Journal of Integrative and Complementary Medicine最新文献

Objective: To characterize clinicians' familiarity, attitudes, and utilization patterns related to complementary and integrative health (CIH) services at an academic medical center in the United States. Methods: This mixed-methods pilot study surveyed and interviewed clinicians (n = 46), including Department of Integrative Health (DIH) nurses who deliver CIH services via a consult model to hospitalized patients. Self-report questionnaires assessed clinicians' familiarity, attitudes, and utilization of CIH services. Qualitative interviews explored CIH perceived benefits, barriers, and opportunities for wider service adoption. Result: Fifty-six percent of clinicians discussed the benefits of CIH services with patients, and 72% reported positive impacts such as improved sleep, coping, healing, and reduced pain and/or stress. Nurses (n = 25) reporting greater work autonomy viewed CIH services as more integral to their practice. DIH nurses demonstrated a high degree of familiarity and comfort in counseling patients with CIH modalities. Qualitative data highlighted the importance of creating safe, therapeutic environments, empowering patients, and improving health literacy. Challenges included limited education, awareness, and staffing, particularly during evenings and weekends. Proposed improvements encompassed expanded education and staffing, dissemination of effectiveness criteria, and automated electronic health record referrals. Conclusion: CIH services are broadly perceived as health-promoting and warrant expansion, but operational and cultural challenges must be addressed. These findings will guide CIH services' refinement in U.S. academic medical centers and serve as a model for institutions seeking to integrate CIH services into patient care.

Aim: This study aimed to examine the effects of foot baths applied during the active phase of labor on labor pain and childbirth comfort in nulliparous women. Method: This randomized controlled clinical study was conducted at a maternity hospital in Turkey between February and July 2024. The sample consisted of 196 primiparous women at 37-42 weeks of gestation, with a cervical dilation of at least 4 cm and a cephalic presentation. Participants were randomly assigned to the intervention (n = 98) and control (n = 98) groups. In the intervention group, participants received two 20-min foot baths at 4 cm and 9 cm cervical dilation. Data were collected using a personal information form, the visual analogue scale to assess labor pain, and the Childbirth Comfort Questionnaire to assess childbirth comfort. Results: Labor pain was the primary outcome, and childbirth comfort was assessed as a secondary outcome. The intervention group reported significantly lower labor pain levels compared with the control group (p < 0.001). However, no significant differences were observed between the groups in the physical, psychospiritual, or environmental dimensions of comfort, nor in the total childbirth comfort scores (p = 1.000). Participants were continuously monitored for any adverse events, including discomfort, skin reactions, or circulatory symptoms; however, no such events were reported during the intervention. Conclusion: Foot baths may contribute to reducing labor pain and possibly shortening the second stage of labor. However, given the multidimensional nature of childbirth comfort, interventions focusing solely on physical relaxation may not address all aspects of comfort. Therefore, integrating physical relaxation practices with psychosocial and environmental support is recommended, and further research is needed to confirm these findings.

Introduction: Indonesia's health care system requires transformation to address its aging population and rising chronic diseases. Medical acupuncture presents a holistic, cost-effective solution but faces integration barriers, including stigma, lack of local research, and absence of educational and regulatory frameworks. The objective of this study is to analyze barriers and opportunities for the integration of medical acupuncture into Indonesia's national health system and to propose strategic steps for developing a standardized curriculum, legal regulation, and interprofessional collaboration to ensure safe and evidence-based implementation. Methods: A literature review was conducted using PubMed, ScienceDirect, and Scopus. Keywords included "acupuncture," "education," "regulation," "medical policy," and "public health." The analysis focused on studies examining integrative medical acupuncture practices in various countries. Results: Comparative analysis revealed that successful integration, as seen in China and Australia, depends on standardized education and clear regulations, ensuring practitioner competence and patient safety. Conversely, nations with fragmented regulations, such as India and Brazil, face quality control challenges. Medical acupuncture demonstrates proven efficacy across the health care spectrum, including pain management, rehabilitation, and palliative care. Discussion: For Indonesia, strategic integration requires two key actions: developing an undergraduate medical acupuncture curriculum and establishing a formal legal framework for its practice. This will provide professional legitimacy, ensure patient safety, and curb illegal practices. These steps must be supported by enhanced interprofessional collaboration with conventional medicine, international partnerships, and increased funding for local evidence-based research. Conclusion: Integrating medical acupuncture is vital for a sustainable Indonesian health care system. Prioritizing a standardized curriculum and formal regulation will ensure its safe and effective practice. Supported by research and collaboration, this integration will expand access to affordable, holistic, and evidence-based care for the population.

Introduction: Chronic pain is a major public health problem. Due to the persistent, costly, and complex nature of chronic pain, there is a need for new safe and effective treatments. Integrative breathwork interventions, or therapeutic styles of conscious breathing, have promise as novel treatments for chronic pain. The primary objective of this proof-of-concept study was to examine the feasibility, acceptability, and clinical significance of an integrative breathwork intervention for adults with chronic pain. Methods: Participants with chronic pain and without prior breathwork experience were eligible for this study. Participants completed online surveys at baseline, 2-week, and 6-week follow-ups as well as a brief survey immediately before and after the single group breathwork session. Guided Respiration Mindfulness Therapy (GRMT) was the integrative breathwork intervention that involved 1 hour of conscious connected breathing while engaging in somatically focused mindfulness and relaxation. Results: A total of 11 participants were enrolled into this study, and 10 completed the breathwork session. The intervention was rated as highly acceptable (M = 9.3, standard deviation [SD] = 1.9) and satisfying (M = 9.7, SD = 0.5). All participants recommended the intervention to someone else suffering from chronic pain. There were large, clinically meaningful improvements in pain intensity and pain interference from baseline to the 2-week (mean difference [MD] = -2.9) and 6-week (MD = -3.5) follow-ups. Conclusion: A single group session of GRMT was shown to be highly acceptable, satisfying, and potentially helpful to individuals with chronic pain. The findings demonstrated proof of concept, with most participants reporting a clinically meaningful improvement in pain outcomes through the follow-ups. Additional research on integrative breathwork interventions for chronic pain is warranted.

Objective: We synthesized the effects of mindfulness-based interventions (MBIs) on anxiety symptoms in adults with cancer. Method: We searched 11 electronic databases from inception to February 2024. We included studies comparing MBIs with usual care, waitlist controls, or no intervention for the improvement of patients with anxiety in cancer (CA). We only reviewed studies written in English. We used a random-effects model to compute the effect size. Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity. Results: Across 26 included studies, 1431 adults with cancer participated in MBIs; 1289 served as controls. Mean age ranged from 42.8 to 70.7 years. Most patients were females (56%), and patients with breast cancer and mixed cancer (55.53% and 26.20%, respectively). Overall, MBIs reduced anxiety in the experimental groups compared to control groups (Hedges' g = 0.977, 95% confidence interval = 0.61, 1.34, I² = 95%), but with substantial heterogeneity. In subgroup analysis, funding, setting, a priori power analysis, providing MBIs in adults with cancer and anxiety disorders, and measuring anxiety after postintervention were moderators affecting the pooled effect size. No other quality indicators moderated the effect sizes of MBIs on anxiety. Conclusion: MBIs appear efficacious in improving patients with CA, especially for those with mild-to-moderate anxiety symptoms. Clinicians and health providers might consider using MBIs as an alternative complementary treatment for improving or preventing anxiety disorders in adults living with cancer. With heterogeneity of studies, a large number of primary studies is needed to explore the source of heterogeneity.

Introduction: Many health care professionals are struggling to cope with high stress and burnout in the workplace. To support these professionals, several strategies have been proposed, including meditation and breathing exercises. This pilot study aimed to determine the feasibility of yogic breathing as a strategy for managing stress and burnout for anesthesia professionals. Feasibility was assessed as recruitment rate, retention rate, and adherence. Secondary efficacy outcomes included changes in stress using validated questionnaires and measures of hair cortisol concentration. Methods: A total of 57 out of 300 eligible anesthesia professionals at the Medical University of South Carolina were recruited. Participants attended a class on yogic breathing practices and were given access to the recorded class and other pre-recorded modules on yogic breathing during the study. At baseline and every 3 months, participants completed a one-question Mini Z survey and the Holmes-Rahe Life Stress Inventory. At those time points, a 3-cm clipping of 50-100 strands of hair was collected for cortisol analysis. Participants reported their time spent meditating each week. Results: This study had poor feasibility, with only 63.2% of participants still reporting on yogic breathing at week 52, including those who recorded no practice of yogic breathing. The median percentage of weeks that participants engaged in some form of yogic breathing was only 13.5% (7/52 weeks), likely due to 31.5% of participants (18/57) who performed no yogic breathing during the study period. Discussion: Although this approach of self-guided yogic breathing was not feasible, these findings can influence future programs that aim to reduce stress in anesthesia professionals.

Context: Safe, effective treatment for chronic pain is needed. Prolotherapy is an injection-based complementary and integrative therapy supported by emerging peer-reviewed evidence. It is anecdotally used in clinical care, yet it is not part of medical society practice guidelines. It is unclear how many medical training programs practice and teach prolotherapy, limiting research and clinical optimization. Objective: To assess the use and teaching of prolotherapy in U.S. medical training programs (residencies and fellowships) in specialties that treat chronic pain. Design and Analysis: A mixed-methods, 21-item cross-sectional anonymized survey was sent to directors of the Accreditation Council for Graduate Medical Education (ACGME) residency and fellowship programs in 11 specialties treating chronic pain. Analysis was by descriptive statistics, ANOVA, and qualitative inductive content analysis. Results: From 1852 mailed surveys, we received 854 responses (46.1%). Two-hundred eleven (24.7%) programs reported prolotherapy use, and 119 (13.9%) reported prolotherapy-focused education. Prolotherapy use was most frequently reported by Osteopathic Manipulative Medicine/Neuromusculoskeletal Medicine (OMM/NMM) and Physical Medicine and Rehabilitation (PM&R) residencies and by Sports Medicine and Musculoskeletal Radiology fellowships. Prolotherapy-focused teaching was most frequently provided by OMM/NMM and PM&R residencies and Sports Medicine Fellowships. Among the 119 programs teaching prolotherapy, educational efforts most commonly addressed knee (91; 76.5%), shoulder (86; 72.3%), and elbow (80; 67.2%) pathology, and most (97; 81.5%) include ultrasound guidance at least some of the time. Qualitative analysis revealed mixed perspectives about the use and teaching of prolotherapy. Non-adopters cited limited peer-reviewed evidence and awareness, while adopters noted supportive evidence, a favorable safety profile, and appreciation of alternative treatment options. Conclusions: This is the first study to assess the practice and teaching of prolotherapy for chronic pain in U.S. ACGME-accredited medical training programs. Prolotherapy appears to be used and taught by a substantial minority of responding programs; results should be interpreted with caution due to potential self-selection bias. Findings suggest more research about the use and training, and the efficacy and effectiveness, of prolotherapy is warranted.