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Pratt M, Wieland S, Ahmadzai N, Butler C, Wolfe D, Pussagoda K, Skidmore B, Veroniki A, Rios P, Tricco AC, Hutton B. A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions. Syst Rev 2020; 9:97. [PMID: 32354348 PMCID: PMC7191816 DOI: 10.1186/s13643-020-01328-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions. METHODS An information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review. RESULTS A total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1-4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias. CONCLUSION The use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed. SYSTEMATIC REVIEW REGISTRATION: https://ruor.uottawa.ca/handle/10393/35658.
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Affiliation(s)
- Misty Pratt
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Susan Wieland
- University of Maryland School of Medicine, Baltimore, MD USA
| | - Nadera Ahmadzai
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Claire Butler
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Kusala Pussagoda
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
| | - Argie Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Patricia Rios
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Paknejad MS, Motaharifard MS, Barimani S, Kabiri P, Karimi M. Traditional, complementary and alternative medicine in children constipation: a systematic review. ACTA ACUST UNITED AC 2019; 27:811-826. [PMID: 31734825 DOI: 10.1007/s40199-019-00297-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. EVIDENCE ACQUISITION Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1-18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. RESULTS 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. CONCLUSION The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. Graphical abstract.
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Affiliation(s)
- Maryam Sadat Paknejad
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Monireh Sadat Motaharifard
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Shahdis Barimani
- Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Kabiri
- Department of Biostatics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran.
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Kim S, Choi S, Lee S, Lee JH, Park JJ. Case study projects by a Korean national research agency: Past 12 years and future. Complement Ther Clin Pract 2019; 35:48-52. [PMID: 31003685 DOI: 10.1016/j.ctcp.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Scientific rigor is a known challenge to establish in heavily individualized practices of traditional medicine. A national research agency in Korea carried out a 12-year project to promote case reports among clinics of Korean Medicine (KM). This report aims at providing challenges, achievements, and thoughts for future endeavors. METHODS We reviewed all the projects executed by the Korea Institute of Oriental Medicine between 2005 and 2017 promoting case reports in clinics of KM. The findings were categorized stage of project development, themes of project stage, achievement, and challenges. RESULTS The implemented studies include eleven prospective- and five retrospective - case series, and one comparative trial. The project stages are divided into four, initial (surveying and building a database on Korean acupuncture), transitional (educating Korean Medicine doctors on writing case reports and building a case report system), stagnation (partially attributable to IRB's considering case report projects as clinical trial) and resurrection (building a rigorous evidence base from local clinics). The major challenges included practitioners' in clinics feeling burdened by the rigor of documentation requirement, the limited options of usable objective measurement tools available at general KM, and IRB's categorizing case report projects as clinical trials hence imposing unrealistic compliance burden. CONCLUSIONS Promoting case reports in local clinics, while being warranted to remain as a crucial research method to build evidence based KM practice, requires supports from stakeholders including motivated clinicians of KM, extended use of diagnostic device available at KM practice, and insightful and flexible regulatory bodies' decision making.
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Affiliation(s)
- Sungha Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Sunmi Choi
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Siwoo Lee
- Future Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea.
| | - Jongbae J Park
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
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Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
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Canaway R, Leach M, Hunter J. Setting an agenda for strengthening the evidence-base for traditional and complementary medicines: Perspectives from an expert forum in Australia. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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A brief summary of pilot and feasibility studies: Exploring terminology, aims, and methods. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Baars EW, Hamre HJ. Whole Medical Systems versus the System of Conventional Biomedicine: A Critical, Narrative Review of Similarities, Differences, and Factors That Promote the Integration Process. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:4904930. [PMID: 28785290 PMCID: PMC5530407 DOI: 10.1155/2017/4904930] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is an increasing need for a worldwide professional integration of conventional medicine and traditional/complementary whole medical systems (WMSs). However, the integration is perceived by conventional medicine as problematic or unacceptable, because of a supposed lack of evidence for specific effects of WMSs therapies and supposed prescientific or unscientific paradigms of WMSs. OBJECTIVES To review the literature on the features of WMSs, similarities and differences between conventional medicine and WMSs, and scientific and clinical practice issues that should be dealt with in order to promote the integration process. METHODS A critical, narrative review of the literature on six WMSs. RESULTS AND CONCLUSIONS Key factors for the integration of WMSs and conventional medicine are as follows: legal frameworks, quality standards, high-quality research on safety and efficacy of WMS interventions, infrastructure, and financial resources. For scientific assessment of WMSs, there are unresolved ontological, epistemological, and methodological issues and issues of diagnostics, therapy delivery, and outcome assessment in clinical practice. Future research not only should be directed at quality assurance and generating the necessary data on safety and efficacy/effectiveness but also should address more fundamental (ontological, epistemological, and methodological) issues, in order to overcome the differences between WMSs and conventional medicine.
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Affiliation(s)
- Erik W. Baars
- European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP), Zechenweg 6, 79111 Freiburg, Germany
- Louis Bolk Institute, Hoofdstraat 24, 3972 LA Driebergen, Netherlands
- University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Harald J. Hamre
- European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP), Zechenweg 6, 79111 Freiburg, Germany
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Zechenweg 6, 79111 Freiburg, Germany
- Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
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Kramer S, Irnich D, Lorenzl S. Acupuncture for Symptom Relief in Palliative Care-Study Protocol and Semistandardized Treatment Schemes. J Acupunct Meridian Stud 2017; 10:294-302. [PMID: 28889847 DOI: 10.1016/j.jams.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/06/2017] [Accepted: 04/18/2017] [Indexed: 11/27/2022] Open
Abstract
The use of complementary and alternative medicine methods such as acupuncture in palliative care has increased over the past years. Well-planned trials are warranted to show its effectiveness in relieving distressing symptoms. The development of treatment schemes to be used in the trial for both acupuncture and medical symptom control is challenging, as both acupuncture and palliative care are highly individualized. Thus, standardized care plans of a randomized controlled trial will have difficulties in producing treatment results that compare to the clinical practice. As an alternative, treatment protocols for both acupuncture and medical symptom control of dyspnea, pruritus, hypersalivation, depression, anxiety, and xerostomia were designed with the input of experts. They are designed to provide sufficient symptom control and comparability for a three-arm, randomized controlled trial. Medical symptom control will be provided to all groups. The two control groups will be medical treatment and sham-laser acupuncture.
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Affiliation(s)
- Sybille Kramer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany.
| | - Dominik Irnich
- Multidisciplinary Pain Centre, Department of Anesthesiology, University of Munich, Munich, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Clinic and Policlinic for Palliative Care, Klinikum der Universität München, Ludwig Maximilians University, Munich, Germany
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Grant SJ, Frawley J, Bensoussan A. Process of care in outpatient Integrative healthcare facilities: a systematic review of clinical trials. BMC Health Serv Res 2015; 15:322. [PMID: 26264852 PMCID: PMC4534115 DOI: 10.1186/s12913-015-0976-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/24/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients currently integrate complementary medicine (CM) and allopathic, choosing a combination of therapies rather than a single therapy in isolation. Understanding integrative healthcare (IHC) extends beyond evaluation of specific therapies to encompass evaluations of multidisciplinary complex interventions. IHC is defined as a therapeutic strategy integrating conventional and complementary medical practices and practitioners in a shared care setting to administer an individualized treatment plan. We sought to review the outcomes of recent clinical trials, explore the design of the interventions and to discuss the methodological approaches and issues that arise when investigating a complex mix of interventions in order to guide future research. METHOD Five databases were searched from inception to 30 March 2013. We included randomized and quasi-experimental clinical trials of IHC. Data elements covering process of care (initial assessment, treatment planning and review, means for integration) were extracted. RESULTS Six thousand two hundred fifty six papers were screened, 5772 were excluded and 484 full text articles retrieved. Five studies met the inclusion criteria. There are few experimental studies of IHC. Of the five studies conducted, four were in people with lower back pain. The positive findings of these studies indicate that it is feasible to conduct a rigorous clinical trial of an integrative intervention involving allopathic and CM treatment. Further, such interventions may improve patient outcomes. CONCLUSIONS The trials in our review provide a small yet critical base from which to refine and develop larger studies. Future studies need to be adequately powered to address efficacy, safety and include data on cost effectiveness.
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Affiliation(s)
- Suzanne J Grant
- National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, NSW, Australia.
| | - Alan Bensoussan
- National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Components and reporting of yoga interventions for musculoskeletal conditions: A systematic review of randomised controlled trials. Complement Ther Med 2014; 22:909-19. [DOI: 10.1016/j.ctim.2014.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/08/2014] [Accepted: 08/09/2014] [Indexed: 11/19/2022] Open
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Baars EW, Kooreman P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open 2014; 4:e005332. [PMID: 25164536 PMCID: PMC4156802 DOI: 10.1136/bmjopen-2014-005332] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To compare healthcare costs and mortality rates of Dutch patients with a conventional (CON) general practitioner (GP) and patients with a GP who has additionally completed training in complementary and alternative medicine (CAM). DESIGN Comparative economic evaluation. SETTING Database from the Dutch insurance company Agis. PARTICIPANTS 1,521,773 patients (98.8%) from a CON practice and 18,862 patients (1.2%) from a CAM practice. MAIN OUTCOME MEASURES Annual information on five types of healthcare costs for the years 2006-2011: care by GP, hospital care, pharmaceutical care, paramedic care and care covered by supplementary insurance. Healthcare costs in the last year of life. Mortality rates. RESULTS The mean annual compulsory and supplementary healthcare costs of CON patients are respectively €1821 (95% CI 1813 to 1828) and €75.3 (95% CI 75.1 to 75.5). Compulsory healthcare costs of CAM patients are €225 (95% CI 169 to 281; p<0.001; 12.4%) lower and result mainly from lower hospital care costs (€165; 95% CI 118 to 212; p<0.001) and lower pharmaceutical care costs (€58; 95% CI 41 to 75; p<0.001), especially in the age categories 25-49 and 50-74 years. The costs in the last year of life of patients with CAM, GPs are €1161 (95% CI -138 to 2461; p<0.1) lower. This difference is entirely due to lower hospital costs (€1250; 95% CI 19 to 2481; p<0.05). The mean annual supplementary costs of CAM patients are €33 (95% CI 30 to 37; p<0.001; 44%) higher. CAM patients do not have lower or higher mortality rates than CON patients. CONCLUSIONS Dutch patients whose GP additionally completed training in CAM on average have €192 (10.1%) lower annual total compulsory and supplementary healthcare costs and do not live longer or shorter than CON patients.
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Affiliation(s)
- Erik W Baars
- Department of Care, University of Applied Sciences Leiden, Leiden, The Netherlands
- Department of Nutrition and Health, Louis Bolk Institute, Driebergen, The Netherlands
| | - Peter Kooreman
- Department of Economics, Tilburg University, Tilburg, The Netherlands
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Fischer FH, Lewith G, Witt CM, Linde K, von Ammon K, Cardini F, Falkenberg T, Fønnebø V, Johannessen H, Reiter B, Uehleke B, Weidenhammer W, Brinkhaus B. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:46. [PMID: 24499316 PMCID: PMC3931324 DOI: 10.1186/1472-6882-14-46] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/04/2014] [Indexed: 01/09/2023]
Abstract
The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens' needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public's health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM research should be established to investigate the identified gaps of knowledge and to address upcoming health care challenges.
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Affiliation(s)
- Felix H Fischer
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin, Luisenstr. 57, 10098 Berlin, Germany
| | - George Lewith
- Complementary and Integrated Medicine Research Unit, University of Southampton, Southampton, UK
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin, Luisenstr. 57, 10098 Berlin, Germany
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, USA
| | - Klaus Linde
- Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Klaus von Ammon
- Institute of Complementary Medicine (KIKOM), University of Bern, Bern, Switzerland
| | - Francesco Cardini
- Healthcare and Social Agency of Emilia Romagna Region, Bologna, Italy
| | - Torkel Falkenberg
- Research Unit for Integrative Healthcare Research, Karolinska Institute, Stockholm, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
| | - Vinjar Fønnebø
- National Research Center on Complementary and Alternative Medicine (NAFKAM), University of Tromsø, Tromsø, Norway
| | - Helle Johannessen
- Institute of Public Health, Research Unit Health, Man and Society, University of Southern Denmark, Odense, Denmark
| | - Bettina Reiter
- International Academy for Holistic Medicine, Vienna, Austria
| | - Bernhard Uehleke
- Institute of Complementary Medicine, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Weidenhammer
- Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Benno Brinkhaus
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin, Luisenstr. 57, 10098 Berlin, Germany
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Mixed Methods in CAM Research: A Systematic Review of Studies Published in 2012. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:187365. [PMID: 24454489 PMCID: PMC3881584 DOI: 10.1155/2013/187365] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/20/2013] [Indexed: 02/03/2023]
Abstract
Background. Mixed methods research uses qualitative and quantitative methods together in a single study or a series of related studies. Objectives. To review the prevalence and quality of mixed methods studies in complementary medicine. Methods. All studies published in the top 10 integrative and complementary medicine journals in 2012 were screened. The quality of mixed methods studies was appraised using a published tool designed for mixed methods studies. Results. 4% of papers (95 out of 2349) reported mixed methods studies, 80 of which met criteria for applying the quality appraisal tool. The most popular formal mixed methods design was triangulation (used by 74% of studies), followed by embedded (14%), sequential explanatory (8%), and finally sequential exploratory (5%). Quantitative components were generally of higher quality than qualitative components; when quantitative components involved RCTs they were of particularly high quality. Common methodological limitations were identified. Most strikingly, none of the 80 mixed methods studies addressed the philosophical tensions inherent in mixing qualitative and quantitative methods. Conclusions and Implications. The quality of mixed methods research in CAM can be enhanced by addressing philosophical tensions and improving reporting of (a) analytic methods and reflexivity (in qualitative components) and (b) sampling and recruitment-related procedures (in all components).
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Weidenhammer W, Brinkhaus B. CAMbrella--a pan-European research network for complementary and alternative medicine: from the beginnings up to first results. FORSCHENDE KOMPLEMENTARMEDIZIN (2006) 2012; 19 Suppl 2:3-5. [PMID: 23883938 DOI: 10.1159/000342753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Wolfgang Weidenhammer
- Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der Isar, Technical University Munich, Germany.
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