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Ben-Arye E, Finkelstein A, Samuels N, Ben-Yehuda D, Schiff E, Reis S, Lesser L, Bergel M, Shaham D. From skepticism to openness: a qualitative narrative analysis of medical students' attitudes following an integrative medicine course. Support Care Cancer 2022; 30:4789-4795. [PMID: 35142910 PMCID: PMC9046550 DOI: 10.1007/s00520-022-06888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study aimed to explore attitudes of medical students following a course in integrative medicine (IM) focused on palliative and supportive cancer. METHOD Attitudes to IM among pre-clerkship medical students were assessed following a 3-day required course, which included interviews with international experts in IM and "hands-on" workshops mentored by IM and non-IM healthcare professionals. Student reflections were analyzed qualitatively, and written narratives were examined thematically. RESULTS Of 161 students, 102 (63.4%) provided post-course reflections. The main narrative themes included pre-course attitudes, attitude changes and influencing factors, and insights on implementing IM in clinical practice. Pre-course attitudes were predominantly skeptical, with post-course attitudes more open and non-judgmental, addressing research on IM effectiveness and safety. Students looked favorably on the implementation of IM in clinical practice and felt the course enhanced communication with patients. CONCLUSIONS Student attitudes to IM shifted following the course, from a skeptical to a more non-judgmental and accepting approach. IM course may facilitate a better understanding of the limitations and risks of IM practices, particularly in the supportive cancer care setting, as well as implications regarding students' own resilience and professional growth.
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Affiliation(s)
- Eran Ben-Arye
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414553.20000 0004 0575 3597Integrative Oncology Program, Clalit Health Services, & Carmel Medical Centers, LinHaifa, Zebulun Israel
| | - Adi Finkelstein
- grid.419646.80000 0001 0040 8485Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noah Samuels
- grid.414505.10000 0004 0631 3825Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dina Ben-Yehuda
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Schiff
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414529.fDepartment of Internal Medicine & Integrative Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Shmuel Reis
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Bergel
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
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Chung VCH, Ho LTF, Leung TH, Wong CHL. Designing delivery models of traditional and complementary medicine services: a review of international experiences. Br Med Bull 2021; 137:70-81. [PMID: 33681965 DOI: 10.1093/bmb/ldaa046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The World Health Organization advocates integration of traditional and complementary medicine (T&CM) into the conventional health services delivery system. Integrating quality services in a patient-centred manner faces substantial challenges when T&CM is delivered within a health system dominated by conventional medicine. This review has synthesized international experiences of integration strategies across different contexts. SOURCES OF DATA Publications describing international experiences of delivering T&CM service in conventional healthcare settings were searched. Backward and forward citation chasing was also conducted. AREAS OF AGREEMENT Capable leaders are crucial in seeking endorsement from stakeholders within the conventional medicine hierarchy and regulatory bodies. However, patient demands for integrative care can be successful as demonstrated by cases included in this review, as can the promotion of the use of T&CM for filling effectiveness gaps in conventional medicine. Safeguarding quality and safety of the services is a priority. AREAS OF CONTROVERSY Different referral mechanisms between conventional and T&CM practitioners suit different contexts, but at a minimum, general guideline on responsibilities across the two professionals is required. Evidence-based condition-specific referral protocols with detailed integrative treatment planning are gaining in popularity. GROWING POINTS Interprofessional education is critical to establishing mutual trust and understanding between conventional clinicians and T&CM practitioners. Interprofessional communication is key to a successful collaboration, which can be strengthened by patient chart sharing, instant information exchange, and dedicated time for face-to-face interactions. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed on the optimal methods for financing integrated care to ensure equitable access, as well as in remuneration of T&CM practitioners working in integrative healthcare.
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Affiliation(s)
- Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong.,School of Chinese Medicine, The Chinese University of Hong Kong
| | - Leonard T F Ho
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
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Silva PHBD, Barros LCND, Barros NFD, Teixeira RAG, Oliveira ESFD. Professional Training in Integrative and Complementary Practices: the meanings attributed by Primary Health Care workers. CIENCIA & SAUDE COLETIVA 2021; 26:399-408. [PMID: 33605317 DOI: 10.1590/1413-81232021262.40732020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the meanings attributed by Primary Health Care workers to the professional training process in Integrative and Complementary Practices. METHOD Descriptive, exploratory study with a qualitative approach, carried out with 20 professionals from 14 health units in three municipalities in the Metropolitan Region of Goiânia, state of Goiás, Brazil. Data were collected through semi-structured interviews, transcribed and analyzed using the thematic content analysis. RESULTS Based on the analysis, the thematic category about training trajectories in Integrative and Complementary Practices emerged. It discusses that the training takes place through training provided by federal and municipal management or professional councils, via distance, semi-presential learning or in-person training. Furthermore, training courses are held at private educational institutions funded by the professionals themselves. Additionally, informal sources of information are used to obtain knowledge (internet, books and magazines). CONCLUSION The results show, on the one hand, insufficient and diffuse training, with limited supply and quality and, on the other hand, the need to increase educational strategies to improve the training of health professionals aiming at providing different Integrative and Complementary Practices in the Primary Health Care.
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Affiliation(s)
- Pedro Henrique Brito da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Goiás. Av. Esperança s/n, Chácaras de Recreio Samambaia. 74690-900 Goiânia GO Brasil.
| | - Leylaine Christina Nunes de Barros
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Goiás. Av. Esperança s/n, Chácaras de Recreio Samambaia. 74690-900 Goiânia GO Brasil.
| | | | - Ricardo Antônio Gonçalves Teixeira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Goiás. Av. Esperança s/n, Chácaras de Recreio Samambaia. 74690-900 Goiânia GO Brasil.
| | - Ellen Synthia Fernandes de Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Goiás. Av. Esperança s/n, Chácaras de Recreio Samambaia. 74690-900 Goiânia GO Brasil.
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Arnon Z, Attias S, Keshet Y, Schiff E. Integrating acupuncturists in a western hospital: A qualitative study in a hospital in Israel. Complement Ther Clin Pract 2019; 36:164-169. [PMID: 31383434 DOI: 10.1016/j.ctcp.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Zahi Arnon
- Complememtary Medicine Service, Bnai Zion Medical Center, Haifa, Israel.
| | - Samuel Attias
- Complememtary Medicine Service, Bnai Zion Medical Center, Haifa, Israel; School of Public Health, University of Haifa, Israel
| | - Yael Keshet
- Western Galilee Academic College, Emek Yezreel Academic College, Emek Yezreel, 19300, Israel
| | - Elad Schiff
- Complementary Medicine Service and Internal Medicine, Bnai Zion Medical Center, Haifa, Israel
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Complementary and alternative medicine interventions for perioperative symptoms: A comparative effectiveness study. Complement Ther Med 2019; 44:51-55. [DOI: 10.1016/j.ctim.2019.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/21/2022] Open
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6
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Levy I, Attias S, Cohen L, Stoppelmann N, Steinberger D, Grimberg O, Ben-Arye E, Matter I, Sroka G, Somri M, Schiff E. Postoperative analgesia by adding acupuncture to conventional therapy, a non-randomized controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2018; 16:/j/jcim.ahead-of-print/jcim-2018-0028/jcim-2018-0028.xml. [PMID: 30312162 DOI: 10.1515/jcim-2018-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022]
Abstract
Background Postoperative pain is common in patients hospitalized in surgical departments, yet it is currently not sufficiently controlled by analgesics. Acupuncture, a complementary medical practice, has been evaluated for its benefits in postoperative pain with heterogeneous results. We tested the feasibility of a controlled study comparing the postoperative analgesic effect of acupuncture together with standard-of-care to standard-of-care only. Methods In this pilot non-randomized controlled study conducted at a tertiary medical center in Israel, patients received either acupuncture with standard-of-care pain treatment (acupuncture group) or standard-of-care treatment only (control group) following surgery. Visual Analogue Scale (VAS) ratings for pain level at rest and in motion were evaluated both at recruitment and two hours after treatment. Acupuncture-related side effects were reported as well. Results We recruited 425 patients; 336 were assigned to the acupuncture group and 89 to the control group. The acupuncture group exhibited a decrease of at least 40% in average level of pain both at rest (1.8±2.4, p<0.0001) and in motion (2.1±2.8, p<0.0001) following acupuncture, whereas the control group exhibited no significant decrease (p=0.92 at rest, p=0.98 in motion). Acupuncture's analgesic effect was even more prominent in reducing moderate to severe pain at baseline (VAS ≥4), with a decrease of 49% and 45% of pain level at rest and in motion respectively (p<0.001), compared with no significant amelioration in the control group (p=0.20 at rest, p=0.12 in motion). No major side effects were reported. Conclusion Integrating acupuncture with standard care may improve pain control in the postoperative setting.
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Affiliation(s)
- Ilana Levy
- Internal Medicine Department B, Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Lior Cohen
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nadav Stoppelmann
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dan Steinberger
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ofra Grimberg
- General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Ibrahim Matter
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
| | - Mostafa Somri
- Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Anesthesiology Department, Bnai Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Internal Medicine Department B, Bnai Zion Medical Center, Haifa, Israel.,Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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A collaborative model of integrative care: Synergy between Anthroposophic music therapy, acupuncture, and spiritual care in two patients with breast cancer. Complement Ther Med 2018; 40:195-197. [DOI: 10.1016/j.ctim.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022] Open
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Attias S, Sivan K, Avneri O, Sagee A, Ben-Arye E, Grinberg O, Sroka G, Matter I, Schiff E. Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial. J Altern Complement Med 2018; 24:809-815. [DOI: 10.1089/acm.2017.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Attias
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Keren Sivan
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ofri Avneri
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Avigail Sagee
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofra Grinberg
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Ibrahim Matter
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
- The International Center for Health, Law and Ethics, Haifa, Israel
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9
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Arnon Z, Dor A, Bazak H, Attias S, Sagi S, Balachsan S, Schiff E. Complementary medicine for laboring women: a qualitative study of the effects of reflexology. ACTA ACUST UNITED AC 2018; 16:jcim-2018-0022. [DOI: 10.1515/jcim-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/28/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women’s experience associated with this treatment.
Methods
This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment.
Results
Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor.
Conclusions
Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.
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Affiliation(s)
- Zahi Arnon
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
| | - Asnat Dor
- Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
- Department of Education , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Hadar Bazak
- Outstanding Students’ Program – Department of Behavioral Science , The Max Stern Yezreel Valley College , Yezreel Valley , Israel
| | - Samuel Attias
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- School of public Health , University of Haifa , Haifa , Israel
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology , Bnai Zion Medical Center , Haifa , Israel
| | | | - Elad Schiff
- Integrative Medicine Service , Bnai Zion Medical Center , Haifa , Israel
- Faculty of Medicine , Technion – Israel Institute of Technology , Haifa , Israel
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Schiff E, Levy I, Arnon Z, Ben-Arye E, Attias S. First, keep it safe: Integration of a complementary medicine service within a hospital. Int J Clin Pract 2018; 72:e13082. [PMID: 29665222 DOI: 10.1111/ijcp.13082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. METHODS We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. RESULTS After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). CONCLUSIONS Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols.
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Affiliation(s)
- Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
| | - Zahi Arnon
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
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Arnon Z, Steinberger D, Attias S, Grimberg O, Peterfreund I, Schiff E, Keshet Y. Nurses as boundary actors: Promoting integrative medicine in hospital wards. Complement Ther Clin Pract 2018; 31:96-103. [DOI: 10.1016/j.ctcp.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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Nascimento MCD, Romano VF, Chazan ACS, Quaresma CH. FORMAÇÃO EM PRÁTICAS INTEGRATIVAS E COMPLEMENTARES EM SAÚDE: DESAFIOS PARA AS UNIVERSIDADES PÚBLICAS. TRABALHO, EDUCAÇÃO E SAÚDE 2018. [DOI: 10.1590/1981-7746-sol00130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Legitimadas pela Organização Mundial da Saúde, as Práticas Integrativas e Complementares apresentam demanda crescente e têm a formação profissional como um dos maiores desafios para o seu avanço no Sistema Único de Saúde. O estudo quantitativo descrito apresenta a oferta de disciplinas e cursos em Práticas Integrativas e Complementares em seis instituições de ensino superior públicas no Estado do Rio de Janeiro, em 2014, identificada em seus respectivos sites e secretarias segundo as variáveis: instituições de ensino superior, subárea de saúde, nível do ensino (graduação e pós-graduação), subtemas das Práticas Integrativas e Complementares (Homeopatia, Acupuntura, Meditação etc.), formato (obrigatório, eletivo ou optativo) e conteúdo (informativo ou formativo). Os resultados mostram uma oferta de 56 unidades de ensino, distribuída em quase todas as subáreas de saúde, com maior concentração em cursos de Medicina, Farmácia e Enfermagem. De perfil predominantemente opcional e informativo, apresenta a Homeopatia, Meditação e Práticas Corporais como temas mais frequentes. A análise desta oferta, apoiada na perspectiva do cuidado integral e referenciada em literatura nacional e internacional, aponta desafios para a ampliação e qualificação do ensino de Práticas Integrativas e Complementares, dentre eles a inserção integrada em cursos de saúde visando a interação e complementaridade entre saberes distintos.
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Griffin KH, Nate KC, Rivard RL, Christianson JB, Dusek JA. Referrals to integrative medicine in a tertiary hospital: findings from electronic health record data and qualitative interviews. BMJ Open 2016; 6:e012006. [PMID: 27456330 PMCID: PMC4964262 DOI: 10.1136/bmjopen-2016-012006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital. DESIGN Retrospective electronic health record review and structured qualitative interviews. SETTING A 630-bed tertiary care hospital with an IM service available to inpatients. PARTICIPANTS IM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services. RESULTS In the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients. CONCLUSIONS Conventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings.
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Affiliation(s)
- Kristen H Griffin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | - Kent C Nate
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Rachael L Rivard
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | - Jon B Christianson
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jeffery A Dusek
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
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Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety. J Clin Anesth 2016; 29:54-64. [DOI: 10.1016/j.jclinane.2015.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/08/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
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15
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Kreindler G, Attias S, Stoppelman N, Lousky D, Arnon Z, Isipovitch IG, Morani M, Ben-Arye E, Dubretzki-Merry I, Schiff E. A tongue's tale – A case report of traditional Chinese medicine integration in the cardiology department. Complement Ther Med 2014; 22:1041-6. [DOI: 10.1016/j.ctim.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/02/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022] Open
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Grant SJ, Bensoussan A. The process of care in integrative health care settings - a qualitative study of US practices. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:410. [PMID: 25342101 PMCID: PMC4223759 DOI: 10.1186/1472-6882-14-410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 10/07/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a lack of research on the organisational operations of integrative healthcare (IHC) practices. IHC is a therapeutic strategy integrating conventional and complementary medicine in a shared context to administer individualized treatment. To better understand the process of care in IHC - the way in which patients are triaged and treatment plans are constructed, interviews were conducted with integrative health care leaders and practitioners in the US. METHODS Semi-structured interviews were conducted with a pragmatic group of fourteen leaders and practitioners from nine different IHC settings. All interviews were conducted face-to-face with the exception of one phone interview. Questions focussed on understanding the "process of care" in an integrative healthcare setting. Deductive categories were formed from the aims of the study, focusing on: organisational structure, processes of care (subcategories: patient intake, treatment and charting, use of guidelines or protocols), prevalent diseases or conditions treated, and the role of research in the organisation. The similarities and differences of the ITH entities emerged from this process. RESULTS On an organisational level, conventional and CM services and therapies were co-located in all nine settings. For patients, this means there is more opportunity for 'seamless care'. Shared information systems enabled easy communication using internal messaging or email systems, and shared patient intake information. But beyond this infrastructure alignment for integrative health care was less supported. There were no use of protocols or guidelines within any centre, no patient monitoring mechanism beyond that which occurred within one-on-one appointments. Joint planning for a patient treatment was typically ad hoc through informal mechanisms. Additional duties typically come at a direct financial cost to fee-for-service practitioners. In contrast, service delivery and the process of care within hospital inpatient services followed a more formalised structure. CONCLUSIONS IHC is a complex, emerging field with divergent meanings and interpretations. The structures and processes of the IHC entities reported provide insight to the variable ways in which IHC manifests whilst commonly holding a similar vision. This report contributes to understanding IHC, providing evidence for future planning, implementation and evaluation to meet patient needs and demands in this area.
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Keshet Y, Attias S, Ben-Arye E, Shaham M, Grimberg O, Schiff E. Integrative Complementary Medicine for Treatment of Bariatric Perioperative Symptoms: Patients' Experiences and Staff Evaluations. Bariatr Surg Pract Patient Care 2014; 8:108-112. [PMID: 24761369 DOI: 10.1089/bari.2013.9980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A unique integrative complementary medicine (CM) pilot program was launched in a general surgery department at a public teaching hospital in Israel. In addition to standard supportive care, CM treatments are used to support patients undergoing laparoscopic sleeve gastrectomy (LSG) in coping with perioperative distresses. We examined the experiences of patients and how the nursing staff evaluate these treatments. METHODS Qualitative semi-structured open-ended interviews were used. RESULTS Most patients reported that the treatments helped them to cope better with preoperative anxiety, and facilitated postoperative breathing and pain relief. Nurses reported that CM treatments enabled them to reduce doses of analgesics. Both patients and nurses suggested that preoperative CM treatment facilitated a better postoperative CM-associated outcome. CONCLUSIONS Integrative perioperative CM treatments improved pain and anxiety care in patients undergoing LSG. More research is needed to examine CM efficacy in improving standard LSG perioperative supportive care and to evaluate cost effectiveness.
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Affiliation(s)
- Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College , Akko, Israel
| | - Samuel Attias
- Complementary/Integrative Surgery Service, Bnai Zion Medical Center , Haifa, Israel
| | - Eran Ben-Arye
- Lin Medical Center , Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Miri Shaham
- PACU Service, Bnai Zion Medical Center , Haifa, Israel
| | - Ofra Grimberg
- Surgery Department, Bnai Zion Medical Center , Haifa, Israel
| | - Elad Schiff
- Internal Medicine Department, Bnai Zion Medical Center , and The International Center for Health, Law & Ethics, Haifa, Israel
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Kreindler G, Attias S, Kreindler A, Hen H, Haj B, Matter I, Ben-Arye E, Schiff E. Treating postlaparoscopic surgery shoulder pain with acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:120486. [PMID: 24864149 PMCID: PMC4017844 DOI: 10.1155/2014/120486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/14/2014] [Accepted: 03/30/2014] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3 P < 0.0001) and general pain (mean reduction 6.4 ± 2.1 P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.
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Affiliation(s)
- Gur Kreindler
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Samuel Attias
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- School of Public Health, University of Haifa, Mount Carmel, 31905 Haifa, Israel
| | - Anna Kreindler
- Faculty of Management, Tel-Aviv University, P.O. Box 39040 , 69978 Tel-Aviv, Israel
| | - Haim Hen
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Bassel Haj
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Ibrahim Matter
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Eran Ben-Arye
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion International School, Mauerberger building, 2nd floor, Technion City, 3200003 Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- Department of Internal Medicine, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- The Department of Complementary/Integrative Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, Israel
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Gaertner K, Müllner M, Friehs H, Schuster E, Marosi C, Muchitsch I, Frass M, Kaye AD. Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna. Complement Ther Med 2014; 22:320-32. [DOI: 10.1016/j.ctim.2013.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/23/2013] [Accepted: 12/29/2013] [Indexed: 02/06/2023] Open
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Heo KH, Cho HW, Hwang EH, Kim KB, Cheon JH, Sul JU, Shin BC. The use of East-West Integrative Medicine in a national university hospital setting in Korea: A review of a new routine integrated hospital dataset. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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