European Journal of Integrative Medicine最新文献

Introduction

Acupoint selection in both clinical trials and practice is predominantly informed by traditional theory and experience rather than clinical or mechanistic research. In-clinic acupoint testing methods are used by some practitioners to help determine acupoint selection based on patient feedback, but to date no quantitative data on these approaches has been published. This paper reports preliminary data where an acupoint testing method was utilised to help inform acupoint selection. These results were then used to develop a theoretical framework to validate the acupoint testing approach as a novel research method.

Methods

Preliminary data on the acupoint testing method was collected as part of a routine clinic audit from a single private practice in the UK using an electronic health record (EHR) and included; patient clinical demographic data, health complaints categorised according to the International Classification of Primary Care (ICPC-2) codes and patient outcomes using a Patient Global Impression of Change (PGIC) scale. The acupoint testing method used acupressure and/or acupuncture on acupoints to establish whether there was an immediate positive therapeutic effect for a patient for either; i) local areas of pain, ii) restricted/painful range of movements (ROM) and/or iii) acute symptoms related to a patients’ health complaint.

Results

A total of 506 acupoint tests were recorded from 398 treatments delivered to 74 patients (63.5% female, 36.5% male, mean age 58 years) presenting with predominantly chronic (77.1%) musculoskeletal (65.7%) issues. Tests were recorded for 61/74 (82.4%) patients and the mean number of tests per patient was 8.3. The majority of test results were positive (78.5%). For most patients at least one positive and negative test was recorded (52.5%). Solely positive tests were recorded for 44.3% of patients and soley negative tests were recorded for 3.3% of patients. The mixture of positive and negative test results suggests acupoint specificity may be clinically relevant.

Conclusion

Preliminary data suggests the testing method was versatile and useful for informing acupoint selection in clinical practice. Further research is required to establish its validity and reliability. The acupoint testing approach may represent a valuable new research method to help inform acupoint selection for both clinical trials and practice.

Introduction

Acupuncture-Moxibustion Therapy (AMT) has been used to treat leukopenia associated with cancer treatment. This systematic review and meta-analysis aimed to assess the clinical efficacy, safety, and degree of evidence of AMT in the treatment of post-chemoradiotherapy leukopenia.

Methods

Four English databases (The Cochrane Library, PubMed, EMBASE, Web of Science) and four Chinese databases (Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and WanFang Database) were searched from inception to February 6, 2023 for randomized controlled trials (RCTs) regarding post-chemoradiotherapy leukopenia with AMT. Two authors extracted data and assessed the quality of trials through the Cochrane risk of bias tool 2.0 independently. All meta-analysis was performed using Review Manager 5.4.1 and GRADE was usually used to measure the certainty of evidence.

Results

The analysis included 18 RCTs with 1,377 patients. The results showed that in treating post-chemoradiotherapy leukopenia, AMT is more effective compared to Chinese herbal medicine (CHM) (e.g., the effective rate: risk ratio (RR)=1.33, 95 % confidence interval (CI) 1.16 to 1.53, 3 RCTs, 349 cases; the white blood cell count (WBC): standardized mean difference (SMD)=1.03, 95 %CI 0.04 to 2.01, 2 RCTs, 148 cases), experimental synthetic drugs (ESDs) (e.g., the effective rate: RR=1.35, 95 %CI 1.13 to 1.61, 3 RCTs, 184 cases; the WBC: SMD=1.43, 95 %CI 1.21 to 1.65, 3 RCTs, 244 cases). AMT in combination with myeloid growth factors (MGFs) significantly improved the effective rate (RR=1.21, 95 %CI 1.09 to 1.35, 3 RCTs, 187 cases) and WBC (SMD=1.86, 95 %CI 1.56 to 2.17, 2 RCTs, 117 cases) compared to MGFs. However, there are no data to support the benefits of AMT or in combination with drugs in terms of Karnofsky performance status scores. The certainty of the overall evidence is very low due to the small sample sizes and poor quality of the included RCTs.

Conclusions

Very low certainty evidence suggests that AMT may be an effective complementary therapy for post-chemoradiotherapy leukopenia. The present evidence does not support a definitive safety profile for AMT. However, the quality of the current studies are low, and these conclusions need to be further validated by conducting more high quality RCTs.

Despite a growing body of research and clinical guidelines advocating for acupuncture, its adoption in healthcare systems remains limited. This manuscript explores the considerable gap between evidence-based recommendations for acupuncture and its implementation, while providing practical examples of collaborative and integrative use of acupuncture in healthcare settings in the UK, USA, and Austria. We aim to inspire and provide guidance for those seeking to replicate these successful initiatives and drive the integration of acupuncture in their own healthcare settings.

Narrative accounts of the experience of three clinician-researchers delivering acupuncture within mainstream healthcare systems in the UK, USA, and Austria respectively were captured. These are presented as standalone exemplars of the integration of acupuncture in real-world settings from the perspective of embedded professionals. Each of the three contributors explores and discusses the challenges faced and opportunities presented in their specific setting, as well as lessons learned in the process which may be more widely transferable. The collective relevance of these three narratives may extend beyond the individual settings, serving as possible blueprints and stimulating further professional discourse and innovation.

In the UK, thanks to a unique collaborative environment, research has provided a platform for the implementation of long-running, sustainable acupuncture services in the National Health Service. In the USA, the provision of acupuncture in a hospital setting is supported by an emphasis on communication and comprehensive multidisciplinary approach to integrative care, aided by the use of electronic medical records. In Austria, acupuncture is predominantly administered by medical doctors and its integration is attributed to evidence-based discussions with patients and caregivers within the hospital setting. These green shoots of acupuncture provision within healthcare systems in three different countries bridge the translational gap between guidelines and delivery, shedding light on the multi-faceted aspects of acupuncture implementation.

Concerted efforts focusing on education, dissemination, and fostering bidirectional communication between acupuncture research and clinical practice are essential for moving beyond the principle of “It Seemed Like A Good Idea At The Time” in acupuncture service provision, and consequently supporting the integration and implementation of acupuncture in healthcare systems utilising existing guidelines.

Introduction

Traditional Chinese medicine (TCM) boosts immunity, aids self-repair, and supports elderly health. Despite government efforts, older adults underutilize TCM preventive health services. This study aimed to develop a reliable and valid Social Cognitive Factor Scale (SCFS) to understand this from a behavioral psychology perspective.

Methods

The SCFS, a self-report questionnaire rooted in Bandura's social cognitive theory, was developed by an expert panel using insights from current literature, focus group qualitative research, and scale testing. Twenty experts in TCM public health research and 840 community-dwelling older adults were included in this study. Scale development involved a literature review to establish the initial item pool, two Delphi expert consultations for item screening and revision, and comprehensive testing for reliability and effectiveness.

Results

The SCFS consisted of 22 items classified into six dimensions: perceived environment, social support, belief and knowledge, self-efficacy, outcome expectations, and self-regulation. The overall Cronbach's alpha of the scale was 0.946, and the split-half reliability of the total scale was 0.828, showing good reliability. A total of six factors were extracted, explaining 78.85 % of the total variation. Exploratory factor analysis showed that the scale had good construct validity. Scores on the SCFS were significantly and positively correlated with the utilization rate of TCM preventive health services for older adults (r = 0.537, p < 0.01).

Conclusion

TCM plays a significant role in actively addressing the challenges of aging. The SCFS provides a reliable and valid tool for understanding the underutilization of TCM preventive health services among older adults. A positive correlation with service utilization rates highlights its potential for guiding interventions.

Introduction

Breathing appears to be an important outcome during labor. Therefore, this systematic review aims to evaluate, using the highest level of evidence, the benefits and potential risks of using breathing exercises during the first stage of labor on maternal and neonatal outcomes.

Methods

A search was conducted in the MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, PEDro, EMBASE, CINAHL, Web of Science, Scopus databases and gray literature was also searched, with no restrictions on period or language. The terms "Breathing Exercises" and "Labor" were used. Randomized and quasi-randomized clinical trials comparing a group using breathing exercises during the first stage of labor with a control group receiving usual care were included. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the certainty of evidence was evaluated using the GRADE system. Quantitative analysis was performed through meta-analyses.

Results

Thirteen studies were included. There was a reduction in pain by -1.64 (95 % CI: -2.81 to -0.46, eight studies, I² 99 %; T2 2.82; p < 0.00001), based on very low certainty of evidence, and a reduction in the duration of the second stage of labor by -7.23 min (95 % CI: -11.08 to -3.38, three studies, random-effects: I² 0 %; T2 0.00; p < 0.0002), based on moderate certainty of evidence.

Conclusion

There is moderate evidence that the use of breathing exercises during the first stage of labor can reduce the duration of the pushing stage and decrease pain intensity, although with very low certainty of evidence. However, there was no difference in other maternal and neonatal outcomes.

Introduction

Traditional Chinese medicine (TCM) dietotherapy, based on the principle of “medicine and food homology”, is widely used across diverse healthcare domains. However, the dual attributes of “medicine” and “food” possessed by medicinal and edible herbs make it challenging to assess the efficacy and harms of TCM dietotherapy using currently available methodological systems. This limits the advancement of health services and regulations in this field. This study introduces the Dietotherapy Intention, Evaluation, and Harm Tracking (DIET) pathway, a staged approach for assessing the efficacy and harms of TCM dietotherapy.

Results

The DIET pathway was developed through comprehensive analysis and two rounds of Delphi expert consensus. Based on the distinct characteristics and management requirements of TCM dietotherapy, the DIET pathway divides the assessment process into three stages: Stage 1 (Intention) aims to establish intended efficacy goals, Stage 2 (Evaluation) aims to validate efficacy and harms, and Stage 3 (Harm Tracking) aims to assess harms in special scenarios. Elaborate methodological guidelines are provided for each stage.

Conclusion

The DIET pathway has created a methodological environment that enables systematic and efficient assessment of the efficacy and harms of TCM dietotherapy regimens, which will facilitate the application and management of TCM dietotherapy.

Introduction

The cervicovaginal microbiota plays a crucial role in women's well-being and reproductive health. This study initially focuses on identifying the chemical components of the essential oils (EOs) from Elettaria cardamomum L. (cardamom) (Ec) and Thymus zygis L. (thyme) (Tz). Subsequently, this study aims to determine the antimicrobial and biofilm inhibitory effects of these EOs against both cervicovaginal mixed cultures and the microbial strains isolated from them.

Methods

The compositions of EOs were determined by GC–MS analysis using an Agilent 7890B GC/5977A Series MSD System. Cervicovaginal samples were obtained from two women presenting complaints of a strong odor and vaginal discharge. Samples were collected from the cervix using a sterile cytobrush, ensuring no contact with the urethra, rectum, or external parts of the vagina. The cytological examination was conducted using Papanicolaou staining. Isolated microorganisms were identified through 16S Ribosomal RNA Gene Sequence Analysis and characterized using antibiogram tests. Antimicrobial tests of the EOs were performed by broth microdilution and disc diffusion methods. Biofilm formation was assessed using a crystal violet binding assay.

Results

The major components of Ec EO were α-terpinyl acetate (41.95 %) and eucalyptol (28.58 %), whereas Tz EO contained significant amounts of o-cymene (38.76 %), carvacrol (22.66 %), and thymol (20.69 %). Escherichia coli codes OR651248 and OR651249 were isolated from CV 6 and CV 7 mixed cultures, respectively. E. coli OR651248 demonstrated a higher antibiotic resistance level than E. coli OR651249. Biofilm formation by mixed cultures was significantly higher than that by E. coli isolates (P < 0.05). The Ec EO displayed minimal to no effect against both mixed cultures, showing zero inhibition zone, 500 μL/mL minimum inhibitory concentrations (MICs), and 500 μL/mL minimum microbicidal concentrations (MMCs). However, the Tz EO exhibited antimicrobial activity against both mixed cultures and the E. coli isolates, with inhibition zones > 15 mm and MICs/MMCs < 4 μL/mL (P < 0.05). In all microbial cultures, 0.5 MIC of both EOs inhibited biofilm formation by more than 80 %.

Conclusion

The Tz EO exhibits promising potential as an antimicrobial and biofilm inhibitory agent for managing cervicovaginal E. coli infections.

Introduction

Classic randomized controlled trial design provides information about the effectiveness of a treatment at population level. In clinical practice based on precision medicine, we seek study designs that provide estimates accounting for individual patients’ demographics and context. Integrative medicine has a strong emphasis on personalization, and there is a pressing need for advancements in trial design to support clinical decisions.

Discussion

To enhance the generalizability and implementation of research evidence, study designs first need to mimic the real-world from both the clinicians’ and patients’ perspectives, which could be optimized based on stakeholder analysis. Previous stakeholder analyzes showed that the lack of personalization in clinical trial design is a key challenge for the adoption of evidence clinically. Variations of randomized controlled trial design including better-powered and better-designed subgroup analysis, pragmatic design, the N-of-1 cross-over design, and adaptive design have been introduced to personalize clinical trials. Each of these variations has unique advantages, assumptions and limitations. Stratified randomization can be used to divide a disease population into subgroups according to different schools of theory to match with the corresponding treatment, while preserving the generalizability to general readership. Patient-level meta-analysis can improve the power and precision of subgroup analysis. Enrichment design can increase the efficiency of a trial in detecting treatment effect(s) and in mimicking actual clinical use. Practical issues, including bias control and assessment in pragmatic trials, and N-of-1 trials are also discussed with recent trials as examples. We suggest strategies to maximize the validity and translation potential of clinical trials in integrative medicine with pragmatic or personalized design.

Conclusion

Variations of randomized controlled trial design improve the precision of estimates at patient level, which should be carefully considered in the trial design of integrative medicine according to the context of the future application of evidence.

Introduction

Guided imagery (GI) helps patients feel happy, relaxed, calm, and safe while ensuring positive thinking. This study was conducted to investigate the impact of GI applied before cesarean section (CS) on preoperative anxiety, surgical fear, and physiological parameters.

Methods

Participants were randomized into the GI (n = 29) or control (n = 28) groups in this randomized controlled trial. Participants in the GI group were given a 15-minute GI audio recording three days before their CS and were allowed to listen to it every night for 3 days until the CS. Finally, they listened on the day of the CS, immediately after preparing for the CS. Anxiety levels were evaluated using the State Anxiety Inventory-S (STAI-S) 3 days before the CS (STAI-S1) and 15 min after the preparations on the CS morning (STAI-S2); while surgical fear was evaluated using the Surgical Fear Questionnaire (SFQ) 3 days before the CS (SFQ1-Total) and 15 min after the preparations on the CS morning (SFQ2-Total). Blood pressure, temperature, heart rate, respiratory rate, and fetal heart rate were also evaluated.

Results

A significant difference in the mean STAI-S scores was observed 15 min after the preparations for the CS between the GI and control groups (mean difference (MD) -4.51, 95 % confidence intervals (CIs) [-7.71, -1.31]). However, no significant difference was found in the mean SFQ scores between the groups (MD -5.53, 95 %CIs [-16.69, 5.63]). In the within group comparison of GI and the control group, no statistically significant difference was observed in the score means of the GI group (STAI-S1 with STAI-S2 and SFQ1-Total with SFQ2-Total). However, the score means of the control groups STAI-S2 was higher than STAI-S1 (MD -5.82, 95 %CIs [-8.16, -3.48]), and SFQ2-Total was higher than SFQ1-Total (MD -6.71, 95 %CIs [-10.97, -2.46]). No significant difference was found in physiological parameters between the groups.

Conclusion

This study revealed the effectiveness of GI during the period before CS in reducing preoperative anxiety and keeping surgical fear under control. Nurses and other healthcare professionals involved in preoperative care can utilize GI to reduce preoperative anxiety and manage surgical fear before a CS.

Clinical trial registration

NCT05790954

Introduction

Case reports have a long history in Chinese herbal medicine (CHM), and even into the modern day, case reports are still a preferred format for traditional East Asian medicine (TEAM) practitioners. However, the tradition of case reports in teaching and research is not nearly as common in the English-speaking world as in China, possibly due to the lack of a specific case report guideline. This study aimed to co-design a CHM guideline (CHM-CARE) to assist practitioners in compiling structured and comprehensive case reports.

Methods

A two-phased mixed approach was used to develop the case report guideline. In phase one, focus groups of TEAM practitioners were used to determine what components of existing guidelines (e.g., Case Report (CARE) and Case Report in Chinese Medicine (CARC)) were relevant to include, along with any additions or changes. Content analysis of phase 1 provided the checklist items for a two-round Delphi process (Phase 2). All checklist items from the first Delphi round with a median of three or higher were included in the second round, with consensus set at >70 % for inclusion in the final guideline.

Results

A total of 18 CHM practitioners from four countries joined five separate focus group discussions. Focus group discussions led to 98 checklist items being used in the first round of the Delphi process. Fifteen international experts on case reports participated in two rounds of Delphi. A total of 69 checklist items moved forward into the second round where 61 items (88 %) reached consensus and formed the final CHM-CARE guideline.

Conclusion

Key elements of a herbal medicine case report checklist were identified, and a 61-item case report guideline (CHM-CARE) was produced, providing clear guidelines for case reports to TEAM practitioners operating in private practice.