu@soton.ac.uk); George Lewith
Purpose
This systematic review aimed to evaluate the clinical effectiveness and safety of
A. paniculata for symptoms of acute RTIs.
Methods
Nine databases were searched from their inceptions to March 2016 for randomised controlled
trials (RCTs) evaluating oral A. Paniculata without language barriers. The primary
outcomes were improvement in RTI symptoms and adverse reactions. Random effects model
was used to poolthe standardised mean differences and risk ratio to incorporate heterogeneity
with 95% CI reported. Methodological quality was evaluated using the Cochrane risk
of bias; 2 reviewers independently screened eligibility and extracted data.
Results
Thirty-three RCTs (7175 patients) were included. Interventions included A. Paniculata
as a monotherapy and as an herbal formula. Most trials evaluated A. Paniculata provided
commercially but seldom reported manufacturing or quality control details. It showed
statistically significant effect in favour of A. Paniculata versus placebo (n = 445,
SMD: -0.69, 95%CI [-1.26, -0.12] for overall symptom; n = 596, SMD: -0.39, 95%CI [-0.67,
-0.10] for cough; and n = 314, SMD: -1.13, 95% CI [-1.37, -0.89] for sore throat).
Favourable effects were shown when compared A. paniculata to standard care, and other
herbal interventions. No major AEs were reported and minor AEs were mainly gastrointestinal.
The methodological quality of included trials were limited.
Conclusions
A. Paniculata appears beneficial and safe for relieving RTI symptoms and shortening
time to symptom resolution. The evidence is inconclusive due to limited study quality
and heterogeneity. Well-designed trials evaluating the effectiveness and safety of
A. Paniculata are warranted.
O15 Yoga in school sport - a non-randomized controlled pilot study in Germany including
a qualitative evaluation
Michael Jeitler1,2, Hannah Zillgen2, Manuel Högl3, Nico Steckhan2, Barbara Stöckigt2,
Georg Seifert2, Andreas Michalsen1,2, Christian Kessler1,2
1Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, 14109,
Berlin, Germany; 2Charité - University Medical Center, Berlin, Germany; 3University
Potsdam, Potsdam, Germany
Correspondence: Michael Jeitler (mika.jeitler@gmail.com)
Question
We aimed to evaluate potential effects of a 10-week yoga course as an alternative
for regular school sport.
Methods
A cohort study design with an active control group (school sport) was implemented
in two secondary schools. Primary outcome measure was stress (CPS) from baseline to
week 10. Secondary outcomes included depression/anxiety (HADS), attention (D2), quality
of life (WHO-5), mood states (POMS) and VAS for general pain, neck pain, headache,
fatigue and sleep quality. Outcome parameters were assessed at baseline, at week 10,
and at a 6-month follow-up. A per-protocol analysis using mixed linear models was
performed. Furthermore qualitative interviews in 3 focus groups with 6 participants
each were performed.
Results
102 adolescents were screened for eligibility. 86 (53% female; mean age 20.2 ± 2.3 years)
were included into the study (50 participants in 3 yoga classes and 36 participants
in 3 school sport classes). 85 data sets were included in the final analysis.
Yoga significantly reduced anxiety/depression when compared to school sport after
10 weeks (p = 0.004). No significant treatment effects were found for the other outcome
measures. Although nonsignificant, yoga showed greater improvement compared to school
sport for most other outcomes. The 6-month follow-up showed inconsistent results.
In the qualitative interviews participants evaluated yoga classes enthusiastically
and reported a variety of physical and psychological benefits as well as overall restorative
effects.
Conclusions
Yoga may be an effective method for coping with anxiety/depression in school sport
settings for adolescents. Well-designed RCTs including active control comparisons
are warranted.
O16 Explain the perception and experience of infertile women undergoing IVF/ICSI from
acupressure: a qualitative study
Talat Khadivzadeh, Maryam Hassanzadeh Bashtian, Shapour Badiee Aval, Habibollah Esmaily
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Correspondence: Maryam Hassanzadeh Bashtian (m.h.bashtian@gmail.com)
Question
Fertility in many cultures has a high value. If it fails, it can become a destructive
emotional experience. In this crisis situation, infertile couples more than other
people are affected by depression, anxiety, low self-esteem and dissatisfied. The
aim of this study is to explain the perception and experience of infertile women undergoing
IVF/ICSI from acupressure.
Methods
This study was a qualitative study and performed on the 16 infertile women undergoing
IVF/ICSI in Milad IVF Center, Imam Reza hospital, Mashhad University of Medical Sciences.
Qualified individuals purposefully selected according to inclusion and exclusion criteria
and were randomly divided into two groups of real and sham acupressure. In the real
acupressure group, P6 and HT7 points on two hands were under acupressure. Points in
the sham acupressure group were two centimeters away from the main points. Acupressure
was performed in twelve sessions. Four sessions were done by the practitioner and
eight sessions by own patient. Acupressure was trained to the patient by practitioner.
After intervention participants were interviewed. Then, interviews were organized
and coded. Data analysis was done by using of conventional content analysis based
on three primary phases of preparation, organization and reporting.
Results
Results of the experience and perception were in two categories. Those were body understandings
and positive experiences from acupressure.
Conclusion
This study showed that acupressure is effective on infertile women health. Further
research is justified about social flexibility and individual in women in related
to reproductive and sexuality issues.
O17 Differences in the tongue features of primary dysmenorrhea patients and controls
Jihye Kim, Keun H Kim
Korea Institute of Oriental Medicine, KM Fundamental Research Division, Daejeon, South
Korea
Correspondence: Keun H Kim (rkim@kiom.re.kr)
Objective
The aim of this study is to investigate the relationships between tongue features
and the presence or absence of menstrual pain.
Methods
This study was designed as a prospective, observational study and was conducted at
the Kyung Hee University hospital. A total of 48 eligible participants aged 20 to
29 years were enrolled and assigned to two groups, with primary dysmenorrhea (PD)
patients in Group A and healthy subjects in Group B, according to their visual analogue
scale (VAS) scores. Group A included 24 females with PD caused by qi stagnation and
blood stasis syndrome (QSBS) with VAS scores ≥ 4. Group B, the healthy subjects, included
24 females with few premenstrual symptoms and VAS scores < 4. All participants completed
four visits (menses-follicular-luteal-menses phases) and tongue images were obtained
using a computerized tongue image analysis system.
Results
The results of this study showed that the tongue coating thickness in the menstrual
phase of the PD group was significantly less than that of the control group, and the
tongue body was more reddish in the PD group than in the control group.
Conclusions
According to traditional Korean medicine theory, patients with typical QSBS normally
exhibit a purplish tongue and thin coating. The results of this study will provide
basic information that may be used as a reference for further studies and to establish
the principles of tongue diagnosis. Additionally, the present study suggests the usefulness
of tongue features as an objective diagnostic tool.
O18 Aromatherapy as a non-pharmacological intervention for dementia care – a review
Carina Klocke, Stefanie Joos
University Hospital Tübingen, Institute of General Practice and Interprofessional
Care, Tübingen, Germany
Correspondence: Carina Klocke (carina.klocke@med.uni-tuebingen.de)
Question
Non-pharmacological interventions in the area of complementary and alternative medicine
are used to increase the well-being and quality of life of dementia patients. As low-threshold
interventions, they are capable to be used by patients themselves or their caregivers,
and possess a low risk of side effects. We earlier conducted a systematic research
in order to identify their evidence. Two promising systematic reviews on aromatherapy
show potentially positive effects for dementia care. However, inclusion criteria were
very heterogeneous and, therefore, clear recommendations for the use of aromatherapy
cannot be made. Hence, this study adopted a more homogeneous approach with the intention
to draw specific recommendations.
Methods
A two-step approach was chosen: first, a research aiming at a scoping review on aromatherapy
was conducted in PubMed from 11/2016 until 12/2016, including primary studies on patients
with a diagnosis of dementia in English or German, interventions of aromatherapy/-massage,
and control with other interventions or placebos or none. There was no restriction
on specific outcome parameters. Second, studies assessing the use of lavender oil,
most commonly used in the included studies, were chosen to produce a homogeneous verbal
synthesis.
Results
In the first step, n = 245 studies were identified. Title and abstract screening left
n = 17 relevant studies for inclusion. A first analysis of the full texts showed the
use of the following plants: lavender (n = 11), lavender/orange (n = 1), melissa (n = 2),
lavender/orange in turn with rosemary/lemon (n = 1), lavender in turn with sweet orange
and tea tree (n = 1), not specified (n = 1). Focusing on lavender, the study designs
are RCTs (n = 5), CTs (n = 4), no control (n = 2). The ways of application are air
diffusion (n = 6), aroma massage (n = 5), dermal application (n = 3), unknown (n = 1);
n = 4 studies examined more than one condition. Group sizes vary between n = 1 and
n = 73. Overall, n = 8 studies using lavender show positive effects on agitation,
behavioral and psychological symptoms, anxiety and insomnia; n = 3 studies cannot
conclude any consistent effects. The combination of aromatherapy with massage tends
to be more effective.
Conclusion
Aromatherapy, with lavender in particular, shows potential for increasing the quality
of life and well-being of dementia patients, independent of the way of application,
e.g. through decreasing behavioral and psychological symptoms. Despite the number
of studies and their samples being small and a meta-analysis hence being as likely
as not possible, starting points for further research and challenges will be discussed
at the congress.
O19 Nigella sativa oil supplementation in asthma: a randomised, double-blind, placebo-controlled,
exploratory phase-II clinical trial
Abdulrahman Koshak1, Li Wie1, Emad Koshak2, Siraj Wali2, Omer Alamoudi2, Abdulrahman
Demerdash2, Majdy Qutub2, Peter Pushparaj2, Michael Heinrich1
1UCL School of Pharmacy, University College London, London, WC1N 1AX, United Kingdom;
2Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Correspondence: Abdulrahman Koshak (abdulrahman.koshak.12@ucl.ac.uk)
Background
Long-term medications in patients with asthma are needed to control the underlying
inflammation and prevent symptoms. However, Asthma control is considered to be suboptimal
regardless of the availability of conventional treatments. Traditionally, Nigella
sativa L. (NS), known as black cumin seed, is thought to be effective in treating
asthma or its key symptoms.
Objective
Our aim is to investigate the benefits of NS supplementation on clinical and inflammatory
parameters of bronchial asthma in patients on standard therapy.
Material and methods
A chemically characterised NS oil product (Marnys®) marketed as a food supplement
was used in a randomised, double-blind, placebo-controlled, phase II trial (RDBPCT)
with asthma patients. The primary outcome was the Asthma Control Test (ACT). The secondary
outcomes were lung function (predicted FEV1%), blood eosinophils, serum total Immunoglobulin
E (IgE), and multiple inflammatory mediators.
Results
Between Jun 1 and Dec 30, 2015, 80 patients were enrolled, with 40 patients each randomly
assigned to treatment and placebo groups. After 4 weeks, 10 patients had withdrawn
from each group. NS showed a statistically significant improvement in ACT and blood
eosinophils count. NS showed non-significant elevation of predicted FEV1%. Changes
in INF-gamma, IL-10, and IL-12p70 were noteworthy between both groups.
Conclusions
NS appeared to improve asthma symptoms, and some asthma-related biomarkers. Future
studies should follow patients for a longer period and be a multicentre.
Trial Registration: The trial was registered with clinicaltrials.gov, identifier NCT02407262.
Keywords: Herbal medicines, clinical trial, RCT, Asthma, Nigella sativa, Black seed
O20 Research in integrative pediatrics at a University Children's Hospital in Munich,
Germany
Sigrid Kruse, Isabell Fischer, Nadine Tremel, Joseph Rosenecker
Dr. von Hauner's Children's University Hospital Munich, Department for Integrative
and Rehabilitative Pediatrics, Munich, Germany
Correspondence: Sigrid Kruse (sigrid.kruse@med.uni-muenchen.de)
Background
The project Integrative Pediatrics was initiated in 2015 in three children’s hospitals
in Germany: Munich (Dr. von Hauners Children University Hospital), Landshut and Essen.
Integrative Pediatrics means the best of conventional medicine plus complementary
medicine including homeopathy and mind-body-medicine. It involves patient care, research
and education. The primary aim is to clarify which methods are suitable for children
in the two criteria effectiveness and safety. Homeopathy has been shown to fulfil
these criteria very well since 1995, when integration of single-remedy-homeopathy
began at the Dr. von Hauners Childrens University Hospital in Munich.
Methods
Research is being conducted as prospective studies in the following fields:
Hypnotherapy in children when taking blood
Recurrent urinary tract infections in children: Phytotherapy, Homeopathy and conventional
therapy in comparison
Recurrent chronic obstructive bronchitis in children: single-remedy-homeopathy as
add-on-therapy
Postoperative urinary retention in children: Is the single-remedy-homeopathy effective
to help in urination and to prevent the catheterization?
Results
Preliminary results will be presented in May 2017 on the WCIMH in Berlin.
Conclusion
The promising results of observational studies will be investigated more closely.
The conclusions to be drawn will depend on the results obtained
Key words: Integrative Pediatrics, University Childrens Hospital Munich, Research,
Homeopathy, Hypnotherapy, Phytotherapy
O21 Pilot study of acupuncture to treat anxiety in children and adolescents
Brenda Leung1, Wendy Takeda2
1University of Lethbridge, Health Sciences, Lethbridge, Canada; 2Elements Physical
Therapy and Acupuncture Ltd, Lethbridge, Canada
Correspondence: Brenda Leung (brenda.leung@uleth.ca)
Background
The prevalence of anxiety disorders in children has been estimated to be as high as
40%. Current treatments for paediatric anxiety have had limited success. Recently,
studies show acupuncture to be relatively safe and effective, even in children.
Objectives
To study the use of acupuncture for pediatric anxiety, and evaluate the feasibility
of the randomization process, adherence to the intervention by this population, and
changes to measures of anxiety.
Methods
This pilot study was a randomized control trial of children with anxiety, age 9 to
15, and living in Lethbridge, AB and the surrounding communities. Participants were
randomized to acupuncture or wait-list control groups. Participants in the waitlist
group was given acupuncture after a wait-period of 5 weeks (matching the time the
treatment group received acupuncture). Anxiety was measured using the Multidimensional
Anxiety Scale for Children (MASC) self and parent rating forms, and the Hamilton Anxiety
Rating Scale for Children and Adolescent (HAM-A). Acupuncture was provided by a licensed
acupuncturist at 1 session per week for 5 weeks. The nurse using the HAM-A was blinded
to the children"s group assignment.
Results
Nineteen participants were enrolled, with 10 in the treatment and 9 in the waitlist
group. Children in the acupuncture group had lower MASC-parent scores following completion
of the acupuncture session than children in the waitlist (no acupuncture) group (p < .05).
Scores were significantly lower for all 3 measures of anxiety from the pre- to post-
acupuncture assessments (p < .01).
Conclusion
Children who received acupuncture treatments had lower anxiety scores from pre- to
post assessments, and compared to the wait-list group. Acupuncture was tolerated and
acceptable to patients and their families.
O22 Traditional Chinese medicine health education on improving sub-health status:
a systematic review
Ning Liang, Xue Feng, Jian-ping Liu, Hui-juan Cao
Beijing University of Chinese Medicine, Center for Evidence-based Chinese Medicine,
Beijing, China
Correspondence: Jian-ping Liu (jianping_l@hotmail.com)
Question
Sub-health status is an intermediate state between health and disease, and could restore
to health if handled well with relative risk factors (e.g. excessive pressure, unbalanced
diet). This article was to summarize the current delivery ways of traditional Chinese
medicine (TCM) health education for sub-health status, and to explore the correlation
between TCM health education and sub-health status.
Methods
Six electronic databases were searched from inception till 2016 August. Studies with
control group including randomized or non-randomized controlled trials, cohort, case
control, and cross-sectional studies were included.TCM education compared with no
TCM education was included. Co-intervention was allowed in both groups. The sub-health
status was considered as primary outcome and health knowledge and behavior changes
as secondary outcomes.
Results
Of the 1451 citations, 106 full papers were screened and finally 4 studies were included.
TCM health education was delivered in two ways: school courses and individualized
clinician counseling. One study showed that compared to common health education alone,
adding on TCM clinicians specific health education improved total sub-health status(P < 0.00001),
and specifically fatigue(P < 0.0001), psychological symptoms(P < 0.00001) and immunity
(P = 0.0003). A statistically significant association was found of female status (e.g.
menstruation) and knowledge and behavior improvement (P = 0.000) between with or without
receiving school-based TCM health education.
Conclusions
Based on limited number of evidence, there was positive correlaton between TCM health
education and sub-health status or specific domains like female status or certain
knowledge and behavior changes. Future more studies were needed and the incorporation
with E-education should be paid much more attention to.
O23 A systematic review of the effects of meditation on empathy, compassion, and pro-social
behavior
Christina M Luberto1, Nina Shinday2, Lisa Philpotts1, Elyse Park1, Gregory L Fricchione1,
Gloria Yeh2
1 Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, United
States; 2Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA,
United States
Correspondence: Christina M Luberto (cluberto@mgh.harvard.edu)
Question
Empathy (i.e., understanding of others emotions), compassion (i.e., desire to relieve
others suffering), and pro-social behaviors (i.e., behaviors intended to help others)
are necessary for societal well-being and improve individual health outcomes (e.g.,
psychological well-being, systemic inflammation). Traditionally, one implicit goal
of meditation practices is to increase empathy and compassion. The purpose of the
current study is to systematically review the empirical literature on the effect of
meditation-based interventions on empathy, compassion, and pro-social behaviors.
Methods
A literature search was conducted in PubMed, MEDLINE, PsycINFO, CINAHL, Embase, and
Cochrane databases from inception through April 2016 using the search terms: mind-body
therapies, mindfulness, meditation, tai chi, yoga, MBSR, MBCT, empathy, compassion,
love, altruism, sympathy, or kindness. Randomized controlled trials in any population
were included.
Results
Twenty-six studies met inclusion criteria (total N = 1,714 subjects). Most studies
were conducted among healthy adults (n = 11) using compassion meditation (n = 10)
or combined mindfulness/compassion meditation (n = 8), often 8-12 weeks in duration
(n = 12) and delivered in a group format (n = 17). Most control groups were wait-list
or no-treatment (n = 15). Outcome measures included self-reported emotions (e.g.,
composite scores, validated measures of empathy) and observed behavioral outcomes
(e.g., real-world helping behavior, donations during computer games). Most studies
showed a low risk of bias. Results of low-bias studies demonstrated significant improvements
in observable pro-social outcomes following meditation training. Results for self-reported
outcomes were encouraging, though less consistent.
Conclusions
Meditation is efficacious for improving pro-social outcomes. Further research using
more diverse samples, longer-term follow-up, and standardized interventions and outcome
measures is warranted.
O24 Deficits in massage related adverse events case reporting and implications for
the therapeutic massage and bodywork field: a systematic audit through mid-2016
Niki Munk1, Arash Zakeresfahani2, Trevor R Foote2, Rick Ralston3, Karen Boulanger4
1Indiana University School of Health and Rehabilitation Sciences, Health Sciences,
Indianapolis, IN, United States; 2Indiana University School of Physical Education,
Tourism, and Management, Kinesiology, Indianapolis, IN, United States; 3Indiana School
of Medicine, Ruth Lilly Medical Library, Indianapolis, IN, United States; 4Stanford
University School of Medicine, Stanford, CA, United States
Correspondence: Niki Munk (nmunk@iu.edu)
Introduction
Adverse event (AE) reporting is lacking in massage research. Many case reports exist
describing medical intervention for purported massage related AEs. The current study
provides a rich description regarding reporting thoroughness and implications of case
reports documenting treatment for massage attributed AEs.
Methods
1)Systematic identification of published, peer-reviewed case reports for treatment
of massage related AEs following PRISMA recommendations, 2)audit development based
on CAse REport (CARE) guidelines and AE reporting guidelines, 3)audit implementation,
and 4)descriptive analysis of audit scores.
Results
Search identified 1041 articles; 71 met study inclusion criteria. Of the 51 audit
items assessed, articles included approximately 49% of the necessary guideline items.
Few audited case reports included client perspective (7%), race(11%), and occupation/activities(21%)
or patient consent to publish the report(7%). On average, articles reported 1.7(SD1.2)
of the 12 possible AE causing descriptors. None included a description of massage
provider training, scope-of-practice, or setting and most (70%) did not describe the
massage provider at all. Few articles included a description of the massage pressure
(6%), number(32%), length(11%), frequency(6%), or duration(4%). None reported an attempt
to contact the massage provider for information. Massage was the likely or absolute
AE cause in 79% of cases but in 59% of those, massage was not the sole cause of the
AE. Thirty percent of articles included situations of unforeseen, underlying, and/or
coincidental conditions. Various implications are discussed.
Conclusion
Most articles implicated massage for AEs yet lacked enough detail to adequacy inform
massage practice and education or massages role in these medically treated situations.
O25 Non-pharmacological multicomponent interventions as a method to treat dementia
Dominik Özbe, Elmar Gräßel, Katharina Luttenberger, Anna Pendergrass
Universitätsklinikum Erlangen, Erlangen, Germany
Correspondence: Dominik Özbe (dominik.oezbe@uk-erlangen.de)
Background
As there is no effective pharmacological treatment for dementia, it is profitable
to focus on non-pharmacological interventions. Our objective is to present the promising
approach of non-pharmacological multicomponent therapies using the example of a German
randomized controlled trial (RCT) and to give a systematic review of the international
literature.
Methods
In the German RCT 119 patients with primary degenerative dementia received either
a highly standardized intervention consisting of motor stimulation, activities of
daily living, and cognitive stimulation (MAKS) or treatment as usual. The systematic
review was based on a search in MEDLINE, PsycINFO, and PSYNDEX. All articles published
till August 2016 in English and German language were considered.
Results
At 6 months the MAKS group showed an improvement in overall dementia symptoms compared
to no change in the control group (adjusted mean difference (AMD) = -6.8, 95% CI = -10.3
to -3.3, P < .001, Cohen"s d = 0.66). The results at 12 months (n = 61) showed, that
the MAKS group remained stable in cognitive function (AMD = -7.7, 95% CI -14.0 to
-1.4, P < .05, Cohen"s d = 0.45) and ADLs (AMD = 3.6, 95% CI 0.7 to 6.4, P < .05,
Cohen"s d = 0.50), whereas the control group showed a significant deterioration. The
literature review showed that the most common components are varieties of physical
and cognitive stimulation.
Conclusion
Multicomponent interventions are able to stabilize and even improve dementia symptoms.
The growing body of work in this field needs to be systematically assessed and evaluated.
O26 Acupuncture for patients with multiple sclerosis associated fatigue – a randomized
controlled trial
Daniel Pach1,2, Judit Bellmann-Strobl3,4, Yinhui Chang1,5, Laura Pasura3, Bin Liu5,
Sven F Jäger3, Ronny Loerch1, Li Jin5, Benno Brinkhaus1, Miriam Ortiz1, Thomas Reinhold1,
Stephanie Roll1, Sylvia Binting1, Katja Icke1, Xuemin Shi5, Friedemann Paul3,4,6,
Claudia M Witt1,2
1Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin
Berlin, Berlin, Germany; 2Institute for Complementary and Integrative Medicine, University
of Zurich and University Hospital Zurich, Zurich, Switzerland; 3NeuroCure Clinical
Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany; 4Experimental
and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité
- Universitätsmedizin Berlin, Berlin, Germany; 5First Teaching Hospital of Tianjin
University of Traditional Chinese Medicine, Tianjin, China; 6Department of Neurology
with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
Correspondence: Daniel Pach (daniel.pach@charite.de)
Background
Fatigue influences daily activities of patients with multiple sclerosis (MS) and reduces
their quality of life. Most of clinical trials evaluating interventions for fatigue
in MS have shown only minor benefits.
Objective
We aimed to evaluate whether 1) acupuncture or 2) mindfulness-based stress reduction
(MBSR) in addition to usual care are effective in reducing fatigue in MS patients
compared to usual care alone.
Methods
We performed a single-center, randomized, three-arm, controlled trial in a university
study center specialized on MS. 116 outpatients with MS and fatigue for at least 3 months
and an average score of ≥ 4 on the Fatigue Severity Scale (FSS) were randomly allocated
to three groups (42 acupuncture, 21 MBSR, and 41 usual care). Patients in the acupuncture
group received 24 treatments within 12 weeks in addition to usual care, the MBSR group
received 12 weeks of MBSR treatment in addition to usual care, and the usual care
group continued any previous treatment. The primary outcome was the Fatigue Severity
Scale (FSS) after 12 weeks (values 1-7, with higher values indicating more fatigue).
Because of recruitment difficulties recruitment for MBSR was stopped early and only
acupuncture vs. usual care was analyzed in the primary analysis (ANCOVA adjusted for
baseline FSS and gender).
Results
The primary outcome fatigue (mean adjusted FSS score after 12 weeks) was 4.7 (95%
CI [4.4;5.1]) in the acupuncture group and 5.4 [5.0;5.7]) in the usual care group
(difference: 0.6 [0.16; 1.07], p = 0.009).
Conclusion
Acupuncture in addition to usual care was significantly superior to usual care alone.
Therefore acupuncture might be beneficial for MS patients with fatigue, particularly
with regard to limited treatment options for these symptoms, but more research is
needed. Further outcomes will be presented at the conference.
Trial Registration: ClinicalTrials.gov identifier NCT01864707
O27 Osteopathic treatment in addition to medical standard therapy in patients with
Gastroesophageal Reflux Disease (GERD): a randomized controlled trial
Michaela Rütz1, Andreas Lynen2, Meike Schömitz2, Maik Vahle2
1 German Academy of Osteopathy, Gauting, 82131, Germany; 2Still Academy, Mühlheim,
Germany
Correspondence:Michaela Rütz (f.schwerla@german-afo.de)
Question
To evaluate the effectiveness of custom tailored osteopathic treatment in addition
to medical standard therapy in patients suffering from GERD.
Methods
Three trained osteopaths conducted the study in their private practices in Germany.
70 patients aged 27 to 75 years with a history of GERD were included in the study.
By means of external randomization 35 patients were allocated to the intervention
group and 35 to the control group. In the intervention group 4 osteopathic treatments
at intervals of two weeks were performed with a follow-up after 12 weeks. All participants
were allowed to continue with their individual pharmacological therapy on demand (usual
care). Primary outcome parameter was frequency and severity of reflux symptoms (Reflux
Disease Questionnaire, RDQ). As secondary outcome parameters quality of life in reflux
and dyspepsia was assessed by a disease-specific questionnaire (QOLRAD).
Results
The inter-group comparison of changes revealed relevant improvements in support of
the osteopathic treatment for the main outcome parameter symptom frequency and severity
(RDQ overall score: between group difference of means 5.9; 95% CI: 3 to 8.9; p < 0.005).
Frequency of symptoms decreased by 37% and severity by 29%. Equally quality of life
improved in favor of the osteopathic group (QOLRAD overall score: between group difference
of means 0.7; 95% CI: 0.35 to 1; p < 0.005).
Conclusion
Four osteopathic treatments over a period of six weeks led to statistically significant
and clinically relevant positive changes of reflux symptoms and quality of life in
reflux and dyspepsia in patients suffering from GERD.
German Clinical Register: DRKS00006824
O28 An integrative curcumin-mesalamine therapy for remission induction in mild-moderate
active ulcerative colitis: an international, multi-center, randomized, double-blind,
placebo-controlled trial
Nir Salomon1, Alon Lang1, Adi Lahat1, Uri Kopylov1, Shomron Ben-Horin1, Ofir Har-Noi1,
Benjamin Avidan1, Rami Elyakim1, Dorit Gamus1, Siew NG2, Jessica Chang2, Justin Wu2,
John Kaimiklotis3
1 Sheba Medical Center, Tel Aviv, Israel; 2Gastroenterology, Chinese University of
Hong Kong, Hong Kong, Hong Kong; 3Cyprus IBD Center, IBD, Nicossia, Cyprus
Correspondence: Nir Salomon (nironsl@gmail.com)
Background and aims
Curcumin, a herbal-compound, may be efficacious in the treatment of ulcerative colitis
(UC). In this study we investigated the efficacy of curcumin add-on therapy for inducing
remission in patients with active mild-to moderate UC.
Methods
In this multi-center randomized, placebo-controlled double-blind study, 50 patients
with active mild-moderate UC (defined by score of 5 to12 in the Simple Clinical Colitis
Activity Index (SCCAI)) were allocated to receive 3gr daily of curcumin or placebo
for one month on top of optimized (oral + topical) 5ASA treatment. Clinical index
(SCCAI), endoscopic index (partial Mayo) and serological parameters were determined
at entry and conclusion of study period.
Results
In the intention-to-treat analysis, 14/26 (54%) patients receiving curcumin and 0/24
patients receiving placebo achieved clinical remission (SCCAI ≤2) at week 4 (P = 0.01,
OR 42.2, 95CI 2.3 to 760). Clinical response (reduction of ≥3 points in SCCAI) was
achieved in 17/26 patients receiving curcumin and in 3/24 patients receiving placebo
(P < 0.001, OR 13.2, 95CI 3.1 to 56.6). Endoscopic remission (partial Mayo score ≤ 1)
was observed in 8/22 (36%) of patients receiving curcumin and in 0/16 (0%) of the
patients receiving placebo (P = 0.035, OR 23.5, 95CI 1.2 to 445). The mean change
in partial Mayo score was +0,15 ± 0.49 for the placebo arm compared to -0.55 ± 0.79
in the curcumin arm (P = 0.04). No serious adverse events were recorded.
Conclusion
Curcumin as add-on therapy was superior to placebo for inducing clinical and endoscopic
remission in mild-to-moderate active UC with no apparent adverse effects. Curcumin
may be a safe and promising agent in the treatment of inflammatory bowel diseases.
O29 Effects of yoga versus the low-FODMAP diet on gastrointestinal symptoms and the
microbiota in patients with irritable bowel syndrome – a randomized controlled trial
Dania Schumann1, Ludovica Buttó 2,3, Jost Langhorst1, Gustav Dobos1, Dirk Haller4,5,
Holger Cramer1,6
1 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of
Medicine, University of Duisburg-Essen, Essen, Germany; 2Division of Gastrointestinal
and Liver Disease, Case Western Reserve University School of Medicine, Cleveland,
OH, United States; 3Case Digestive Health Research Institute and Departments of Medicine,
Case Western University School of Medicine, Cleveland, OH, United States; 4ZIEL -
Institute for Food & Health, Technical University of Munich, Freising, Germany; 5Nutrition
and Immunology, Technical University of Munich, Weihenstephan, Germany; 6Australian
Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health,
University of Technology Sydney, Sydney, Australia
Correspondence: Dania Schumann (d.schumann@kliniken-essen-mitte.de)
Purpose
To examine the effect of a yoga intervention versus a low-FODMAP diet (LFD) on irritable
bowel syndrome (IBS), as well as to explore potential changes in the gut microbiota.
Methods
59 patients with IBS undertook a single-blind, randomized controlled trial involving
a yoga intervention or LFD for 12 weeks. Changes in gastrointestinal symptoms (primary
outcome IBS-SSS), quality of life (IBS-QOL, SF-36) and perceived stress (CPSSS, PSQ)
were examined at weeks 12 and 24. 16S RNA analysis was performed after 12 weeks to
investigate the microbiota.
Results
There was no significant difference between the groups after 12 weeks in the IBS-SSS
(-31.80; 95%CI = -11.90,75.50; p = 0.151), or 24 weeks (-33.41; 95%CI = -4.21,71.04;
p = 0.081). Explorative within group comparison showed significant effects for yoga
and LFD at 12 weeks and 24 weeks (all p < 0.001). Comparable within group effects
occurred for the other outcomes. Significant changes in the composition of the gut
bacteria could be seen between the groups after 12 weeks (p = 0.041, corr. p = 0.082)
with a decrease in certain species after the FODMAP intervention.
Conclusions
This study found that both yoga and LFD group had a significant reduction in gastrointestinal
symptoms and an increase in the quality of life, but seemed to act though different
pathways. The FODMAP diet might unfold its effects through a change in the gut bacteria
composition while Yoga might act through the parasympathetic nervous system. More
research is warranted on the underlying mechanism of both interventions and the potential
benefit of their synergetic use, its effects and its safety.
O30 Acupuncture to improve live birth rates for women undergoing IVF: findings from
a randomized controlled trial
Caroline Smith1, Sheryl de Lacey2, Michael Chapman3, Julie Ratcliffe2, Neil Johnson4,
Jane Lyttleton1, Clare Boothroyd5, Paul Fahey6
1Western Sydney University, NICM, Penrith, Australia; 2Flinders University, Bedford
Park, Australia; 3University of New South Wales, Sydney, Australia; 4University of
Auckland, Auckland, New Zealand; 5IVF Med, Brisbane, Australia; 6Western Sydney University,
School of Science and Health, Campbelltown, Australia
Correspondence: Caroline Smith (caroline.smith@westernsydney.edu.au)
The evidence of acupuncture as an adjunct to IVF is conflicting. The aim of this study
was to determine the efficacy of a short course of acupuncture compared with a non-invasive
sham control for women undergoing a fresh IVF cycle on clinical outcomes.
Methods: a randomized controlled trial included women aged less than 43 years and
undergoing a fresh IVF or ICSI cycle was conducted at IVF units in Australia and New
Zealand. At randomization there was stratification by number of previous embryo transfers,
age of the women and IVF clinic site. Treatment was administered between days 6 to
8 of the stimulated cycle and two treatments were administered on the day of embryo
transfer. Participants, outcomes assessors and the analyst were blind to group allocation,
and acupuncturists were not blinded. The primary study outcome was live birth. Secondary
outcomes included clinical pregnancy, miscarriage prior to 12 weeks, quality of life,
and infertility self-efficacy.
Results: 848 women were randomly allocated to acupuncture (n = 424) or sham acupuncture
(n = 424). Fifty one women were excluded due to post randomisation exclusions or women
withdrew their consent, 193 women had a cancelled cycle e.g. no oocytes collected,
no surviving embryo, clinical decision to freeze all embryos. 604 women proceeded
to embryo transfer (acupuncture n = 301, sham acupuncture n = 303). The live birth
rate was 24.3% of those having an embryo transfer in the acupuncture group and 23.4%
of those in the sham acupuncture control group (relative risk, 1.04, 95% confidence
interval 1.04 to 1.38).
Conclusion: There was no evidence of a difference in the live birth rate for women
undergoing embryo transfer for women receiving acupuncture or non-invasive sham acupuncture.
O31 Effects of a mindfulness training on perceived stress, self-compassion and empathy
of primary care physicians: a quantitative and qualitative analysis
Bram Tjaden1, Marja van Vliet2, Herman van Wietmarschen2, Miek Jong2
1 Aandachtigedokters.nl, Zeist, 3702GV, Netherlands; 2Louis Bolk Instituut, Driebergen,
Netherlands
Correspondence: Miek Jong (m.jong@louisbolk.nl)
Background
Primary care physicians are subjected to high administrative demands and a high workload
leading to a large incidence of burnout. Mindfulness training has been found to improve
stress resilience in medical students and physicians. This study reports on the effects
of an 8 week mindfulness training on self-compassion, empathy and perceived stress
in primary care physicians.
Methods
A mixed quantitative and qualitative methodology was chosen. The enrolled primary
care physicians completed questionnaires on perceived stress (PSS), self-compassion
(Neff), self-reflection (Groningen reflective ability scale) at baseline, 6 months
and 12 months. A phenomenological qualitative content analysis was conducted on 6
semi-structured interviews 3 months after the training to evaluate: in which manner
the mindfulness training changed the way of looking at yourself, looking at your environment
and looking at your patient.
Results
First analysis of data from 44 participating primary care physicians indicated a significant
reduction in perceived stress (p < 0,000), improvement in self-compassion (p < 0,000)
and an improvement in self-reflection (p = 0,018) after the mindfulness training compared
to before the training. Qualitative analysis revealed the themes awareness, acceptance,
peace, openness, and integration in daily life several, related to changes in self-reflection
and changes in perceiving your environment. Additionally, "connection with the patient"
was revealed as a strong theme, indicating a better understanding of the patient and
an improved ability to regard the patient as a whole.
Conclusions
Mindfulness training is an effective approach for fostering compassion and self-reflection
in primary care physicians, in addition to improvement of stress-resilience.
O32 Cancer therapy with mistletoe extracts. Short overview of 100 year experiences
and recent clinical results
Wilfried Tröger (troeger@crdt.de)
Verein für Krebsforschung e.V., medial science, Arlesheim, Switzerland
Introduction
Cancer therapy with mistletoe extracts has been proposed by Rudolf Steiner 100 years
ago in 1917. The first preparation “Iscador” should “replace the knife of the surgeon”
and be used in all types of cancer.
The first cases already showed less morbidity of the patients and a better quality
of life, as well as a surprisingly long survival time.
In the following, a short overview and recent results of randomized studies are shown.
Methods
To find out the mode of action, in vitro research has been done since the early sixties.
The first clinical trials were retrospective studies comparing with a historical population,
case series prospective or non-randomized clinical trials. In parallel many ex vivo/in
vitro - studies have been done, because of the multiple immunomodulating activities
of mistletoe. End of the seventies the first prospective randomized clinical trials
were published.
Results
Some constituents of mistletoe extract are cytotoxic. Mistletoe lectins induce apoptosis
and viscotoxins cause necrosis in cancer cells. Surprisingly healthy human lymphocytes
are not affected in the same way. In contrary, many of their subtypes are stimulated
by mistletoe lectins (T- and B-cells) or oligosaccharides like rhamnogalactouronanes
(NK-cells) in in vitro assays. Mistletoe may protect healthy PBMC from the DNA-damaging
effects of chemotherapy. Recent results even showed a synergistic effect of mistletoe
and chemotherapy on cancer cells in vitro, testing different tumor cells and their
respective standard chemotherapy regimen.
There are about 90 clinical trials with Iscador published since 1962. The examined
tumour entities were in breast, colon, lung, skin, cervix, pancreas, stomach, bladder
and others. Several reviews showed strong effects regarding morbidity and quality
of life, and moderate effects on tumour response and survival. None of the studies
showed negative effects or reported from serious adverse events.
Recent GCP-studies showed a benefit in quality of life as well as a prolongation of
the survival time. A randomized early breast cancer study using Iscador in parallel
to CAF showed the improvement of quality of life and neutropenia. A study with patients
with locally advanced or metastatic carcinoma ot the pancreas showed a median survival
of the Iscador-patients of 4,8 months and 2,7 months for the control patients, who
received no therapy anymore (HR = 0,49; p < 0,0001).
Conclusion
Mistletoe extracts decrease the morbidity of the patients and increase the quality
of life as well as the survival time of cancer patients. The therapy is safe.
O33 Research in complementary and alternative medicine in Finland: a literature review
Pia Vuolanto1, Paulina Aarva1, Minna Sorsa1, Kaija Helin2
1University of Tampere, Faculty of Social Sciences, Tampere, Finland; 2Åbo Akademi
University, Åbo, Finland
Correspondence: Pia Vuolanto (pia.vuolanto@uta.fi)
The situation and prerequisites of research in complementary and alternative medicine
(CAM) vary between countries across the world. Some countries have well established
CAM research centers and in most countries the numbers of CAM publications have grown
steadily during the last couple of decades. Finland does not have a CAM research center
and its prerequisites for CAM research have been very scarce. The regulation of CAM
is far from being solved. Public discussion on CAM often ends up in controversies
characterized by strong juxtapositions.
The presentation focuses on Finnish CAM research in the long-term perspective by analysing
CAM research articles and PhD theses from the 1960s until 2015. The analysis shows
the slow growth of the number of publications and the heterogeneity of settings for
CAM research. However, certain trends in Finnish CAM research could be identified.
The most important focus of research has been on CAM use and the experiences of CAM
users. Also the attitudes of health care personnel in Finland have been studied, as
well as the history of different traditional healing practices. Surprisingly little
research conducted on the efficacy of CAM treatments was found which might be due
to the lack and scarcity of research resources. We argue that due to the absence of
national CAM policy including research policy and the dominance of research on CAM
usage, the category of CAM and its central concepts have not been analysed thoroughly.
This might have an impact on the strong controversies in public discussions about
CAM treatments in the Finnish context.
O34 The potential of video analysis for recognising ergotropic and trophotropic phases
of patients during music and occupational therapy
Claudia Wenzel, Iris Zoderer, Patricia Pammer, Patrick Simon, Gerhard Tucek
Department of Health Sciences, IMC University of Applied Sciences/Austria, Krems an
der Donau, 3500, Austria
Correspondence: Claudia Wenzel (claudia.wenzel@fh-krems.ac.at)
Purpose
As part of a mixed-methods study focusing on the optimum chronobiological phase for
therapeutic processes, the main objective of this qualitative part of the study was
to identify ergotropic and trophotropic phases of patients participating at music
or occupational therapies with the help of systematic video analysis.
Methods
Data collection included videographies (n = 10) of music and occupational therapies
as well as qualitative expert interviews (n = 10). Grounded Theory was used both as
a methodology and as a method of analysis (coding). The computer software Atlas.ti
(Vers. 7.0) was used for both interview and video analysis.
Results
The systematic interview and video analysis showed that researchers and professionals
can differentiate between ergotropic and trophotropic phases in the course of music
or occupational therapies, but there are no unique categories referring only to ergotropic
or to trophotropic phases. Posture & motor function, followed by verbal, action &
activity, concentration facial expression and interaction were the most frequently
categories.
Conclusions
As there are no unique categories for either ergotropic or trophotropic phases, the
context of the therapy must be taken into account as well as parameters like the subjective
motivation of the patient. The empirical results can be considered as the foundation
for the development of an observance tool for identifying ergotropic or throphotropic
phases of patients with the objective to find the right chronobiological phase for
clinical therapies.
O35 The use of complementary and alternative methods (CAM) among Swedish cancer patients
Kathrin Wode1, Roger Henriksson1,2, Lena Sharp1,3, Anna Stoltenberg1, Johanna Hök
Nordberg1,3
1Regional Cancer Center Stockholm Gotland, Stockholm, Sweden; 2North Sweden University
Hospital, Umeå, Sweden; 3Karolinska University Hospital, Stockholm, 14186, Sweden
Correspondence: Johanna Hök Nordberg (Johanna.hok@ki.se)
Although Swedish conventional health care providers rarely discuss, recommend or prescribe
CAM, research indicates use comparable to other high-income countries. The aim of
this study was to describe patterns of CAM use among Swedish cancer patients.
In this cross-sectional study, questionnaires were distributed consecutively to 1297
cancer patients at Stockholm’s university hospital’s out-patient units. Response rate
was 58% (n = 755). Answers were analyzed using descriptive statistics and content
analysis.
Use of CAM over lifetime was reported by 34%; after cancer diagnosis by 26% and new
CAM use since cancer diagnosis by 17%. Females, age 30-49 and high education predicted
CAM use. Top 3 methods were vitamins and minerals, natural products and relaxation.
Main reasons for use were improvement of physical, emotional and general wellbeing.
Side-effects were few and mild; average monthly costs <50 €; satisfaction was high.
One third discussed their CAM use with cancer care providers; 2% thought that the
Oncology team didn’t need to discuss CAM. Over 50% thought that CAM therapies should
be offered in cancer care.
Swedish cancer patients use CAM despite limited access and information, are highly
satisfied and experience specific benefits. In general, CAM use seems to be a conscious
choice compatible with daily life and reflects patients’ needs to contribute to their
wellbeing. The lacking involvement of conventional providers in patients CAM use diverge
with patients needs and might be a risk for patient safety. If cancer care has the
ambition to be person centered, patients preferences about CAM need to be addressed.
O36 Dengzhan Shengmai capsule as adjunctive treatment for ischemic stroke: a systematic
review and meta-analysis of randomized clinical trials
Yang Xiao-ying, Li-qiong Wang, Jin-gen Li, Ning Liang, Ying Wang, Jian-ping Liu
Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine,
Beijing, China
Correspondence: Yang Xiao-ying (yuki-ying@bucm.edu.cn)
Objective
The review aimed to assess the effectiveness and safety of Dengzhan Shengmai (DZSM)
capsule for ischemic stroke.
Methods
We searched six electronic databases for randomized controlled trials of DZSM capsule
for people with ischemic stroke. Co-intervention was allowed if applied in all arms.
Risk ratio and mean difference with a 95% confidence interval (CI) were used as effect
measures by using RevMan 5.3.
Results
We identified 14 RCTs involving 5206 participants, and all trials were conducted in
China. Majority of the included trials were of high risk of bias in methodological
quality. For acute ischemic stroke, adding DZSM capsule to conventional therapy achieved
higher Barthel Index scores (MD 22.37, 95% CI 21.34 to 23.40), lower neurological
function deficit scores (MD - 3.73, 95% CI -5.27 to -2.19) and lower recurrence rate
(RR 0.22, 95% CI 0.10, 0.46). For patients in their convalescence (or convalescence
and sequelae stage) of ischemic stroke, DZSM capsule was superior in improving quality
of life (MD 28.8, 95% CI 7.10 to 50.50) and recurrence (RR 0.71, 95% CI 0.51 to 0.99)
compared to placebo. No trials reported the serious adverse events.
Conclusion
DZSM capsule appears to improve neurological function, quality of life and reduce
recurrence rate based on conventional therapy for ischemic stroke and seems generally
safe. However, the findings of benefit are inconclusive due to generally weak evidence,
and further large, rigorous trials are still warranted.
Clinical care
O37 Medical cannabis access in Canada: new opportunities and challenges
Lynda Balneaves1, Rielle Capler2
1 College of Nursing, University of Manitoba, Winnipeg, R3T 2 N2, Canada; 2Interdisciplinary
Studies Graduate Program, University of British Columbia, Vancouver, Canada
Correspondence: Lynda Balneaves (lynda.balneaves@umanitoba.ca)
Introduction
Since 2001, Canadians have had access to medical cannabis. In 2013, new regulations
and a production system were instated to maintain reasonable access to medical cannabis
while addressing safety issues. Recent court rulings, as well as a movement towards
legalization, have further shifted how medical cannabis is conceptualized and offered
in Canada. The purpose of this review is to examine the opportunities and challenges
facing medical cannabis access in Canada.
Methods
This review will reflect on the current literature and regulation history in Canada
regarding how medical cannabis has been offered and produced, as well as research
that has explored the access experiences of patients utilizing medical cannabis. Preliminary
findings from a survey of 369 medical cannabis users will be considered in the context
of new legislation.
Findings
Qualitative research has revealed Canadians have struggled to access medical cannabis,
with gatekeeping, social stigma, and poor quality being reported as challenges. Survey
research shows access remains problematic for 50% of patients, with cost, product
availability, and wait-times posing significant challenges. To address these issues,
new legislation has expanded the types of product available as well as legalized some
forms of self-production. A recent task force on legalization has also been offered
as a way to increase access to cannabis.
Conclusion
While legalization of cannabis may improve access, it poses new challenges with regards
to how medical cannabis use is conceptualized, researched and made available to Canadians.
Thoughtful dialogue about these challenges is needed prior to future legislation changes
and program development.
O38 Possibility of cure and prevention of radiation therapy injury
Chiara Bocci, Marta Guffi, Marina Paolini, Ilaria Meaglia, Patrizia Porcu, Giovanni
B Ivaldi
ICS MAUGERI, Radiotherapy, Pavia, Italy
Correspondence: Chiara Bocci (chiara.bocci@fsm.it)
Radiotherapy treats many types of cancer effectively. But like other treatments, it
often causes side effects. These are classified as acute (occurring within few weeks
after therapy), intermediate or late (occurring months or years after the therapy)
and can have a devastating effect on the quality of life of cancer patients and survivors.
Due to the inadequacy of most of the radio-protectors in controlling the side effects
of conventional cancer therapy the complementary and alternative medicines have attracted
the view of researchers and medical practitioners more recently.
The use of compounds which can selectively protect normal tissues against radiation
injury is of immense interest because beside protecting the normal tissue, could also
permits use of higher doses of radiation to obtain better cancer control and possible
cure. Curcumin, for example, has been reported to protect various study systems against
the deleterious effects induced by ionizing radiation and also to enhance the effect
of radiation.
Oncology acupuncture has become a new and promising field of research. Recent trials
made efforts in studying hot flashes in breast cancer patients under hormonal therapy,
xerostomia induced by radiotherapy in head and neck cancer, and fatigue and insomnia.
Dietary modification such as caloric restriction has been shown to decrease tumor
initiation and progression and could be used during radiotherapy course as a novel
therapeutic intervention to enhance cytotoxic therapies and reduce the cytotoxic effects
on normal tissue.
Preliminary data support the efficacy of Homoeopathic topical Calendula for prophylaxis
and treatment of acute dermatitis during radiotherapy.
O39 Type D personality, anxiety and depression – does the presence of type 2 diabetes
mellitus make a difference in coronary and hypertensive patients?
Simona Dragan, Petru Bucuras, Ana M Pah, Marius Badalica-Petrescu, Florina Buleu,
Gheorghe Hogea-Stoichescu, Ruxandra Christodorescu
University of Medicine and Pharmacy Victor Babes, Cardiology, Timisoara, Romania
Correspondence: Simona Dragan (simona.dragan@umft.ro)
Introduction
Cardiovascular morbidity and mortality rates are linked to certain personality traits
associated with depression and anxiety. Type D behavior is characterized by the shared
inclination to experience negative emotions and to inhibit them while avoiding social
contact. In this study, we assessed the impact of the presence of type 2 diabetes
mellitus (T2DM) on quantified anxiety and depression scores and type D personality
in hypertensive and coronary patients.
Material and methods
The study was carried out on 107 patients with coronary artery disease (CAD; mean
age 64.8 years) and 203 patients with hypertension (HT; mean age 63.7 years). The
hospital-based 14 item anxiety and depression scale (HAD) and the Duke Anxiety-Depression
Scale (DUKE) were used for standardized self-reported measurements for anxiety and
depression scores. Type D personality was assessed using the DS-14 scale, containing
7 item negative affectivity (NA) and social inhibition (SI) subscales. Correlations
were made using the chi2 test and the non-parametric Mann-Whitney and Kruskal-Wallis
tests.
Results
T2DM was present in 62 patients with CAD and 97 patients with HT. Type D personality
(NA added to SI scores ≥14) was found in 29% patients with CAD and 27,7% with HT.
Anxiety scores (HAD A) were significantly higher in CAD patients with T2DM than in
non-diabetics (p = 0.014) and correlated with LDL levels (r = 0.133, p = 0.025). DS-14
NA scores were significantly higher in HT patients with T2DM than in non-diabetics
(p = 0.023). Type D personality was present to a significant extent in HT patients
with T2DM compared to non-diabetics (p = 0.015).
DUKE scale scores correlated significantly with HDL levels (r = 0.297, p < 0.001)
and arterial diastolic pressure (ADP) levels for both CAD (r = 0.225, p = 0.004) and
HT (r = 0.180, p = 0.003) patients. Higher DUKE scores were obtained in CAD compared
to HT patients, regardless of T2DM diagnosis (Mann-Whitney test, p = 0.011). Patients
with stage 3 HT had higher DUKE scores than those with stage 2, thus correlating with
disease progression.
Conclusion
This study showed that type D personality and anxiety are closely linked to diabetes
in coronary and hypertensive patients. Based on these findings, we consider that personalized
psychotherapeutic interventions are extremely important for disease progression and
should be part of complex cardiovascular prevention programs.
O40 An integrative approach with acupuncture for post-traumatic stress disorder (PTSD):
a case report
Lan Kao, Yumin Cho
Department of General Internal Medicine, Center for East-West Medicine, University
of California Los Angeles (UCLA), Los Angeles, CA 90024, USA
Correspondence: Yumin Cho (cho.yumin@gmail.com)
Background: This study is an assessment of the acupuncture utility for treatment of
post traumatic stress disorder (PTSD), which is characterized by “intrusive thoughts,
nightmares, flashbacks of past traumatic events, avoidance of reminders of trauma,
hypervigilance, sleep disturbance, all of which lead to considerable social, interpersonal1”
and physiological dysfunctions. This case involves a 43-year old female veteran diagnosed
with PTSD and mild traumatic brain injury, due to military combat and sexual trauma,
after her 2012 deployment to Afghanistan. She presented with depression, anxiety,
sleep disturbance, headaches, chest pain, lower back pain, bladder pain, and constipation.
Methods: Patient completed a questionnaire pre and post acupuncture to assess the
severity of symptoms. Acupuncture sessions were 30 minutes, administered once a week
for 3 weeks in a group setting, using sishencong, GB20, DU9/11/13/14/15/16, Ub23.
Other interventions included qigong, cognitive processing therapy, emotion regulation,
distress tolerance, biofeedback, mindfulness, art therapy, and equine therapy.
Results: Anxiety level reduced from 9/10 to 4/10. Depression reduced from 10/10 to
0/10. Sleep duration and quality improved from 2-4 hours a night to 6-7 hours of sustained
sleep without medication, and sleep apnea subsided. Headaches diminished and medication
stopped. Back pain improved from 5-7/10 severity to 2/10 and medication stopped by
the third treatment. Bladder pain eased and medication usage ceased. Bowel movement
became regular.
Conclusions: This case demonstrates the potential utility of acupuncture within an
integrative setting as an adjunct intervention for the treatment of PTSD. Written
informed consent was obtained from the patient to publish this data.
1. Sareen, J, Stein, M B, Hermann, R. UpToDate. Post traumatic stress disorder in
adults: Epi- demiology, pathophysiology, clinical manifestations, course, assessment,
and diagnosis. Avail- able at https://www.uptodate.com. December 15, 2015.
O41 Quality of life and fatigue in breast and gynecologic cancer patients during chemotherapy
supported by a complex nurse-led CAM intervention – results of a randomized-controlled
trial
Nadja Klafke1, Cornelia Mahler1, Cornelia von Hagens2, Lorenz Uhlmann3, Martina Bentner1,
Andreas Schneeweiss4, Andreas Mueller5, Joachim Szecsenyi 1, Stefanie Joos1
1University Hospital Heidelberg, Department of General Practice and Health Services
Research, Heidelberg, Germany; 2University Women's Hospital Heidelberg, Department
of Gynecologic Endocrinology and Reproductive Medicine, Division Naturopathy and Integrative
Medicine, Heidelberg, Germany; 3University Hospital Heidelberg, Institute of Medical
Biometry and Informatics, Heidelberg, Germany; 4National Center for Tumor Diseases,
Gynecologic Oncology, Heidelberg, Germany; 5Community Hospital Karlsruhe, Women's
Clinic, Karlsruhe, Germany
Correspondence: Nadja Klafke (nadja.klafke@med.uni-heidelberg.de)
Question
Conventional cancer treatment is associated with patients' impaired physical and emotional
functioning, affecting quality of life outcomes. Fatigue belongs to one of its most
distressing symptoms. The majority of cancer patients complement conventional cancer
treatment with Complementary and Alternative Medicine (CAMs), however, more evidence
to encourage such supportive treatments is urgently needed.
The primary objective of the CONGO (Complementary Nursing in Gynecologic Oncology)-study
was to investigate if a complex CAM intervention, consisting of a CAM nursing package,
resource-oriented counseling, and CAM information materials, improves health-related
quality of life (HRQOL) and associated patient-oriented outcomes in breast and gynecologic
cancer patients receiving chemotherapy. As part of the HRQOL analyses, we aimed to
analyze if and how patients' fatigue levels benefited from the CAM interventions.
Methods
From July 2014 until April 2016, randomized controlled trial data of 251 patients
treated for localized or metastatic cancers were collected in the National Center
of Tumor Diseases (NCT) Heidelberg and the Community Hospital Karlsruhe (SKK). The
intervention group patients received routine care plus the CAM intervention package
during chemotherapy treatment (CHT); control group patients received routine supportive
care only.
The primary endpoint HRQOL was assessed with the EORTC-QLQ-C30; the secondary endpoint
fatigue was assessed with the 13-item scale of the Functional Assessment of Cancer
Therapy-Fatigue (FACIT-F). Both endpoints were measured at T1 – baseline, T2 – midline
of CHT, T3 – end of CHT, and follow-up T4 – 6 months after CHT. In addition the HRQOL
was assessed weekly in the patient diary.
Results
Databank cleansing of all time points was finalized in December 2016. Currently, the
data of the primary and secondary outcomes are being examined. Data are analyzed with
linear mixed models including intervention/control group, the interaction of treatment
and time, fatigue/HRQOL baseline scores, and the strata center and stage of cancer
as fixed effects. The models will also consider a random intercept to take account
of the correlation between observations of the same patients assuming an unstructured
correlation structure. Complete results of these analyses can be presented in May
2017 at the ECIM&ICCMR.
Conclusions
The CONGO-study evaluates if cancer patients' supportive therapy can be improved by
a CAM intervention delivered by trained oncology nurses. Due to patients' increasing
uptake of holistic practices and products, it is essential that healthcare professionals
know how to respond to patients' needs, and that evidence-based CAM programs are further
integrated into oncology healthcare services.
O42 Acupuncture in post-date pregnancy
Isabella Neri (isabella.neri@unimore.it)
Ob-Gyn, University of Modena, Modena, 41125, Italy
Question
Pharmacological labor induction is obtained through intracervical/vaginal prostaglandins
and/or oxytocin infusion; however, the use of these agents produces fetal and maternal
side effects. Traditional Chinese medicine advocates the use of acupuncture to soften
the cervix and induce uterine contractions. The aim of the present study is to investigate
the effect of acupuncture to induce labor onset. Acupuncture was applied in post-date
pregnancies and the primary outcome was the rate of women submitted to labor induction
for prolonged pregnancy at week 41 5.
Methods
After informed consent, 375 undelivered women after 40 2 gestational age were considered
eligible for the study and 112 women treated with acupuncture and 263 in the observation
group. The acupuncture sessions were planned up to a maximum of 4 sessions up to 41st
week plus 4 days. At 41 5 week a pharmacological induction of labor was planned.
Results
Acupuncture and observation groups showed a similar rate of nulliparous women (66.1%
vs 55.9%) pre-labor rupture of membranes (32.1% versus 31.2%), gestational age to
hospitalization (287.7 ± 3.1 versus 287.1 ± 2.9 days), blood loss (470.9 ± 331.6 versus
400.9 ± 321.5 ml),) rate of caesarean section (12.5% versus 14.8%) and birth weight
(3532.7 ± 375.8 versus 3537.1 ± 399gr).The rate of operative delivery is lower in
women treated with acupuncture in respect to control (6.3% versus 11.4%). The total
rate of labor induction significantly differed between acupuncture and control groups
(19.6% versus 38.0%). In particular the labour induction indicated for "prolonged
pregnancy" was lower in women submitted to acupuncture(6/112 versus 23/263).
Conclusion
The present study demonstrated that acupuncture applied a term of delivery seems effective
in reducing the rate of labor induction performed for prolonged pregnancy at 41 5 weeks.
O43 Complementary and integrative medicine in nursing homes - results of a prospective,
exploratory, comparative, two-armed cohort study from the residents' perspective
Miriam Ortiz, Katharina Schnabel, Michael Teut, Gabriele Rotter, Sylvia Binting, Margit
Cree, Fabian Lotz, Ralf Suhr, Benno Brinkhaus
Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin
– Berlin, Berlin, 12209, Germany
Correspondence: Miriam Ortiz (Miriam.oritz@charite.de)
Question
"Kneipp Therapy" (KT) is a form of Complementary and Integrative Medicine (CIM) that
includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical
activities and healthy nutrition. Since 2007 nursing homes (NH) in Germany started
to integrate KT in daily care. The aim was to investigate the long-term impact of
KT on NH residents.
Methods
We conducted a prospective, exploratory, two-armed cohort study to compare NH with
(KT group) and without KT (but with routine health preventive interventions (HPI);
control group) over 12 months. Each NH with KT was matched to a control NH. Outcomes
included frequency of received KT resp. HPI, a quality of life (QUALIDEM) and a multidimensional
global impression scale (NOSGER).
Results
We included n = 105 residents from 7 NH (KT group) and n = 69 residents from 6 NH
(control group). 82% of the residents were female (BMI 28.3 ± 5.9; age: 83.4 ± 7.7 years).
There were no major differences between the groups in the QUALIDEM items. KT group
residents had significantly better values for the NOSGER dimension "challenging behaviour"
(p = 0.003) after 6 months and "memory capacities" after 12 months (p = 0.040). In
a post hoc sensitivity analysis residents of both groups who had received more than
30 times KT resp. HPI per month showed significantly better values in social and well-being
items of the QUALIDEM and NOSGER.
Conclusions
The study showed only few significant differences between both NH groups in favour
for KT. The frequency of KT or HPI applications seems to influence social aspects
and well-being.
Trial Registration: DRKS-ID: DRKS00005049
O44 Integrative oncology in the region of Tuscany: a successful integration
Elio Rossi1, Sonia Baccetti2, Fabio Firenzuoli2, Maria V. Monechi2, Mariella Di Stefano2,
Gianni Amunni3
1 Homeopatic Clinic ASL Tuscany North West Lucca, Tuscan network for Integrative Medicine,
Lucca, 55100, Italy; 2 Tuscan Network of Integrative Medicine, Florence, 50139, Italy;
3 ISPO, Tuscan Tumor Institute, Florence, 50139, Italy
Correspondence: Elio Rossi (e.rossi@mednat.it)
Purpose
To describe the process of integration of complementary medicine (CM) in the network
of Cancer Departments of Tuscan public healthcare which is ongoing since 2009.
Methods
In 2009 the Tuscan Tumor Institute and the Tuscan Network of Integrative Medicine
(TNIM) established a working group composed of experts in CM and oncologists to review
the literature on the use of CM in cancer care. Later in 2013 the TNIM participated
in the European Partnership for Action Against Cancer-EPAAC (7th Framework Programme),
with the purpose of collecting evidence on the use of CM in cancer and mapping the
European centers offering integrative oncology.
Results
In 2015 a Resolution of the Tuscan Regional Government ratified to develop the use
of some CM as treatment of cancer-related symptoms, and side effects of conventional
cancer therapy (acupuncture for nausea and post-chemotherapy and post-surgery vomiting,
pain, hot flushes of iatrogenic menopause, xerostomia; homeopathy for hot flushes
of iatrogenic menopause and the side-effects of radiotherapy; herbal medicine for
anxiety, depression, cancer-related fatigue, mucositis, nausea, vomiting and pain).
A Commission of CM experts and oncologists will define how to apply this resolution.
The role of CM in cancer care has been recently strengthened within the reform of
Public Health Service ongoing in Tuscany.
Conclusions
The integration of evidence-based complementary treatments as a part of a Comprehensive
Cancer Care Network allows to respond safely and effectively to the demand coming
from cancer patients and combine safety and equity of access in public health systems.
O45 Increasing the survival of pancreatic cancers by Chinese Herbal Medicine
Wendy Wong, Bingzhong Chen, Justin Wu
Chinese University of Hong Kong, Hong Kong Institute of Integrative Medicine, School
of Chinese Medicine, Hong Kong, Hong Kong
Correspondence: Wendy Wong (wendy.wong@cuhk.edu.hk)
With advance diagnosis of health care system, pancreatic cancer has the lowest overall
5-years overall survival among all other cancers. Systematic review or meta-analysis
have concluded that the radio-therapy or chemotherapy are least effective. Chinese
Herbal Medicine (CHM) is being commonly used among patients for cancer treatments.
The concurrent use of CHM for cancer treatment remain controversial since herbs were
found to be interfering with the efficacy of chemotherapy or leading to potential
associated toxicities.
In this study, we proposed a retrospective case series study to investigate the survival
gain for pancreatic cancer patients who had different treatment regimens across their
patients journeys. With Hong Kong the best location for bridging both Chinese and
Conventional Medicine, the outcomes will be able to advance global interdisplinary
medical industry for recommendation. This study aims at identifying the benefits and
safety of CHM for cancer patients in terms of survival, safety, adverse effect, drug-related
symptoms. With the global trend of Integrative Medicine, this study could facilitate
inter-professional communication for improving the clinical management of pancreatic
cancer patients in Chinese.
Methods
A retrospective case series was conducted on 182 patients diagnosed with pancreatic
cancer from 2005 to 2015 who consulted for Chinese Medicine Practitioner for CHM treatment
at Central of Hong Kong. Primary outcome was the overall survival after the diagnosis
of cancer.
Results
With mean age of 56 (range of 30-87), 6 patients had only taken only CHM and refusing
surgery, chemo- or radiotherapies. All other 176 patients had taken in parallel of
CHM and conventional treatment of any combination of sugery, radio- or chemotherapy.
The range of survival was 4 months to 9 years with mean of 29.6 months. The median
of survival was 15.2 months. More than 76% patients can sustain the 1-year survival.
Conclusion
These illustrated a superior clinical outcomes than solely intake of conventional
medications. The specific herbs in playing of the role of prolonging survival of pancreatic
cancer should be investigated for wider application. This will help in identifying
benefits and safety of CHM in pancreatic cancer patients. The results will help guide
strategies to improve patient-centered actions relating to pancreatic cancer treatment
and survivorship.
Education
O46 Graduate Masters of Science Degree Program in Complementary and Integrative Medicine:
opportunity to inform, cultivate and develop future healthcare leaders
Hakima Amri, Aviad Haramati, Lucy Kotlyanskaya
Biochemistry and Cellular and Molecular Biology, Georgetown University Medical Center,
Washington, DC 20007, United States
Correspondence: Hakima Amri (amrih@georgetown.edu)
Offering Integrative Medicine (IM) content, as a course of study prior to entering
medical school or other health professions, can enhance a students awareness about
values relevant to their future career and practice. In this presentation, we intend
to describe the curriculum for a unique Masters Degree Program, now in its 14th year,
in the integrative biomedical sciences at Georgetown University.
The program is designed to be completed in 11 months. The curriculum includes three
tracks: Science-based courses: such as Biochemistry, Physiology, Pharmacology, CIM-based
courses such as Survey of CAM Disciplines addressing Traditional Medical Systems (TCM,
Ayurveda, Unani, Naturopathy, etc.), Physiology of Mind-Body Medicine, CAM in Pathophysiological
States, Nutrition, Botanicals and Supplements, and courses aimed at Skills to Assess
Evidence, such as Evidence-based Medicine, Critical Reading, Biostatistics, as well
as series of elective courses. In addition, students are required to participate in
an 8-week practicum during the summer, in which they are immersed in some aspect of
integrative medicine (from bench lab to clinic or government office).
We plan to share experiences from our educational model where our graduates contributed
to and led a number of initiatives, that impacted their schools and careers. Thus,
emphasizing the importance of teaching CIM and how it promotes inter-professional
education, creativity, and leadership skills. Over the years, we have also found that
our graduates go on to demonstrate other desirable skills such as: 1) creative communication
skills about IM; 2) community-building, 3) assuming leadership roles, 4) developing
networking skills, and 5) fostering inter-professional collaborations.
O47 Attitudes and beliefs about evidence-based and integrative medicine within the
Chinese medicine profession
Belinda Anderson1, Roni Evans2, Ben Kligler3, Paul Marantz1
1 Pacific College of Oriental Medicine; Albert Einstein College of Medicine, New York,
NY 10038, United States; 2 University of Minnesota, Minneapolis, MN, United States;
3 Beth Israel/Mount Sinai, New York, NY, United States
Correspondence: Belinda Anderson (banderson@pacificcollege.edu)
Purpose
Attitudes and beliefs have profound impacts upon behavior and learning. However, with
regard to evidence-based medicine (EBM) education, little attention has been given
to exploring the attitudes and beliefs of complementary healthcare students, faculty
and clinicians.
Methods
At the Pacific College of Medicine (New York campus) surveys (containing close-ended
and open-ended questions) of Chinese medicine students and faculty, and an ethnographic
qualitative study of acupuncturists (via an online forum) were undertaken to explore
perspectives on research, evidence-based and integrative medicine.
Results
The survey response rates for students and faculty were 42 and 89%, respectively.
Faculty and students indicated high degrees of interest in, and support for, the value
of research and EBM. However, this declined as students progressed through their degree
programs. Responses to the open-ended survey questions, and the qualitative study,
indicate that there is concern about paradigm differences, relevance of the scientific
method, power dynamics in the healthcare system, and a preference for pluralism over
integration. The relevance and impact of these outcomes upon learning and clinical
practice is discussed.
Conclusions
Motivating clinicians to seek out and use the latest evidence to inform patient treatment
requires an understanding of the barriers. Some of these have been shown to be practical,
like lack of time or access to relevant databases and full text articles, but there
is also evidence that significant cultural issues should be considered.
O48 T90/R90 Building Research across Inter-Disciplinary Gaps (BRIDG) Clinical Research
Training Program in Complementary and Integrative Health
Ryan Bradley1, Cathryn Booth-LaForce2, Heather Zwickey1
1National University of Natural Medicine, Helfgott Research Institute, Portland, OR,
United States; 2University of Washington, Seattle, WA, United States
Correspondence: Ryan Bradley (rbradley@nunm.edu)
Question
Questions remain regarding the optimal approach for clinical research training, i.e.,
training conventionally trained researchers in CIH clinical research or training CIH
clinicians in clinical research methodologies.
Methods
Supported by a five-year grant from the National Center for Complementary and Integrative
Health (NCCIH), the University of Washington (UW) in Seattle, WA and the National
University of Natural Medicine (NUNM) in Portland, OR developed the T90/R90 Building
Research across Inter-Disciplinary Gaps (BRIDG) Clinical Research Training Program
in Complementary and Integrative Health. The T90 trains doctoral-level CIH providers
in clinical research activities at the research-intensive University of Washington.
The R90 trains conventionally trained researchers in the clinical practices of CIH
at the clinic-intensive NUNM. The Translational Research Spectrum provides a conceptual
framework for both programs. Program elements include: didactic training in clinical
research (T90 & R90) and in CIH disciplines (R90), placement with active clinical
research mentors (T90 & R90), placement with active clinical mentors in CIH disciplines
(R90), plus shared (T90) and independent (R90) research project development. T90 trainees
and R90 participants also co-train on a collaborative team science project, i.e.,
a "Implementation of Clinical Research" practicum, hosted at both training sites.
Program evaluation includes semi-annual completion of the Clinical Research Assessment
Inventory (CRAI) which queries confidence in research skills and methods on a 0-10
scale; periodic evaluation of programmatic elements using the Supplemental Kellogg
Logic –WHO (SKL/WHO) model, which emphasizes relevance, adequacy, efficiency, effectiveness,
process, impact, equity and sustainability; and mentor evaluations. Trainee progress
is also evaluated using Individualized Development Plans (IDPs).
Results
T90 clinical backgrounds include Doctors of Acupuncture and Oriental Medicine (DAOM;
n = 3) and Naturopathic Medicine (ND; n = 1). R90 research backgrounds include Doctors
of Philosophy in Toxicology (n = 1) and Nutrition and Food Science (n = 1). Mean results
of baseline CRAI assessments suggest moderate confidence in choosing a research topic
(7.3), refining a study question (7.5), providing a scientific rationale (7.7) and
expressing the idea in writing (7.7). Mean results suggest less confidence in choosing
appropriate research methods (5.6), choosing an appropriate population (5), designing
a statistical analysis plan (5), choosing an appropriate funding source for their
research (4.5) and analyzing data (4).
Conclusions
By combining clinical research methodologies with immersive mentorship in the context
of complementary and integrative health, the UW-NUNM BRIDG program exemplifies a new
standard for training clinical researchers in CIH.
O49 The National Center for Integrative Primary Healthcare - Enhancing Interprofessional
Integrative Health Education
Benjamin Kligler1, Audrey Brooks2, Mary J Kreitzer3, Patricia Lebensohn2, Elisabeth
Goldblatt4
1Icahn School of Medicine at Mount Sinai, Family and Community Medicine, Brooklyn,
New York, NY, United States; 2University of Arizona, Center for Integrative Medicine,
Tucson, AR, United States; 3University of Minnesota, Center for Spirituality & Healing,
Minneapolis, MN, United States; 4Academic Collaborative for Integrative Health, Mercer
Island, WA, United States
Correspondence: Benjamin Kligler (bkligler@chpnet.org)
Evidence is accruing for the clinical and cost-effectiveness of integrative healthcare
(IH); however, there is a knowledge gap for primary care professionals, which has
hindered widespread adoption of IH into healthcare systems. The University of Arizona
Center for Integrative Medicine received a HRSA grant to establish the National Center
for Integrative Primary Healthcare (NCIPH) to address this need. Based on a coordinated
set of IH competencies across primary care professions and needs assessment, a 45-hour
online interprofesssional IH course, Foundations in Integrative Health (FIH), was
developed and pilot-tested in primary care training programs, e.g., family medicine,
internal medicine residencies, nursing, pharmacy, behavioral health, oriental medicine,
chiropractic. Units include: Introduction to IH; Prevention and Lifestyle; Healthcare
Professional Wellbeing; Addressing Patients through an Integrative Lens; Integrative
Interventions; and Community Settings and Systems. A unit evaluation survey assesses
met objectives, educational depth, clinical utility, helpfulness of resources and
reflections, and ease of technology. A final evaluation assesses interest in applying
IH principles in clinical practice, desire to seek additional IH education, course
enhanced educational experience, recommend course, incorporation of self-care practices,
and site leader support for completing and relating course to training. Items are
rated on a 5-point scale. Measures of resiliency and gratitude were completed at the
start of the Wellbeing unit and following a two-week daily self-care practice.
677 trainees completed the course. Units were highly rated: met objectives (4.4),
technology (4.2), clinical utility (4.1), resources helpful (3.8), reflections helpful
(3.8), educational depth (3.7) and sharing reflections helpful (3.2). A majority (60-73%)
recommended incorporating the units into required training. Final survey ratings were
also positive: interest in applying in practice (4.5), seek additional IH education
(4.3), course enhanced educational experience (4.3), recommend to others (4.2), and
leader support for course completion (3.8) and integrating material (3.7). Two-thirds
reported incorporating new self-care practices based on what they learned in the course.
Pre-post improvements (p < 0.001) were observed for the resiliency and gratitude measures.
The goal of NCIPH is to transform primary care health professional education to include
an emphasis on providing an integrative approach to patient care utilizing an interprofessional
collaborative team. The FIH course can serve as a foundation in this effort. An online
course addresses the challenges of time, cost, and curriculum consistency and can
be widely disseminated to the entire spectrum of primary care training programs.
O50 Integrative nursing: reflexology effects of a teaching program on nursing students
Neus Esmel-Esmel1,2, Maria Jiménez-Herrera1
1 Faculty of Nursing, Nurding, Tarragona, Spain; 2 Nursing, Integrative Therapy Center,
Tarragona, Spain
Correspondence: Neus Esmel-Esmel (neus.esmel@urv.cat)
Background
Reflexology, as a modality of Integrative Medicine, recognizes the importance of the
person from a comprehensive and non-invasive care, enhancing the search for a physical,
emotional and spiritual balance.
The aim of this study was to evaluate the effects of a teaching program that introduces
reflexology as an integrative modality in university nursing education.
Methods
A descriptive observational study was carried out, in which 85 students participated.
The students responded by initiating and completing the teaching program, the health
questionnaire (SF12v2) and the emotional intelligence questionnaire (TMMS24). The
perceived effects during and between sessions were collected on a records grid and
their vivid experience were also collected by personal stories.
Analysis. Data were analyzed qualitatively and quantitatively with the SSPS v.10 program.
Results
The results showed an improvement in the quality of life and emotional well-being,
mainly in regulation and emotional understanding. Relaxation and well-being were the
most perceived effects. No adverse effects were observed. The analysis of the stories
revealed a new concept in the understanding of integrative care, as well as the discovery
of a new way of understanding the body. The methodology used was shown to be effective
in health education. The students identified the potential of the reflexology within
the new paradigm of integrative medicine.
Conclusions
Reflexology promotes physical and emotional well-being, facilitating an integrative
understanding of the body and health. Students affirm the need to include this knowledge
in the training nursing program of an integrative and holistic care.
O51 Addressing the international acupuncture standards gap for physiotherapists and
chiropractors: a comparative review
Nadine Ijaz, Heather Boon
University of Toronto, Toronto, L4A1T3, Canada
Correspondence: Nadine Ijaz (nadine.ijaz@mail.utoronto.ca)
Purpose
Physiotherapists and chiropractors across North America, the United Kingdom, Australia
and New Zealand perform a range of therapeutic needling practices to treat musculoskeletal
disorders, including traditional East Asian acupuncture, traditional acupuncture techniques
performed in line with biomedical diagnostic principles, and'dry needling' based on
the biomedical hypodermic "trigger point wet needling" research of Dr. Janet Travell.
In this work we review and evaluate the range of regulatory and certification standards
for these professionals' needling practices across the aforementioned jurisdictions.
Methods
Drawing on the scholarly literature as well as a range of public documents (in particular
those published by regulatory bodies), we collected data pertaining to regulatory
needling standards for all chiropractic and physiotherapy professionals across the
United States, Australia, and Canada, where regulations govern acupuncture practitioners.
We also collected standards-related data from documents published by several voluntary
certification bodies for these same professionals performing therapeutic needling
in the United Kingdom and New Zealand, where acupuncture has not been regulated. To
gain insight into the rationale behind the identified standards, we critically analysed
the standards-related discourses across these documents.
Results
Certification and regulatory standards for these needling practices – where such exist
– vary widely; and in many cases fall below the internationally-recognized 1999 World
Health Organization acupuncture training standards recommended for biomedical physicians
(200 hours). To justify their comparatively low standards for therapeutic needling,
physiotherapy and chiropractic groups discursively differentiate their professional
needling activities from those used by other professions; and characterize their core
professional trainings as providing the substantive requirements necessary for safe
needling practice.
Conclusions
There is an urgent need for the development of independent, international training
and certification standards for non-physician practitioners of biomedical acupuncture,
to serve as a consensus document for adoption by physiotherapy and chiropractic regulators
across the jurisdictions under study.
O52 Why do students in German medical universities select elective courses on acupuncture
and homeopathy? – a survey
Alexandra Jocham1, Beate Stock-Schröer2, Pascal O Berberat1, Antonius Schneider1,
Klaus Linde1
1 Technical University of Munich, München, 81675, Germany; 2 Carstens-Foundation,
Essen, 45276, Germany
Correspondence: Beate Stock-Schröer (b.stock-schroeer@carstens-stiftung.de)
Question
Aim of the survey was to investigate what motives students at German medical universities
specify when attending elective courses on homeopathy or acupuncture. Main focus in
this piece of work is the qualitative part of the survey.
Methods
A cross – sectional survey throughout Germany was conducted. Medical students participating
in courses on homeopathy or acupuncture during the academic half-year 2013/14 were
asked to take part. A questionnaire was developed consisting of four parts. The first
nineteen items were about attitudes towards complementary medicine and science, care
and status orientation. The second part (Big-Five-Inventory-10) recorded personal
characteristics. Part three asked for biographical, study- and career-related data.
In the last part, students were asked about personal experience and environment, scientific
and opportunistic aspects and the role of the therapy as a complement to conventional
medicine. In a free text section they could describe their personal motivation in
detail.
Results
Medical students in 16 of 18 acupuncture courses (n = 220) and in 12 of 13 homeopathy
courses (n = 113) participated. As personal statements in the free text section 191
acupuncture and 109 homeopathy students described the most crucial motivation for
their interest in acupuncture or homeopathy.
Personal experiences, way of working with patients, dissatisfaction with conventional
medicine, developing a coherent approach for oneself and also scepticism with acupuncture
or homeopathy were recurrent motives. There were differences between the two groups.
Conclusion
Medical students interested in acupuncture or homeopathy are motivated by personal
experiences and a desire for a complement to conventional treatment.
O53 On behalf of an ethical encounter: the influence of health professionals’ training
on cowling on the quality of health communicational process
Morgana Masetti (morgana.ops@terra.com.br)
Psychology, Pontificia Universidade Católica de Sao Paulo, Rio de Janeiro, 22430,
Brazil
Medicine is, above all, a social science, a process that involves not only technical
but human relationships. It"s a place through which we can live experiences related
to life, death, suffering and loss. However, the current structure of medicine impedes
the of "flowing" this process. Medical training gives major focus to procedures, symptoms
and technical knowledge, and everything that cannot be named under this knowledge
framework is not incorporated in health professionals" education. In an attempt to
reverse this situation, several groups of health students in Brazil include in their
training - via university extension programs - preparatory courses to act as clowns
in hospitals. Through this endeavor, the students are claiming for one important goal:
go beyond the university"s learning experiences; thru immersive and grounding experiences
on the physical senses (to look, hear, touch) as well as on the reflection about issues
such as health, illness and healing. In this communication, the author share the training
intervention that was developed (from 1998 to 2014) in Doutores da Alegria Training
Center, Brazil. By the use of games, promptness, and music improvisation, these workshops
aim to encourage the quality of health professionals" communication processes. The
research-action process developed around this formative experience will be the focus
of reflection. Evidence collected over 14 years of intervention and research (based
on systematic records of lessons and evaluations conducted during this period) show
the need to create care experiences for health caregivers, and to generate channels
of communication, joint reflection and preparation for the use of these fundamental
skills.
O54 Education with MeSaCoSa concept for healthy living and coping with chronic pain
syndromes
Henriette Murakozy (drmurakozy_henriette@yahoo.de)
Rheumaklinik Dr. Lauven Bad Oeynhausen, Rheumatolgy, Bad Oeynhausen, Germany
Question
Cognitive behaviour and educative methods can play a central role in healthy living
and coping with negative stress related conditions like chronic pain syndromes and
may prevent early death. Our innovative, integrative, educative, holistic MeSaCoSa
(mens sana in corpore sano) medical concept for an active and conscious health management
can be an important option for coping with these circumstances in the modern medicine.
The aim of the study was to investigate the efficiency of our concept for these reasons.
Methods
Clinical prospective, long-time follow up study of effectiveness of the MeSaCoSa concept,
at the beginning and at the end of each indoor therapy cycle and at the long-time
tight control follow up ambulant control investigations. Statistical analysis: Student
T probe of pain relief, quality of life, down-regulation of inflammation and reduction
of impairment of motion of the inpatients at the beginning and at the end of each
indoor therapy cycle and at the ambulant re-evaluations.
Results
Improvement and significant alleviation of pain, and inflammatory signs and symptoms,
capability for better relaxation, better life quality HAQ with lower medicine consumption
and fewer local corticosteroid infiltration, effective, long lasting, analgesic and
anti-inflammatory potential, relaxing to 6,6 months after emission (p < 0,05), long-time
change of life-style & prevention.
Conclusions
Beneficial role of behavioural education for healthy living with MeSaCoSa concept,
completed with a complex physical therapy regime and acupuncture (as a part of TCM)
on negative stress related conditions and chronic pain disorders. Our concept is recommended
to prevent or to treat these circumstances, generally for conserve and preserve health,
enhance life quality, acquisition capability and maybe for preventing early death
as well.
O55 Mind-Body Medicine as a pathway for an improved connection with self and the world
around: results from a phenomenological study among medical and nursing students
Marja Van Vliet1, Mats Jong2, Miek Jong3
1 Department of Health Sciences, Mid Sweden University, Sundsvall, SE-85170, Sweden;
2 Department of Nursing, Mid Sweden University, Sundsvall, Sweden; 3 Department of
Healthcare and Nutrition, Louis Bolk Institute, Driebergen, Netherlands
Correspondence: Marja Van Vliet (marjavanvliet@gmail.com)
Purpose
To obtain an in-depth understanding of the meaning of participation in a Mind-Body
Medicine Skills (MBM) course in personal and professional lives of medical and nursing
students.
Method
The MBM course was adapted from the program developed at Georgetown University and
included experiential sessions of various mind-body techniques, such as mindfulness
meditation, guided imagery, bio-feedback. Eleven medical and fourteen nursing students
shared their lived experiences with the course in in-depth interviews which were analyzed
using a hermeneutical phenomenological method. The study was conducted next to an
intervention study that evaluated the effects on stress, empathy and self-reflection.
Results
The essential meaning was that participation in the MBM course was a pathway to inner
awareness and supported in connecting with the surrounding world. Students described
that the course gave them the opportunity to experience calmness and that they gained
the ability to be more present in their personal and professional lives. The course
led to an increased awareness of themselves and their emotions and was a barrier opener
for further personal growth. Increased perception of their inner world made them more
conscious of the impact of their behavior on others. Sharing of personal stories fostered
them to connect on a deeper level with others, which they regarded helpful to better
understand their patients.
Conclusion
Participation in the MBM course fostered medical and nursing students' perception
of themselves and made them more connected to the world around. This experience stimulated
participants for further personal growth in their personal and professional lives.
Traditional healing systems
O56 Energy healing for cancer patient - does their perception of cancer change
Rita Agdal (riag@hib.no)
Health and social sciences, Bergen University College, Bergen, 5020, Norway
Purpose
Firstly, to investigate energy healers` (spiritual healers) perception of cancer,
illness and health. Secondly, how they might influence their patients perception of
cancer, illness and health.
Methods
I used a cultural phenomenological methodology for interviews and analysis. 25 energy
healers were interviewed (semi-structured) to identify key metaphors in their description
of illness, health and cancer. 32 patients diagnosed with cancer were interviewed
four times (30 minutes to three hours) to identify changes in perception: before the
first treatment with energy healing, after the first treatment, after one and three
months. The patient interviews were analysed to identify key metaphors and changes
in their description of their illness, health and cancer, and compared to the metaphors
used by the energy healers.
Results
Energy healers have distinct perceptions of cancer, illness and health that involve
a focus on the energy body, as well as causes and cures for cancer. The patients started
to use the key metaphors used by energy healers to describe illness, health and cancer,
after several visits to the energy healers. Some patients thought about this as a
process of learning and some changed their health behavior.
Conclusions
The patients perception of illness and health in general, and cancer in particular,
changed as the energy healers treated them. Further, these changes in perception lead
to changes in health behavior. In some cases the changes in perception influenced
the way patients interpreted their own health condition and what would be considered
symptoms of cancer from a biomedical perspective.
O57 Traditional Persian herbal remedies for asthma
Fatemeh Atarzadeh, Amir M. Jaladat, Leila Hoseini, Fatemeh Amini
Department of Traditional Medicine, Shiraz University of Medical Sciences, Shiraz,
7134845794, Iran, Islamic Republic of
Correspondence: Fatemeh Atarzadeh (dr.atarzadeh@gmail.com)
Purpose
The increasing prevalence of asthma and lack of strong prevention and curative treatment
for it has increased seeking for complementary and alternative medicine therapies
including Traditional Persian Medicine (TPM). In this study, through investigation
of TPM references, we aimed to identify medicinal plants for treatment of asthma.
Methods
In this qualitative study, entities about asthma were checked under reliable sources
of traditional Persian medicine, and recommended medicinal plants were extracted from
the books. Likewise, for investigating the pharmacological properties of offered herbs
electronic databases such as PubMed, Scopus, Google Scholar and some Iranian databases
like SID and IranMedex were employed.
Results
Ancient Iranian scholars, including Avicenna have discussed asthma in their books
in a chapter entitled Rabv. It has been defined as a chronic disabling dyspnea with
periodic attacks like epilepsy. Mucous accumulation in the lung is the main etiologic
factor, although in rare cases depending on patient symptoms and trigger factors lung
dryness is considered as the cause with different therapeutic approach. Honey, and
medicinal herbs such as Hyssopus officinalis, Ficus carica, Drimia maritima, Nigella
sativa, and Glycyrrhiza glabra are among the most common remedies in the management
of mucous based disease, while Goat milk, Barley, Cydonia oblonga, Astragalus sp.,
and Violette odorante are prescribed for dry cases.
Conclusions
TPM prescribes medicinal plants for asthma based on each patients symptoms and trigger
factors. This review will provide new research ideas based on TPM for herbal anagement
of asthma.
O58 Analysis on clinical symptom regularity and medication rules of herbal prescriptions
for pneumonia in preschool children treated by traditional Chinese medicine based
on apriori and clustering algorithm
Chen Bai, Tiegang Liu, Zian Zheng, Yuxiang Wan, Jingnan Xu, Xuan Wang, He Yu, Xiaohong
Gu
Beijing University of Chinese Medicine, Beijing, 100029, China
Correspondence: Xiaohong Gu (GUXH1003@126.com)
Purpose
To analyze the clinicalsymptom regularity and medication rules in herbal prescriptions
for pneumonia in preschool children treated by traditional Chinese medicine (TCM)
on the basis of using traditional Chinese medicine inheritance support system (TCMISS).
Methods
The clinicalsymptoms and herbal prescriptions for pneumonia in preschool children
treated by TCM were collected from the literatures in China National Knowledge Internet
(CNKI), and then the data were entered into TCMISS. And the symptom regularity and
medication rules were analyzed by the unsupervised data mining methods such as apriori
algorithm and complex system entropy clustering in order to find the core symptom
profile and new symptom as well as the core medication profile and new prescriptions.
Moreover, there was the network association among the symptoms, syndrome and Chinese
medications.
Results
Based on the analysis of 136 medicalrecords and 133 herbal prescriptions from 59 cases,
the occurrence frequency of each symptom and the association rules among the symptoms
were determined. There were 12 core symptom profiles and 6 new symptoms with the cardinal
symptoms as follows: 1. Yellow sticky phlegm; 2. Dry lips and crimson tongue; 3. Fever
and asthma; 4. Nasal obstruction and whitegreasythicktonguefur; 5. Scanty sputum;
6. Sputum hard to expectorate and paroxysmal cough. As for the medications, there
were 12 core medication profiles and 6 new prescriptions with the main herbs as followings:
1. Maidong (Radix Ophiopogonis); 2. Mahuang (Herba Ephedrae); 3. Zhuru (Caulis Bambusae
in Taenia); 4. Ziyuan (Radix Asteris); 5. Taoren (Semen Persicae); 6. Pugongying (Herba
Taraxaci).
Conclusion
For the preschool children with pneumonia, respiratory infection symptoms with damp-heat
nature are with the highest occurrence frequency. And the commonly used traditional
Chinese medicines were the exterior-releasing medications, the heat-clearing medications,
the yin-nourishing medications and the phlegm-resolving and asthma-relieving medications.
O59 Insomnia in traditional Persian medicine
Babak Daneshfard1, Majid Nimrouzi2, Vahid Tafazoli2
1 Student Research Committee,Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of; 2 Traditional Persian Medicine, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Correspondence: Babak Daneshfard (babakdaneshfard@gmail.com)
Insomnia is a commom complaint in out-patient clinics. It usually affects quality
of life negatively specially in severe cases. Nowadays, routine medical interventions
comprise pharmacological approaches and cognitive behavioural therapy. Commonly used
medications for the afflicted patients are not competent enough beside their annoying
side effects. It would naturally denotes the need for considering novel strategies
for treating insomniac patients. Approach to insomnia in traditional Persian medicine
(TPM) has been cited in a scrutinized manner focusing on its main causes. Accordingly,
its treatment is tailored based on the constitution of the patient, intensity of the
disease, and type of the cause. This study aimed at defining the causes of insomnia,
diagnostic approach, and various medical interventions proposed in valid sources of
TPM.
O60 Assessment of the impact of traditional Persian medicine lifestyle recommendations
in the treatment of chronic constipation, a randomized controlled clinical trial
Seyed M Emami Alorizi, Seyed A Saghebi, Mohammad R Fattahi, Alireza Salehi, Hossein
Rezaeizadeh, Mohammad M. Zarshenas, Majid Nimrouzi
Traditional Persian Medicine, Shiraz University of medical sciences, Shiraz, 71348457,
Iran, Islamic Republic of
Correspondence: Seyed M Emami Alorizi (smemami@sums.ac.ir)
Background
To manage chronic constipation, numerous lifestyle modification schemes and recommendations
as well as applications of natural medicaments have been mentioned in manuscripts
of traditional Persian medicine (TPM). This study was aimed to compare the impacts
of some of those recommendations with lactulose, on functional chronic constipation.
Methods
Via a blocked randomization, 100 patients were enrolled. Schemes and recommendations
from TPM as intervention group were evaluated versus lactulose as control by weekly
follow-ups with standard questionnaire for 3 months. Stool frequency, hard stool,
painful defecation, incomplete evacuation sensation, anorectal obstruction sensation
and manual maneuvers were considered as outcome measures.
Results
Eighty-six patients (42 in schemes and 44 in lactulose groups) completed the study.
Median weekly stool frequency in 0, 4, 8 and 12 weeks of treatment was 1.76_1.79,
2.88_0.89, 2.95_1.05 and 2.93_1.11 in the schemes and 2.41_1.67, 2.57_0.90, 2.84_0.91
and 2.77_1.00 in lactulose groups, respectively (p = 0.10, 0.11, 0.60, 0.51). Thirty-two
(76.2%) patients in schemes and 24 (54.5%) patients in lactulose groups were treated
at the end of the protocol as they did not meet the Rome III criteria for constipation
(p = 0.04). In schemes group, patients reported no undesirable effects, whereas seven
(15.9%) in lactulose group reported flatulence (p = 0.02).
Conclusions
Studied schemes were as effective as lactulose, a gold standard to manage constipation.
Results demonstrated that TPM schemes and recommendations, as lifestyle modification,
for at least 3 months can be introduced as cheap, available and accessible approaches
for the management of constipation.
Keywords: clinical trial, constipation, lactulose, lifestyle modifications, Persian,
traditional medicine.
O61 Kūkulu Ola Hou. Reconstructing the native Hawaiian medical inventory based on
traditional and contemporary Kānaka ʻŌiwi perceptions of illness and disease
Kealoha Fox (kealohaf@oha.org)
John A Burns School of Medicine, Office of Hawaiian Affairs & University of Hawaii
at Manoa, Honolulu, 96817, Hawaii, United States
Purpose
Medical ethnohistories suggest a deep and rich philosophy of health and sciences ancestral
to the ancient practices of Kānaka ʻŌiwi (Native Hawaiians (NH)). The objective of
this exploratory qualitative health study examines the customs, rituals, and practices
relating to Hawaiian maʻi, or NH conceptualizations of illness, sickness and disease,
and produced an inventory of findings. This research is motivated by the desire to
apply traditional Hawaiian systems of health and medicine to the analysis and resolution
of clinical questions.
Methods
Hawaiian research processes were developed to conduct this mixed method study across
eight arms before validating both traditional and contemporary knowledge and beliefs.
An inductive qualitative method based on in-depth open-ended interviews was undertaken.
Primary data collection consisted of key informant interviews (N = 26) and one focus
group (N = 27). The key informant sample was selected by snowball sampling of men
and women aged 40–85 years with expert practice in traditional Hawaiian medicine.
The data were analyzed according to grounded theory. Additionally, we conducted one
focus group from a cohort sample of intermediate level practitioners of traditional
Hawaiian medicine. The data were analyzed according to phenomenology procedures. Secondary
data collection, synthesis and analyses were conducted in English and ʻŌlelo Hawaiʻi
(Hawaiian Language) utilizing over 100,000 records in multiple Hawaiian kingdom era
archives (N = 11).
Results
Study significance indicates the first comprehensive manual documenting knowledge
of Hawaiian maʻi. Comparative analysis from the primary participants confirmed maʻi
from secondary sources through novel collections. Using robust data analysis techniques,
we systematically coded more than 1,000 unique Hawaiian maʻi based on the ancestral
taxonomy unique to the traditional Hawaiian health system. Several specific maʻi will
be shared to illustrate the etiological context to these findings. Preliminary analysis
of qualitative feedback demonstrated enthusiasm for the project across the study contributors
and stakeholders.
Conclusion
This unprecedented study documents the etiology and diagnostics of ailments, illness,
sickness and disease from a traditional system of mauli ola loa. Hawaiian maʻi provide
an epistemological framework of pathologies which are culturally shaped and enable
us to examine the links between culture, history, and biological disease, which together
generate lāhui (population-based) imbalance. Qualitative findings suggest this integrative
medical inventory can inform diagnostic process and improve diagnosis procedures for
NH health care. Further, it can create new quality standards for culturally and linguistically
appropriate services for NH health.[University of Hawaii Human Subjects Protection
review approved CHS#23530]
O62 Europe-wide pilot field testing the Traditional Medicine (TM) Chapter of the ICD-11
John Hughes1, Nenad Kostanjsek2, Stéphane Espinosa2, George Lewith3, Peter Fisher1
1 Royal London Hospital for Integrated Medicine, UCLH NHS Trust, London, WC1N 3HR,
United Kingdom; 2 World Health Organization, Geneva, Switzerland; 3 University of
Southhampton, Southhampton, United Kingdom
Correspondence: John Hughes (john.hughes@uclh.nhs.uk)
Purpose
The World Health Organisation recently developed International Classification of Diseases
codes for Traditional Medicine (TM ICD-11). The TM ICD-11 codes are based on a unified
set of traditional medicine disorders and patterns based on national classifications
from China, Japan and Korea. The primary objective of the study was to pilot field
test the TM ICD-11 codes.
Methods
Mixed methods approach including, online European survey of practitioner views on
TM ICD-11 codes; coding process of case study vignettes to establish inter-rater reliability;
and survey of coders experiences of using TM ICD-11 codes.
Results
127 online survey questionnaires completed. Key findings included, the majority of
participants agreed the TM ICD-11 codes provide a meaningful way to classify TM disorders
and patterns (76%); believed their patients diagnosis can be represented within the
TM ICD-11 codes (73%); believed the distinction between TM disorders and patterns
was clear (77%); and did not feel any categories were misplaced (93%). 15 European
acupuncturists coded 5 case study vignettes and provided details on their experiences
of using the TM ICD-11 codes. Key findings included, participants perceived the TM
ICD-11 codes as being of greatest use for communicating with colleagues/professionals;
the main added value of the TM ICD-11 codes could be an increase in the appreciation,
acceptance and integration of TM within conventional medical systems. A first attempt
at assessing the inter-rater reliability of diagnoses of case study vignettes showed
a low level of agreement.
Conclusions
The findings indicate European TM practitioners perceive the TM ICD-11 codes as valuable,
conceptually accurate, and easy to learn.
O63 Principles & factors of safest use of Unani drugs in the light of pharmacoviglance
Abdul Latif (abdullatifamu@gmail.com)
Aligarh Muslim University, Department of Ilmuladvia (Unani Phamacology), Aligarh,
India
Unānī Medicine is said to have a holistic approach; it refers to the whole knowledge
as a total recognition of the patients condition. Is there any rationality in its
principles, is the first question to answer? Looking at the concept and principles
of Unānī Medicine, it is clear that it does not interfere with physiologically inherent
forces of medicatrix naturae, that is of self-preservation. The purpose of Unānī Medicine
is to assist natural recuperative power and thus eradicate the disease from the human
body.
Factors associated with preventable adverse drug reactions (ADRs) in a Unani Medicine
hospital patient population are well documented.
The data were collected by concurrent review of all ADRs reported by Unani Physician
in their literature as patient details, ADR variables, length of stay, and preventability
of ADR. These ADRs are identified as preventable and developed based on these factors.
Principles of safety evaluation carried out on the basis of Medical Ethics and Pharmacovigilance
of Unani System of Medicine.
However, Unānī Drugs can also produce some harmful effect, but lots of
in-vitro
and
in-vivo
techniques for detoxification of Unani drugs that are followed along with precautions
for minimizing the harmful effects.
O64 Acupuncture Evidence Based Medicine Practice for Stroke Rehabilitation
Donald Lefeber, William Paske
Memorial Hermann/Community Medical Foundation for Patient Safety, Bellaire, TX, United
States
Correspondence: Donald Lefeber (djlefeber@comofcom.com)
Question
Research has been done to assess efficacy and effectiveness of acupuncture, however,
there is still much to learn about its mechanisms and treatment effects for stroke
rehabilitation [1,2].
An exploratory research study using RU-FitTM [3,4] medical device tested; is it possible
to obtain physical measurements of Fine Motor Control (FMC) that directly correlate
to acupuncture treatment and protocol and perhaps coincide with treatment outcomes?
A case is presented—70 year-old male that suffered from stroke 3 years ago—hemorrhagic
infarction left thalamus.
Methods
Throughout three months of acupuncture treatments subject was tested before and after
acupuncture with FDA-approved medical instrument RU-Fit™, to obtain measurements based
on FMC, reaction time, hand strength and coordination variation.
Results
Right hand FMC measurements originated at 48% (Normal Probability) and fluctuated
between 34%-86% through first 5 weeks. In last month, FMC measurements appeared in
upper 80-90 percentile. Left hand FMC measurements originated at 77%. Within first
4 treatments increased to 98% and maintained in high 90th percentile for duration
of acupuncture treatment period. Observed treatment outcomes during treatment period
were slightly improved gait, increased coordination and grip in both hands.
Conclusion
Difficulty exists to track improvements and/or changes for stroke rehabilitation.
FMC physical measurements are attributable to acupuncture. Data indicates treatment
outcomes are a function of acupuncture point selection, treatment frequency. Having
a device to objectively measure changes in FMC may aid in: producing more optimal
treatment protocol and outcomes for patients, inspiring increased treatment compliance,
understanding the effectiveness/efficacy of acupuncture for stroke rehabilitation.
Citations
1. Yang, A., HM Wu, JL Tang, L. Xu, M. Yang, and GJ Liu. "Acupuncture for Stroke Rehabilitation."
(2016). Cochrane Database of Systematic Reviews.
2. Li, Li, Hong Zhang, Shu-Qing Meng, and Hai-Zhou Qian. "An Updated Meta-Analysis
of the Efficacy and Safety of Acupuncture Treatment for Cerebral Infarction." PLoS
ONE 9.12(2014).
3. Mireles C, Paske WC. mTBI Screening Based on Functional Assessment of Fine Motor
Control. In: Brain Injury Association of Texas 25th Annual Conference; 2009; Austin.
4. Paske WC, Metzger CL, Sutherland JM. Biomechanical Hand-Functionality Measurement
System. Review of Scientific Instruments. 2005;76:054301(1-9).
Medicine and arts
O65 The inherent relationship of Yamamoto New Scalp Acupuncture (YNSA) with Awareness
Under Conscious Hypnosis (AUCH©) method
Ali Ö Öztürk, Gizemnur Öztürk
The Society of Medical Hypnosis (THD), Istanbul, Turkey
Correspondence: Ali Ö Öztürk (auchozturk@gmail.com)
Purpose
To elaborate the inherent relationship of Yamamoto New Scalp Acupuncture (YNSA) microsystem
with a conscious hypnosis method named "Awareness Under Conscious Hypnosis (AUCH©)".
Methods
AUCH© is a state of consciousness created by specific induction techniques and suggestions;
and it aims to make changes in attention, perception, memory, emotions and senses
of the patient. To create these aimed changes; AUCH© has a treatment protocol consisting
of three steps: "1) MAYA© (Making Acceptance with Your Awareness), 2) Induction and
3) Autohypnosis". On the other hand, AUCH© can be used integratively in different
fields of medicine including acupuncture. To be more precise, there is a great similarity
and relationship with YNSA microsystem zones & points and the various body areas induced
spontaneously during hypnotic rituals as a part of the "Eye-to-Eye Fixation and Giving
Suggestions Technique", the main induction technique of AUCH© Method. In other words,
various points and zones stimulated via the active use of "hand passes, touchings
and tapings" during hypnotic induction coincide inherently with YNSA microsystem.
Results
The inherent relationship of YNSA with AUCH© Method is analyzed by mapping YNSA zones
& points coinciding with the hypnotic application areas induced spontaneously during
hypnotic induction.
Conclusions
The mapping illustrating the inherent relationship of various YNSA acupuncture zones
& points with hypnotic application areas summarizes the similarities of YNSA microsystem
and AUCH© Method comprehensively.
Keywords: Microsystems acupuncture, Yamamoto New Scalp Acupuncture (YNSA), Awareness
Under Conscious Hypnosis (AUCH©), Medical Hypnosis, Integrative Medicine.
Various topics
O66 The development of an evidence-based decision aid concerning Complementary and
Alternative Medicine (CAM) for parents of children with cancer
Inge Boers1, Wim Tissing2, Marianne Naafs3, Martine Busch4, Miek Jong1,5
1 Healthcare & Nutrition, Louis Bolk Institute, Driebergen, 3972 LA, Netherlands;
2 Pediatric Oncology, University Medical Center Groningen, University of Groningen,
Groningen, Netherlands; 3 Netherlands Childhood Cancer Parent Organization VOKK, Nieuwegein,
Netherlands; 4 Van Praag Institute, Utrecht, Netherlands; 5 Nursing, Mid-Sweden University,
Sundsvall, Sweden
Correspondence: Inge Boers (i.boers@louisbolk.nl)
Question
CAM is often used by parents of children with cancer to reduce side-effects of regular
treatment or to improve quality of life. Support is needed for making well-informed
decisions, essential for self-management, communication and shared decision making.
The objective of this project was to develop and implement an evidence-based decision
aid concerning CAM for parents of children with cancer, which is widely accepted by
future users.
Methods
The project consisted of four phases. During phase 1 an inventory was made on the
current state of information and needs of parents. Literature and internet searches,
questionnaires and focus group discussions with parents and healthcare professionals
were used. During phase 2 content of evidence was gathered based on a GRADE analysis
including systemic literature search and expert opinion. In the 3rd and 4th phase
an informative website was developed, implemented and evaluated.
Results
Little information sources were found for parents concerning CAM and pediatric oncology
in the Netherlands. Parents underlined the importance of reliable information, especially
focused on communication and complaints as: fatigue, anxiety, pain and sleeping problems.
A GRADE analysis was performed to investigate the effectiveness and safety of CAM
for pain. Evidence of good quality was found for hypnotherapy in contrast to moderate
to low quality for other CAM. Chosen form of decision aid was an informative website
for parents, embedded in regular care.
Conclusion
A start was made on the development of an evidence-based informative website for parents,
focused on the complaint pain. Next steps will be to extend the website with evidence
for CAM on other cancer-related complaints. This project was a unique collaboration
of patients, healthcare professionals and researchers.
O67 From virtuality to repeatable patterns: consciousness as the governing software
Babak Daneshfard1, Mohammad R Sanaye2
1Shiraz University of Medical Sciences, Student Research Committee, Shiraz, Iran,
Islamic Republic of; 2Shiraz University of Medical Sciences, Essence of Parsiyan Wisdom
Institute, Phytopharmaceutical Technology and Traditional Medicine Incubator, Shiraz,
Iran, Islamic Republic of
Correspondence: Babak Daneshfard (babakdaneshfard@gmail.com)
The consciousness field as manifested through a series of treatments not normally
obtainable by conventional methods, has been the pivot of so many papers, articles,
and reviews by the Iranian tradition of mind-body healing (most recently named: Faradarmani).
The approach in this methodology would be the mending of "software structuration"
rather than making attempts to focus on merely material hardware. Accordingly, consciousness
is described to be the differential field of constant repeatability by means of which
not only the blueprints of living entities are provided, but also the mannerism of
their probable repairing is to be set down.
In addition, immunity could also be elucidated by means of the same field(s) that
are present to return likely abnormalities back to their original natural state. The
very fact that not all vectors of pathogens fall victims to varieties of diseases,
might be evidence to the novel theory of "consciousness immunity". There is, of course,
the capacity to link on to such consciousness field(s) for purposes of activating
so many potentialities including repair, fractal correction, and medical treatment.
Room is undoubtedly extant for basic and applied multidisciplinary investigation when
it comes to scientifically expanding upon the repeatable patterns of existence and
curing throughout the cosmos of entities —be they of the animal kingdom, plant kingdom,
human beings, or even non-living materials.
O68 Induction of coherent fields in osteopathic treatment proposes to be potential
by influencing the genetic field
Kilian Dräger (draeger@daego.de)
DÄGOsteopathy, Hamburg, Germany
The genetic code was seen as stable reference of the body that guarantees cell identity
and health. Now the genetic code shows up with much higher variability, more like
a genetic mosaic. The genome differs even from conception to birth, with every cell
division.
Transposons take an important part in that process and they are regulated by some
molecules. How does a molecule make its decision of building in or keeping out a tranposon?
Where does the body rely on?
The body expresses itself in motion, analyzed in direction, force and frequency. Micro-
and macromotion can be described as multidimensional coherent oscillation via molecules,
cells, tissues and functional organs.
E.g. connective tissue has this physiologic steady circle of decline and reconstruction
with various processes such as signal transduction, metabolic function and mechanisms
for compensation and stabilization of body integrity [1, 2, 3, 4, 5, 6, 7]. All functions
can be seen as motion, as change from one state to another.
Physiologic motions are going to be synchronized. Dysfunction occurs by divergence
and incoherence.
The decision of assimilation or separation of a transposon or any part of the body
could be made by identifying a divergence in a coherent oscillation field, like identifying
a divergent instrument in an playing orchestra. It isnt able for coherent oscillation.
Osteopathic treatment is aiming for reintegration of divergent zones into the coherent
field(s) of the body. This is implemented by balanced-techniques, which use a simple
general physical option of synchronization: connection and freedom of movement.
References
1. Langevin, Helene/Cornbrooks, Carson/Taatjes, Douglas (2004):Fibroblasts form a
body-wide cellular network, Histochem Cell Biol 122: 7-15
2. Langevin, Helene (2005): Dynamic fibroblast cytoskeletal response to subcutaneous
tissue stretch ex vivo and in vivo, Am J Physiol Cell Physiol 288: C747-C756; first
published October 20, 2004
3. Langevin, Helene et al. (2006): Fibroblast spreading induced by connective tissue
stretch involves intracellular redistribution of α- and β-actin, Histochem Cell Biol
125: 487-495
4. Iatridis, James et al. (2003): Subcutaneous tissue mechanical behaviour is linear
and viscoelastic under uniaxial tension, Connective Tissue Research, 44: 208-217
5. Ingber, D.E. et al.(1994): Cellular tensegrity: exploring how mechanical changes
in the cytoskeletton regulate cell growth, migration and tissue pattern during morphogenesis,
Int. Rev. Cytol. 150, 173-224
6. Ingber, D.E. (2006): Mechanical control of tissue morphogenesis during embryological
development. Int J Dev Biol, 50, 255-266
7. Dräger, Kilian/Heede, Patrick van den/Kleßen, Henry (2011): Osteopathie – Architektur
der Balance, Elsevier Urban Fischer Verlag, München
O69 The implications of the World Health Organization Traditional Medicine Strategy
2014-2023 for integrative medicine
Peter Fisher (peter.fisher@uclh.nhs.uk)
Royal London Hospital for Integrated Medicine, London, WC1N 3HR, United Kingdom
Question
What are the implications of the WHO Traditional Medicine Strategy for integrative
medicine?
Results
The WHO Traditional Medicine Strategy was adopted at the World Health Assembly in
May 2014. It has important implications for integrative medicine. The terms "Traditional
Medicine" (TM) and "Traditional and Complementary Medicine" (T&CM) are used interchangeably.
It has strong support from Director-General Dr Margaret Chan who said that T&CM is
an important and often underestimated part of health care; there is a need for a cohesive
and integrative approach that allows governments, practitioners and users to access
T&CM in a safe and effective manner; and that proactive policy towards this important
often vibrant and expanding part of health care is required.
The goals of the strategy are to harness the potential contribution of T&CM and to
promote its safe and effective use. The objectives are in terms of policy: integrating
T&CM into national health care systems; safety, efficacy and quality; access to increase
availability and affordability; rational use by practitioners and consumers. Challenges
include integration of T&CM into universal health coverage (UHC) and primary health
care (PHC), lack of research, communication, and reliable information for consumers.
The integrative medicine community is a key stakeholder in this strategy. Actions
recommended for stakeholders include: establishing best practice; recommending research
priorities; advising on risks and benefit; promoting a culture of communication, evaluation,
education and innovation; increasing the availability of literature, database and
other knowledge resources; developing research methods consistent with T&CM concepts;
building research capacity and promoting international collaboration including protection
of intellectual property.
WHO has developed ICD-11 codes for oriental TM diagnoses. It is reviewing the safety
of T&CM practices, starting with acupuncture.
Conclusions
The WHO TM strategy is an important opportunity to encourage official and funding
bodies to support integration in UHC and PHC and research. We should emphasise our
strengths including effective, safe, popular, economical, eco-friendly treatments
which harness natural healing; continue to strengthen the knowledge base; promote
communication; develop and disseminate effective models of integration in UHC and
PHC. Establishing accessible databases to inform evidence-based policy on integration
particularly in middle and low income countries is a high priority.
O70 Food literacy and attitudes in a healthy population of US adults
Mary J Kreitzer, Roni Evans, Brent Leininger, Kate Shafto, Jenny Breen
Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN 55455,
United States
Correspondence: Mary J Kreitzer (kreit003@umn.edu)
Question
This study focused on factors related to food literacy and healthy eating behaviors
in adults including individuals knowledge of healthy food choices; confidence related
to food choices and preparation; and preferences for education. Obesity is one of
the most serious public health challenges of the 21st century and is among the leading
causes of deaths globally.
Methods
The population surveyed included a convenience sample of adults (18 of age and over)
who agreed to complete a survey on an iPad while attending a large public event.
Results
659 adults who participated in the study were primarily female (69%), well educated
(62% with 4 year college degree or above, and healthy (66% described themselves as
healthy or very healthy). Despite being confident in their ability to chose healthy
food (70%), scores revealed a lack of food literacy. For example, less than 1/2 knew
the USDA Healthy Plate recommendation around the percent of food that should be fruit
and vegetables and that transfat is the least healthy fat to consume. Slightly over
a 1/3 reported that they cook food daily for themselves. Factors preventing them from
eating healthy foods include lack of time, willpower and a demanding work or travel
schdedule. The sources of information that most influenced eating were family and
friends (81%), followed by health professionals (45%) and TV cooking shows (35%).
Conclusion
Consumer food literacy and reported barriers to healthy eating likely contribute to
unhealthy eating and the public health problems associated with obesity and chronic
disease.
O71 HCT (Holistic Clinical Trials) and ICT (Integrative Clinical Trials)
Mohammad R Sanaye1, Babak Daneshfard2
1Shiraz University of Medical Sciences, Essence of Parsiyan Wisdom Institute, Phytopharmaceutical
Technology and Traditional Medicine Incubator, Shiraz, Iran, Islamic Republic of;
2Shiraz University of Medical Sciences, Traditional Persian Medicine, Shiraz, Iran,
Islamic Republic of
Correspondence: Babak Daneshfard (babakdaneshfard@gmail.com)
Any holistic medicine, if it is to be truly holistic, cannot possibly take the policy
of escapism from Clinical Trials. The intention to design experimental trials on animals
before coming over to humankind has been focused on to procreate the most state-of-the-art
clinical trials for human holistic medicine. Thus, split-plots [and even: split-split
plots] are brought at work to employ the full efficiency of Bayesian statistics for
purposes of holistically infer posterior likelihood in cases of predictions based
on priors. This spells that on the on the one hand clinical trials are not necessarily
to be of randomized nature. On the other hand, the basic ideas of HCT [Holistic Clinical
Trials] and ICT [Integrative Clinical Trials] by means of incorporating Algebraic-Topologic
notions (rather than simple numerically crunched data analysis) into the main body
of any trial of clinical essence, thence, emerges to be the most applicable handy
clinical trials of near-future medicine.
O72 Organic food consumption during pregnancy and its association with health-related
characteristics: the KOALA Birth Cohort Study
Ana P Simões-Wüst1,2, Carolina Moltó-Puigmartí3, Martien van Dongen3, Pieter Dagnelie3,
Carel Thijs3
1 Obstetrics, University Hospital Zurich, Zurich, 8091, Switzerland; 2 Research, Clinic
Arlesheim, Arlesheim, Switzerland; 3 Epidemiology,CAPHRI School for Public Health
and Primary Care, Maastricht University, Maastricht, Netherlands
Correspondence: Ana P Simões-Wüst (anapaula.simoes-wuest@usz.ch)
While evidence for health-related benefits of consuming organic foods is scarce, their
consumption has been shown to be often accompanied by specific food patterns. The
aim of the present study was to investigate whether the consumption of organic food
during pregnancy and accompanying food pattern are associated with selected health-related
characteristics and biomarkers.
Blood from 1339 pregnant women participating in the KOALA Birth Cohort Study as well
as information on demographic, lifestyle, health-related and diet characteristics
was collected and analysed. Participants were grouped depending on whether none (reference
group), less than 50%, between 50% and 90%, or more than 90% of the consumed food
was of organic origin.
Consumption of organic food was associated with a more favourable pre-pregnancy BMI
and a lower prevalence of gestational diabetes. Plasma levels of ferritin, homocysteine,
25-hydroxyvitamin D and plasma triglycerides were lower in the organic groups than
in the reference group. Plasma phospholipid levels of several fatty acids differed
among the various groups. Compared with the reference group, markers of the intake
of trans fatty acids from natural origin (e.g. vaccenic and rumenic acid) were higher
in the organic groups, whereas elaidic acid, a marker of the intake of trans fatty
acids found in industrially hydrogenated fats was lower.
The lower intake of animal products previously observed in the organic groups is likely
to play a role in the differences found in biomarker levels. Potential health-related
effects of a diet associated with the consumption of organic food are discussed.
O73 101: practical strategies for creating a successful integrative medicine and health
program
Shelley White (shelley.white@hci.utah.edu)
Huntsman Cancer Institute/University of Utah, Wellness and Integrative Health Center,
Salt Lake City, UT, United States
Since many presentations evaluate integrative program offerings through scientific
abstracts, this presentation will offer practical strategies and instruction on how
to set up successful program services. This session will provide descriptive details
about how the presenter was able to increase integrative health and medicine services
at the Huntsman Cancer Institute, an NCI Comprehensive Cancer Center, at the University
of Utah from five program offerings to forty program offerings for patients, caregivers,
and staff within a five-year period. Total visits increased by nearly 800% from 2,310
in 2013 to 18,375 in 2016.
The Wellness and Integrative Health Center at the Huntsman Cancer Institute offers
forty services to people affected by cancer. Uniquely, therapeutic services are offered
on site, within our clinical medical setting. Services include: acupuncture, art,
bone health/osteoporosis, clinical hypnosis, cooking demonstration classes, core &
stretch, creative and expressive writing, cranial sacral therapy, dance, energy medicine,
cancer exercise fitness therapy, group circuit training, integrative oncology consultations,
Jin Shin Jyutsu, Laugh/Live out Loud, Look Good-Feel Better, massage therapy, mind-body
medical interventions (meditation, mindfulness-based practices), music therapy, narrative
therapy (life story recordings), nutritional counseling, osteopathic manipulation
treatments, Pilates mat, Physiatrist visits, Qigong, resistance training, road-biking,
rowing, running, snow-shoeing, Tai-Chi, weight reduction, yoga, yogalates, and Zumba®
The presenter is currently working with the Chief Wellness Officer, the Associate
Vice President for Health Equity and Inclusion, the Medical Director for Supportive
Oncology and Survivorship, a Distinguished Professor in the College of Nursing and
investigator and co-leader of Cancer Control and Population Sciences at the Huntsman
Cancer Institute, the Director of Nursing and Patient Care Services, the Associate
Dean of Research for the Graduate School of Social Work, the Associate Vice President
for the Art, and the Associate Dean of Research for the Arts to bring campus clinical
programs into additional health care and community settings to provide additional
clinical, educational, and research opportunities. The community space will offer
arts, wellness, psychosocial service as well all of the integrative health services
we currently offer on-site with the addition of an arts installation space; performance
space; a counseling center (for psychosocial services); a recording studio for music
therapy, spoken word, and life stories; group fitness and dance space; additional
exercise and research space, and medical follow-up clinic space for patients who need
post-treatment follow-up. The presenter also managed Patient and Family Support (emotional,
spiritual, and practical services).
O74 The broken link! Combining conventional and complementary medicine in a safe health
care delivery chain
Solveig Wiesener, Anita Salamonsen, Trine Stub, Vinjar Fønnebø
Faculty of health care sciences, NAFKAM, Tromsø, 9037, Norway
Correspondence: Solveig Wiesener (solveig.wiesener@uit.no)
Question
The aim of the study is to analyze how a combination of conventional medicine and
CAM (complementary and alternative medicine) may affect patient safety, and investigate
whether the concurrent use of CAM threatens patient safety in conventional health
care services.
Methods
We have reanalyzed the EU FP7 CAMbrella data collected on regulation of CAM in 39
countries in Europe and the European Union (EU), and supplemented this with recent
emerging knowledge in the area.
Results
The World Health Organization (WHO) and the EU have both given priority to safety
and patients" right to choose treatment. Consequently, the regulation of national
health care services in many countries focuses on strengthening patient safety and
highlights patients" right to choose safe and suitable treatment. Moreover, public
patient safety strategies, especially within cancer treatment, highlight "a safe pathway
of treatment". About 40% of Norwegian patients combine CAM and conventional treatment,
and surveys conducted in Europe demonstrate the same trend.
We found, however, insufficient documentation on safety and risk aspects when patients
combine CAM and conventional medicine. The risks and safety challenges include lack
of communication between health personnel, patients and CAM providers, negative interactions
between herbal and medicinal products and insufficient patient information. Further,
there are challenges with regard to supervision, claims and reimbursement.
Conclusions
Combining CAM and conventional medicine may influence patient safety. There are risk
and safety challenges due to disharmonized regulation, unclear treatment standards,
insufficient patient information and lack of communication between health care professionals
and CAM providers.
Posters
Research
P1 Cobalamin (vitamin B12) functional status is not correctly assessed by common biomarkers
being used: 2 case reports and a review of the literature
Sergio Abanades1, Mar Blanco2, Laia Masllorens1, Roser Sala3
1 Research, Human Nutrition and Functional Medicine, Barcelona, 08391, Spain; 2 Nutrition,
COFB, Barcelona, 08009, Spain; 3 Synlab diagnósticos globales, Clinical Analysis,
Barcelona, Spain
Correspondence: Sergio Abanades (s.abanades@gmail.com)
Question
Main biomarkers of cobalamin status include blood concentrations of cobalamin, holoTranscobalamin
(holoTC), methylmalonic-acid(MMA) and homocysteine (tHcy). However, only cobalamin
blood concentrations are usually measured.
Methods
High plasma cobalamin levels in spite of suspected low cobalamin functional status
were found in 2 clinical cases. Clinical symptoms and additional biomarkers of cobalamin
low status were assessed. Intestinal dysbiosis was also tested by the KyberKompaktPRO
test. Review of the literature included the European Food Safety Authoritys position
document on reference values for cobalamin. PubMed database was also reviewed (September
2016). Key words included cobalamin, holotranscobalamin, vitamin b12, dysbiosis and
Small-intestinal-bacterial-overgrowth.
Results
Standard serum cobalamin concentration comprises both the functional and the inert
fractions of cobalamin and refers typically only to standardised cyanocobalamin levels.
Cut-off values have not yet been clearly defined and are not correlated with functional
status. In the 2 patients described, in spite abnormally high levels, clinical signs
of cobalamin low-status were found in conjunction with tHcy abnormal high values.
Intestinal dysbiosis was also present. Resolution of dysbiosis and administration
of methyl-cobalamin normalised cobalamin levels and improved clinical status in the
2 cases reported.
Conclusions
Measurement of serum cobalamin levels alone is not an adequate method to assess cobalamin
functional status. A combination of biomarkers including HoloTC is more suitable for
assessing functional cobalamin status. Cobalamin plasma concentrations could be falsely
raised in several medical conditions where low cobalamin functional status is present.
Correct treatment of intestinal dysbiosis could lead to improvements in cobalamin
functional status.
Written informed consent for the publication of these details was previously obtained
from the participants.
P2 Factors influencing self-care behaviors (Khat use) among type II diabetes mellitus
patients in Yemen
Shafekah Al-Ahnoumy1, Dongwoon Han2, Luzhu He1, Ha Yun Kim2, Da In Choi1
1 Hanyang University, College of Medicine, Seoul, 133-791, South Korea; 2 Global Health
and Development, Hanyang University, College of Medicine, Seoul, 04763, South Korea
Correspondence: Shafekah Al-Ahnoumy
Purpose
Worldwide, diabetes Mellitus (DM) is becoming a big challenge, particularly the prevalence
of DM is higher in Arab regions than global average with predominance of type II DM.
Self-care as a cost-effective intervention was presented as a solution of diabetes
prevention and management by WHO and AADE. Diabetic individuals independently make
decision and different life activities to maintain their health condition, prevent
DM related complications and improve life quality. Good diabetes self-care behaviors
can be affected by many factors, including social, cultural, financial and health
care system. However, to our best knowledge, factors influencing diabetes self-care
behaviors hasnt been investigated among Yemeni diabetic patients.The Aim of this study
wasto provide an overview of self-care behaviors among type II DM Yemeni patients,
and expound the affect factors and barriers of self-care behaviors among them.
Methodology
A descriptive cross-sectional study was designed. 350 participants were out-patients,
who were approached in 4 major public governmental hospital (Al-Gumhouri, Al-Thawra
and Al-Kuwait hospital and the University of Science & Technology Hospital) and 1
major private hospital in Sanaa City(capital city), during 5th October to 10th November,
2015. A questionnaire was developed with 5 parts, including Self-care Behaviors, Diabetic
Characteristics, Barriers of Self-care Behaviors, Knowledge level of DM and social-
demographic characteristics. Data collected through face to face interview survey,
then coded and analyzed with Excel and SPSS software 21. Chi-square was used to test
association between self-care behaviors and independents variables.
Results
Only 28.5% of patients had good self-care behavior score, most of them had fair to
poor self-care. Taking medicine, general diet and exercise were the most taking self-care
behaviors among good self-care behavior patients. Specifically, over half of patients
reported they were chewing Khat, among them 41.9% take Khat every day. The biggest
barriers of self-care behaviors was insecure situation, following were lack of transportation
and lack of electricity. Analyzing with Chi-square, house-hold income, whether having
Glucometer, Meal plan, snacks per day and DM duration were factors influencing the
self-care behaviors.
Conclusion
Type II diabetes patients in Yemeni have not good self-care behaviors. Taking medicine
is the most self-care behavior, but testing blood glucose was the lowest. It emphasizes
the role of health care workers to support patients with required knowledge and skills
to improve their health outcome.
P3 «Everyone with a chronic disease should be offered this program» - participants
experience with an integrative medicine group program
Terje Alræk1, Trine Stub1, Agnete Kristoffersen1, Christel von Sceidt2, Andreas Michalsen3,
Stig Bruset4, Frauke Musial1
1 Department of Community Medicine, National Research Center in Complementary and
Alternative Medicine, NAFKAM, UiT, The Arctic University of Norway, Tromsø, 9037,
Norway; 2 Mind Body Medicine, Immanuel Krankehnhaus, Berlin, Germany; 3 Institute
for Social Medicine, Epidemiology and Health Economics, Charité University Hospital,
Berlin, Germany; 4 Regnbuen helsesenter, Lierskogen, Norway
Correspondence: Terje Alræk
Background
The Integrated Medical Care Rehabilitation (IMCR) program was designed for patients
with amalgam-attributed health complaints. Special emphasis was placed on patient
participation and patient empowerment. The aim of this qualitative study was to describe
personal feedback on mental, emotional, and bodily experiences with the program.
Methods
Qualitative data were drawn from the study participants (n = 18) from the three intervention
groups. Four open questions were asked as part of a anonymized questionnaire, which
presented a possibility to describe personal experiences with the IMCR program. The
questionnaires were sent back to the research team in sealed envelopes. Analysis method
was systematic text condensation.
Results
Most participants were very satisfied with the program. They appreciated the resource
oriented focus of the program. After completion of the training, many participants
integrated relaxation and breathing exercises into their daily lives and reported
calmness and a more positive view on life.
Conclusion
Data from this qualitative study suggests that a program with several modalities such
as life style advices, complementary therapies, relaxation exercises and stress management
tools is beneficial for chronically ill patients with amalgam attributed health complaints.
Beyond that, we conclude that the IMCR program can be useful for chronically ill patients
with a similar symptom profile.
P4 Systematic review and meta-analysis of herbal medicine in children with respiratory
tract infection
Dennis Anheyer1, Holger Cramer 1, Romy Lauche2, Felix J Saha1, Gustav Dobos1
1 Department of complementary and integrative medicine, Kliniken Essen Mitte, University
of Duisburg-Essen, Essen, 45276, Germany; 2 University of Technology Sydney, Australian
Research Centre in Complementary and Integrative Medicine (ARCCIM), Sydney, Australia
Correspondence: Holger Cramer
Question
Herbal medicines are particularly regarded as an alternative or complement to conventional
pharmaceuticals in the treatment and prevention of respiratory tract infections (RTI).
The purpose of this review was to identify evidence for herbal therapy in the treatment
of RTI concerning effectiveness and safety.
Methods
Medline/PubMed, Scopus and the Cochrane Library were searched through 12 February
2015.Only randomized controlled trials comparing herbal therapy with no treatment,
placebo or any pharmaceutical medication in children and adolescents (age 0 to 18 years)
with RTI were considered to be eligible.
Results
Eleven trials with 2.181 participants were included. No clear evidence for Echinacea
(4 trials) or an herbal compound preparation (1 trial) in preventing RTI symptoms
was found. Meta-analysis revealed evidence for efficacy (responder rates: risk ratio
[RR] = 2.56; 95% confidence interval [CI], 1.54 to 4.26; P < 0.01; heterogeneity:
I
2 = 38%; χ2 = 9.63; P = 0.14) and safety (patients with adverse events: RR = 1.06;
95% CI, 0.42 to 2.66; P = 0.9; heterogeneity: I
2 = 72%; χ2 = 10.64; P = 0.01) of Pelargonium sidoides in treating respiratory tract
infection symptoms compared to placebo (6 trials).
Conclusion
Due to the heterogeneity of the included studies no concrete conclusion on preventive
effects of Echinacea could be drawn so far. In case of pelargonium sidoides a performed
meta-analysis revealed moderate evidence for efficacy and safety in the treatment
of respiratory tract infections in children.
P5 A systematic review and meta-analysis of mindfulness-based stress reduction for
treating low back pain
Dennis Anheyer1, Heidemarie Haller1, Romy Lauche2, Gustav Dobos1, Holger Cramer1
1 Department of complementary and integrative medicine, Kliniken Essen Mitte, University
of Duisburg-Essen, Essen, 45276, Germany; 2 University of Technology Sydney, Australian
Research Centre in Complementary and Integrative Medicine (ARCCIM), Sydney, Australia
Correspondence: Holger Cramer
Question
Mindfulness-based stress reduction (MBSR) is frequently used in treating pain conditions.
While meta-analyses on MBSR for chronic pain have been conducted, no meta-analysis
specifically for low back pain is available.
Methods
Medline/PubMed, Scopus, the Cochrane Library, and PsycINFO were screened through June
2016. Only randomized controlled trials (RCTs) were included when they assessed the
effects of MBSR in patients with a diagnosis of low back pain. Usual care (no specific
treatment) or any active treatments were acceptable as control interventions. For
each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI)
were calculated. Risk of bias was assessed using the Cochrane risk of bias tool. Primary
outcome measures were pain intensity and pain disability. Health-related quality of
life, pain acceptance, mindfulness, and safety were defined as secondary outcomes.
Results
Seven RCTs, involving 864 low back pain patients, proved eligible for review. Compared
to usual care, MBSR was associated with short-term improvements in pain intensity
(4 RCTs; Mean Difference (MD) = -0.96 points on a numeric rating scale; 95%CI = -1.64,-0.34;
Standardized Mean Difference (SMD) = -0.48 95%CI = -0.82,-0.14) and physical functioning
(2 RCTs; MD = 2.50; 95%CI = 0.90,4.10; SMD = 0.25 95%CI = 0.09,0.41) that were not
sustained long-term. Between-group differences in disability, mental health, pain
acceptance and mindfulness were not significant at short- or long-term follow-up.
Compared to an active comparator, MBSR was not associated with any significant differences
in short- or long-term outcomes. No serious adverse events were reported.
Conclusions
There is promising evidence of short-term efficacy and safety of MBSR in low back
pain patients. While further RCTs with larger sample sizes and longer follow-up periods
are needed to underpin these results, MBSR can be recommended as an adjunct intervention
for patients with chronic low back pain.
P6 Chinese herbal therapy compared with cryotherapy in the treatment of chronic cervicitis
and cervical erosion: a randomized controlled trial
Hoda Azizi1, Nayereh Khadem1, Malihe Hassanzadeh1, Nazanin Estiri1, Hamideh Azizi1,
Fatemeh Tavassoli1, Marzieh Lotfalizadeh1, Reza Zabihi1, Habibollah Esmaily1,2,3
1 Department of Complementary Medicine, Mashhad University of Medical Sciences, Mashhad,
91359135, Iran, Islamic Republic of; 2 Department of Medical Imaging, Razavi Hospital,
Mashhad, 9187195786, Iran, Islamic Republic of; 3 Mashhad University of Medical Sciences,
Department of Biostatistics, Mashhad, Iran, Islamic Republic of
Correspondence: Hoda Azizi
Background
Chronic cervicitis is one of the common disorders in daily practice. We aimed to compare
the effectiveness and safety of Chinese herbal medicine in comparison with cryotherapy
in the treatment of chronic cervicitis and cervical erosion.
Materials and methods
Seventy women with cervicovaginal smears class I or II without a papilloma or Cervical
intraepithelial neoplasia who referred to gynecology clinic of Imam Reza Hospital
and Qaem Hospital, Mashhad, Iran entered the study. The experimental group received
Chinese herbal treatment and the control group received cryotherapy. The main outcome
measures were the number of treated patients, the time of recovery and side effects.
All subjects were evaluated for study outcomes at 48 hours after treatment, week 1,
3 days after the end of menstruation, weeks 6 and 12.
Results
Seventeen and 9 patients were treated in experimental group at days 2 and 7 after
intervention while none of the control group showed treatment at those times. The
number of treated patients were 29 vs 5 in experimental and control groups 3 days
after next menstruation (P < 0.001); 31 vs. 12, 6 weeks after treatment (P < 0.001);
and 34 vs. 24, 12 weeks after treatment (P < 0.001). One patient in the experimental
group vs. 11 patients in the control group did not answer to the treatment (P < 0.001).
The median (interquartile range) for time to treatment response was 3 (4) days in
the experimental group and 35 (48) in the control group (P = 0.015).
Side effects including spotting, hypogastric pain, fever and yellow vaginal discharge
were observed in 15 patients in the experimental group vs. 24 patients in the control
group (P = 0.03). The complete cure was observed in 97.1% of patients in the experimental
group vs. 68.5% in the control group (P < 0.001).
Conclusions
Chinese herbal therapy is suggested to be better tolerated and more successful with
less side effects comparing to cryotherapy for women with chronic cervicitis.
Trial registration: IRCT201512107265N4
P7 The effect of acupuncture on refractory chest pain of patients with patent coronary
angiogram: a randomized controlled trial
Hoda Azizi1, Mahmoud Mohammadzadeh Shabestari2, Reza Paeizi3, Masoumeh Alvandi Azari4,
Hamidreza Bahrami-Taghanaki1, Reza Zabihi4, Hamideh Azizi5, Habibollah Esmaily6
1 Department of Complementary Medicine, Mashhad University of Medical Sciences, Mashhad,
91359135, Iran, Islamic Republic of; 2 Department of Cardiology, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of; 3 School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of; 4 Department of
Medical Imaging, Razavi Hospital, Mashhad, 9187195786, Iran, Islamic Republic of;
5 Department of Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of; 6 Department of Biostatistics, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Correspondence: Hoda Azizi
Background
Five percent of patients with acute coronary syndrome and 15% of patients with stable
angina suffer from refractory chest pain while their angiogram is patent which indicates
no need for invasive interventions such as percutaneous coronary intervention or coronary
artery bypass grafting. We aimed to investigate the effect of acupuncture on the chest
pain of those patients.
Materials and methods
Forty patients with typical angina pectoris and patent coronary angiogram, whose chest
pain was persistent despite medical treatment in maximum dosage, entered the study.
They were randomly assigned in 2 groups. The experimental group received acupuncture
treatment 3 times a week plus medication, while the control group received medication
alone for 4 weeks. All patients were fallowed up 4 weeks after the end of intervention.
The intensity of chest pain according to Visual Analogue Scale (VAS) and Canadian
Cardiovascular Society Grading System (CCS), the number of weekly episodes of chest
pain, the length of each pain episode and changes in ST-T segment of electrocardiography
were recorded at baseline, week 4 and week 8.
Results
The mean (SD) of VAS score decreased from 7.2(1.4) pre-treatment to 3.1(1.4), 1.6(1.1)
and 0.2(0.7) at week 2, 4 and 8 in the experimental group vs. 6.1(1.5) pre-treatment
to 3.9(1.1), 3.1(0.7) and 2.3(1.5) in week 2, 4 and 8 in the control group (P < 0.001).
The CCS score decreased in 14 patients in experimental group vs. 7 patients in control
group at week 2(P = 0.03), 16 vs. 10 at week 4(P = 0.01), and 18 vs. 15 at week 8(P = 0.008).
The mean (SD) of the number of weekly episodes of chest pain decreased from 21.9(20.9)
pre-treatment to 3.2(3.0), 0.1(0.8), and 0.1(0.3) at week 2, 4 and 8 in the experimental
group vs. 30.8(19.5) pre-treatment to 20(17.8), 16.7(18.5) and 11.7(19.3) in week
2, 4 and 8 in the control group (P = 0.001). The mean (SD) of the length of each pain
episode decreased from 17.9(14.2) minutes pre-treatment to 3.8(4.2), 1.3(2.5), and
0.3(1.2) minutes at week 2, 4 and 8 in the experimental group vs. 7.5(7.6) minutes
pre-treatment to 3(3.01), 2.3(2.2) and 1.5(1.8) minutes in week 2, 4 and 8 in the
control group (P = 0.001). No change was seen in the ST-T segments of patients" electrocardiographs
in both groups. The mean (SD) of systolic blood pressure changed from 130(17.3) pre-treatment
to 111.3(18.3), 111.9(11.6) and 116.6(12.9) at week 2, 4 and 8 in the experimental
groups vs. 139.3(12.6) pre-treatment to 134.9(12.9), 131.5(12.5) and 132.8(12.3) at
week 2, 4 and 8 in the control group (P < 0.001).
Conclusion
The intensity of chest pain, the number of weekly episodes of chest pain and the length
of each pain episode decreased significantly by acupuncture treatment. Results of
this study suggests that acupuncture could help as an adjuvant therapy in the management
of chest pain of patients with patent coronary angiogram.
Trial registration: IRCT201512037265N2
P8 Methodological issues regarding the development of individualizing whole medical
system interventions
Erik Baars, Anja De Bruin, Anne Ponstein
University of Applied Sciences Leiden, Leiden, 2333CK, Netherlands
Correspondence: Erik Baars
Purpose
In conventional medicine evidence-based, group-oriented protocols and guidelines are
considered to guarantee the quality of interventions for conventional indications.
However, whole medical system (WMS) approaches lack this group-oriented focus and
are characterized by a highly individualized diagnostic and therapeutic approach.
Thus, other instruments than the group-oriented protocols and guidelines are requested
to allow for guideline developments and quality assurance.
Methods
The development of two WMS (Anthroposophic Medicine) healthcare programs for patients
with cancer and depression, and the literature on WMSs, complex interventions and
individualization in therapeutic processes was analyzed.
Results
The core elements of the WMS individualizing interventions are: (1) a set of consensus
and evidence-based treatment phases, treatment goals per phase and therapies per goal;
(2) professionals with trained system thinking and reflection skills who are able
to judge the whole, complex and unique situation of the patient leading to individualization
in diagnostics and treatments. Additionally they are able to reflect on therapy progress
and steer the therapy process accordingly.
Conclusions
The quality of individualizing WMS interventions cannot be guaranteed by the same
approach as used in group-oriented protocols and guidelines. They require identification
of a set of treatment phases and related goals and therapies, and specifically trained
professional who are able to rationally choose the best option from the redundant
set of treatment options. Individualization of WMS interventions thus largely depends
on professional clinical reasoning.
P9 Complementary medicine and lifestyles in Tuscany: a comparative study
Sonia Baccetti1, Mariella Di Stefano2, Elio Rossi2, Fabio Firenzuoli2, Sergio Segantini2,
Maria Valeria Monechi2, Fabio Voller3
1 Centre of Acupuncture and Traditional Chinese Medicine, Tuscan network for Integrative
Medicine, Florence, 50133, Italy; 2 Tuscan Network of Integrative Medicine- Region
of Tuscany, Florence, Italy; 3 Regional Health Agency of Tuscany, Florence, Italy
Correspondence: Sonia Baccetti
Background
According to international literature, users of CM are more active, less overweight
and have healthier lifestyles.
Aim
To evaluate the lifestyle of patients of CM public clinics in Tuscany and compare
it with general data of the surveillance system Multiscopo in Tuscan population (Istat
2013) adjusted for sex and age.
Methods
In 2014 the Tuscan Network of Integrative Medicine in co-operation with the Regional
Health Agency of Tuscany has distributed to 1,064 patients (age >18) in public clinics
of CM, anonymous questionnaires on lifestyles, that included questions on exercise,
smoking, diet, alcohol.
Results
The sample was divided according to educational level (medium-high and medium-low).
All the subjects who used CM had less sedentary habits (statistically significant)
compared to controls in both groups (19% versus 26.9% medium-high educational level,
32.1% versus 48% medium-low educational level). Also the consumption of fruit and/or
vegetables was significantly higher in 2 groups who used CM (41,2% versus 7,5% medium-high
and 35,4% versus 4,5% medium-low). In the subjects with low educational level, smoking
was significantly lower (15,6% versus 23,2%) and obesity was higher (18.3% versus
11.7%) compared to the control group. Finally, in the subjects with low education
who used CM prevalence of drinkers at risk was higher compared to Tuscan population
(21,6% versus 11,9%).
Conclusions
Contrary to what literature reports, lifestyles of our sample were not better in alcohol
consumption and obesity. CM patients ate more fruit and vegetables, were moderately
less sedentary than Tuscan population and smoked less compared to the control group.
Keywords: Lifestyles; Complementary Medicine (CM); Public Regional Healthcare System
P10 Expectation for acupuncture treatment (EAT): scale development and performance
Jürgen Barth, Alexandra Kern, Sebastian Lüthi, Claudia Witt
Institute for Complementary and Integrative Medicine, University Hospital Zurich,
Zurich, 8006, Switzerland
Correspondence: Jürgen Barth
Background
High expectations about acupuncture might contribute to larger treatment effects (Prady
et al., 2015). However, problems in the assessment are well known: 1) floor or ceiling
effects lower variance; 2) expectation measures include general beliefs about complementary
medicine; 3) construct validity of expectation measures remains unclear since assessment
strategies were often ad hoc developed. We aimed to develop an expectation scale for
acupuncture with good reliability, convergent validity (other expectation scales)
and distinctness to more general constructs (like optimism).
Methods
In this web based survey we included 110 participants with pain. All participants
filled in nine statements on expectations of which five were used for the final version
of the Expectation for Acupuncture Treatment scale (EAT). Convergent validity was
tested against the Acupuncture Expectation Scale (AES), Life Orientation Test (LOT),
Patient Health Questionnaire (PHQ), Sensitivity to Medication (BMQ-D), and other measures.
Results
Factor analysis showed a one factor solution of the EAT items and reliability was
high (alpha = 0.902). The correlation with another measure of patient expectation
(AES) was high. Moderate correlation of 0.20 to .30 were found for LOT, PHQ and BMQ-D.
No association was present for the personality characteristics neuroticism and openness
to experience. Re-test reliability after one week was good (ICC > .70).
Conclusion
The EAT seems to be a reliable, valid and very feasible measure for assessing acupuncture
expectations in pain patients. The items can be adapted for other treatments and an
English version is available to be tested.
P11 Changing expectation for acupuncture treatment (CHEAT)
Jürgen Barth, Anja Zieger, Fabius Otto, Claudia Witt
Institute for Complementary and Integrative Medicine, University Hospital Zurich,
Zurich, 8006, Switzerland
Correspondence: Jürgen Barth
Background
Changing expectations by verbal suggestions might improve acupuncture effects (Suarez-Almazor
et al., 2010). However, designing appropriate communication for verbal suggestions
might be a difficult task. Web based experiments can be a tool to develop effective
suggestions to change expectations.
Methods
In this web based study we randomly informed subjects in two different ways with visual
and written materials about the benefits of acupuncture: In the high expectation group
(HE) the subjects were told that acupuncture leads to a substantial decrease in symptoms
in about 50% of cases. In the low expectation group (LE) the participants were told,
that about half of the patients get better but the specific effect of acupuncture
is still unclear. We included subjects with an adequate information processing (memory
task and a minimum reading time of 25 seconds). The strength of the message was tested
with a manipulation check and the Expectation for Acupuncture Treatment (EAT) scale
was the primary outcome.
Results
Of 369 subjects 244 were included in the analysis (having pain n = 78; HE n = 33,
LE n = 45, having no pain n = 166; HE n = 86, LE n = 80). Manipulation check was positive.
For pain patients the expectations did not differ between HE and LE (p > .60). For
no pain subjects expectation differed between HE and LE (p = .02). This effect was
robust effect after controlling for sex, age, earlier acupuncture experience, and
health status.
Conclusion
Web experiments can help to make empirically based decisions on how to create persuasive
messages for verbal suggestions on expectations. High dose communication including
audio visual information about acupuncture might be needed for patients to have similar
effects like in healthy subjects.
P12 Mind-body therapies for eating disorder prevention: a systematic review and meta-analysis
Ariel Beccia, Corina Dunlap, Brendan Courneene
National University of Natural Medicine, Helfgott Research Institute, Portland, OR,
United States
Correspondence: Ariel Beccia
Question
Eating disorders represent a significant public health concern. The challenges associated
with treatment highlight the importance of prevention. Calls for increased efficacy
of such programs have led to the development of novel approaches, including those
incorporating mind-body therapies. The purpose of this review is thus to assess the
effectiveness of mind-body therapies in promoting protective factors and reducing
risk factors associated with eating disorders.
Methods
MEDLINE, PsychINFO, CINAHL, Scopus, and AMED were screened through November 2016.
Randomized controlled trials (RCTs) comparing mind-body therapies to dissonance-based
or assessment-only controls were analyzed. Outcome measures included standardized
measures of protective and risk factors associated with eating disorder development.
For each outcome, standardized mean differences (SMD) and 95% confidence intervals
(CI) were calculated, if at least 2 studies assessing this outcome were available.
As a measure of heterogeneity, I2 was calculated. Data synthesis was completed using
RevMan software and risk of bias was assessed using the Cochrane risk of bias tool.
Controlled before-and-after and pre-post studies were also eligible, although were
not included in the meta-analysis.
Results
Out of 1675 identified studies, 15 trials (1368 participants) were included in the
meta-analysis, evaluating meditation and/or mindfulness-based therapies (10 trials),
mirror-exposure therapy (2 trials,) yoga (2 trials), and autogenic training (1 trial).
Mind-body therapies may significantly reduce body image concern (SMD -0.36; 95% CI
-0.66 to -0.06), negative affect (SMD -0.40; 95% CI -0.76 to -0.03), and improve body
appreciation (SMD 0.58; 95% CI 0.35 to 0.81) as compared to assessment-only control,
and may significantly improve self-esteem (SMD 0.80; 95% CI 0.37 to 1.23) as compared
to dissonance-based controls. No significant differences were found for any other
outcome measure. 5 non-randomized studies (519 participants) were identified; interventions
included mindfulness-based therapies and yoga, and all reported significant changes
on included outcome measures.
Conclusions
Mind-body therapies may be an effective form of eating disorder prevention. Based
the combined data from 15 RCTs, there is moderate evidence for the effectiveness of
mind-body therapies in reducing risk factors and promoting protective factors associated
with eating disorders. The main limitations of the studies were the lack of blinding
and the variations in included interventions. A meta-analysis of outcome measures
assessed at 1-month follow-up is currently being conducted.
P13 Chilean National Health Survey 2010-2011: chronic pain in adults and the use of
complementary and alternative therapies (CAM)
Paula Bedregal1, Alvaro Passi1, Alfredo Rodríguez2, Mayling Chang3, Soledad Gutiérrez4
1 Public Health. Unit of Integrative Medicine and Health, Pontificia Universidad Catolica
de Chile, Santiago, 8330077, Chile; 2 Family Medicine, Pontificia Universidad Catolica
de Chile, Santiago, 8330077, Chile; 3 Unit of Integrative Medicine and Health, Pontificia
Universidad Catolica de Chile, Santiago, 8330077, Chile; 4 Integrative Medicine Unit.
CASR, Hospital Dr. Sótero del Río, Santiago, Chile
Correspondence: Paula Bedregal
Chronic pain is a public health problem. About 43.5% (95% CIs 38.4% to 48.6%) of population
is estimated to have this condition. One third of Chilean population use CAM. There
is no current data about use of CAM in people with chronic pain and its perceived
benefits neither in Chile nor in Latin America.
Methods
A cross-sectional representative national survey of 5285 adults (≥18 years old) was
interviewed directly about their use of CAM. We analyzed the frequency of CAM use,
the types of CAM used, the perceived efficacy and factors influencing its use.
Results
Prevalence of chronic pain in Chile is 39.7% (95% CIs: 38.4-41.0%). Prevalence of
CAM use in those with chronic pain is 42.6%, in those without chronic pain is 36.1%
(p = 0.0001). The most common type of CAM used is herbal therapies (34.7%), followed
by homeopathy (12.5%). The use of CAM in those with chronic pain is associated with
better educational level (>12 years of studies); women (44.6% vs 38.3%; p = 0.004);
being elderly (49.5 ± 19.0 vs 52.1 ± 17.3 years old; p = 0.002); and perception of
poor health. Perceived efficacyis better with Herbal therapies (92%), Reiki (79.2%)
and Bach’s Flowers (75%). Adjusted by educational level, only gender and age is associated
to use of CAM among adult Chilean population with chronic pain.
Conclusion
The use of CAM in chronic pain patients is higher than the general population. Most
felt that it improved their pain. CAM may have a role in the management of chronic
pain in particular herbal therapies.
P14 Therapeutic sensations show high similarity between different body-oriented therapies
Florian Beissner
Somatosensory and Autonomic Therapy Research, Hannover Medical School, Hannover, 30625,
Germany
Question
Complex bodily sensations that patients experience during therapeutic interventions
are a common phenomenon in many body-oriented therapies. Despite the striking similarity
of sensations across different therapy systems, no attempt has been made so far to
understand their characteristics and clinical relevance from a perspective that transcends
the borders between these systems.
Methods
We searched the pubmed database for the terms therapeutic sensation, deqi, needling
sensation, enhanced touch sensation, acupuncture sensation, propagated sensation,
and alternative spellings thereof. We identified 311 studies of which we included
those that reported verbal descriptors together with their relative frequencies, i.e.
information on how often each descriptor had been used by subjects to describe their
TS. To reflect both within- and between-study variance we first calculated relative
frequencies for each of the descriptors used in the single studies. We then multiplied
these frequencies by the weighting factor n/27, where n was the number of studies
reporting the descriptor at least once. The results were transformed into a word cloud.
Results
Our final sample consisted of 27 studies which comprised different acupuncture modalities
(manual, electric, auricular, laser), tactile stimulation, focused ultrasound as well
as various sham or placebo interventions. We found that the terms which are most frequently
used to describes therapeutic sensations across various fields were numbness (37.6),
tingling (36.4), and soreness (31.4), followed by heaviness (24.0), dull pain (23.4),
aching (22.1), fullness (21.1), sharp pain (18.6), pressure (15.1), distention (13.7),
warmth (13.3), throbbing (10.6) and spreading (7.4), where the numbers in brackets
denote the product of mean and weighting factor.
Conclusions
Sensations experienced during therapeutic interventions are highly similar in their
qualitative nature across different modes of stimulation and therapies. Since no generally
accepted scientific term exists for this phenomenon, we propose the term therapeutic
sensations (TS) for it. TS may be a thread linking seemingly unrelated therapy systems
and even explain some pre-scientific concepts, like the meridians of Chinese medicine
or the idea of some form of energy exchange between practitioner and patient.
P15 Acupuncture-enhanced psychotherapy for painful endometriosis: the role of anxiety
and the anterior hippocampus
Florian Beissner1, Christine Preibisch2, Annemarie Schweizer-Arau3, Roxana Popovici4,
Karin Meissner5
1 Somatosensory and Autonomic Therapy Research, Hannover Medical School, Hannover,
30625, Germany; 2 Department of Neuroradiology, Technische Universität München, Munich,
Germany; 3 Practice for Psychotherapeutic Medicine, Diessen, Germany; 4 Department
of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women’s
Hospital, Heidelberg, Germany; 5 Institute of Medical Psychology, Ludwig-Maximilians-University,
Munich, Germany
Correspondence: Florian Beissner
Question
Endometriosis is a gynecological disorder affecting 6-10% of all women in their reproductive
age. Previous studies have shown an association between pelvic pain and trauma. We
wanted to know if patients with painful endometriosis may benefit from a treatment
combining psychotherapy for trauma release with acupuncture and related techniques.
Methods
67 patients with severe painful endometriosis (maximum pain: 7.6 ± 2.0, average pain:
4.5 ± 2.0 on a 10-point numeric rating scale) were included in the study. Resting-state
functional magnetic resonance imaging was used to assess brain connectivity of these
patients at baseline, after three months of therapy and after six months. The analysis
was focused on the hippocampus.
Results
We identified a cortical network comprising of the right anterolateral hippocampus
– a region modulating the hypothalamic-pituitary-adrenal (HPA) axis – and somatosensory,
viscerosensory and interoceptive brain regions. Regression analysis showed that reduction
in connectivity of this network predicted therapy-induced improvement in patients'
anxiety in the treatment group, but not in the control group. After six months, when
controls had received delayed intervention, both groups showed this association.
Conclusions
Patients with a history of endometriosis, who suffer from pelvic pain, can obtain
substantial benefit from acupuncture-enhanced psychotherapy. We have identified a
putative mechanism underlying this potent combination of therapies in treating symptoms
of endometriosis. Our results emphasize the importance of trauma as a central factor
in the etiology of pelvic pain and endometriosis.
P16 DNA targeted therapy for prostate, ovarian and pancreatic cancers
Sylvie Beljanski
The Beljanski Foundation, New York, NY 10017, United States
Purpose
Research from M. Beljanski and D. Malins, has demonstrated that virtually all cancers
are associated with physical damage to cellular DNA caused by the binding of carcinogens
in our environment. This damage involves destabilization of the DNA double helix (breakage
of the hydrogen bonds that hold the two strands together) and disorder in the chemical
integrity of the DNA building blocks (breakage of covalent bonds).
Despite being well established scientifically, DNA damage associated with destabilization
and disorder is not widely appreciated. This is remarkable because these physical
changes are found in virtually all types of cancer from all individuals. Destabilization
and disorder appear to be the underlying causes of cancer that precede mutations and
indeed enable the accumulation of mutations. This is a powerful contribution to our
understanding of carcinogenesis, but Beljanski went a step further. He identified
compounds in plant extracts that specifically target destabilized DNA and prevent
proliferation of cancer cells by disrupting DNA duplication (Pao pereira and Rauwolfia
vomitoria).
Methods
MTT assays for inhibition of cell proliferation, PARP cleavage for apoptosis, orthotopic
grafts for tumors, and bioluminescence for assessing inhibition of tumor growth in
vivo.
Results
The extracts are active against prostate, ovarian and pancreatic cancers in vitro
and in vivo. They are effective alone and are synergistic with chemotherapy drugs,
providing a dose reduction effect. The extracts do not induce negative side effects
of their own.
Conclusions
The discovery of DNA destabilization is presented and the activity of the extracts
against three cancers is described.
P17 Music listening to reduce anxiety among older adults in the emergency department
Laura Belland1, Laura Rivera-Reyes2, Ula Hwang2
1 Family Medicine, NewYork-Presbyterian, New York, NY 10032, United States; 2 Emergency
Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Correspondence: Laura Belland
Background
A visit to the emergency department (ED) may be distressing and anxiety-provoking
for older adults (age 65). The objective of this pilot study was to evaluate the effect
of music listening on anxiety levels in older adults in the ED.
Methods
This was a pilot study at the Mount Sinai Hospital during April and May 2015. Inclusion
criteria were English-speaking adults 65 who were not deaf. Subjects were randomly
assigned to standard care (control) or standard care with 30-60 minutes of music listening
that commenced immediately after enrollment. Intervention subjects were provided headphones
and an iPad with pre-downloaded music (choice of classical, jazz, new age, Chinese
traditional, or Latin guitar). Anxiety levels were measured by the Spielberger State
Trait Anxiety Inventory (STAI) which was conducted at enrollment and after one hour.
Results
A total of 317 patients were screened during study hours; of these patients, a total
of 35 (11%) were enrolled. When comparing control (n = 16) vs. intervention subjects
(n = 16), there were no significant differences in initial STAI scores (43.0 ± 15.0
vs 40.3 ± 12.8, p = 0.57). However, when comparing scores one hour after enrollment,
the mean reduction in STAI scores of the intervention subjects was significantly greater
than those of the control subjects (-10.0 ± 12.29 vs -1.88 ± 7.97, p = 0.034).
Conclusions
These pilot results suggest that music listening may be an effective, non-invasive
tool for reducing anxiety among older adults in the ED.
P18 Is an anthroposophic curriculum for children with Type 1 Diabetes mellitus (T1DM)
different from usual care?
Bettina Berger1,2, Dominik Sethe1,2, Dörte Hilgard3, Peter Heusser1,2
1 Theory of Medicine, Integrative and Anthroposophic Medicine, Witten/Herdecke University,
Herdecke, Germany; 2 Institute of Integrative Medicine, Witten/Herdecke University,
Herdecke, Germany; 3 Community Hospital, Herdecke, Germany
Correspondence: Bettina Berger (bettina.berger9@googlemail.com)
Aim
Development of the curriculum as first part of a complex evaluation of an anthroposophic
education programme for children between 6 and 12 years with T1DM.
Background
T1DM is the most common metabolic disease in childhood. Patients have to substitute
insulin by daily injections or insulin-pump. The standard of diabetes treatment includes
educational programmes to enable patients to self-manage their insulin-substitution.
However, these programmes are focused on blood-sugar management only, and therefore
might miss the developmental needs of the children (f.e. growing independency from
parents). The anthroposophic educational programme of Herdecke (HeKiDi) focus on these
needs of children to enable them to manage their T1DM. The training programme at the
Community-Hospital Herdecke has been approved by the German Diabetes Association as
a therapy and training facility for stage 2 pediatrics and treats 400 children in
various school formats per year [1]. To compare this programme to others, anthroposophicaspects
of curriculum have to be described.
Methods
Hospitations, interviews with most people responsible for the programme and content
analysis of interviews and teaching materials to identify intended learning aims,
contents and methods of the curriculum, following the guidelines of TiDieR [2]. Definition
of main learning aims and finalisation of the curriculum with the person responsible
for the programme.
Results
The curriculum of HeKiDi can be presented. It follows the standard curriculum in Germany
[3], but the learning aims for children within HeKiDi differ, they might also learn
to:
feel accepted in their personal developmental or diabetes-related needs, consented
as an individual treatment aim between doctors, parents and themselves
develop self-efficacy in diabetes-related but although other fields
understand their T1DM as life-long consciouness-related task
develop their motoric abilities f.e. to foster their will
develop their artistic and communicative abilities to perceive and express emotions
develop their social competencies f.e. to use the social network as support.
The curriculum focus on individualised treatment, through the establishment of adult
mentors, suffering on T1DM themselves, serving as role model, supporting the children
in their daily tasks.
Conclusion
The HeKiDi-Programm differs from standard programmes. How far the HeKiDi programme
is better to foster self-efficacy of children has to be investigated in an interventional
study.
References
1. Kienle GS, Meusers M, Quecke B, Hilgard D. Patient-centered Diabetes Care in Children:
An Integrated, Individualized, Systems-oriented, and Multidisciplinary Approach. Glob
Adv Health Med. 2013 Mar;2(2):12-9
2. Hoffmann TC, et al. (2014). Better reporting of interventions: template for intervention
description and replication (TIDieR) checklist and guide. BMJ 348:1687.
3. Lange K,Swift P, Pankowska E,Danne T (2014). Diabetes education in children and
adolescents. Pediatric Diabetes 2014a; 15:77-85
P19 Non-specific mechanisms in orthodox and complementary/alternative management of
back pain: recruitment rates and baseline data
Felicity Bishop1, Miznah Al-Abbadey1, Katherine Bradbury1, Dawn Carnes2, Borislav
Dimitrov3, Carol Fawkes2, Jo Foster1, Hugh MacPherson4, Lisa Roberts3, Lucy Yardley1,
George Lewith3
1 University of Southampton, Psychology, Southampton, United Kingdom; 2 Queen Mary
University of London, Blizard Institute, London, United Kingdom; 3 University of Southampton,
Southampton, United Kingdom; 4 University of York, Health Sciences, York, United Kingdom
Correspondence: Felicity Bishop
Question
Five domains of non-specific treatment components may influence patient outcomes:
therapeutic relationship, healthcare environment, incidental treatment characteristics,
patients" beliefs and practitioners" beliefs. This study investigates the relationship
between non-specific treatment components and low back pain (LBP) outcomes in physiotherapy,
osteopathy, and acupuncture.
Methods
In a major prospective questionnaire-based study, public (NHS) and private-sector
practitioners were recruited by UK-wide mailshots; practitioners then give invitation
packs to eligible adult patients. Practitioners and patients complete validated, reliable,
questionnaires measuring non-specific treatment components, mediators and outcomes
at: baseline (after first consultation for new episode of LBP), during treatment (2-weeks
post-baseline) and outcome (3-months post-baseline). Recruitment is ongoing; rates
and preliminary baseline data from the first 15 months were analysed descriptively.
Results
3% of invited acupuncturists have enrolled (n = 51), 6% of osteopaths (n = 54), 8%
of physiotherapists (n = 84). More acupuncturists and osteopaths have been recruited
from private settings; more physiotherapists have been recruited from the NHS. Acupuncturists
have recruited on average 1 patient each, osteopaths 4, and physiotherapists 2. Patient
recruitment rates are higher in NHS than private settings. Patients' baseline disability
is comparable across therapies (Roland Morris Questionnaire scores: acupuncture M = 10.0,
osteopathy M = 9.4, physiotherapy M = 10.3, p = .23). Baseline disability is higher
in NHS patients (M = 10.7) than private patients (M = 9.6, p = .03).
Conclusions
Recruiting practitioners has been challenging, particularly acupuncturists and NHS-based
CAM practitioners. This may be because acupuncturists treat fewer LBP patients than
previously and NHS commissioning of these therapies has decreased. Higher patient
recruitment rates in NHS settings may reflect different patient populations across
sectors.
P20 Exploring change processes in acupuncture for back pain: a qualitative thematic
analysis
Felicity Bishop1, Michelle Holmes1, George Lewith2, Lucy Yardley1, Paul Little2, Cyrus
Cooper2
1 Department of Psychology, University of Southampton, Southampton, SO171BJ, United
Kingdom; 2 Department of Medicine, University of Southampton, Southampton, SO171BJ,
United Kingdom
Correspondence: Felicity Bishop
Purpose
To explore patients' experiences of acupuncture for back pain and identify psychosocial
processes that might support clinical changes.
Methods
We conducted a qualitative study using semi-structured interviews and thematic analysis.
23 interviewees were purposively sampled from a nationwide longitudinal questionnaire
study (n = 485). We deliberately interviewed men (n = 8) and women (n = 15), of varying
ages (29 – 82 years), receiving acupuncture in diverse settings (7 acupuncture clinics;
5 physiotherapy; 9 pain clinic; 1 general practice), with different adherence levels
(17 attended all appointments). We also sampled for diversity in outcomes (positive/negative/no
change in disability/pain/wellbeing).
Results
Participants described how, on starting treatment, they were desperately hoping that
acupuncture would improve their ability to function and enjoy their lives despite
back pain, and so they typically cared little about how it might work. They expressed
concerns about acupuncture needles and side-effects, and trusted acupuncturists who
made them feel safe, explained the treatment clearly, and made them feel special and
listened to. Participants felt more in control when acupuncturists created space for
dialogue and this was important because they perceived little control over pain and
conventional treatment options. Some but not all participants experienced benefits
including: pain relief, better functioning, and feeling happier or less depressed.
As a result of their experiences, they described believing that acupuncture can work
to produce real, if short-term, benefits.
Conclusions
Clinical changes in back pain as a result of acupuncture may be supported by therapeutic
relationships that empower patients and attend to their concerns.
P21 Biotechnological approaches for studying the interaction between endophytic bacteria
and Echinacea spp.
Patrizia Bogani, Valentina Maggini, Eugenia Gallo, Elisangela Miceli, Sauro Biffi,
Alessio Mengoni, Renato Fani, Fabio Firenzuoli
Department of Biology, University of Florence, Sesto Fiorentino, Florence, 50019,
Italy
Correspondence: Patrizia Bogani
Purpose
Present work aimed to understand if distinct bacterial communities could account for
the differences in the medicinal properties of two Echinacea plant species by affecting
their physiology and metabolism.
Methods
Axenic E. purpurea and E. angustifolia plants were infected with E. purpurea endophytes
and examined for the presence of bacteria and for different physiological parameters.
VAP assays were performed to test bacteria effect on primary root elongation and morphology.
Dual cultures experiments between Echinacea cell cultures and different bacteria were
established to test the influence on both plant and bacterial cells growth.
Results
Endophytic strains tended to recolonize the host plant native niche, endophytes from
stem/leaves increasing the number of leaves, or the plant weight if coming from roots.
In vitro morphogenetic behaviour indicated that the two Echinacea species had a different
content of endogenous plant hormones. E. purpurea was able to regenerate new shoots
in culture media enriched with high content of cytokinins while E. angustifolia produced
only clusters of undifferentiated cells (callus). VAP analyses showed effects on plant
root elongation and morphology depending on differences in IAA production by different
bacteria. Dual cultures experiments showed that plant cells promote the growth of
endophytes, these latter affecting the plant growth itself.
Conclusions
In vitro colonization of endophytes is divergent according to their native in vivo
compartment. Different composition in plant primary metabolism in the two Echinacea
species affect the plant-bacteria interaction modulating the production of plant metabolites,
key compounds for colonization strictly related to the Echinacea therapeutic properties.
P22 Equipment-based movement therapy in stroke rehabilitation
Nadine Brands-Guendling, Peter W Guendling
Complementary Medicine, Hochschule Fresenius, Bad Camberg, 65520, Germany
Correspondence: Nadine Brands-Guendling
Background
Stroke is the third leading cause of death in Germany, a leading cause of disability
and a considerable cost factor in the health care system. Despite a variety of specific
therapies available, a recovery of impaired motor functions after a stroke is in most
instances incomplete. Hence, complementary therapeutic strategies of neurological
rehabilitation are needed to improve the recovery of impaired persons.
Objectives
The aim of this study is to depict the general importance of an electrically driven
exercise machine for arms and legs for mobility training in the neurological rehabilitation.
Methods
20 stroke patients randomized into an intervention group (ten subjects, arm and leg
training) and a control group (ten subjects, physiotherapy gait training), are treated
for four weeks, five times a week. In week zero and four, the patients are tested
on motor performance, walking ability, physical and mental quality of life, endurance
and rough movement skills.
Results
The test of motor performance with the Rivermead Motor Assessment (p = 0.006) and
the test of rough movement skills of the arms with the Box and Block Test (p = 0.042)
indicate significant main effects. The quality of life, which is measured by the SF-36,
points out a significant main effect for the physical health score (p = 0.008). The
measurement of endurance with the 6-Minute Walk Test (p = 0.000) and the walking ability
with the Dynamic Gait Index (p = 0.033) indicate significant differences between both
groups. No noticeable outcomes appear from the testing of the walking ability with
the Functional Ambulation Categories and the mental health score of the SF-36.
Conclusion
An equipment-based mobility training seems to be beneficial for stroke patients with
hemiparesis. The significance of the test series is to some extent limited due to
the small sample size. The positive results, however, might provide thought-provoking
impulses for neurological therapies.
P23 Spinal manipulation and exercise for adolescent low back pain
Gert Bronfort1, Roni Evans1, Mitch Haas2, Brent Leininger1, Craig Schulz3
1 University of Minnesota, Minneapolis, MN 55455, United States; 2 University of Western
States, Portland, OR, United States; 3 Children's Hospital and Clinics of Minnesota,
Minneapolis, MN, United States
Correspondence: Gert Bronfort
Question
Low back pain (LBP) is a leading cause of disability worldwide. While there is a growing
recognition that LBP in adolescents approximates that of adults, there has been very
little research to guide therapeutic management. This trial is one of the firstto
determine whether spinal manipulative therapy (SMT), a commonly used complementary
health approach combined with exercise therapy (ET) compares with ET alone, to reduce
chronic LBP in the short and long term in adolescents.
Methods
We conducted a controlled pragmatic trial with random allocation by minimization from
2010 to 2013 in two research centers (Minnesota and Oregon, USA). The primary outcome
was participant-rated LBP at 12, 26, and 52 weeks. Secondary outcomes included patient-rated
disability, quality of life (PedsQL), medication use, patient and caregiver rated
improvement and satisfaction. Objective biomechanical outcomes were collected at baseline,
12, and 26 weeks post enrollment by blinded examiners.
Results
Participantswere 185 adolescents aged 12-18 years with chronic LBP, who received 12 weeks
(8-16 sessions) of SMT ET or ET alone.Of the 185 enrolled patients, 179 (97%) provided
follow-up data at 12 weeks and 174 (94%) at 26 and 52 weeks. For LBP, SMT ET compared
to ET had a small advantage of 5 percentage points ([95% CI, 0 to 11], P = 0.08) at
the end of treatment (12 weeks). Larger, clinically important advantages of 11 percentage
points at 26 weeks ([95% CI, 5 to 17]; P = 0.001) and 8 percentage points at week
52 ([95% CI, 2 to 14], P = 0.009) for SMT ET were also observed. At 26 weeks only,
SMT ET performed better than ET alone in terms of low back disability (P = 0.04) and
global improvement (P = 0.02). The SMT ET group also experienced significantly greater
satisfaction with care than ET alone at weeks 12, 26, and 52 (P ≤ 0.02). There were
no serious treatment-related adverse events.
Conclusions
For adolescents with chronic LBP, adding spinal manipulation to exercise was more
effective than exercise alone in the long-term but not the short-term.
P24 Effect of Chinese herbal decoction Qinlingye extract on the PGC-1α/RANTES inflammatory
metabolic signaling pathway in rats with uric acid-induced renal injury
Xiangwei Bu1, J Wang1, T Fang2, Z Shen3, Y He1, X. Zhang1, Zhengju Zhang1, Dali Wang1,
Fengxian Meng 1
1 Dongfang Hospital, Beijing University of Chinese Medicine, Rheumatology, Beijing,
China; 2 Community Health Service Center of Yangsong Town, Traditional Chinese Medicine,
Beijing, China; 3 Jingzhou Central Hospital of Hubei Province, Traditional Chinese
Medicine, Beijing, China
Purpose
To explore the effect of Chinese herbal decoction Qinlingye extract(QLYE) on gene
transcription and expression of PGC-1α, RANTES, IL-1β in rats with uric acid-induced
renal injury(UAIRI).
Methods
69 SPF male SD rats (200 ± 10 g) aged 6 weeks were acclimated for 1 week, 6 of which
were selected randomly as Normal Control Group(NCG).63 rats were fed with yeast feed
and adenine gavage to establish UAIRI model. Successful models (n = 60) were randomized
into model, positive drug and high-, medium-, low-dose of QLYE group (n = 12 per group),
given gavage administration of distilled water(10 ml.kg-1), allopurinol(23.33 mg.kg-1)
and QLYE(7.46 g.kg-1, 3.73 g.kg-1, 1.87 g.kg-1) everyday. After 6 and 8 weeks, half
rats of every group were sacrificed. We used RT-PCR to detect mRNA transcription of
IL-1β,PGC-1α,RANTES in renal tissue, ELISA to measure protein expression of IL-1βand
RANTES in serum, Western blot and immunohistochemistry to analyze protein expression
of PGC-1α in renal tissue.
Results
Compared with NCG, the mRNA transcription and protein expression of PGC-1α in model
group were lower at 6th and 8th weeks (P < 0.05, P < 0.01),while RANTES and IL-1β
were higher (P < 0.05, P < 0.01).Compared with model group, protein expression of
PGC-1α in 3 QLYE groups was higher(P < 0.01), protein expression of RANTES in medium-,low-dose
groups was lower(P < 0.05),and mRNA transcription and protein expression of IL-1β
in 3 QLYE groups were lower(P < 0.05,P < 0.01) at the 6th week. At the 8th week, mRNA
transcription and protein expression of PGC-1α were higher (P < 0.05,P < 0.01), whereas
those of RANTES were lower(P < 0.05,P < 0.01) in 3 QLYE groups,and protein expression
of IL-1β in high-, medium-dose groups was lower(P < 0.05,P < 0.01).
Conclusion
The mechanism of QLYE ameliorating UAIRI may be related to regulation of PGC-1α signaling
pathway and inhibition of inflammatory metabolic injury.
P25 Sense of coherence and perception of the transcendent as contributors of Catholic
priests’ life satisfaction
Arndt Büssing1, Klaus Baumann2, Eckhard Frick3, Christoph Jacobs4
1 Quality of Life, Spirituality and Coping, Witten/Herdecke University, Herdecke,
58313, Germany; 2 Faculty of Theology, Caritas Science and Christian Social Work,
Albert-Ludwig University, Freiburg, Germany; 3 Department of Psychosomatic Medicine
and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich,
Germany; 4 Pastoral Psychology and Sociology, Faculty of Theology Paderborn, Paderborn,
Germany
Correspondence: Arndt Büssing
Background
Aaron Antonovsky"s salutogenetic model has become one of the most important conceptual
frameworks in health sciences in recent decades. Less is known about Catholic priests
who’s global life orientation is their religious faith. We thus intended to analyze
the influence of SOC, transcendence perception as a measure of (affective) spirituality,
spiritual dryness as a phase of a spiritual crisis on their life satisfaction, and
social support.
Methods
This study is part of the German Pastoral Ministry Study, an anonymous survey among
Catholic priests from 22 out of 27 German dioceses using standardized questionnaires
(i.e., SOC-13, DSES-6, SDS, FSozU, SWLS). For this analysis we relied on data of 4,157
priests with a predominantly age range from 45 to 85 years, and performed first correlation
analyses and then regression analyses to define which of these variables may predict
their life satisfaction.
Results
The SOC correlated positively with life satisfaction (SWLS, r = .49), transcendence
perception (DSES, r = .33), and social support (FSozU, r = .30), and negatively with
spiritual dryness (SDS, r = -.49). SOC explains only 14% of DSES’s variance, and DSES
14% of SOC’s variance. Stepwise regression analyses indicated that priests’ life satisfaction
was predicted best by SOC (Beta = .37, T = 23.1, p < .0001) explaining 28% of variance.
Transcendence perception (Beta = .29, T = 17.9, p < .0001) would add further 9% of
explained variance, while social support (Beta = .09; T = 6.6; p < .0001) and spiritual
dryness (Beta = -.04, T = -2.4, p = .018) would add both < 1% of further variance
explanation, and are thus of minor relevance.
Conclusions
For Catholic priests having a meaningful life and perceiving the sacred in their life
are relevant sources contributing to their life satisfaction, while social support
was of minor relevance.
P26 Validation of the Affected Body Image questionnaire in people with limb amputations
– not satisfaction with themselves and their appearance was of relevance but dissatisfaction
with living circumstances
Arndt Büssing1, Ralph-Achim Grünther2, Désirée Lötzke1
1 Quality of Life, Spirituality and Coping, Witten/Herdecke University, Herdecke,
58313, Germany; 2 Helios Rehazentrum Bad Berleburg, Baumrainklinik, Bad Berleburg,
Germany
Correspondence: Arndt Büssing
Purpose
Having an amputated limb represents a relevant turning point in life. For individuals
the amputation is interference in the personal physical and psychological integrity.
Body image changes are an important consequence to be considered with regard to the
adjustment process and rehabilitation after a limp amputation. This paper presents
the findings of the validation of the Affected Body Image (ABI) questionnaire in a
sample of older patients with amputated limbs with and without phantom pain.
Methods
Cross-sectional, anonymous survey among 112 individuals with an amputated limb using
standardized questionnaires (i.e., GCPS, HADS, SF-12, BMLSS, etc.).
Results
The mean age of the sample (66% men) is 63 ± 10 years; phantom pain is present on
58% of the cases. Exploratory factor analysis of the 14 item ABI questionnaire indicated
four sub-constructs explaining 65% of the total variance in the data, i.e., Distance
to own body; (intention to) Change own body; (perception of being) Avoided by others;
Dislike own body. The internal reliability of the instrument is good (Cronbach’s alpha = 0.86).
The ABI scores correlated strongly with depressive states (Escape from illness/affection,
dissatisfaction with living situation, depressive symptoms), and moderately with disability
scores and low mental quality of life and life satisfaction. Escape and dissatisfaction
with living situation were the best predictors of patients’ ABI scores, explaining
51% of variance. Interestingly, it was not patients’ satisfaction with themselves
and their appearance, or whether they mind the look of their body at all, which showed
significant differences for the ABI perceptions, but their dissatisfaction with their
living circumstances. The prevalence of phantom pain had no relevant influence on
ABI scores. While most amputees enrolled in this study did not perceive relevant ABI,
Distance from the own body was perceived with high scores by 9%, while the intention
to Change their body was scored high by 24%.
Conclusions
The 14-item instrument is a practical instrument with good internal consistency and
plausible associations with external measures. It measures how individuals feel about
their changed body image and how they deal with the situation after an amputation.
The scale may have an important strength to address more closely the attitude and
the living conditions of amputees and their complex adjustment process following an
amputation.
P27 Randomized clinical trial to treat patients with chronic back pain: a comparison
of the efficacy of Yoga, Eurythmy therapy and standard physiotherapy
Arndt Büssing1, Sonny Jung1, Désirée Lötzke1, Daniela R. Recchia1, Sibylle Robens2,
Thomas Ostermann 2,3, Bettina Berger 3, Josephin Stankewitz4, Matthias Kröz3,4,5,
Mika Jeitler6,7, Christian Kessler6,7, Andreas Michalsen 6,7
1 Quality of Life, Spirituality and Coping, Witten/Herdecke University, Herdecke,
58313, Germany; 2 Research Methodology and Statistics in Psychology, Witten/Herdecke
University, Witten, Germany; 3 Institute of Integrative Medicine, Witten/Herdecke
University, Herdecke, Germany; 4 Research Institute Havelhöhe, Berlin, Germany; 5
Internal Medicine, Havelhöhe Hospital, Berlin, Germany; 6 Clinical Naturopathy, Institute
for Social Medicine, Epidemiology and Health Economy, Charité – University Medicine,
Berlin, 10117, Germany; 7 Internal and Complementary Medicine, Immanuel Hospital Berlin,
Berlin, Germany
Correspondence: Arndt Büssing
Purpose
To treat patients with chronic low back pain, multimodal approaches are seen as essential.
While particularly physical training is increasingly recommended, there are several
other important interventions which might be effective, too. We thus aimed to compare
the effectiveness of yoga, eurythmy therapy (EuT) and physiotherapeutic exercises
(PhyE).
Methods
In a three-arm multicenter RCT we treated patients with chronic low back pain for
8 weeks in group sessions (90 minutes once per week), with a further 8 week follow-up
phase. Additionally, 15 min. daily home exercises were recommended. Primary outcome
was patients’ physical disability (RMDS); secondary outcome variables were pain intensity,
health-related quality of life (SF-12), life satisfaction (BMLSS), positive mood (ASTS),
stress perception (PSS), depression (CES-D), Self-Regulation (SR), mindfulness (FMI),
Inner Coherence (ICS), and Inner Correspondence and Peaceful Harmony (ICPH).
Results
After multiple imputations of missing data, data of 270 patients were used for statistical
analyses (Yoga, n = 96; EuT, n = 88; PhyE, n = 86). There were no significant baseline
differences. In all groups, RMDS and pain intensity scores decreased significantly
within the 16 weeks, while quality of life increased. There were no significant differences
between the three groups for the pain variables, while for SF-12’s mental health component
EuT had a significant benefit compared to PhyE (ß = 4.6, p = 0.008). Within the groups,
we see significant improvements of BMLSS, ASTS, PSS, CES-D, ICS and ICPH scores for
Yoga and EuT, but not for PhyE, while there were no significant improvements for FMI
and SR.
Conclusions
Compared to the ‘gold standard’ PhyE, the two rather "meditative" interventions EuT
and yoga were similar effective to reduce pain-associated affections. However, there
was a significant benefit for EuT to improve SF-12's mental health component compared
to yoga and PhyT.
P28 Influence of lifestyle on hypertension, diabetes, and dyslipidemia based on Korea
Community Health Survey
Chunhoo Cheon, Bo H Jang, Seong G Ko, Ching W Huang, Yui Sasaki, Youme Ko
Kyung Hee University, Seoul, 02447, South Korea
Correspondence: Chunhoo Cheon
Background
These days, non-communicable diseases have received increasing attention. Hypertension,
diabetes mellitus, and dyslipidemia which are known to be closely related to lifestyle
were defined lifestyle related disease. The present study was designed to investigate
the influence of lifestyle on hypertension, diabetes, and dyslipidemia.
Methods
Each determinants of lifestyle related disease include following risk factors. Lifestyle
determinants: alcohol consumption, smoking, physical activities, dietary patterns.
Sociodemographic determinants: age, sex, residential area, household income, education.
Psychological determinants: subjective perception of stress. Comorbidity determinants:
obesity, hypertension, diabetes mellitus, dyslipidemia. The associations between diagnosis
of hypertension, diabetes mellitus, dyslipidemia and lifestyle factors were analyzed
using simple and multiple logistic regression analysis.
Results
More than 4 hours of sedentary time, eating food bland showed significant association
with hypertension. Smoking and more than 9 hours of sleep showed significant association
with diabetes. Dyslipidemia was significantly associated with more than 4 hours of
sedentary time. High risk drinking showed positive correlation with hypertension and
negative correlation with diabetes. Pack years of smoking had negative correlation
with hypertension. Breakfast skipping showed negative correlation with hypertension
and diabetes, and positive correlation with dyslipidemia in 16-44 years. More than
4 hours of sedentary time were positively correlated with hypertension, diabetes,
and dyslipidemia.
Conclusions
Lifestyle has considerable influence on hypertension, diabetes and dyslipidemia, and
these are also risk factors for other disease. Therefore, it is important to manage
lifestyle for preventing lifestyle disease. Further studies will be required to clearly
define the causal relationship between lifestyle and diseases.
P29 The personal is political: influences on GP coping and resilience
Anna Cheshire1, Damien Ridge1, John Hughes2, David Peters1, Maria Panagioti3, Chantal
Simon4,5, George Lewith1, 6
1 University of Westminster, London, W1W6UW, United Kingdom; 2 Royal London Hospital
for Integrated Medicine, London, United Kingdom; 3 Institute of Population Health,
Manchester, United Kingdom; 4 The Banks and Bearwood Medical Centres, Bournemouth,
United Kingdom; 5 Royal College of General Practitioners, London, United Kingdom;
6 University of Southampton, Southampton, United Kingdom
Correspondence: Anna Cheshire
Background
Neoliberal work policies, austerity, NHS restructuring and increased GP consultation
rates, provide the backdrop against increasing reports of GP burnout and a looming
shortage of GPs.
Aim
To explore GPs experiences of workplace challenges and stresses and their coping strategies,
particularly focusing on understanding the impact of NHS workplace change. Design
Study design was qualitative, with data collected from two focus groups and seven
one-to-one telephone interviews.
Method
Focus groups (n = 15) and interviews (n = 7) explored the experiences of currently
practicing GPs in England, recruited through convenience sampling. Data were collected
using a semi-structured interview approach and analysed using thematic analysis.
Results
Interviewees understood GPs to be under intense and historically unprecedented pressures,
which were tied to the contexts in which they work; with important moral implications
for good doctoring. Many reported that being a full-time GP was too stressful: work-related
stress led to mood change, sleep disruption, increases in anxiety and tensions with
loved ones. Some had subsequently sought ways to downsize their clinical workload.
Workplace change resulted in little time for the things that helped GP resilience:
a good work life balance and better contact with colleagues. Whilst some GPs were
coping better than others, GPs acknowledged that there was only so much an individual
GP could do to manage their stress, given the external work issues they faced.
Conclusion
GPs grasp their emotional lives and stresses as being meaningfully shaped by NHS factors;
resilience building should move beyond the individual to include systemic work issues.
P30 Use of complementary and alternative medicine during an outbreak of MERS among
community people
Hyun J Cho, Dongwoon Han, Soo J Choi, Young S Jung, Hyea B Im
Global Health and Development, Hanyang University, College of Medicine, Seoul, 133-791,
South Korea
Correspondence: Hyun J Cho
Purpose
To obtain information on the use of complementary and alternative medicine (CAM) among
community people during MERS outbreak in Korea.
Methods
To collect data, we conduct a cross sectional study using semi-structured questionnaire
during 26th November to 2nd December 2015. The sample size of participants was 331(response
rate 82.75%). Respondents were asked questions about their use of CAM in the past
12 months, perception on CAM and outbreak, reasons for the use of CAM and so on, as
well as general socio-demographics
Results
During the 2015 MERS outbreak, the percentage of participants who had used at least
one CAM therapy was 76.1%. The most popular CAM used was vitamins (51.6%). The most
common reason participant gave for using CAM was to "stimulate an immune response"
(63.1%). The higher level of concern on no available treatment method for MERS was
associated with greater use of CAM, that is statically significant. The predictors
on the use of CAM were: gender, age, perception on government policy on MERS outbreak,
subjective health status.
Conclusions
CAM was popular among community people during 2015 MERS outbreak in Korea. The results
of this study show that community people currently lack the knowledge, confidence,
and information to provide proper guidance to the increasing number of people being
using CAM modalities. Central and local government, academia, healthcare professionals
should responsibly advise community people and patients about the use of CAM. And
further studies are required to important sources of guidance with respect to providing
community people and patient counseling.
P31 Attitudes and knowledge towards interprofessionalism among naturopathic students
Kieran Cooley1,2, Laura Tummon-Simmons1
1 Canadian College of Naturopathic Medicine, Department of research and clinical epidemiology,
Toronto, Canada; 2 University of Technology Sydney, ARCCIM, Faculty of Health, Sydney,
Australia
Correspondence: Kieran Cooley
Background
Attitudes among health care practitioners have been shown to impact their effectiveness
in collaborative practice. Naturopaths have scope and interest in collaboration, however
there is a lack of quantitative evidence evaluating their attitudes towards interprofessional
collaboration (IPC). Understanding these attitudes and those of cooperating practitioners
may assist in future integrative practice.
Methods
All Naturopathic Interns (NIs) from the Canadian College of Naturopathic Medicine
(n = 131) were surveyed using the validated Attitudes to Health Professionals Questionnaire
(AHPQ) following informed consent. Responses were anonymous, scales were scored in
duplicate to enhance accuracy. Demographic information (age, gender, self-rated experience
in interprofessional settings), and knowledge and attitudes towards nine healthcare
professions (medical doctors, nurses/nurse practitioners, pharmacists, naturopathic
doctors/interns, chiropractors, registered massage therapists, physiotherapists, traditional
Chinese medical practitioners, registered dieticians) were assessed. Results were
summarized as 2 aggregate subscales, "caring" and "subservient". Two-tailed students
t test, and linear regression tests were to used to assess differences across healthcare
professionals and examine correlations.
Results
88 responses (67.2% response rate) were collected from initial general survey of NIs
with 58 of these responses being completed effectively. The majority of participants
were female (87.9%), with less than 1 year of experience as a part of a regulated
health care profession (75.9%); 29.6% indicated they had 0 or no expertise in integrative
health care models (29.6%). By NIs, NDs were seen as the most "caring."; a statistically
significant difference compared to NI"s views of other professions (p < 0.05). R.Phs
and MDs were rated lowest on the "caring" subscale in comparison to other professions.
NDs, RN/NPs, RMTs, TCMs, and RDs were found to have non-statistically significant,
but higher "subservience" attributed to their professions while. MDs, DCs, and PTs
were rated lowest in terms of "subservience" in comparison to other professions (p < 0.05).
Conclusion
It is feasible to assess knowledge and attitudes of NIs. NIs view themselves differently
than other health care professionals. Further understanding of NDs attitudes towards
interprofessional collaboration would inform educational competencies, professional
development and IPC.
P32 Abbreviated mindfulness-based cognitive therapy intervention for hospital employees:
feasibility, acceptability and preliminary effectiveness
Sian Cotton1, Christina M Luberto2, Rachel Wasson3, Kristen Kraemer4, Richard Sears5,
Carly Hueber6
1 Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati,
OH 45267, United States; 2 Psychiatry, Harvard Medical School, Boston, MA, United
States; 3 Psychology, Bowling Green State University, Bowling Green, OH, United States;
4 Pyschology, Medical University of South Carolina, Charleston, SC, United States;
5 University of Cincinnati, Cincinnati, OH 45242, United States; 6 Integrative Medicine,
UC Health, Cincinnati, OH, United States
Correspondence: Sian Cotton (sian.cotton@uc.edu)
Background
Hospital employees may experience occupational stress and burnout, negatively impacting
both quality of life and job performance. Evidence-based interventions implemented
within hospitals are needed to promote employees well-being. Mindfulness-Based Cognitive
Therapy (MBCT) is an 8-week evidence-based group intervention for reducing stress
and improving well-being. No research has explored the use of an abbreviated MBCT
protocol specifically for hospital employees that would be feasible and practical.
The purpose of this study was to explore the feasibility/acceptability, and preliminary
effectiveness of a 4-week MBCT intervention for hospital employees.
Methods/Results
Participants were 65 employees (Mage = 45.22; 85% White; 86% female) who participated
in the intervention between September 2015-January 2016. Participants completed self-report
measures of stress and burnout pre and post intervention, and answered open-ended
satisfaction questions post-intervention. Four rounds of the 4-week group were completed,
each one enrolling at least 10 participants, but with attendance rates declining across
sessions (60% at session 2 vs. 49% at session 4) due to work-related schedule conflicts.
Intervention content was acceptable as evidenced by high perceived value (M = 9.18
out of 10), homework compliance (51% practicing at least 3 times/week), and unanimous
requests for the intervention to expand. There were large, statistically significant
decreases in stress (ΔM = 2.1, p < .001, d = 1.23) and burnout (ΔM = .46, p = .01,
d = .62), which were supported by qualitative themes of improved self-regulation,
mindfulness, stress reduction, and work productivity.
Conclusions
It is feasible to implement an abbreviated MBCT intervention for hospital employees
within busy hospital settings. This intervention is both acceptable and useful for
improving employees health-related outcomes.
P33 Iyengar Yoga Therapy: seventeen years of experience at a single yoga center
Gwendolyn Derk1,2, JR Lill1,2, Ruopeng An1, Lois Steinberg2
1 Kinesiology and Community Health, University of Illinois, College of Medicine, Urbana-Champaign,
61801, United States; 2 Iyengar Yoga Center, Urbana, 61801, United States
Correspondence: Gwendolyn Derk
Purpose
To retrospectively analyze data collected at the Iyengar Yoga Center of Champaign-Urbana
(IYCU) between 1999-2016, in order to quantify the types of patient conditions and
change in self-rated health status
Methods
IYCU yoga therapy students fill out a survey before and after every class, ranking
their physical and mental status. The scale ranges from 1 (completely good) to 7 (completely
bad) with a neutral point. Students also fill out a detailed patient history form
at their first session. Students without the history form were excluded from analysis.
Survey values were normalized to values between 0 and 1. A repeated measures mixed
effect model was created for analysis.
Results
There were 200 eligible students (n = 200) with ages ranging from 14-80 years and
a mean age of 45.9 ± 15.0 years. Participants were 77% (n = 154) female and 22.5%
(n = 45) male. The top five chief complaints include low back pain (n = 40, 19.0%),
hips (n = 18, 9.0%), menstrual problems (n = 16, 8.00%), cancer (n = 14, 7.00%), and
neck pain (n = 12, 6.0%). The median number of classes attended is 9. The median ratio
of length of practice to the number of classes attended is 9.33 days per class. The
repeated measures mixed effect model (n = 4126) showed statistically significant improvements
in both physical status (0.148 ± 0.007, p = 0.00, 95% CI [0.164, 0.132]) and mental
status (0.126 ± 0.007, p = 0.00, 95% CI [0.140, 0.112]) after a yoga therapy session.
Conclusions
Iyengar yoga therapy is an effective complementary therapy for a wide variety of patients,
including those with multiple comorbidities.
This project was reviewed by the University of Illinois Institutional Review Board
and determined to meet the criteria for exemption at 45CFR46.101(b)(4).
P34 Enhancing cardiac balance in high-burden caregivers after a Reiki training program
Lourdes Diaz Rodriguez1, Francisca García-de la Fuente2, Miguel De la Vega3, Keyla
Vargas-Román1, Jonatan Fernández-Ruiz1, Irene Cantarero-Villanueva1
1 Nursing, Faculty of Health Sciences/University of Granada, Granada, 18971, Spain;
2 Emergency Unit, University Hospital San Cecilio, Granada, Spain; 3 Sol y Luna center,
Granada, Spain
Correspondence: Lourdes Diaz Rodriguez
Purpose
The aim of this study was to compare the effects of a Reiki training program during
1 month 5 hours per week (Experimental group n = 19) versus no treatment (control
group n = 18) in high-burden caregivers.
Methods
A controlled repeated-measures single-blind trial was conducted in 37 volunteer caregivers
24.3% male and 75.7% female with a mean (SD) age of 44.03 (7.30) years. The inclusion
criteria were: parents caring for sick children with a caregiver burden of more than
55 points in Zarit Burden Scale and live with the child in the same home for at least
2 years before the study. They were recruited from associations in Granada city and
its province and through word and mouth.
Heart rate variability, blood pressure and resting heart rate were assessed as outcomes
and were measured before and after the program (0,1 month).
Results
We found no significant between-group differences in descriptive characteristics or
in any pre-intervention outcome measure. A repeated measured analysis revealed significant
increases in HRV Index (F = 8.4, p = 0.006), SDNN (F = 13.59, p = 0.001), RMSSD (F = 10.72,
p = 0.002) and significant decreases in systolic blood pressure (F = 16.23, p = 0.000),
diastolic blood pressure (F = 34.39, p = 0.000) and in rest heart rate (F = 17.90,
p = 0.000) in experimental group in comparison to the control group.
Conclusions
A Reiki training program improves the cardiac balance in high burden caregivers across
enhancing heart rate variability and diminishing blood pressure.
P35 Effects of a Reiki program on psychological state and happiness in high-burden
caregivers
Lourdes Diaz Rodriguez1, Francisca García-De la Fuente2, Fanny Jiménez-Guerrero3,
Keyla Vargas-Román1, Jonatan Fernández-Ruiz1, Noelia Galiano-Castillo1
1 Nursing, Faculty of Health Sciences/University of Granada, Granada, 18971, Spain;
2 Emergency Unit, University Hospital San Cecilio, Granada, Spain; 3 Reiki Center,
Granada, Spain
Correspondence: Lourdes Diaz Rodriguez
Purpose
The aim of this study was to compare the effects of a Reiki training program during
1 month 5 hours per week (Experimental group n = 19) versus no treatment (control
group n = 18) in high-burden caregivers.
Methods
A controlled repeated-measures single-blind trial was conducted in 37 volunteer caregivers
24.3% male and 75.7% female with a mean (SD) age of 44.03 (7.30) years. The inclusión
criteria were: parents caring for sick children with a caregiver burden of more than
55 points in Zarit Burden Scale and live with the child in the same home for at least
2 years before the study. They were recruited from associations in Granada city and
its province and through word and mouth. Participants completed the Lima Scale Happiness
and the Hospital Anxiety and Depression Scale before and after the program (0, 4 weeks).
Results
We found no significant between-group differences in descriptive characteristics or
in any pre-intervention outcome measure. A repeated measured analysis revealed significant
increases in global score of happiness (F = 297.42, p = 0.000) and in all subscales:
positive sense of the life (F = 74.61, p = 0.000), satisfaction with the life (F = 111.62,
p = 0.000), personal realization (F = 41.64, p = 0.000) and happiness of living (F = 234.57,
p = 0.000); and also diminished anxiety levels (F = 24.92, p = 0.000) in experimental
group in comparison to the control group. There were not significant differences in
depression levels between groups (F = 1.75, p = 0.19).
Conclusions
A Reiki training program during one month improves the psychological state and happiness
in high burden caregivers.
P36 Retrospective study on the use of homeopathy in a public primary care setting
Gualberto Diaz-Saez1,2, José I Torres-Jimenez2,3, Olga Garcia-Gomez2,4, Luis Hortal-Muñoz2,5,
Camino Diaz-Diez6,2
1IMOHE (IOB), Integrative Oncology, Madrid, Spain; 2SEMERGEN, Homeopathy, Madrid,
Spain; 3Centro de Salud Dr Castroviejo, Madrid, Spain; 4MD Anderson, Homeopathy, Madrid,
Spain; 5Centro de Salud Gandhi, Madrid, Spain; 6Clinica de Medicina Integrativa -
CMI, Homeopathy, Madrid, Spain
Correspondence: Gualberto Diaz-Saez (diazgual@yahoo.es)
Objectives
Describe the frequency of use of homeopathic treatments in a public primary care outpatient
clinic, the diseases treated and the clinical outcome.
Methods
A retrospective observational study of the patients of a general practice unit was
performed. 142 medical records were randomly selected. The variables were: use of
homeopathy, diagnosis; kind of illness (acute or chronic), prescribed treatment, role
of homeopathy and clinical outcome.
Results
63,4% of the patients had used homeopathy at least once, which was independent form
gender and age. Of them, 55,6% were treated for chronic conditions. Homeopathy was
the only prescription in 46,7% of cases (main in 89% and adjuvant in 44,4%). Most
frequently treated complaints were musculoskeletal (289%), respiratory (178%), psychic
(167%), cardiovascular (78%) and cutaneous (67%).
The clinical outcome was favourable (improved or cured) in 578% of cases, 60% of the
acute and 56% of the chronic. No adverse reactions were recorded.
Conclusions
Homeopathy can be a useful therapeutical option in a public primary care setting.
The study points out the feasibility of its implantation and the effectiveness and
safety of the homeopathic prescription.
Keywords: Homeopathy; Primary care; Pharmacoepidemiology; Retrospective study.
P37 Assessing and promoting the use of integrative medicine in the medically-underserved
and uninsured community of Anaheim through crescent clinic of Orange County
Demijon Dicen
University of California, Irvine, Huntington Beach, 92647, CA, United States
Background
While it is evident that the use of Integrative Medicine (IM) amongst Americans has
increased, there has been a clear separation of those who can and cannot gain access
to integrative health. Since there has been limited knowledge of IM-use in minorities,
more research on patient attitudes of IM, including nutritional and lifestyle medicine,
is critical to explore its role amongst the underserved community.
Purpose
The goal of this study is to understand the position of integrative medicine (IM)
in the low income and underserved population of Anaheim and how IM can be incorporated
into the quality improvement of outpatient primary health care amongst minorities.
Methods
A survey was administered for eight weeks to patients at Crescent Clinic, a non-profit,
free clinic for the uninsured located in Anaheim. The 14-question survey assessed
patient attitudes and knowledge of IM, interest of IM health fairs and workshops,
and the overall role of IM in health care in terms of disease prevention and treatment.
The data was stored in Microsoft Excel and analyzed with RedCAP.
Results
Of the 48 Crescent Clinic patients surveyed, 72.0% of patients had little to no knowledge
about IM, but 95.8% of patients would consider IM if his or her physician recommended
it. Additionally, 92.0% of the patients were willing to learn more about IM if there
were accessible workshops in the community. While 89.5% of Crescent Clinic patients
believed that IM should be a treatment option, 97.0% of the patients believed IM can
be used as preventative medicine.
Conclusion
Overall, the study greatly supports the role of IM amongst the uninsured and underserved
community of Anaheim through more education and intervention. There is also a high
demand in IM prevention and treatment from healthcare providers. This may suggest
implementing intervention programs on nutritional medicine and lifestyle medicine
to improve wellness and manage blood pressure amongst Crescent Clinic patients, which
can be made available to all underserved and uninsured patients of Anaheim, CA.
P38 Measuring complementary medicine in Australian conventional healthcare education
Helene Diezel1,2, Jon Adams2, Amie Steel1,2, Jon Wardle2
1 Office of Research, Endeavour College of Natural Health, Fortitude Valley, 4006,
Australia; 2 Australian Research Centre in Complementary and Integrative Health (ARCCIM),
University of Technology Sydney (UTS), Sydney, Australia
Correspondence: Helene Diezel
Background
Complementary medicine (CM) is being accessed at a high rate in developing countries.
Little is understood about how much conventional medicine practitioner learn about
CM, so this study aimed to develop a quantitative tool to enable the CM content in
Australian conventional healthcare courses to be mapped.
Methods
A questionnaire was developed to investigate the level of inclusion in CM content
in CHC and the attitudes and beliefs of the faculty responsible for determining curriculum
CM content in the form of the Curriculum in Integrative Medicine Questionnaire (CIMQ).
This including consideration of cognitive and communicative processing and was then
pre-tested through cognitive and linguistic interviewing with a convenience sample
of conventional healthcare course content decision makers (n = 5). The pre-validated
tools CAM Health Belief Questionnaire (CHBQ) and Integrative Medicine Attitude Questionnaire
(IMAQ) were included in the attitudes and perceptions construct of the CIMQ.
Results
Non-standardised incorporation of CM inclusion in nursing and midwifery courses meant
the general course characteristics construct required significant refinement to allow
for variability in CM inclusion. CM content delivery in courses was another CIMQ construct
that had to reflect this flexibility in CM presence within conventional healthcare
higher education.
Conclusions
Variability of CM inclusion means measuring CM presence in discrete health professionals
education courses is difficult so knowing what exposure to complementary healthcare
exists is very problematic. The CIMQ is the first step forward in understanding the
level of familiarity conventional healthcare has of CM and furthering the possibility
of interprofessional communication and eventually collaboration.
P39 Providing maternity care in a silo: experiences of Complementary Medicine practitioners
in Australia
Helene Diezel1,2, Amie Steel1,2, Jane Frawley2, Jon Wardle2, Alex Broom3, Jon Adams2
1 Office of Research, Endeavour College of Natural Health, Fortitude Valley, 4006,
Australia; 2 Australian Research Centre in Complementary and Integrative Health (ARCCIM),
University of Technology Sydney (UTS), Sydney, Australia; 3 Sociology, University
of New South Wales, Sydney, Australia
Correspondence: Helene Diezel
Background
Women’s use of Complementary Medicine (CM) during pregnancy is reported as high in
developed countries but little is known about the experiences of providers of this
care and how this care is occurring in contemporary healthcare.CM practitioners are
involved in maternity care at an increasing rate where patient centred care and interprofessional
collaboration are paramount to ensure the effective and safe health provision for
mothers and babies. Despite this, complementary healthcare providers are not currently
included in the mainstream category of services providing maternity care in most developed
countries. The study presents the perspectives and experiences of CM practitioners
providing care to pregnant and birthing women from outside of the established maternity
care system.
Methods
Semi-structured interviews were conducted using an interview guide, which had been
piloted with a CM practitioner known to the researcher. Thematic data analysis was
undertaken from the interview transcripts after importing into NVIVO qualitative data
analysis program.
Results
Practitioners from a variety of CM disciplines were interviewed (n = 23) and a semi-structured
approach was employed. Fieldwork was also designed to remain sensitive to participants"
own telling and concerns. Themes emerged around professional practice of CM practitioners
falling outside of the maternity "system" and how this was reported to negatively
impact CM practitioner’s experiences of working with other maternity care providers.
Conclusions
CM practitioners experiences of appear to experience a lack of interprofessional collaboration
when providing maternity care to women and do not feel supported by mainstream healthcare
systems in their provision of maternity services.
P40 Exploring diet-related factors associated with gastrointestinal heat retention
syndrome in children: a cross-sectional study
Fei Dong, He Yu, Tiegang Liu, Xueyan Ma, Liyi Yan, Yuxiang Wan, Zian Zheng, Xiaohong
Gu
Beijing University of Chinese Medicine, Beijing, 100029, China
Correspondence: He Yu (yuhe221@126.com)
Background
Gastrointestinal heat retention syndrome (GHRS) is a syndrome that is associated with
increased gastrointestinal heat caused by a metabolic block in energy. This study
aim to explore the diet-related factors which may be associated with GHRS.
Methods
A cross-sectional study has been conducted in pediatric clinic department of Beijing
Dongfang Hospital from October 2014 to January2016.Children who were eligible for
inclusion criterion in our study were those with age ≥1 year old and ≤18 years old
and with a history of 3 or more RTI episodes in the past 12 months. TCM symptoms,
demographic and physiological characteristics were recorded by using semi-structured
questionnaire. Participants were enrolled into group with GHRS and group without GHRS
according to whether they had GHRS or not. Logistic regression model was used to screen
diet-related independent variables.
Results
275 (50.46%) children with GHRS and 270 (49.54%) without GHRS were enrolled and finished
questionnaire survey. Beef eating frequency moderate POR = 1.26(0.85-1.85), beef eating
frequency morePOR = 3.48(1.13-10.71), duck eating frequency moderatePOR = 1.66(1.11-2.48),
duck eating frequency morePOR = 1.84(0.82-4.10), eating other convenience foods(sesame
paste, snack gruel et al) POR = 2.18(1.07-4.41),engorgementPOR = 2.21(1.47-3.32]),
eating preferences POR = 1.49(1.02-2.17) were positively correlated with GHRS; vegetables
eating quantity moderate POR = 0.59(0.39-0.88),vegetables eating quantity more POR = 0.89
(0.49-1.60), fruit eating frequency moderate POR = 0.71(0.40-1.26), fruit eating frequency
more POR = 0.29(0.10-0.81), bean curd eating frequency moderate POR = 0.61(0.42-0.88),
bean curd eating frequency more POR = 0.49(0.17-1.42) were negatively correlated with
GHRS in our logistic regression model.
Conclusions
Beef eating frequency, duck eating frequency, eating other convenience foods(sesame
paste, snack gruel et al), engorgement, eating preferences were positively associated
with GHRS. Vegetables eating quantity, fruit eating frequency, bean curd eating frequency
were negatively correlated with GHRS.
P41 Exploring association between gastrointestinal heat retention syndrome and pneumonia
in children: a prospective cohort study
Fei Dong, He Yu, Liqun Wu, Tiegang Liu, Xueyan Ma, Jiaju Ma, Liyi Yan, Yuxiang Wan,
Zian Zheng, Jianhua Zhen, Xiaohong Gu
Beijing University of Chinese Medicine, Beijing, 100029, China
Correspondence: Xiaohong Gu (guxh1003@126.com)
Aim
To explore the association between gastrointestinal heat retention syndrome (GHRS)
and pneumonia in children.
Methods
A prospective cohort study has been conducted in pediatric clinic department of Beijing
Dongfang Hospital from October to December in 2014.TCM symptoms, demographic and physiological
characteristics were recorded by using semi-structured questionnaire. GHRS was considered
as a predisposing factor. Children participants were followed up for next 12 months.
We contacted with their parents by using a face-to-face questionnaire interview, via
email or phone every 6 months. Episodes of pneumonia and RTIs were recorded in detail.
Results
420 children were enrolled and 370(88.10%) followed up for 12 months. The incidence
of RTI was 5.37 (5.14-5.60)episodes per child-year. The risk ratio (RR) value of pneumonia
occurrence in 6 months follow-up visit was 1.58 (0.94-2.65), RR value of pneumonia
occurrence in 12 months follow-up visit was 1.54(0.91-2.59). Swift digestion with
increased appetite (P = 0.069), excess head sweating (P = 0.006), foul breath (P = 0.085),
and fingerprint red or purple (P = 0.021) were positively correlated with pneumonia
occurrence in 12 months follow-up visit in linear regression model. Severe swift digestion
with increased appetite OR = 15.69(1.21-203.46), severe foul breath OR = 1.76(0.97-3.22),
mild dry stool OR = 1.94(1.01-3.71), and fingerprint red or/and purple OR = 7.48(1.23,
45.66) were positively correlated with pneumonia occurrence in 12 months follow-up
visit in logistic regression model.
Conclusions
GHRS is a risk factor of pneumonia in children and may be associated with pneumonia.
Swift digestion with increased appetite, excess head sweating, foul breath, yellow
urine, dry stool, purple fingerprint were positively associated with pneumonia.
Chinese Clinical Trial Registry Number: ChiCTR-CCH-13003770
P42 Patients, medical staff and complementary therapists' conceptions of integrative
medicine: a systematic review
Julie Dubois, Pierre-Yves Rodondi
Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne,
1010, Switzerland
Correspondence: Julie Dubois
Purpose
Attempts to integrate complementary and alternative medicine (CAM) treatments into
conventional care are being made throughout the world. The objective was to investigate
patients, medical staff and complementary therapists’ position towards the inclusion
of CAM into conventional care and the forms it should take.
Method
A database search was conducted in EMBASE, Medline, Pubmed and Web of Science for
the period 2000-2016. Research articles were included if they specifically addressed
perspectives of users and professionals in western countries towards the integration
of CAM into conventional care and the modalities of that integration.
Results
On a total of 644 identified papers 15 met the inclusion criteria. Ten articles used
questionnaire surveys, 4 used qualitative methods and 1 used a mixed-method approach.
Ten studies were conducted in Israel (by the same research team), 2 in the USA, 2
in Europe and 1 in Australia. Those studies revealed a tendency to support the principle
of CAM integration but discrepancies on the forms it should take. Family physicians
were often considered as the best source for referral, but views diverged on whom
should provide treatments (MD vs non-MD CAM practitioners) and where (primary care
clinics/hospitals vs distinct location). Patients constituted the most homogenous
group in their conceptions of integrative medicine.
Conclusion
This review showed that, with the exception of the Israeli ones, few studies have
addressed the subject under scope. More investigations are needed among the various
actors involved to delineate how integrative medicine should be implemented to fit
local contexts and needs.
P43 Movements during eurythmy therapy induce cardio-locomotor coherence
Friedrich Edelhäuser1,2, Sophia Schwartze1, Barbara Trapp1, Dirk Cysarz1,2
1 Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke,
Herdecke, 58313, Germany; 2 Institute of Integrative Medicine, University of Witten/Herdecke,
Herdecke, Germany
Correspondence: Friedrich Edelhäuser
Background
Eurythmy therapy (EYT), a mind-body therapy from Anthroposophic Medicine, has an impact
on cardiac autonomic regulation as assessed e.g. by the analysis of heart rate variability
(HRV). EYT consists of a repetition of a pre-defined movement sequence in conjunction
with guided and motor imagery. In this study, the impact of the movement sequence
and its repetition during an EYT exercise on cardiovascular regulation is investigated.
Methods
Twenty-eight healthy subjects (age: 27.1 ± 5.9 year, 20 female) performed an EYT exercise
guided by an EYT therapist. The therapist controlled the speed of the EYT exercise
by means of a repeatedly shown video recording of the movement sequence. Control exercise
1 (CE1) consisted of the exercise movements without guided imagery, control exercise
2 (CE2) was walking on the spot. Exercise movements were video recorded for movement
analysis. Coherence between exercise movements and oscillations of HRV (extracted
from Holter ecg recordings) were analyzed.
Results
The coherence between exercise movements and oscillations of HRV were pronounced during
the EYT exercise (0.96) and CE1 (0.98). CE2 showed a lower level of coherence (0.47).
The duration of a single movement sequence was 30 seconds, i.e. 0.033 Hz repetition
frequency, leading to an increase of very low frequency power of HRV compared to CE2
(9.60 ± 0.67 vs. 6.59 ± 0.84 ln ms2).
Conclusions
The repetition of movement sequences during EYT and CE1 led to oscillations of cardiac
autonomic regulation similar to the repetition frequency of the exercise. Hence, EYT
induces cardio-locomotor coherence.
Clinical trials registration number: DRKS00006760 (registered on 10/10/2014)
About this supplement
These abstracts have been published as part of BMC Complementary and Alternative Medicine
Volume 17 Supplement 1, 2017. The full contents of the supplement are available online
at https://bmccomplementalternmed.biomedcentral.com/articles/supplements/volume-17-supplement-1.
Please note that this is part 1 of 3.