Designing delivery models of traditional and complementary medicine services: a review of international experiences

Complementary Care Collaboration: A Call to Action

Collaboration among members of a client's/patient's wellness team is a key goal for effective service delivery, and yet often remains elusive. It is proposed that complementary health care practitioners are well situated to lead the way in collaboration. In this article, a framework for how practitioners in any discipline can begin to develop these professional collaborations is presented-NOTP! Network, openness, time, patience. It is a call to action.

Non-pharmacological therapies for cancer patients in Portugal and Brazil: an experience report

OBJECTIVE

To describe the experience of nurses from a center in Portugal and two in Brazil regarding the use of non-pharmacological therapies in cancer patients.

METHOD

This is a professional experience report.

RESULTS

In the Portuguese institution, a group of nurses has been performing massage therapy, reflexology, postural teaching, thermotherapy, relaxation, guided imagery, Reiki, music therapy, aromatherapy, among others, for 17 years, with significant results in pain and vital signs with satisfactory perceptions. In Brazil, the clinical application is incipient, clinical studies with auriculotherapy, relaxation with guided imagery and floral therapy are taking place, with significant results for physical symptoms, anxiety, and quality of life improvement.

CONCLUSION

In both countries, nurses have made efforts to implement non-pharmacological therapies. While in the Portuguese reality they have been formally institutionalized in care, in Brazil the therapies take place with voluntary work and through intervention research. This report can encourage the translation of autonomous practice to clinical studies for proposing evidence of therapies in Integrative Oncology.

Experiences and challenges of African traditional medicine: lessons from COVID-19 pandemic

Management of COVID-19 in Africa is challenging due to limited resources, including the high cost of vaccines, diagnostics, medical devices and routine pharmaceuticals. These challenges, in addition to wide acceptability, have resulted in increased use of herbal medicines based on African traditional medicines (ATMs) by patients in Africa. This is in spite of the often-significant gaps in evidence regarding these traditional medicines as to their efficacy and safety for COVID-19. African scientists, with some support from their governments, and guidance from WHO and other bodies, are addressing this evidence gap, developing and testing herbal medicines based on ATMs to manage mild-to-moderate cases of COVID-19. Such efforts need further support to meet public health needs.

Integrative oncology in cancer care - implementation factors: mixed-methods systematic review

BACKGROUND

Integrative oncology (IO) appears to be beneficial to patients with cancer, but its implementation remains a challenge. Guided by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this systematic review identified the barriers to and facilitators of IO implementation in conventional cancer care settings.

METHODS

We searched eight electronic databases from their inception until February 2022 for qualitative, quantitative or mixed-methods empirical studies reporting the implementation outcomes for IO services. Critical appraisal approach was tailored according to study types. The identified implementation barriers and facilitators were mapped onto TDF domains and the COM-B model, and subsequently onto the behavioural change wheel (BCW) for formulating behavioural change interventions.

RESULTS

We included 28 studies (11 qualitative, 6 quantitative, 9 mixed-methods and 2 Delphi studies) of satisfied methodological quality. The main implementation barriers were the lack of IO knowledge, the absence of funding and healthcare professionals' low level of IO receptiveness. The key implementation facilitators were the dissemination of evidence on IO clinical benefits, the equipping of professionals with IO service delivery skills and the provision of a supportive organisational climate.

CONCLUSION

Multifaceted implementation strategies are needed to address the determinants influencing IO service delivery. Based on our BCW-based analysis of the included studies, the key behavioural change techniques are: (1) educating healthcare professionals about the value and application of traditional and complementary medicine; (2) ensuring access to actionable clinical evidence on IO effectiveness and safety and (3) designing guidelines on communicating traditional and complementary medicine interventions with patients and caregivers for biomedically trained doctors and nurses.

Dragon’s Blood: antioxidant properties for nutraceuticals and pharmaceuticals

Plants are the source of a large spectrum of phytochemicals, and the combined and concerted action of biologically active compounds lead to the potential beneficial properties of each plant matrix. A great attention is being addressed over the years toward herbs and medicinal plants. Dragon’s Blood is a reddish resin oil extracted from Croton lechleri tree. It has been extensively used by indigenous cultures of the Amazon River since ancient times due to the beneficial nutraceutical and pharmaceutical properties. This perspective aims at providing a current framework on Dragon’s Blood with focus on antioxidant properties for nutraceuticals and pharmaceuticals in a novelty integrated and multidisciplinary manner, highlighting the current knowledge, the main research lines, and emerging strategies. A literature quantitative research analysis approach was applied as starting point. The literature search was carried out by means of the Scopus database; 365 documents have been retrieved in the year range from 1854 to 2021, and a total of 269 terms were identified. Among the top-recurring keywords appear: unclassified drug, nonhuman, plant extract/s, Dragon’s Blood, dracaena, Dragon Blood, chemistry, human, animal/s, plant resin. Source, chemical composition, potential nutraceutical, and therapeutical applications of Dragon’s Blood are discussed here. The anti-inflammatory, wound healing, antidiarrheals, anticancer, antirheumatic, antiseptic, and antioxidant activities identified in the Dragon’s Blood extracts can open novel perspectives for its use in food and pharmaceutical industries. While different bioactive compounds have already been identified in Dragon’s Blood extract, only a few studies can be found in literature.

Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States

BACKGROUND

The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits.

PURPOSE

The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective.

METHODS

Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach.

RESULTS

Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice.

CONCLUSION

Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.

Acupuncture in hematologic malignancies and hematopoietic cell transplantation

Acupuncture is an integrative medicine modality that has been used historically and studied recently for managing various symptoms and diseases. Patients with hematological malignancies often experience a high symptom burden including pain, fatigue, nausea, vomiting, and insomnia. Pharmacological interventions are the mainstay of managing these symptoms, although they may not provide adequate control or are not well tolerated due to side effects. There have been many randomized controlled trials of acupuncture on reduction of these symptoms. In this review, we will summarize the current evidence on the effect of acupuncture on the management of common symptoms experienced by patients with hematological malignancies and the current understanding of acupuncture's mechanism of action. The evidence is the strongest for reducing pain and nausea vomiting, less strong for symptoms such as peripheral neuropathy, fatigue, constipation, insomnia, night sweat, and pruritus.

Herbal medicine for functional dyspepsia: Network meta-analysis of placebo-controlled randomised trials

ETHNOPHARMACOLOGICAL RELEVANCE

Conventional treatments for functional dyspepsia (FD) are limited. Herbal medicine (HM) use is prevalent despite unclear comparative effectiveness among different formulae.

AIM OF THE STUDY

This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of HM formulae for FD against placebo.

MATERIALS AND METHODS

Seven international and Chinese databases were searched for randomised controlled trials (RCTs) on HM versus placebo. Risk of bias among RCTs was assessed using Cochrane Risk-of-Bias Tool 2. Data from RCTs were extracted for random-effect pairwise meta-analyses. NMAs were performed to evaluate the comparative effectiveness of HM formulae. GRADE partially contextualised framework was adopted to facilitate NMA result interpretation.

RESULTS

Twelve different HM formulae were identified from fifteen RCTs of mediocre quality. At 8-week follow-up, pairwise meta-analyses indicated that HM was superior to placebo in alleviating global symptoms (pooled risk difference (RD): 0.20; 95% confidence interval (CI): 0.11-0.29), with effect size larger than the minimally clinically important difference of 0.20 RD. Sensitivity analysis showed no significant impact on results attributable to risk of bias. NMAs demonstrated that Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction probably have a large beneficial effect on alleviating global symptoms (RD: 0.37; 95% CI: 0.03-0.99) and postprandial fullness (standardised mean difference: -0.93; 95% credible interval: -1.61 to -0.06), respectively. No serious adverse events were reported.

CONCLUSIONS

Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction may be considered as an alternative among patients unresponsive to conventional treatments. The comparative effectiveness of these two formulae should be evaluated in future trials.

Chinese herbal medicine for functional dyspepsia: a network meta-analysis of prokinetic-controlled randomised trials

BACKGROUND

Prokinetic is the first-line conventional treatment for functional dyspepsia (FD) in Asia despite potential adverse events. Chinese herbal medicine (CHM) may be an effective and safe substitution. This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of different CHM formulae for FD against prokinetics.

METHODS

Seven international and Chinese databases were searched from their inception to July 2020 for randomised controlled trials (RCTs) on CHM versus prokinetics. Data from each RCT were first pooled using random-effect pairwise meta-analyses and illustrated as risk difference (RD) or standardised mean difference (SMD) with 95% confidence interval (CI). Random-effect NMAs were then performed to evaluate the comparative effectiveness of CHM formulae and displayed as RD with 95% CI or SMD with 95% credible interval (CrI). The GRADE partially contextualised framework was applied for NMA result interpretation.

RESULTS

Twenty-six unique CHM formulae were identified from twenty-eight RCTs of mediocre quality. Pairwise meta-analyses indicated that CHM was superior to prokinetics in alleviating global symptoms at 4-week follow-up (pooled RD: 0.14; 95% CI: 0.10-0.19), even after trim and fill adjustment for publication bias. NMAs demonstrated that Modified Zhi Zhu Decoction may have a moderate beneficial effect on alleviating global symptoms at 4-week follow-up (RD: 0.28; 95% CI: - 0.03 to 0.75). Xiao Pi Kuan Wei Decoction may have a large beneficial effect on alleviating postprandial fullness (SMD: - 2.14; 95% CI: - 2.76 to 0.70), early satiety (SMD: - 3.90; 95% CI: - 0.68 to - 0.42), and epigastric pain (SMD: - 1.23; 95% CI: - 1.66 to - 0.29). No serious adverse events were reported.

CONCLUSION

Modified Zhi Zhu Decoction and Xiao Pi Kuan Wei Decoction may be considered as an alternative for patients unresponsive to prokinetics. Confirmatory head-to-head trials should be conducted to investigate their comparative effectiveness against prokinetics.