Journal of Integrative and Complementary Medicine最新文献

Introduction: Xinmailong injection (XMLI) is a common Traditional Chinese Medicine for treating chronic heart failure (CHF) in China. However, strong evidence-based medical evidence for XMLI is lacking. Purpose: To evaluate the efficacy and safety of XMLI in patients with CHF. Methods: PubMed, the Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, VIP Database for Chinese Technical Periodicals, and Chinese Biomedical Literature Database were searched to identify randomized controlled trials (RCTs) of XMLI for CHF from the inception of the databases to November 2, 2024. The Cochrane risk of bias tool for randomized trials (RoB 2) was used to evaluate the quality of studies, and STATA 17.0 software was used to perform a meta-analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-min walking distance (6-MWD), and adverse reactions. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Twenty-three RCTs comprising 2643 patients were included. Meta-analysis showed that compared with those under conventional Western drug treatment (CWT), combined XMLI and CWT effectively increased LVEF (mean difference [MD] = 6.66, 95% confidence interval [CI] [5.23, 8.09], Z = 9.12, p < 0.001) and 6-MWD (MD = 44.01, 95% CI [28.63,59.38], Z = 5.61, p < 0.001) and reduced LVEDD (MD = -4.19, 95% CI [-5.55, -2.83], Z = -6.05, p < 0.001), BNP (MD = -178.84, 95% CI [-230.29, -127.40], Z = -6.81, p < 0.001), and NT-proBNP (MD = -490.95, 95% CI [-729.40, -252.50], Z = -4.04, p < 0.001). There were no statistically significant differences between the two adverse reactions (risk ratio [RR] = 1.47, 95% CI [0.73,2.99], Z = 1.08, p = 0.28). The GRADE assessment rated adverse reactions as moderate-quality evidence, while LVEDD, BNP, NT-proBNP, and 6-MWD were classified as low-quality evidence, and LVEF was categorized as very low-quality evidence. Conclusions: This systematic review demonstrates that combining XMLI with CWT is effective and safe for managing CHF and offers an evidence-based adjunctive therapeutic strategy. Further high-quality clinical trials are required to investigate the prognostic implications and long-term outcomes.

Objective: To assess the effectiveness of acupressure in addressing the symptom cluster of pain, fatigue, sleep disturbances, and depression (P-F-S-D) in patients with cancer through a systematic review. Methods: A comprehensive search was conducted across three English-language medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang). Only randomized controlled trials (RCTs) examining the impact of acupressure on the P-F-S-D symptom cluster were included. Two reviewers independently screened studies, evaluated the risk of bias, and extracted relevant data in parallel. The risk of bias in eligible RCTs was appraised using the revised Cochrane Risk of Bias tool (RoB 2.0). Meta-analysis was performed using Stata software. Results: A total of 20 studies (reported in 21 articles) met the inclusion criteria and were classified as either having a low risk of bias or some concerns regarding bias. Meta-analysis revealed that acupressure achieved large-effect reductions in the P-F-S-D symptom cluster compared to both sham acupoint (endpoint standardized mean difference [SMD] = -0.84 [-1.05, -0.63], 4-week follow-up SMD = -0.87 [-1.35, -0.39]) and usual care groups (endpoint SMD = -0.68 [-0.83, -0.53], 4-week follow-up SMD = -0.60 [-0.87, -0.33]) (all p = 0.000). Initial high heterogeneity (I² = 65.6%-67.1%) resolved after sensitivity analysis (I² = 19.7%-35.2%), confirming result robustness. Subgroup analysis further revealed that acupressure significantly benefited various symptom combinations, including P-F-S-D, P-F-S, F-S-D, F-S, P-S, and P-F. No serious adverse events were reported. Conclusions: The findings of this study suggest that acupressure should be considered for patients with cancer experiencing the P-F-S-D symptom cluster. However, given the considerable heterogeneity, potential bias, and lack of systematic adverse event reporting in the included studies, further large-scale, multicenter, high-quality RCTs are necessary to better evaluate the effectiveness and safety of acupressure for multisymptom relief.

Introduction: Among rural communities, there is a growing occurrence of persons with multiple chronic conditions (MCC) who have many unmet health care needs. Innovative interventions are needed to help address these needs. The purpose of this article is to describe the feasibility and uptake of a Whole Health System (WHS) health coaching support for rural-residing Veterans with MCC. Methods: This was a prospective qualitative case study of the development and early implementation of two types of health coaching support conducted at the VA Portland Health Care System. The two types of support offered were a health coach alone or a health coach plus remote patient monitoring-home telehealth (RPM-HT). Two clinical teams collaborated on the planning and implementation of the interventions using a collaborative learning process. The observations from this process were then used to conduct a formative evaluation using the Mobilizing Integrated Promoting Action on Research Implementation in Health Services (Mi-PARIHS) toolkit. Results: Of the 56 Veterans offered health coaching support, 6 (10.7%) engaged with the health coach. Among the 32 Veterans offered health coach plus RPM-HT support, 12 (37.5%) participated. Many factors contributed to the limited engagement of Veterans in the WHS coaching interventions including system-, clinician-, and patient-level concerns. Discussion: Our study examining the feasibility and uptake of providing WHS health coaching support highlights the complex care needs and numerous challenges of providing this type of support. Moreover, the formative evaluation using the Mi-PARIHS toolkit reinforced specific barriers that need to be addressed in future implementation efforts of providing person-centered care supported by health coaches. Finally, there is an urgent need for effective solutions given the health disparity gaps in rural communities, shortage of health care professionals, limited access to specialty care and closure of rural hospitals, and the estimated doubling prevalence of MCC over the next 25 years.

Background: A contributing factor to male pattern hair loss (MPHL) is a compromised microcirculation and increased vasoconstriction in the scalp. Since endothelial nitric oxide (NO) was found to act as a vasodilator, our study looked at the efficacy of an amaranthus hair cream in delivering absorbable nitrates to the scalp that would convert to NO resulting in vasodilation and also deliver the nutrients to the scalp. Methods: This was a randomized, double-blinded, placebo-controlled parallel arm study of 50 males of 25-45 years. The study included clinically diagnosed MPHL having Norwood classification III vertex, IV, V, and hair density >100 as measured with Trichoscan. Individuals having a history of active hair loss due to alopecia areata, scarring alopecia, diffuse telogen effluvium or dermatological conditions other than androgenic alopecia were excluded from the study. Amaranthus or placebo cream ∼2 g was applied to the targeted area once daily at night for 90 days. The primary outcome was the mean change in terminal hair density and hair-shaft diameter of terminal hair. The secondary outcome was a mean change in the density of vellus, anagen, and telogen hairs, pilary index, terminal to vellus ratio, and anagen to telogen ratio. Results: The terminal hair density increased significantly (p < 0.0001) by 28% from baseline while placebo had 15% change. Anagen hair count and density increased significantly (p < 0.0001) by 54% from baseline while placebo had a 17.5% change. The pilary index was significantly increased (p < 0.0001) by 25% from baseline while placebo had 7.3% change. The anagen by telogen ratio showed significant increase (p < 0.0001) of 1.5 times whereas placebo showed only 21% change. Conclusion: Amaranthus extract cream significantly improved anagen hair density and follicular health. No adverse effects recorded from this suggest that the Amaranthus extract cream is potential as a safe, and effective supportive therapy for MPHL.

Objective: To explore the acceptability of an 8-week, telehealth, group-based, mindful exercise intervention in individuals with knee osteoarthritis (OA). Methods: This qualitative study was nested within a randomized controlled trial (N = 40) comparing a mindful exercise intervention to an exercise-only control group. Thirteen participants from the mindful exercise arm were individually interviewed remotely using HIPAA-compliant Zoom. Interviews were guided by the Theoretical Framework of Acceptability (TFA). The transcripts were analyzed using an inductive thematic approach, and the identified themes were mapped onto TFA constructs to determine factors related to the intervention's acceptability. Results: Eight key themes were identified as follows: (1) Openness to Alternative Treatments for Knee Pain, (2) Challenges with Exercise and Equipment, (3) Varied Perceptions of Mindfulness, (4) Mindfulness was Enjoyable but Challenging, (5) Integration of Mindfulness with Exercise Varied by Exercise Type, (6) Perceived Impact of Intervention was Physical and Psychological, (7) Group Telehealth Format Enhanced Intervention Acceptability, and (8) 2-H Time Commitment was Challenging. Mapping these themes onto the constructs of the TFA highlighted factors that influenced the acceptability of the mindful exercise intervention. These included enjoyment in practicing mindfulness especially when integrated with familiar exercises, the 8-week intervention length, and convenience of the group and telehealth aspects of the intervention. Participants encountered challenges with the 2-h weekly time, exercise equipment, learning and practicing mindfulness independently, and absence of alternative formats (e.g., hybrid or self-guided options). Conclusion: The mindful exercise intervention was generally acceptable to people with knee OA. However, to enhance acceptability, modifications may be needed, such as adjusting the exercise types and equipment, providing additional support for learning and practicing mindfulness, and offering greater flexibility in session format, timing, and duration. These insights are valuable for developing more effective, patient-centered, mindfulness-based exercise interventions for individuals with knee OA.

Background: We recently developed and established the feasibility of the first mind-body program aiming to prevent persistent concussion symptoms among young adults with anxiety - the Toolkit for Optimal Recovery after Concussion (TOR-C) and an active health education control (HE-C). Both interventions demonstrated preliminary improvements between baseline and post-intervention in outcomes including post-concussion symptoms, physical function, and anxiety. Here, we report on these outcomes 3 months post-intervention. Methods: Fifty young adults (ages 18-35) with a recent concussion (3-10 weeks) and anxiety (≥5 on GAD-7) were randomized to TOR-C (n = 25) or HE-C (n = 25). Participants completed measures of concussion symptoms (PCSS), anxiety (GAD-7), and physical function (WHODAS 2.0) at baseline (pre-randomization), post-intervention, and 3 months post-intervention. We used mixed-model ANOVA with a shared baseline to adjust for baseline differences and assessed within-group changes in these outcomes from baseline to 3 months. Results: Preliminary improvements in concussion symptoms from baseline to 3 months post-intervention were statistically significant in both groups, but clinically meaningful (i.e., exceeding the Minimal Clinically Important Difference) only for TOR-C. Baseline versus 3-month follow-up improvements in physical function and anxiety were statistically significant and clinically meaningful for both groups. Conclusions: Findings provide preliminary evidence that TOR-C may help improve post-concussion recovery, and support a future fully-powered trial to establish the efficacy and sustained effects of TOR-C versus HE-C.