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Schwermer M, Längler A, Zuzak T. Consensus-based guideline for the supportive anthroposophic therapies to treat children with pseudocroup (stenosing laryngotracheitis). Complement Ther Med 2024; 84:103072. [PMID: 39117123 DOI: 10.1016/j.ctim.2024.103072] [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: 02/05/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Supportive anthroposophic therapies are used to treat children with pseudocroup by pediatricians in outpatient and inpatient settings. Anthroposophic treatment comprises forms of creative therapies, external applications as well as remedies, which production is based on the knowledge of the human being, nature and substances. A scientifically based guideline for these therapies is lacking. Due to insufficient study situation, we developed a consensus-based guideline to make therapy decisions more transparent and facilitate clinical routine. METHODS An online Delphi process with 67 anthroposophic pediatricians was conducted. Recommendations were accepted when reaching more than 75 % of expert agreement; otherwise, recommendations were revised and assessed by the experts once again. RESULTS Recommendations for general interventions and for anthroposophic remedies (Bryonia/Spongia comp.; Larynx/Apis comp.) as well as for external applications (embrocation with lavender oil) were developed. Recommendations have a consensus of 96.4 % or more. CONCLUSION The consensus-based guideline provides practical recommendations for the supportive anthroposophic therapies for pseudocroup. The implementation and practicability of this guideline has to be investigated.
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Affiliation(s)
- Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Professorship for integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany.
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Professorship for integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany
| | - Tycho Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Faculty of Medicine, University of Duisburg-Essen, Germany
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Jäckle S, Timmis JK. Esoteric beliefs and CAM impact SARS-CoV-2 immunization drivers, uptake and pediatric immunization views in Germany. NPJ Vaccines 2024; 9:137. [PMID: 39097580 PMCID: PMC11297982 DOI: 10.1038/s41541-024-00928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/17/2024] [Indexed: 08/05/2024] Open
Abstract
Recent studies demonstrate that sociopolitical attitudes partially explain variance in (SARS-CoV-2) vaccine hesitancy and uptake. Other attitudes, such as those towards esoteric beliefs, complementary and alternative medicine (CAM), and religion, have also been proposed. However, pertinent studies provide limited direction for public health efforts, as the impact of such attitudes has been tested in isolation or on different outcomes. Moreover, related associations between SARS-CoV-2 immunization drivers as well as views towards other modes of immunization (e.g., routine pediatric immunization), remain unclear. Based on a sample of ~7400 survey participants (Germany), where esoteric belief systems and CAM (Waldorf, homeopathy) are rather prevalent, and controlling for other sociological factors, we found that (i) individuals with positive attitudes towards Waldorf education and homeopathy are significantly less likely to have received a (further) dose of SARS-CoV-2 vaccine compared to those with positive views of mainstream medicine; (ii) for the former, immunization decisions are primarily driven by external pressures, and for the latter overwhelmingly by voluntary considerations; (iii) attitudes influencing adult SARS-CoV-2 vaccine uptake similarly influence views towards routine pediatric immunization. Our findings provide significant evidence informing a more nuanced design of public health and communication campaigns, and pertinent policies.
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Affiliation(s)
- Sebastian Jäckle
- Department of Political Science, University of Freiburg, Freiburg, 79085, Germany.
| | - James K Timmis
- Department of Political Science, University of Freiburg, Freiburg, 79085, Germany
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
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Schwermer M, Fetz K, Ostermann T, Truxius L, Längler A, Jan Zuzak T. Evaluation of a guideline for supportive anthroposophic therapies for hospitalised children with acute gastroenteritis - A prospective case series study. Complement Ther Med 2024; 82:103042. [PMID: 38636719 DOI: 10.1016/j.ctim.2024.103042] [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: 12/18/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Even though several German children's hospitals offer integrative, anthroposophic medical therapies in addition to the standard medical care, guidelines for these anthroposophic therapies are still rare. Therefore, we investigated the feasibility of implementing a published, consensus-based guideline for the treatment of children with acute gastroenteritis (aGE) with anthroposophic therapies in the community hospital Herdecke. DESIGN A prospective case series of paediatric patients (≤18 years) with an aGE admitted to the department of integrative paediatrics of the community hospital Herdecke was conducted. Demographic, clinical and therapeutic data was recorded at initial presentation and at follow-up visits. Physicians were surveyed with a questionnaire to evaluate feasibility of implementing the guideline. RESULTS Sixty-two patients (0-15 years; 22 male, 40 female) were included in the case series. All patients received some form of anthroposophic therapy. The most frequently used remedies were Geum urbanum, Nux vomica and Bolus alba comp. Treating physicians showed a high adherence to the expert-based consensus guideline in their prescribed therapies. All physicians stated that they were familiar with the guideline and used the recommendation to inform their therapy decision. Suitability for daily use and effectiveness in treating the main symptoms of aGE were highly scored by the physicians. CONCLUSION The consensus-based guideline of anthroposophic therapies for aGE in children was successfully implemented and found to be useful for physicians in clinical practice.
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Affiliation(s)
- Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Professorship for Integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany.
| | - Katharina Fetz
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany
| | - Louisa Truxius
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Professorship for Integrative Pediatrics, Witten/Herdecke University, Faculty of Health, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany; Faculty of Medicine, University of Duisburg-Essen, Germany
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Vagedes J, Huber BM, Islam MOA, Vagedes K, Kohl M, von Schoen-Angerer T. Antibiotic Use in a Neonatal Intensive Care Unit Practicing Integrative Medicine-A Retrospective Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:394-402. [PMID: 37815790 PMCID: PMC11001955 DOI: 10.1089/jicm.2023.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background: Antibiotic use in neonatal intensive care units (NICUs) remains high. Low antibiotic prescribing has been documented among physicians trained in complementary medicine. This study sought to identify if an NICU integrating complementary medicine has low antibiotic prescribing. Methods: We conducted a retrospective analysis at the level-2 NICU of the Filderklinik, an integrative medicine hospital in Southern Germany, to compare antibiotic use locally and internationally; to compare neonates with suspected infection, managed with and without antibiotics; and to describe use and safety of complementary medicinal products. Results: Among 7778 live births, 1086 neonates were hospitalized between 2014 and 2017. Two hundred forty-six were diagnosed with suspected or confirmed infection, their median gestational age was 40.3 weeks (range 29-42), 3.25% had a birthweight <2500 g, 176 were treated with antibiotics for a median duration of 4 days, 6 had culture-proven infection (0.77 per 1000 live births), and 2.26% of live births were started on antibiotics. A total of 866 antibiotic treatment days corresponded to 111 antibiotic days per 1000 live births and 8.8 antibiotic days per 100 hospital days. Neonates managed with antibiotics more often had fever and abnormal laboratory parameters than those managed without. Complementary medicinal products comprising 71 different natural substances were used, no side effect or adverse event were described. A subanalysis using the inclusion criteria of a recent analysis of 13 networks in Europe, North America, and Australia confirmed this cohort to be among the lowest prescribing networks. Conclusions: Antibiotic use was low in this NICU in both local and international comparison, while the disease burden was in the mid-range, confirming an association between integrative medicine practice and low antibiotic prescribing in newborns. Complementary medicinal products were widely used and well tolerated. Clinical Trial Registration number: NCT04893343.
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Affiliation(s)
- Jan Vagedes
- ARCIM Institute, Filderstadt, Germany
- Department of Pediatrics, Filderklinik, Filderstadt, Germany
- Department of Neonatology, University Hospital Tübingen, Tübingen, Germany
| | - Benedikt M. Huber
- Center for Integrative Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
- Department of Community Health, Fribourg University, Fribourg, Switzerland
| | | | | | - Matthias Kohl
- Institute of Precision Medicine, University Furtwangen, Furtwangen, Germany
| | - Tido von Schoen-Angerer
- ARCIM Institute, Filderstadt, Germany
- Center for Integrative Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
- Department of Community Health, Fribourg University, Fribourg, Switzerland
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Peng J, Cheng D. The effectiveness of therapeutic artmaking on depression, anxiety, quality of life, and psychological distress in cancer patients on chemotherapy: a systematic review of the literature. Support Care Cancer 2024; 32:245. [PMID: 38519596 DOI: 10.1007/s00520-024-08427-0] [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: 01/19/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the evidence of art therapy on depression, anxiety, quality of life, and mental distress in cancer patients undergoing chemotherapy. METHODS A systematic literature search was conducted. A systematic search of online electronic databases including, PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Art Therapy," and "Neoplasms," "Cancer," and "Chemotherapy" from the earliest to January 11, 2023. A total of 3890 publications were assessed for relevance by title and abstract. The remaining 1298 articles were examined using three inclusion criteria: interventions were guided by an artist or art therapist, participants were actively involved in the creative process, and anxiety, depression, and/or quality of life were included as outcome measures. The methodological quality of the included studies was appraised using specific checklists. RESULT A total of 495 patients with cancer undergoing chemotherapy participated in ten studies. Among the participants, 87.21% were female and 63.43% of them were in the intervention group. The mean age of the participants was 53.93 in five studies that reduced depression in cancer patients undergoing chemotherapy. Six studies investigated the effect of different art therapy methods on the anxiety of patients, which in four studies reduced their anxiety. Also, three studies investigated the effect of different art therapy methods on patients' distress, which in two studies reduced their distress. CONCLUSION Art therapy had positive effects on depression, anxiety, quality of life, and psychological distress of cancer patients undergoing chemotherapy. Meanwhile, research on art therapy in cancer patients on chemotherapy is insufficient. We cannot conclude that art therapy benefits cancer patients on chemotherapy. More rigorous research is needed.
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Affiliation(s)
- Juan Peng
- School of Education, Hanjiang Normal University, Shiyan, 442000, Hubei, China
| | - Dan Cheng
- School of Early-Childhood Education, Nanjing Xiaozhuang University, Nanjing, 211171, Jiangsu, China.
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Hellhammer J, Spitznagel-Schminke L, Hufnagel R. Kalium phosphoricum comp. in patients with neurasthenia: a randomized, double-blind, placebo-controlled clinical trial. Curr Med Res Opin 2024; 40:239-251. [PMID: 38099469 DOI: 10.1080/03007995.2023.2291169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This Phase IV placebo-controlled clinical trial was designed to demonstrate the efficacy and safety of the product Neurodoron (Kalium phosporicum comp., KPC) in patients with neurasthenia. METHODS This monocenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial (registration number: DRKS00003261) was conducted in an outpatient German trial site. Women and men aged 18 and above were randomized to receive either KPC or placebo if they reported typical symptoms of neurasthenia and a severe psychiatric disorder could be excluded. The primary objectives were a reduction in characteristic symptoms of nervous exhaustion and perceived stress as well as improvement in general health status after 6 weeks of treatment. RESULTS In total, 204 patients underwent screening, 78 were randomized in each treatment group, and 77 patients each received treatment (intention-to-treat (ITT) population = 154 patients). For none of the primary efficacy variables, an advantage in favor of KPC could be demonstrated in the pre-specified analysis (p-values between 0.505-0.773, Student's t-test). In a post-hoc analysis of intra-individual differences after 6 weeks treatment, a significant advantage of KPC vs. placebo was shown for characteristic symptoms of nervous exhaustion (irritability (p = 0.020); nervousness (p = 0.045), Student's t-test). Adverse event (AE) rates were similar between treatment groups, in both groups six AEs were assessed as causally related to treatment (severity mild or moderate). No AE resulted in discontinuation of treatment. CONCLUSIONS Trial treatment was well tolerated with only a few and minor AEs reported, confirming the markedly good safety of KPC. A significant improvement of neurasthenia was seen for the total study population at the end of the treatment period. Superiority of KPC vs. placebo could not be demonstrated with the pre-specified analysis with regards to a sum score of 12 typical symptoms, perceived stress, or general health status. However, the explorative post-hoc analysis revealed that KPC is superior to placebo in the characteristic symptoms irritability and nervousness. KPC could therefore be a beneficial treatment option for symptomatic relief of neurasthenia.
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von Schoen-Angerer T, Manchanda RK, Lloyd I, Wardle J, Szöke J, Benevides I, Martinez NSA, Tolo F, Nicolai T, Skaling-Klopstock C, Parker T, Suswardany DL, van Haselen R, Liu J. Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO's current and future strategy. BMJ Glob Health 2023; 8:e013150. [PMID: 38050407 PMCID: PMC10693890 DOI: 10.1136/bmjgh-2023-013150] [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: 06/15/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023] Open
Abstract
As the 'WHO Traditional Medicine Strategy: 2014-2023' is entering its final phase, reflection is warranted on progress and the focus for a new strategy. We used WHO documentation to analyse progress across the objectives of the current strategy, adding the role of traditional, complementary and integrative healthcare (TCIH) to address specific diseases as a dimension absent in the current strategy. Our analysis concludes on five areas. First, TCIH research is increasing but is not commensurate with TCIH use. TCIH research needs prioritisation and increased funding in national research policies and programmes. Second, WHO guidance for training and practice provides useful minimum standards but regulation of TCIH practitioners also need to reflect the different nature of formal and informal practices. Third, there has been progress in the regulation of herbal medicines but TCIH products of other origin still need addressing. A risk-based regulatory approach for the full-range of TCIH products seems appropriate and WHO should provide guidance in this regard. Fourth, the potential of TCIH to help address specific diseases is often overlooked. The development of disease strategies would benefit from considering the evidence and inclusion of TCIH practices, as appropriate. Fifth, inclusion of TCIH in national health policies differs between countries, with some integrating TCIH practices and others seeking to restrict them. We encourage a positive framework in all countries that enshrines the role of TCIH in the achievement of universal health coverage. Finally, we encourage seeking the input of stakeholders in the development of the new WHO Traditional Medicine Strategy.
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Affiliation(s)
- Tido von Schoen-Angerer
- International Federation of Anthroposophic Medical Associations, Brussels, Belgium
- Division of General Pediatrics, Geneva University Hospitals, Geneve, Switzerland
| | - Raj Kumar Manchanda
- Health and Family Welfare Department, Government of Delhi, Directorate of Ayush, Delhi, India
| | - Iva Lloyd
- World Naturopathic Federation, Toronto, Ontario, Canada
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Janka Szöke
- International Federation of Anthroposophic Medical Associations, Brussels, Belgium
| | - Iracema Benevides
- RedePICS Brasil, Brazilian Network of Integrative and Complementary Practices in Healthcare, Belo Horizonte, Brazil
| | | | - Festus Tolo
- Keny Medical Research Institute, Nairobi, Kenya
| | | | | | - Tabatha Parker
- Academy of Integrated Health and Medicine, La Jolla, California, USA
| | - Dwi Linna Suswardany
- Indonesian Public Health Association, Jakarta, Indonesia
- Department of Public Health, University of Muhammadiyah Surakarta, Jakarta, Indonesia
| | | | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Herzig van Wees S, Abunnaja K, Mounier-Jack S. Understanding and explaining the link between anthroposophy and vaccine hesitancy: a systematic review. BMC Public Health 2023; 23:2238. [PMID: 37957574 PMCID: PMC10644591 DOI: 10.1186/s12889-023-17081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Due to low vaccination uptake and measles outbreaks across Europe, public health authorities have paid increasing attention to anthroposophic communities. Public media outlets have further described these communities as vaccine refusers or "anti-vaxxers". The aim of this review was to understand the scope of the problem and explore assumptions about vaccination beliefs in anthroposophic communities. For the purpose of this review, we define anthroposophic communities as people following some/certain views more or less loosely connected to the philosophies of anthroposophy. The systematic review addresses three research questions and (1) collates evidence documenting outbreaks linked to anthroposophic communities, (2) literature on vaccination coverage in anthroposophic communities, and (3) lastly describes literature that summarizes theories and factors influencing vaccine decision-making in anthroposophic communities. METHODS This is a systematic review using the following databases: Medline, Web of Science, Psycinfo, and CINAHL. Double-blinded article screening was conducted by two researchers. Data was summarized to address the research questions. For the qualitative research question the data was analysed using thematic analysis with the assistance of Nvivo12.0. RESULTS There were 12 articles documenting 18 measles outbreaks linked to anthroposophic communities between the years 2000 and 2012. Seven articles describe lower vaccination uptake in anthroposophic communities than in other communities, although one article describes that vaccination coverage in low-income communities with a migrant background was lower than in the anthroposophic community they studied. We found eight articles examining factors and theories influencing vaccine decision making in anthroposophic communities. The qualitative analysis revealed four common themes. Firstly, there was a very broad spectrum of vaccine beliefs among the anthroposophic communities. Secondly, there was a consistent narrative about problems or concerns with vaccines, including toxicity and lack of trust in the system. Thirdly, there was a strong notion of the importance of making individual and well-informed choices as opposed to simply following the masses. Lastly, making vaccine choices different from public health guidelines was highly stigmatized by those outside of the anthroposophic community but also those within the community. CONCLUSION Continuing to further knowledge of vaccine beliefs in anthroposophic communities is particularly important in view of increasing measles rates and potential sudden reliance on vaccines for emerging diseases. However, popular assumptions about vaccine beliefs in anthroposophic communities are challenged by the data presented in this systematic review.
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Affiliation(s)
| | - Khadija Abunnaja
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical, London, UK
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Ploesser M, Martin D. The Effects of Anthroposophic Medicine in Chronic Pain Conditions: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:705-717. [PMID: 37358805 PMCID: PMC10663697 DOI: 10.1089/jicm.2022.0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Background: The currently available evidence is unclear in regard to pain-related outcomes of patients with chronic pain conditions who undergo treatment with anthroposophic medicine (AM). Aim: To identify and synthesize the evidence in patients with chronic pain before and after AM therapy. Methods: The following databases and search interfaces were searched on October 21, 2021: Embase (via Embase.com), Medline (via PubMed), and the Cochrane Library. Additional references were identified via bibliographies of included studies. In at least one experimental arm that used anthroposophic therapy to treat chronic pain, AM treatments were required to be documented. Included studies reported on pain severity and physical and emotional functioning. Two authors independently assessed the studies for inclusion criteria, extracted the data, and conducted the quality evaluation of the included studies based on the critical appraisal tools provided by the Joanna Briggs Institute. Results: Seven studies (eight publications) were included in the review, of which were three randomized controlled trials (RCTs), two non-RCTs, and two pretest-post-test studies. A total number of 600 patients participated in the identified experimental studies, of whom all were adults. Three studies included patients with low back pain, one study each assessed patients with fibromyalgia, migraine, dysmenorrhea, and postpolio syndrome, respectively. The identified clinical studies reported considerable reductions in symptoms and effect sizes of pain outcomes after AM therapies being predominantly large, with no notable adverse effects. Conclusion: The findings of this systematic review of studies assessing AM therapies in patients with chronic pain problems revealed that there is a scarcity of evidence currently available, with unclear effects of AM treatments in reducing pain intensity and improving quality of life in the evaluated health conditions. Although most of the studies revealed a favorable benefit on one or more pain-related outcomes, the variability of the research did not allow for generalization across different studies, health conditions, and populations.
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Affiliation(s)
- Markus Ploesser
- Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Herdecke, Germany
| | - David Martin
- Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Herdecke, Germany
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Mehl A, von Laue B, Trapp B, Gerlach K, Reif M, Pretzer K, Zerm R, Berger B, Gutenbrunner C, Kröz M. The Anthroposophic Artistic Movement Assessment for Eurythmy Therapy (AART-ASSESS-EuMove). A validation study. Complement Ther Med 2023; 76:102957. [PMID: 37286140 DOI: 10.1016/j.ctim.2023.102957] [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: 03/22/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE Eurythmy Therapy (ET) is a mindfulness oriented therapy developed in the context of anthroposophic medicine. Despite commonly used in practice, it remains unclear whether active participation (Inner Correspondence) during ET can be observed in eurythmy gestures (EGest). So far, no validated peer-report instrument to evaluate EGest exists. METHOD To validate an 83-item ET peer-report scale, a nested study on a sample of n = 82 breast cancer survivors with cancer-related fatigue was conducted. EGest were evaluated twice, at baseline and at 10-week follow-up, by peer-reports from two separate therapists. Interrater-reliability (IRR) was estimated by Cohen's weighted kappa (κw) across all items. Additionally, reliability-(RA) and principal component analyses (PCA) were conducted. Patients completed two self-report scales: Satisfaction with ET (SET) and Inner Correspondence with the Movement Therapy (ICPH). RESULTS IRR was greater than or equal (κw ≥ 0.25) for 41 items (49.3%) with a mean weighted kappa of κ̅w = 0.40 (SD = 0.17, range = 0.25-0.85). RA resulted in the exclusion of 25 items with insufficient item-total correlations < 0.40. A PCA with 16 items revealed 3 subscales: 1. Mindfulness in Movement (8 items), 2. Motor Skills (5 items), 3. Walking Pattern (3items) explaining 63.86% of total variance. Internal consistency (Cronbach's alpha) was high for the sum score with α = 0.89 and for the subscales with α = 0.88, 0.86 and 0.84 respectively. Significant small to moderate subscale correlations were found ranging from r = 0.29-0.63 (all p < 0.01). Mindfulness in Movement correlated with Inner Correspondence (r = 0.32) and with Satisfaction with ET (r = - 0.25, both p < 0.05). CONCLUSIONS The new AART-ASSESS-EuMove is the first consistent and reliable peer-report instrument to evaluate EGest. It shows associations between peer-reported Mindful Movement and patients' self-reported ICPH and SET.
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Affiliation(s)
- A Mehl
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany.
| | - B von Laue
- AnthroMed Öschelbronn - Centre for Integrative Medicine, 75233 Niefern-Öschelbronn, Germany
| | - B Trapp
- Praxis Frauenheilkunde - Lebenswunder, Berlin-Havelhöhe, 14089 Berlin, Germany
| | - K Gerlach
- Institute for Eurythmy Therapy, Research Institute of Arts Therapy, Alanus Hochschule, Villestraße 3, 53347 Alfter, Germany
| | - M Reif
- Society for Clinical Research, Hardenbergstraße 20, 10623 Berlin, Germany
| | - K Pretzer
- Raumzeitwerker, Practice for Eurythmy Therapy, 10967 Berlin, Germany
| | - R Zerm
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany
| | - B Berger
- Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313 Herdecke, Germany
| | - C Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - M Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089 Berlin, Germany; Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313 Herdecke, Germany; Hospital Arlesheim, Research Department, Pfeffinger Weg 1, 4144 Arlesheim, Switzerland
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Nicoletti M. The Antioxidant Activity of Mistletoes ( Viscum album and Other Species). PLANTS (BASEL, SWITZERLAND) 2023; 12:2707. [PMID: 37514321 PMCID: PMC10384781 DOI: 10.3390/plants12142707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
In addition to the European mistletoe, Viscum album, which is the most known and utilized one, there are several species commonly known as mistletoe. They are spread in various regions of the planet and are all characterized by hemiparasitism and epiphytic behaviour. The published studies evidence other similarities, including the sharing of important biological properties, with the common presence of antioxidant effects. However, whereas the European mistletoe is largely utilized in medical treatments, although with controversial aspects, the scientific knowledge and medical uses of other mistletoes are still insufficient. This review focuses on the controversial medical story of European mistletoe regarding its antioxidant activity and the potentiality of the other species named mistletoe pertaining to botanical families and genera different from Viscum.
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Affiliation(s)
- Marcello Nicoletti
- Department of Environmental Biology, Foundation in Unam Sapientiam, Sapienza University of Rome, 00185 Rome, Italy
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Castro-Sánchez E. Nursing care towards the global challenges of the climate crisis: If not now, when? ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:247-250. [PMID: 37392998 DOI: 10.1016/j.enfcle.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/28/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Enrique Castro-Sánchez
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom; Imperial College London, NIHR Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance, London, United Kingdom; Global health and Sustainable Human Development Research Group, University of the Balearic Islands, Palma de Mallorca, Spain.
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Voss SS, Nørgaard SK, Valentiner-Branth P. Identification of subgroups in the Danish population for targeted human papillomavirus vaccination efforts. Vaccine 2023; 41:3525-3533. [PMID: 37142460 DOI: 10.1016/j.vaccine.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND In the Danish childhood vaccination program, the human papillomavirus (HPV) vaccination coverage is lower than for other vaccines. To tailor a targeted HPV vaccination effort, we aimed to identify girls in Denmark with lower first dose HPV vaccination coverage than girls in general. METHODS A population-based retrospective cohort study was performed of girls born in 2001-2004, residing in Denmark in September 2019 (N = 128,351). Data from the Danish Vaccination Register was linked to sociodemographic data from the Danish Civil Registration System and Statistics Denmark. Cox's proportional hazard regression models were used to compare vaccination uptake rates between subgroups of girls. RESULTS HPV vaccination coverage at 14 years of age varied widely by municipality (53.4-80.6%). Girls living with neither of their parents had a lower chance of being vaccinated compared to girls living with both their parents (HR 0.43; 95% CI 0.41-0.46), likewise for girls attending special need education compared with girls attending public schools (HR 0.50; 95% CI 0.42-0.59). The vaccination uptake among immigrants was lower compared to Danish-born girls (HR 0.51; 95% CI 0.49-0.54), especially among immigrant girls whose parents had not passed any Danish exams. Finally, girls who were DTaP-IPV revaccinated had a 50% greater chance of being HPV vaccinated compared to girls who were not (HR 1.61; 95% CI 1.58-1.64). CONCLUSION To increase the HPV vaccination uptake, we recommend vaccination efforts targeting girls living without any of their parents, girls attending special need education, immigrants, and girls who are not DTaP-IPV revaccinated. When targeting immigrants, the effort should focus on disseminating sufficient and understandable information about the Danish childhood vaccination program to the parents.
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Affiliation(s)
- Sidsel Skou Voss
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Sarah Kristine Nørgaard
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Palle Valentiner-Branth
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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Nicoletti M. The Anti-Inflammatory Activity of Viscum album. PLANTS (BASEL, SWITZERLAND) 2023; 12:1460. [PMID: 37050086 PMCID: PMC10096603 DOI: 10.3390/plants12071460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
The therapeutic story of European mistletoe (Viscum album L.) presents a seesawing profile. In ancient times, this hemiparasitic plant was considered a panacea and even to be endowed with exceptional beneficial properties. In more recent times, despite its multiple uses in traditional medicines, some parts of the plant, in particular the berries, were considered poisonous and dangerous, including concerns of cytotoxicity, which spread serious suspicion on its medicinal utility. However, since the last century, medical interest in mistletoe has come back in force due to its utilization in clinical cancer treatments, based on its selective action on tumor cells. In Central Europe, the hydro-alcoholic extracts of European mistletoe register a relevant and continuous utilization in anthroposophic medicine, which is a holistic system that includes the utilization of phytomedicinal substances. In Switzerland and Germany, most physicians and patients use these products as complementary therapy in oncological treatments. However, despite its increasing use in this field, the results of mistletoe's use are not always convincing, and other aspects have appeared. Nowadays, products that contain mistletoe are utilized in several fields, including diet, phytotherapy, veterinary medicine and homeopathy, but in particular in cancer therapies as coadjuvant factors, in consideration of several positive effects including effects in the improvement of quality-of-life conditions and reinforcement of the immune system. In this review, based on the understanding of the association between cancer and inflammation, we propose a relationship between these recent uses of mistletoe, based on its antioxidant properties, which are supported by phytochemical and pharmacological data. The unicity of mistletoe metabolism, which is a direct consequence of its hemiparasitism, is utilized as a key interpretation element to explain its biological properties and steer its consequent therapeutic uses.
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Affiliation(s)
- Marcello Nicoletti
- Department of Environmental Biology, Sapienza University of Rome, 00185 Rome, Italy
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15
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Assessing Effects of Mandala Painting on Anxiety of 9–14-Year-Old Children with Cancer. ADVANCES IN INTEGRATIVE MEDICINE 2023. [DOI: 10.1016/j.aimed.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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16
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Mascher A, Pelzer F, Duncan LJ, Martin DD, Baumgartner S, Berger B. The Introspective Patient Experience of Mistletoe Therapy in Cancer: A Qualitative Study. Integr Cancer Ther 2023; 22:15347354231198474. [PMID: 37731253 PMCID: PMC10515602 DOI: 10.1177/15347354231198474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The introspective experience of cancer patients using mistletoe therapy has received little scientific interest, although it is crucial for a holistic understanding of this therapy. This study contributes to patient-centered research and treatment by documenting the subjective experiences of individuals undergoing mistletoe therapy. METHODS In this qualitative, explorative study, 20 outpatients with a history of various cancer types were recruited from Arlesheim Hospital (Arlesheim, Switzerland). All patients received subcutaneous mistletoe therapy for at least 2 years (median 7.5 years). Data was collected through 2 semi-structured, in-depth interviews per patient. Qualitative content analysis was applied to examine the data. The individual experience of mistletoe therapy was analyzed in relation to 6 predefined levels of human experience: physical, vital, emotional, mental, spiritual and social. In addition, 3 further aspects, considered as cross-dimensional perspectives, emerged out of the material: warmth, immune strengthening, and general wellbeing. RESULTS Data analysis revealed considerable heterogeneity among patients' experiences with mistletoe therapy. The importance of specific aspects became apparent, such as increased vitality to manage daily life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, heightened self-awareness and improved self-care, as well as sensations of spiritual connectedness. CONCLUSIONS Prior to this study it had not been shown that cancer patients using mistletoe therapy do have observations on different levels of experience. These results may lead to a deeper understanding of patients receiving mistletoe therapy, enabling them to be supported in a more holistic way both during mistletoe treatment and on their life path. Further investigations into the effects of mistletoe therapy on the emotional, mental, and spiritual level are warranted.
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Affiliation(s)
- Annika Mascher
- Witten/Herdecke University, Witten, Germany
- Society for Cancer Research, Arlesheim, Switzerland
- Klinik Arlesheim, Arlesheim, Switzerland
| | - Florian Pelzer
- Witten/Herdecke University, Witten, Germany
- Society for Cancer Research, Arlesheim, Switzerland
| | | | | | - Stephan Baumgartner
- Witten/Herdecke University, Witten, Germany
- Society for Cancer Research, Arlesheim, Switzerland
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Mühlenpfordt I, Blakeslee SB, Everding J, Cramer H, Seifert G, Stritter W. Touching body, soul, and spirit? Understanding external applications from integrative medicine: A mixed methods systematic review. Front Med (Lausanne) 2022; 9:960960. [PMID: 36619637 PMCID: PMC9813495 DOI: 10.3389/fmed.2022.960960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction External applications from anthroposophic medicine (EAAM) are touch-based applications such as rhythmical massages, embrocations, and compresses that serve as components of complementary treatment concepts for various diseases. The aim of this review is to gain an understanding of typical indications and outcomes and to systematically assess the effectiveness and safety of EAAM. Materials and methods Medline/PubMed, CINAHL, the Cochrane Library, Embase, and PsycINFO were searched through May 2021 and supplemented by searches in specialized databases and personal requests to experts in the field. Studies and case reports on EAAM in patients, as well as healthy individuals, were included in the qualitative synthesis. Outcome parameters depending on each study were grouped as effect themes and assigned to study clusters using Thematic Analysis for a thematic overview of effect patterns. Results Four RCTs, 7 cohort studies, 1 mixed-methods, 1 retrospective, 4 qualitative studies, 3 case series, and 25 case reports on EAAM were identified. The analysis indicated various effects of EAAM on physiological as well as psychological health indicators and patterns of effect development. Study quality was found to be high for only 2 studies, and moderate for 1 study, and all remaining 45 studies showed a moderate or high risk of bias or were not ratable with used rating tools. Conclusion The included studies present a wide range of potential indications for EAAM, while showing methodological drawbacks. To determine whether EAAM can be considered an effective treatment option, clinical studies exploring the effect of different EAAM modalities on defined patient groups are recommended for the future. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214030], identifier [CRD42020214030].
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Affiliation(s)
- Inga Mühlenpfordt
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany,*Correspondence: Inga Mühlenpfordt,
| | - Sarah B. Blakeslee
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Janina Everding
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany,Bosch Health Campus, Stuttgart, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany,Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Hinse M, Thronicke A, Berghöfer A, Matthes H. New multimodal intervention to reduce irritable bowel syndrome (IBS) severity symptoms-Pilot study with a 12 month follow-up. PLoS One 2022; 17:e0277880. [PMID: 36409730 PMCID: PMC9678296 DOI: 10.1371/journal.pone.0277880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is characterized by patients' high level of suffering. Up to 60% of patients with IBS have symptoms of anxiety or depression and only little attention has been paid to their specific requirements. Anthroposophical multimodal therapy (AMT) has been shown to significantly improve health-related quality of life of patients with high symptomatic burden. OBJECTIVE The aim of this pilot study was to find out whether AMT meets the needs of IBS patients and the interactions of AMT with IBS, depression and anxiety. METHODS Patients with diagnosed IBS were included in a feasibility study and received 12 sessions of AMT over 8 weeks (drks.de, DRKS00016890). The primary endpoint was the change of the IBS severity score (IBS-SSS) and changes were calculated by linear mixed effects analyses. The secondary endpoints were changes of self-reported PHQ-9 and GAD-7 for mental comorbidity as well as self-valued effectiveness and satisfaction of AMT. RESULTS Thirty-six patients, 89% female, were included in the study. AMT was successfully applied to IBS patients (-45 points in the IBS-SSS, p < .05). AMT had a large positive effect (-84 points in IBS-SSS, p < .003) on patients without anxiety or depression. Over time, patients with higher anxiety scores worsened with regard to their IBS compared to patients with depression and without mental comorbidity. The AMT effect was maintained at a 12 month follow up and both mentally affected and unaffected patients, had even lower IBS severity than shortly after AMT. AMT modules were rated by IBS patients as very effective. CONCLUSION Our findings suggest that an 8-week program of AMT improves the severity of IBS with an ongoing effect at a 12 month follow-up. Especially for patients without psychological comorbidities, AMT is very successful. Future IBS therapies should incorporate a modified multimodal concept with stronger psychological therapy modules in parallel for patients with depression and anxiety.
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Affiliation(s)
- Maximilian Hinse
- Institute of Social Medicine, Epidemiology and Health Economy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Thronicke
- Institute of Social Medicine, Epidemiology and Health Economy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Harald Matthes
- Institute of Social Medicine, Epidemiology and Health Economy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Do Chest Compresses with Mustard or Ginger Affect Warmth Regulation in Healthy Adults? A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5034572. [PMID: 35899230 PMCID: PMC9313983 DOI: 10.1155/2022/5034572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Background Chest compresses with mustard (MU) or ginger (GI) are a complementary treatment option for respiratory tract infections. However, little is known about their specific thermogenic qualities. This study examines the short-term effects of MU, GI, and chest compresses with warm water only (WA) on measurable and self-perceived body warmth in healthy adults. Methods This was a single-center, randomized controlled trial with cross-over design (WA versus MU versus GI). 18 participants (23.7 ± 3.4 years; 66.7% female) received MU, GI, and WA in a random order on three different days with a mean washout period of 13.9 days. Chest compresses were applied to the thoracic back for a maximum of 20 minutes. The primary outcome measure was skin temperature of the posterior trunk (measured by infrared thermography) immediately following removal of the compresses (t1). Secondary outcome measures included skin temperature of the posterior trunk 10 minutes later (t2) and several parameters of self-perceived warmth at t1 and t2 (assessed with the Herdecke Warmth Perception Questionnaire). Results Skin temperature of the posterior trunk was significantly higher with MU compared to WA and GI at t1 (p < 0.001 for both, primary outcome measure) and t2 (WA versus MU: p=0.04, MU versus GI: p < 0.01). Self-perceived warmth of the posterior trunk was higher with MU and GI compared to WA at t1 (1.40 ≥ d ≥ 1.79) and remained higher with GI at t2 (WA versus GI: d = 0.74). The overall warmth perception increased significantly with GI (d = 0.69), tended to increase with MU (d = 0.54), and did not change with WA (d = 0.36) between t0 and t1. Conclusions Different effects on warmth regulation were observed when ginger and mustard were applied as chest compresses. Both substances induced self-perceived warming of the posterior trunk, but measurable skin temperature increased only with MU. Further research is needed to examine the duration of these thermogenic effects and how chest compresses with ginger or mustard might be incorporated into practice to influence clinical outcomes in respiratory tract infections.
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Schnell-Inderst P, Steigenberger C, Mertz M, Otto I, Flatscher-Thöni M, Siebert U. Additional treatment with mistletoe extracts for patients with breast cancer compared to conventional cancer therapy alone - efficacy and safety, costs and cost-effectiveness, patients and social aspects, and ethical assessment. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc10. [PMID: 36160875 PMCID: PMC9487779 DOI: 10.3205/000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 11/07/2022]
Abstract
Background Chemotherapy is often used in the treatment of breast cancer in women. Side effects such as diarrhea, fatigue, hair loss, fever or disturbances in blood formation impair the women's quality of life. An essential treatment goal of the accompanying mistletoe therapy (MT) used in complementary medicine is to improve the health-related quality of life during cancer therapy. Aim and methods The HTA report on which this article is based examines the medical efficacy and safety, costs and cost-effectiveness, patient and social aspects, and ethical aspects of MT in women with breast cancer. Systematic reviews were conducted for this purpose. The search period of the literature search ranged from 2004 to October 2020. Results A total of 2 evidence-based medical guidelines, 3 randomized trials assessing efficacy and 1 additional non-randomized intervention trial, as well as 3 observational studies assessing safety, a cost analysis, 12 cross-sectional studies on patient aspects and 17 articles on ethical evaluation were included. Improvements in health-related quality of life compared to the control group were small to moderate. Due to the high risk of bias in the studies, it is possible that the difference is not caused by MT. One study with a small sample size showed no effect on progression-free survival after 5 years. Studies on the effect of MT on overall survival are lacking. In seven studies, local skin reactions of low and moderate severity were reported in a median of 25% (range 5 to 94%) of patients, and mild to moderate systemic reactions in a median of 2% (range 0 to 8%) of patients. A comparative cost analysis from Germany reported significantly lower medical costs within 5 years after surgery for patients with MT than for patients without MT, but the underlying observational study did not control for systematic bias. With regard to patient aspects, the frequency of use and the reasons for use from the patient's or practitioner's point of view were mainly investigated. A median of 25% (range 7 to 46%) of patients with breast cancer and 29% (range 29 to 79%) of treatment providers use MT. The main motivations of patients for use were to reduce side effects, strengthen the immune system and take an active role in the treatment process. Patients felt insufficiently advised. Studies on other aspects are lacking. The ethical evaluation was able to identify 6 overarching themes; the central challenge is the insufficient evidence on efficacy and safety.
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Affiliation(s)
- Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Caroline Steigenberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Marcel Mertz
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Ilvie Otto
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Magdalena Flatscher-Thöni
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA
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21
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Seifert G, Blakeslee SB, Calaminus G, Kandil FI, Barth A, Bernig T, Classen CF, Corbacioglu S, Föll J, Gottschling S, Gruhn B, Vom Hoff-Heise C, Lode HN, Martin D, Nathrath M, Neunhoeffer F, Pekrun A, Wulff B, Zuzak T, Henze G, Längler A. Integrative medicine during the intensive phase of chemotherapy in pediatric oncology in Germany: a randomized controlled trial with 5-year follow up. BMC Cancer 2022; 22:652. [PMID: 35698215 PMCID: PMC9195372 DOI: 10.1186/s12885-022-09703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background Integrative medicine is used frequently alongside chemotherapy treatment in pediatric oncology, but little is known about the influence on toxicity. This German, multi-center, open-label, randomized controlled trial assessed the effects of complementary treatments on toxicity related to intensive-phase chemotherapy treatment in children aged 1–18 with the primary outcome of the toxicity sum score. Secondary outcomes were chemotherapy-related toxicity, overall and event-free survival after 5 years in study patients. Methods Intervention and control were given standard chemotherapy according to malignancy & tumor type. The intervention arm was provided with anthroposophic supportive treatment (AST); given as anthroposophic base medication (AMP), as a base medication for all patients and additional on-demand treatment tailored to the intervention malignancy groups. The control was given no AMP. The toxicity sum score (TSS) was assessed using NCI-CTC scales. Results Data of 288 patients could be analyzed. Analysis did not reveal any statistically significant differences between the AST and the control group for the primary endpoint or the toxicity measures (secondary endpoints). Furthermore, groups did not differ significantly in the five-year overall and event-free survival follow up. Discussion In this trial findings showed that AST was able to be safely administered in a clinical setting, although no beneficial effects of AST between group toxicity scores, overall or event-free survival were shown. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09703-0.
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Affiliation(s)
- Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sarah B Blakeslee
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Düsseldorf, Germany.,Department of Pediatric Hematology and Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Farid I Kandil
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Barth
- Institute of Applied Analysis and Numerical Simulation, Research Group for Computational Methods for Uncertainty Quantification, University of Stuttgart, Stuttgart, Germany
| | - Toralf Bernig
- Department of Pediatrics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Carl Friedrich Classen
- Division of Pediatric Oncology, Hematology and Palliative Medicine Section, Department of Pediatrics and Adolescent Medicine, University Medicine Rostock, Rostock, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital Regensburg, Regensburg, Germany
| | - Jürgen Föll
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital Regensburg, Regensburg, Germany
| | - Sven Gottschling
- Center for Palliative Care and Pediatric Pain Medicine, Saarland University Medical Center, Homburg, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Claudia Vom Hoff-Heise
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine, Greifswald, Germany
| | - David Martin
- Department of Hematology Oncology, University Children's Hospital, Tübingen, Germany.,Department of Human Medicine, Faculty of Health, University Witten/Herdecke, Herdecke, Germany
| | - Michaela Nathrath
- Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.,Pediatric Oncology Center, Department of Pediatrics, Technische Universität München, Munich, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Arnulf Pekrun
- Department of Pediatric Hematology and Oncology, Hospital Bremen-Mitte, Bremen, Germany
| | - Beate Wulff
- Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Tycho Zuzak
- Department of Pediatric Hematology-Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany.,Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Günter Henze
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alfred Längler
- Department of Integrative Pediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.,Centre for Integrative Medicine, University of Witten/Herdecke, Witten, Germany
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Baars EW, Kienle GS, Heusser P, Pedersen PA, van Wietmarschen HA, Kiene H, von Schoen-Angerer T, Hamre HJ. Anthroposophic Medicinal Products: A Literature Review of Features, Similarities and Differences to Conventional Medicinal Products, Scientific and Regulatory Assessment. Glob Adv Health Med 2022; 11:21649561211073079. [PMID: 35281956 PMCID: PMC8915225 DOI: 10.1177/21649561211073079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regulatory assessment of anthroposophic medicinal products (AMPs) can be challenging due to their specific features. Objective The aim of this paper is therefore to provide adequate scientific information on AMPs for regulatory purposes. Methods A literature review was executed with database searches in PubMed, Cinahl, Merkurstab, Anthromedics, and https://iaap-pharma.org/. Search terms were: anthroposophic medicinal products, anthroposophic medicines, anthroposophic pharmacy. There was no language restriction; searches were executed from onset until June 11, 2020. In addition, experts were invited to suggest relevant literature. Results Eighty-seven of 660 identified publications were included. The system of anthroposophic medicine (AM) with its conceptual background and various aspects of AMPs was described: definition, pharmaceutical properties, an example of AMP development, use in clinical practice, similarities with and differences to conventional medicinal products, societal aspects, scientific and regulatory assessment. Conclusion AMPs are part of the integrative whole medical system of AM. AMPs are manufactured according to Good Manufacturing Practice and national drug regulations and have an excellent safety status; the limited available evidence suggests clinical benefits. Current drug regulation of AMPs in the EU and most European countries does not take the special properties of AMPs into account. Future research should focus on appropriate methodologies for the evaluation of effects of AMPs as part of the AM whole medical system, the scientific quality of its non-atomistic holistic ontological position, and the integration of AM and conventional medicine in clinical practice. Future policies should focus on appropriate ways of addressing regulatory challenges to AMPs.
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Affiliation(s)
- Erik W Baars
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands.,Faculty of Healthcare, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Gunver S Kienle
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Faculty of Medicine, Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Heusser
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Peter A Pedersen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Independent Pharmaceutical Consultant, Søborg, Denmark
| | - Herman A van Wietmarschen
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | | | - Harald J Hamre
- ESCAMP, European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Freiburg, Germany.,Faculty of Health, Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
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Chen Q, Wright F, Duncan L, Huntley A. Profiling mistletoe therapy research and identifying evidence gaps: A systematic review of conditions treated, mode of application and outcomes. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Oei SL, Rieser T, Becker S, Groß J, Matthes H, Schad F, Thronicke A. TANGO: effect of tango Argentino on cancer-associated fatigue in breast cancer patients-study protocol for a randomized controlled trial. Trials 2021; 22:866. [PMID: 34857031 PMCID: PMC8637025 DOI: 10.1186/s13063-021-05869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The majority of breast cancer patients suffer from persistent impairments after completion of their primary oncological therapy. Cancer-related fatigue (CRF) in particular is a multidimensional syndrome having a profound negative impact on the quality of life. To counter CRF symptoms, physical activities are suggested as first-line interventions, mind-body therapies have been shown to be effective, and music therapy can also reduce anxiety and stress in breast cancer patients. Tango therapy that combines various elements can have an impact on physical, psychological, and cognitive abilities and could therefore have a beneficial effect on breast cancer patients. The purpose of this study is to investigate whether a 6-week tango module is suited as a therapeutic approach for people after primary breast cancer therapy to favorably influence their quality of life, especially CRF levels. METHODS Sixty patients with a diagnosis for stage I-III breast cancer 12-48 months before enrollment and with CRF (age > 18) will be recruited and randomized 1:1 to a tango or a waiting-list group. Movement concepts using elements of Argentine tango (self-awareness, musical and spatial perception, self-perception, playfulness, shared experience) will be examined with the participants during six consecutive weekly 1-h tango sessions. The primary outcome will be the improvement of CRF (German version of the Cancer Fatigue Scale), and the secondary outcomes will be the improvement in sleep quality (Pittsburgh Sleep Quality Index) and quality of life (EORTC-QLQ-C30). Patient-reported outcomes will be measured at baseline and 6 weeks later; follow-up will be performed 6, 12, and 24 months after baseline. An evaluation will be performed by means of descriptive data analyses. DISCUSSION Argentine tango, as a music-based movement therapy, can influence different skills and may improve several outcomes. The therapeutic use of Argentine tango in the care of breast cancer patients has not yet been reported. It is anticipated that participants receiving the tango module will have improved CRF, sleep, and quality of life scores compared to a waitlist control. TRIAL REGISTRATION German Clinical Trials Registry (DRKS) DRKS00021601 . Retrospectively registered on 21 August 2020.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Thomas Rieser
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sarah Becker
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Jessica Groß
- Breast Cancer Centre, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
- Institute for Gastroenterology, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Anja Thronicke
- Research Institute Havelhöhe at the Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany.
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Michaelis R, Schiepek G, Heinen GM, Edelhäuser F, Viol K. Process-oriented and personalized psychotherapeutic care for epilepsy: Interim results of a feasibility study. Epilepsy Behav 2021; 124:108313. [PMID: 34560360 DOI: 10.1016/j.yebeh.2021.108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes. METHODS This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models. RESULTS Twenty patients [15 women/5 men, median age 48 years (range: 23-73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6-22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma. CONCLUSION The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.
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Affiliation(s)
- Rosa Michaelis
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
| | - Günter Schiepek
- Faculty of Psychology and Educational Sciences, Ludwig-Maximilians-University Munich, Germany; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | | | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Kathrin Viol
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
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High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study. Epilepsy Behav 2021; 122:108119. [PMID: 34139618 DOI: 10.1016/j.yebeh.2021.108119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients' compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. METHODS A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system's model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients' replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. RESULTS Twenty patients [15 women/5 men, median age 48 years (range 23-73 years)] were recruited. Compliance rates were high (median: 93%, range 31-100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. CONCLUSION The results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.
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Weinzirl J, Garnitschnig L, Scheffers T, Andrae L, Heusser P. Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review. Digestion 2021; 102:326-334. [PMID: 32408299 DOI: 10.1159/000507346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Before the discovery of immunological and haematological functions of the spleen, it had for centuries been considered to be a digestive organ of variable size with a role in the portal vein system and nutritional metabolism. In the 19th and 20th centuries, volume changes in the spleen related to nutrition were studied using plethysmographic measurements. Rhythmical and regulatory functions of the spleen were demonstrated in the haemodynamics of the splanchnic region and were described as a "hepatolienal pendulum," a "Windkessel function," or a "pressure compensation." These studies were mainly published in German-speaking countries and have not, as far as is known, been discussed in the English-speaking world so far. SUMMARY This review explores the historical development of the rhythmical regulatory function of the spleen in the splanchnic region. Older studies and results are followed up in the modern literature, wherever possible, up to the present. The clinical relevance is illustrated with portal hypertension (with congestive or hyperdynamic splenomegaly), coeliac disease, and chronic inflammatory bowel diseases (with functional hyposplenism). Key Message: The spleen's rhythmical regulatory function in nutrition is based on an autonomous rhythm comprising cycles of contractions and dilations of the spleen of around 1 min. These cycles can be influenced by sympathetically mediated single contractions with a release of pooled blood or by portal vein congestion. After food ingestion, the spleen responds either with contraction according to a vasomotor reaction or postprandial congestion with significant increases in volume. The spleen's rhythmical function is lost in the clinical picture of portal hypertension or in coeliac disease and chronic inflammatory bowel diseases. In the aforementioned gastrointestinal diseases, we recommend taking more account of the haemodynamics between the spleen, liver, and intestine. New innovative techniques for recording splenograms are required which, besides elastographic measurements of spleen stiffness, could offer an important tool for early detection, diagnosis, and therapeutic evaluation.
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Affiliation(s)
- Johannes Weinzirl
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany,
| | - Lydia Garnitschnig
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Tom Scheffers
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Lukas Andrae
- Department of Internal Medicine, Community Hospital Herdecke, Herdecke, Germany
| | - Peter Heusser
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
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Vagedes J, Kleih T, Belizer C, Svaldi J, Hautzinger M, von Schoen-Angerer T. Sense of coherence in long-term follow-up of adolescents with anorexia nervosa. Nord J Psychiatry 2021; 75:415-419. [PMID: 33559511 DOI: 10.1080/08039488.2021.1877814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sense of coherence (SOC) is a personal resource that allows people to stay healthy in spite of stressful situations. SOC is known to be low in eating disorders. We explored whether SOC correlated with anorexia nervosa (AN) symptoms several years after initial hospitalization for AN, to inform us whether AN treatment concepts could more specifically focus on increasing SOC. METHODS Former patients were contacted 5-11 years after hospitalization for AN in a German integrative medicine hospital. Participants completed the Eating Disorder Inventory (EDI-2) and the SOC Questionnaire (SOC-13). Hospital records were reviewed. Correlations between EDI-2 subscales and SOC-13 were tested. A t-test was conducted to assess the difference between the SOC-13 and the norm. A median split was performed, dividing SOC scores into two groups and comparing these with EDI-2 subscales. RESULTS Of 149 previously hospitalized female patients, 83 could be contacted and 68 agreed to participate (46%). 17.6% self-reported that they currently suffered from an eating disorder. The mean follow-up time was 7.2 years. All EDI-2 subscales correlated negatively with the SOC-13 score (p < .01). The mean SOC was significantly lower than the norm (p < .001). In the median split, the lower SOC group had significantly higher scores on all EDI-2 subscales. CONCLUSIONS Amongst previously hospitalized AN patients, the SOC was lower than a normative sample and correlated with on-going eating disorder symptoms in long-term follow-up. Strengthening SOC as a personal resource should be incorporated as a specific goal in AN treatment and its impact on long-term outcomes evaluated.
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Affiliation(s)
- Jan Vagedes
- Department of Pediatrics, University Hospital Tübingen, Tübingen, Germany.,ARCIM Institute, Filderklinik, Filderstadt, Germany
| | - Theresa Kleih
- ARCIM Institute, Filderklinik, Filderstadt, Germany.,Institute of Medical Psychology, Charité Universitätsmedizin, Berlin, Germany.,Institute of Psychology, Humboldt University of Berlin, Germany
| | - Cara Belizer
- ARCIM Institute, Filderklinik, Filderstadt, Germany.,Department of Clinical Psychology, University of Tübingen, Tübingen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology, University of Tübingen, Tübingen, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology, University of Tübingen, Tübingen, Germany
| | - Tido von Schoen-Angerer
- ARCIM Institute, Filderklinik, Filderstadt, Germany.,Department of Pediatrics, Fribourg Cantonal Hospital HFR, Fribourg, Switzerland.,Department of Community Health, University of Fribourg, Fribourg, Switzerland
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Jong MC, van Wietmarschen H, Glockmann A, Baars EW, Hamre HJ. Safety of Anthroposophic Medicinal Products: An Analysis of Adverse Drug Reactions from German Pharmacovigilance Databases. Drugs Real World Outcomes 2021; 8:589-601. [PMID: 34322827 PMCID: PMC8605942 DOI: 10.1007/s40801-021-00262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anthroposophic medicinal products (AMPs) are widely used in Europe and world-wide. OBJECTIVE To determine the frequency of reported adverse drug reactions (ADRs) from all AMPs on the market, in absolute numbers and relative to the maximum daily administration doses (MDADs). PATIENTS AND METHODS Retrolective safety analysis of AMP-related ADRs in pharmacovigilance databases of four AMP Marketing Authorisation Holders in Germany. For each ADR, information about the patient, outcome, causality and AMP was retrieved. Primary outcome was the frequency of reported ADRs relative to MDADs sold. RESULTS In the period 2010-2017, a total of 5506 ADRs were reported that had occurred in 2765 different patients, comprising 370 different AMPs. A total of 104 ADRs (1.9%) were classified as serious. The frequency of ADRs for all AMPs was 1.50 per million MDADs. For serious ADRs the frequency was 0.03 per million MDADs. ADRs were more frequently reported with parenteral AMP administration (injections) than with oral or local administration (18.85 vs. 0.59 vs. 1.61 ADRs per million MDADs, respectively; p < 0.0001). The large majority of users (91.9%) had recovered or were recovering from the ADRs and there were no reports with a fatal outcome. Most frequently reported ADR symptom was injection site inflammation for parenteral AMPs (4.66 ADRs per million MDADs), nausea for oral AMPs (0.03 ADRs per million MDADs), and eye irritation for locally administered AMPs (0.23 ADRs per million MDADs). CONCLUSIONS In this retrolective safety analysis of pharmacovigilance data, the frequency of ADRs to AMPs was 1.50 per million MDADs. Notably, the ADR frequency in this study based on spontaneous reporting is not directly comparable to frequencies in prospective clinical studies nor to frequencies based on other measures of patient exposure than MDADs.
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Affiliation(s)
- Miek C Jong
- ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products, Zechenweg 6, 79111, Freiburg, Germany
| | - Herman van Wietmarschen
- ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products, Zechenweg 6, 79111, Freiburg, Germany. .,Louis Bolk Institute, Hoofdstraat 24, 3972 LA, Driebergen, The Netherlands.
| | - Anja Glockmann
- ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products, Zechenweg 6, 79111, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, 79111, Freiburg, Germany
| | - Erik W Baars
- ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products, Zechenweg 6, 79111, Freiburg, Germany.,Louis Bolk Institute, Hoofdstraat 24, 3972 LA, Driebergen, The Netherlands.,University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK, Leiden, The Netherlands
| | - Harald J Hamre
- ESCAMP - European Scientific Cooperative on Anthroposophic Medicinal Products, Zechenweg 6, 79111, Freiburg, Germany.,Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Zechenweg 6, 79111, Freiburg, Germany.,Faculty of Health, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
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Influence of Alternative Lifestyles on Antibiotic Use during Pregnancy, Lactation and in Children. Antibiotics (Basel) 2021; 10:antibiotics10070837. [PMID: 34356758 PMCID: PMC8300802 DOI: 10.3390/antibiotics10070837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Alternative lifestyles are likely to be associated with distinct usage of specific medicinal products. Our goal was to find out whether the intake of antibiotics during pregnancy and by children differs according to whether the mothers have alternative or conventional lifestyles. Therefore, we investigated the use of antibiotics by pregnant women and by children up to 11 years of age participating in the KOALA Birth Cohort Study. This cohort comprises two recruitment groups of mother–infant pairs, one with alternative lifestyles (selected via organic food shops, anthroposophic clinicians and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines, n = 491) the other with conventional lifestyles (no selection based on lifestyle, n = 2343). Mothers in the alternative lifestyle group more frequently adhered to specific living rules and identified themselves with anthroposophy more than mothers in the conventional lifestyle group. The results revealed significant differences in antibiotic use during pregnancy and in children from 3 months to 10 years of age between the two groups. The rate of antibiotic use in children was consistently lower in the alternative lifestyle group than in the conventional lifestyle group. Antibiotic use in pregnancy was higher in low educated women, and maternal antibiotic use during lactation was higher after an instrumented delivery in hospital. Antibiotic use in the infant was higher when they had older sibs or were born in hospital, and lower in those who had been longer breastfed. After adjustment for these factors, the differences in antibiotic use between the alternative and conventional groups remained. The results suggest that an alternative lifestyle is associated with cautious antibiotic use during pregnancy, lactation and in children.
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Wopker PM, Schwermer M, Sommer S, Längler A, Fetz K, Ostermann T, Zuzak TJ. Expert consensus-based clinical recommendation for an integrative anthroposophic treatment of acute bronchitis in children: A Delphi survey. Complement Ther Med 2021; 60:102736. [PMID: 34058369 DOI: 10.1016/j.ctim.2021.102736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute bronchitis is one of the most common pediatric diseases. In addition to conventional therapies, a frequent use of complementary and alternative medicine (CAM) has been stated. Anthroposophic medicine (AM) is one of the most practiced complementary and integrative medicine (CIM) approaches in Central Europe but hitherto no consensus-based clinical recommendations or guidelines are available. Therefore, a consensus-based recommendation leading to an informed and reasonable use of AM in the treatment of acute bronchitis in pediatrics was developed. METHODS A total of 61 physicians in Germany with expertise in the field of anthroposophic pediatrics was invited to complete an online multistep Delphi process. Two independent reviewers quantitatively and qualitatively evaluated the results. The survey was completed when >75 % consensus was achieved. RESULTS The clinical recommendation comprises 15 subitems related to treatment as well as clinical and psychosocial aspects. All items reached strong consensus (>90 %; N = 9) or consensus (75-90 %; N = 6). CONCLUSION The comprehensive clinical recommendation creates a scientific base for the anthroposophic integrative treatment of acute bronchitis in children in Germany. It will make the anthroposophic approach more applicable, understandable and comparable to a wider public of physicians and other health professionals in Germany.
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Affiliation(s)
- Pilar Marie Wopker
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany; Witten/Herdecke University, Faculty of Health, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany; Witten/Herdecke University, Faculty of Health, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Simon Sommer
- Department of Pediatrics, Vestische Kinder- und Jugendklinik Datteln, Dr.-Friedrich-Steiner-Straße 5, 45711, Datteln, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany; Witten/Herdecke University, Faculty of Health, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Katharina Fetz
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany; Department of Pediatric Oncology and Hematology, University of Duisburg-Essen, Hufelandstr.55, 45147, Essen, Germany
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Kienle GS, Werthmann P, Grotejohann B, Hundhammer T, Schmoor C, Stumpe C, Voigt-Radloff S, Huber R. Addressing COVID-19 challenges in a randomised controlled trial on exercise interventions in a high-risk population. BMC Geriatr 2021; 21:287. [PMID: 33933014 PMCID: PMC8087880 DOI: 10.1186/s12877-021-02232-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a threat to ongoing clinical trials necessitating regular face-to-face, in-person meetings, particularly in participants with a high risk of complications. Guidance on how to handle and safely continue such trials is lacking. Chronically ill elderly individuals require-in addition to protection from infection-regular physical exercise and social contact to remain healthy. Solutions on how to handle these conflicting necessities are needed. The ENTAIER-randomised controlled trial was investigating the influence of mindful movements on fall risk, fear of falling, mobility, balance, life quality, and other outcomes. The study population was planned to comprise of 550 chronically ill elderly individuals with a high risk of falling. The movements were regularly performed in coached groups over 6 months. After the trial began, COVID-19 lockdowns stopped all in-person meetings, and it was expected that the limitations of this pandemic would continue for a long term. Therefore, the exercise programme, which involved complex movements and was typically conducted face-to-face in groups, had to be substituted by a telemedicine programme within a short timeframe. The objectives, therefore, were to identify challenges and tasks that could to be resolved and steps that could to be taken to achieve high-quality, efficacy, safety, and enable human encounter and motivation. METHODS We proceeded with four steps: 1) A literature review on the quality and feasibility issues of telemedicine in general, and specifically, in exercise training in elderly individuals. 2) Participation in two international telemedicine task forces on integrative medicine, particularly, mind-body medicine. 3) Interviews with study therapists, (for practical purposes, eurythmy therapists and Tai Chi teachers are summarized here as therapists) personnel, and international experts on providing mindful movement exercises and other physiotherapies via live telecommunication technology, and with scientists and patient representatives. 4) Final evaluation by the core trial team and subsequent planning and implementation of changes in the trial organisation. RESULTS Various tasks and challenges were identified: for the technical equipment for therapists and patients; for the ability of therapists and trial participants to adequately manage the technology and telemedicine intervention; the reservations and concerns about the technology among therapists and participants; safety and data protection in using the technology; and study design. The two major options found on how to continue the trial in the COVID-19 situation were a complete switch to telemedicine and a partial switch in the form of risk management implemented into the former design. CONCLUSIONS The management of an ongoing clinical trial in a national or international crisis with a minimum of available time and extra financial resources, alongside with two checklists on steps and procedures for trial continuation and telemedicine implementation, may be informative for other researchers or healthcare providers faced with similar challenges and making similar decisions in the current situation or similar future scenarios. TRAIL REGISTRATION: www.drks.de . DRKS00016609. Registered July 30, 2019.
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Affiliation(s)
- G S Kienle
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany.
| | - P Werthmann
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IFAEMM at the University of Witten/Herdecke, Freiburg, Germany
| | - B Grotejohann
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - C Schmoor
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ch Stumpe
- Shen Men Institute, Institute for Qigong, Taiji, Acupressure & Traditional Chinese Medicine (TCM), Düsseldorf, Germany
| | - S Voigt-Radloff
- Centre for Geriatric Medicine and Gerontology Freiburg, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Huber
- Centre for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Jäger T, Würtenberger S, Baumgartner S. Effects of Homeopathic Preparations of Mercurius corrosivus on the Growth Rate of Moderately Mercury-Stressed Duckweed Lemna gibba L. HOMEOPATHY 2021; 110:122-131. [PMID: 33694141 PMCID: PMC8084595 DOI: 10.1055/s-0040-1718743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
A bioassay with severely mercury-stressed duckweed (
Lemna gibba
L.) had revealed growth-inhibiting effects of homeopathically potentised mercury(II) chloride (
Mercurius corrosivus, Merc-c.
). We hypothesised that effects of potentised preparations are dependent on the stress level of the organisms used in the bioassay. The aim of the present investigation was to examine the response of duckweed to potentised
Merc-c.
at a lower stress level.
Methods
Duckweed was moderately stressed with 2.5 mg/L mercury(II) chloride for 48 hours. Afterwards plants grew in either
Merc-c.
(seven different potency levels, 24x–30x) or water controls (unsuccussed or succussed water) for 7 days. Growth rates of the frond (leaf) area were determined using a computerised image-analysis system for day 0–3 and 3–7. Three independent experiments with potentised
Merc-c.
and three systematic negative control experiments were performed. All experiments were randomised and blinded.
Results
Unsuccussed and succussed water did not significantly differ in their effects on duckweed growth rate. The systematic negative control experiments did not yield any significant effects, thus providing evidence for the stability of the experimental system. Data from the two control groups and the seven treatment groups (
Merc-c.
24x–30x) were each pooled to increase statistical power. Duckweed growth rates for day 3–7 were enhanced (
p
< 0.05) after application of
Merc-c.
compared with the controls. Growth rates for day 0–3 were not influenced by the homeopathic preparations.
Conclusions
Moderately mercury-stressed
Lemna gibba
L. yielded evidence of growth-enhancing specific effects of
Merc-c.
24x–30x in the second observation period (day 3–7). This observation is complementary to previous experiments with severely mercury-stressed duckweed, in which a decrease in growth was observed in the first observation period (day 0–3). We hypothesise that the differing results are associated with the level of stress intensity (moderate vs. severe).
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Affiliation(s)
- Tim Jäger
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten/Herdecke, Germany
| | - Sandra Würtenberger
- Scientific and Regulatory Affairs, Hevert-Arzneimittel GmbH & Co. KG, Nussbaum, Germany
| | - Stephan Baumgartner
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten/Herdecke, Germany.,Society for Cancer Research, Hiscia Institute, Arlesheim, Switzerland
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Witteman L, van Wietmarschen HA, van der Werf ET. Complementary Medicine and Self-Care Strategies in Women with (Recurrent) Urinary Tract and Vaginal Infections: A Cross-Sectional Study on Use and Perceived Effectiveness in The Netherlands. Antibiotics (Basel) 2021; 10:antibiotics10030250. [PMID: 33802263 PMCID: PMC8000599 DOI: 10.3390/antibiotics10030250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/01/2023] Open
Abstract
Due to the excessive use of antibiotic and antimycotic treatments, the risk of resistant microbes and fungi is rapidly emerging. Previous studies have demonstrated that many women with (recurrent) urinary tract infection (UTI) and/or vaginal infections (VIs) welcome alternative management approaches to reduce the use of antibiotics and antifungals and avoid short- and long-term adverse effects. This study aims to determine which complementary medicine (CM) and self-care strategies are being used by women suffering from (recurrent) UTI and VI in The Netherlands and how they perceive their effectiveness in order to define directions for future research on safety, cost-effectiveness, and implementation of best practices. A cross-sectional online survey was performed among women, ≥18 years old, with a history of UTIs; 162 respondents were included in the data analysis, with most participants aged between 50 and 64 years (36.4%). The women reported having consulted a CM practitioner for UTI-specific symptoms (23.5%) and VI-specific symptoms (13.6%). Consultations of homeopaths, acupuncturists, and herbal physicians are most often reported. Overall, 81.7% of the women suffering from UTI used complementary or self-care strategies besides regular treatment, and 68.7% reported using CM/self-care strategies to treat vaginal symptoms. UTI- related use of cranberries (51.9%), vitamin C (43.8%), and D-mannose (32.7%) were most reported. Perceived effectiveness was mostly reported for homeopathic remedies and D-mannose. The results showed a substantial burden of UTI and VI on daily and sexual activities. Besides the frequency of use, the indication of perceived effectiveness seems to be an important parameter for further and rigorously designed research to encourage nonantibiotic/antifungal treatment implementation into daily clinical practice.
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Ben-Arye E, Portalupi E, Keshet Y, Bonucci M, Can G, Kading Y, Samuels N, Livas M, Gressel O, Silbermann M, Breitkreuz T. Enhancing Palliative Care With Mindful Touch: Impact of a Manual and Movement Therapy Training Program in an International Multidisciplinary Integrative Oncology Setting. J Pain Symptom Manage 2021; 61:229-236. [PMID: 32795608 DOI: 10.1016/j.jpainsymman.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training. OBJECTIVES In this study, we examine the impact of an MMT-based integrative oncology training program with the participation of an international and multidisciplinary group of oncology HCPs. The feasibility of implementing these skills in palliative cancer care is examined. METHODS A three-day evidence-based hands-on teaching program was designed to train oncology HCPs working in supportive cancer care MMT modalities from traditional Chinese and anthroposophic medicine. Prequalitative and postqualitative assessments of the trainees' narratives were analyzed using ATLAS.Ti software (Scientific Software Development GmbH, Berlin, Germany) for systematic coding. RESULTS The training program was attended by 30 participants from Israel (15), Germany (7), Italy (6), Turkey (1), and Cyprus (1). The group included 13 nurses, 10 physicians, 6 complementary/integrative HCPs, and 1 psycho-oncologist. The pretraining expectations that were met at post-training included gaining knowledge and practical QOL-oriented skills, which could be implemented in the palliative and supportive care setting. A significant change in the attitude of trainees to touch therapy was also identified, with respondents seeing MMTs promoting patient-centered palliative care, including nonverbal communication. CONCLUSION An MMT training program for oncology HCPs for QOL-related indications is both feasible and likely to be implemented in palliative and supportive cancer care. Nonspecific effects of MMTs were also recognized for their ability to facilitate patient-centered care.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Lin, Zebulon & Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Middle East Research Group in Integrative Oncology (MERGIO), Middle East Cancer Consortium, Haifa, Israel.
| | - Emanuela Portalupi
- Associazione Italiana di Ricerche e Studi per la Medicina Antroposofica (ARESMA), Milan, Italy; Association Research on Integrative Oncology Therapies (A.R.T.O.I.), Rome, Italy
| | - Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Galilee, Israel
| | - Massimo Bonucci
- Association Research on Integrative Oncology Therapies (A.R.T.O.I.), Rome, Italy
| | - Gulbeyaz Can
- Florence Nightingale Nursing Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Yolanda Kading
- Cyprus Association of Cancer Patients and Friends (PASYKAF), Nicosia, Cyprus
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Maria Livas
- Staedtisches Klinikum Karlsruhe and Paracelsus-Krankenhaus, Bad Liebenzell, Germany
| | - Orit Gressel
- Integrative Oncology Program, Lin, Zebulon & Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Michael Silbermann
- Middle East Research Group in Integrative Oncology (MERGIO), Middle East Cancer Consortium, Haifa, Israel
| | - Thomas Breitkreuz
- Staedtisches Klinikum Karlsruhe and Paracelsus-Krankenhaus, Bad Liebenzell, Germany; Die Filderklinik, Stuttgart/Paracelsus-Krankenhaus, Bad Liebenzell, Germany; International Federation of Anthroposophic Medical Associations (IVAA), Brussels, Belgium
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36
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Oei SL, Thronicke A, Matthes H, Schad F. Assessment of integrative non-pharmacological interventions and quality of life in breast cancer patients using real-world data. Breast Cancer 2021; 28:608-617. [PMID: 33393018 DOI: 10.1007/s12282-020-01193-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatments with non-pharmacological interventions (NPIs), comprising art and exercise therapies, nursing interventions, and educational components, are considered to improve quality of life of cancer patients. The aim of this study was to assess the longitudinal changes in self-reported quality of life of breast cancer patients receiving an integrative medicine program consisting of hospital-based NPIs and standard oncological treatments. METHODS This real-world data study was conducted using data from the Network Oncology clinical registry of the Gemeinschaftskrankenhaus Havelhöhe. Primary breast cancer patients of all tumor stages, who answered the European Organization of Research and Treatment Health-Related Quality of Life Core Questionnaire scale (EORTC QLQ-C30) at first diagnosis and 12 months later, were included. Association factors between received NPIs and longitudinal EORTC QLQ-C30-changes were analyzed with additive non-parametric regression tests, considering treatment regimens and demographic variables, using the software R. RESULTS A total of 231 primary breast cancer patients were enrolled and separate regression analyses were carried out. Significant associations between the received NPIs elaborate consultations and life review, nursing compresses, music and eurythmy therapy and improvements of 8-13 points for global health, all five functional EORTC-scales, and symptoms fatigue, dyspnea, insomnia, and financial difficulties were observed. CONCLUSION Our findings support the beneficial impact of NPIs for breast cancer patients. Further research could be directed towards synergistic effects of multimodal applied NPIs. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Medical Clinic for Gastroenterology, Infectiology and Rheumatology CBF, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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37
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Bartelme RR. Anthroposophic Medicine: A Short Monograph and Narrative Review-Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions. Glob Adv Health Med 2020; 9:2164956120973634. [PMID: 33457106 PMCID: PMC7783888 DOI: 10.1177/2164956120973634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate. METHODS Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author's personal references were also consulted. RESULTS The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed. DISCUSSION An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.
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Affiliation(s)
- Ricardo R Bartelme
- Department of Family Medicine, University of Michigan Medical
School, Ann Arbor, Michigan
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38
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Fetz K, Längler A, Schwermer M, Carvalho-Hilje C, Vagedes J, Zuzak TJ, Ostermann T. Comparative analysis of resource utilization in integrative anthroposophic and all German pediatric inpatient departments. BMC Health Serv Res 2020; 20:939. [PMID: 33046108 PMCID: PMC7552368 DOI: 10.1186/s12913-020-05782-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrative Medicine (IM) combines conventional and complementary therapies. It aims to address biological, psychological, social, spiritual and environmental aspects of patients' health. During the past 20 years, the use and request of IM in children and adults has grown. Anthroposophic Medicine (AM) is an IM approach frequently used in children in Germany. From both public health and health economic perspectives, it is relevant to investigate whether there are differences in the resource utilization between integrative pediatric departments (IPD) and the entirety of all pediatric departments. METHODS Standard ward documentation data from all German integrative anthroposophic pediatric departments (2005-2016; N = 29,956) is investigated and systematically compared to data of the entirety of all pediatric departments in Germany derived from the Institute for the Hospital Reimbursement System (2005-2016, N = 8,645,173). The analyses focus on: length of stay, Diagnosis Related Groups (DRG), Major Diagnosis Categories (MDC), and effective Case Mix Index (CMI). RESULTS The length of stay in the IPD (M = 5.38 ± 7.31) was significantly shorter than the DRG defined length of stay (M = 5.8 ± 4.71; p < .001; d = - 0.07) and did not exceed or undercut the DRG covered length of stay. Compared to the entirety of all pediatric departments (M = 4.74 ± 6.23) the length of stay was significantly longer in the in the IPD (p <. 001; d = 0.12). The effective CMI in IPD and all pediatric departments were identical (M = 0.76). The frequencies of DRG and MDC differed between IPD and all pediatric departments, with higher frequencies of DRGs and MDCs associated with chronic and severe illnesses in the IPD. CONCLUSIONS Treatment within integrative anthroposophic pediatric departments fits well in terms of the DRG defined conditions concerning length of stay, even though integrative pediatric patients has an increased length of stay of averagely 1 day, which is most likely associated to time consuming, complex integrative treatment approaches and to a certain extend to higher amount of chronic and severe diseases.
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Affiliation(s)
- Katharina Fetz
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - Clara Carvalho-Hilje
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Jan Vagedes
- ARCIM Academic Research in Complementary and Integrative Medicine, Filderstadt, Germany.,Department of Neonatology, University Hospital Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Essen, Hufelandstr.55, 45147, Essen, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
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Rutert B, Stritter W, Eggert A, Auge U, Laengler A, Seifert G, Holmberg C. Development of an Integrative Care Program in a Pediatric Oncology Unit. Complement Med Res 2020; 28:131-138. [PMID: 33040053 DOI: 10.1159/000510247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this article is to describe what needs to be considered in implementing care practices, in this case an integrative care program consisting of anthroposophic treatments, in an intensive care unit (ICU) of a teaching hospital. METHODS We used a pediatric oncology department to implement an integrative care program. We conducted a qualitative study including participant observation and semi-structured interviews with parents, nurses, doctors, and therapists. Data analysis was based on a grounded theory approach and focused on the status quo of care in the ICU. RESULTS The following factors needed to be considered: the structure of the ICU, communication and information dissemination, and time constraints. This led to the following components of the integrative care program: (1) a training plan in anthroposophic treatments for all nurses that was conducted by 2 trained anthroposophic nurses, and (2) the introduction of an integrative shift that was on top of regular care at the ICU and focused on delivery of integrative care to patients. CONCLUSION To add new care components to an ICU, the existing context has to be considered. Time constraints and high workload are factors that need to be recognized. In this particular context, a highly flexible program was the solution.
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Affiliation(s)
- Britta Rutert
- Berlin-Brandenburg Academy of the Sciences and Humanities, Berlin, Germany
| | - Wiebke Stritter
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angelika Eggert
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Auge
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alfred Laengler
- Division of Oncology and Hematology, Institute for Pediatrics, Gemeinschaftskrankenhaus Herdecke, Witten-Herdecke University, Witten-Herdecke, Germany
| | - Georg Seifert
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Berlin, Germany, .,Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany,
| | - Christine Holmberg
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany.,Departamento de Pediatria, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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40
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Elimimian EB, Elson L, Stone E, Butler RS, Doll M, Roshon S, Kondaki C, Padgett A, Nahleh ZA. A pilot study of improved psychological distress with art therapy in patients with cancer undergoing chemotherapy. BMC Cancer 2020; 20:899. [PMID: 32962660 PMCID: PMC7510066 DOI: 10.1186/s12885-020-07380-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background Art therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients. Methods Chemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0–10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48–72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics. Results Through a reasonable pilot sample (n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) (p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy (P = 0.03) and during the follow-up intervals (p = 0.047). Conclusion Art therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.
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Affiliation(s)
- E B Elimimian
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - L Elson
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - E Stone
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - R S Butler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/ Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - M Doll
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - S Roshon
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - C Kondaki
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - A Padgett
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL, 33431, USA
| | - Z A Nahleh
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic - Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Mehl A, Brauer D, Didwiszus A, Gelin-Kröz B, Pranga D, Zerm R, Gutenbrunner C, Reif M, Kröz M. The Anthroposophic Art Therapy Assessment Paint (AART-ASSESS-P): A peer-report instrument to assess patients' pictorial expression during Anthroposophic Painting Therapy. Explore (NY) 2020; 17:541-548. [PMID: 32843248 DOI: 10.1016/j.explore.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anthroposophic painting therapy (APT) is a specific form of art therapy that aims to activate self-healing capacities through painting aquarelles. METHODS The Anthroposophic Art Therapy Assessment-Paint' (AART-ASSESS-P) was developed to measure pictorial expression and validated in the framework of a comprehensive cohort design study. The validation study examined 68 breast cancer patients with fatigue. Art therapists made pre- and post-assessments of spontaneously drawn water-color paintings with a preliminary version of the AART-ASSESS-P (58 items). Inter-rater reliability (IRR) for the items was examined with Cohen's weighted Kappa (κw). Additionally, a reliability- and factor analysis (FA) were conducted. Convergence criteria were patients' self-report measures: the Satisfaction with Painting Therapy, Inner Correspondence with Painting Therapy and the Self-Regulation Questionnaire. RESULTS IRR for the items was heterogeneous (κw= 0.09-0.89, Mean κw= 0.40, SD = 0.17). Thirty-six items were excluded due to insufficient IRR and item-total correlation (κw= < 0.30, ρitem-total< 0.30). A FA with 22 items revealed 5 subscales: Shape Development (6 items), Shape Arrangement (6 items), Order and Symmetry (5 items), Color Application (3 items), and Color Quality (2 items) explaining 61% of total variance. Psychometric properties for the AART-ASSESS-P were satisfying with Cronbach's alpha coefficients (rα = 0.60-0.81) across subscales. Due to weak inter-subscale correlations (r = 0.18-0.48, p < 0.05) and the ambiguity of face validity a sum-score was not formed. Correlations between subscales and self-reports were small (all p < 0.05). CONCLUSION The AART-ASSESS-P is the first reliable instrument to measure pictorial expression during APT.
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Affiliation(s)
- A Mehl
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany.
| | - D Brauer
- Medical Section, School of Spiritual Science/Goetheanum, 4134Dornach, Switzerland
| | - A Didwiszus
- Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089Berlin, Germany
| | - B Gelin-Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany
| | - D Pranga
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany
| | - R Zerm
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany; Department of Internal Medicine Havelhöhe Hospital, Kladower Damm 221, 14089Berlin, Germany
| | - C Gutenbrunner
- Clinic for Rehabilitative Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625Hannover, Germany
| | - M Reif
- Society for Clinical Research, Hardenbergstraße 20, 10623Berlin, Germany
| | - M Kröz
- Research Institute Havelhöhe, Kladower Damm 221, 14089Berlin, Germany; Institute for Integrative Medicine, University Witten/Herdecke, Gerhard Kienle Weg 8, 58313Herdecke, Germany; Hospital Arlesheim, Research Department, Pfeffinger Weg 1, 4144Arlesheim, Switzerland
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Schmidt G, Mathes S, Klein E, Kiechle M, Paepke D. Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy. J Evid Based Integr Med 2020; 25:2515690X20949444. [PMID: 32808558 PMCID: PMC7436788 DOI: 10.1177/2515690x20949444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose. Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013. Methods. In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire. Results. 78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients. Conclusion. Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
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Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Sofia Mathes
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
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Oei SL, Thronicke A, Matthes H, Schad F. Evaluation of the effects of integrative non-pharmacological interventions on the internal coherence and resilience of breast cancer patients. Support Care Cancer 2020; 29:1413-1421. [PMID: 32671562 DOI: 10.1007/s00520-020-05617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE In the breast cancer center at the Gemeinschaftskrankenhaus Havelhöhe (GKH), integrative strategies are implemented in the routine care of breast cancer patients. The aim of this breast cancer real-world study was to systematically evaluate changes in patients' internal coherence and resilience, associated with the use of non-pharmacological interventions (NPIs). METHODS This study included 231 primary breast cancer patients treated with standard oncological therapy and NPIs, which comprise art and movement therapies, nursing interventions, and educational components, and had answered the internal coherence scale (ICS) questionnaire at first diagnosis and 12 months later. Data were collected from the Network Oncology clinical registry of the GKH, and effects of NPIs on ICS changes were analyzed with adjusted linear multivariable regression analyses, using the software R. RESULTS Two hundred twenty breast cancer patients of all tumor stages were eligible for a total of 27 separate adjusted multivariable linear regression analyses. The NPIs elaborate consultations and life review (ECLR); nursing compresses, music therapy, and rhythmic massages were significantly associated with increases of about 2-point changes in inner resilience and coherence (p < 0.05). Furthermore, a significant association with an elevation of the thermo coherence was observed for the application of nursing compresses. CONCLUSIONS The evaluation of real-world data carried out here shows that the application of the multimodal treatment concept can lead to an enhancement of the internal coherence and resilience in breast cancer patients. To improve the care of cancer patients, this multimodal program should be further expanded into routine clinical practices. TRIAL REGISTRATION Trial registration number DRKS00013335 on 27/11/2017 retrospectively registered.
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Affiliation(s)
- Shiao Li Oei
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.
| | - Anja Thronicke
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Harald Matthes
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics and Medical Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe, Forschungsinstitut Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany.,Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
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Hamre HJ, Glockmann A, Marti J, Soldner G. Mapping Physicians' Experiences with Medicinal Products from Whole Medical Systems: A Descriptive Analysis of the Vademecum of Anthroposophic Medicines. Complement Med Res 2020; 27:336-347. [PMID: 32450561 DOI: 10.1159/000507541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Therapy in whole medical systems involves a large number of medicinal products. One source of knowledge of clinical properties of such products is the experience of therapy providers. A systematic approach to documentation, assessment, and aggregation of physicians' experiences with anthroposophic medicinal products (AMPs) has been developed: the Vademecum of Anthroposophic Medicines. MATERIAL AND METHODS The Vademecum contains structured information on AMPs, including therapeutic rationale, indications, and therapy recommendations. The information is based on a 17-item questionnaire of physicians' therapy experiences, which is peer-reviewed by an interdisciplinary editorial board. We conducted a descriptive analysis of the Vademecum, 4th edition. RESULTS The Vademecum comprised 799 different AMPs, used for 1,773 indications, based on 2,543 questionnaires submitted by 274 physicians from 19 countries. The 799 AMPs comprised 52.6% of all AMPs marketed in Germany in 2015-2016. The 1,773 indications corresponded to 544 different ICD-10 three-digit codes, amounting to 29.3% (n = 544/1,854) of all three-digit codes. A total of 30.6% (n = 542/1,773) of indications were supported by ≥2 questionnaires. CONCLUSIONS The current Vade-mecum covers more than half of all AMPs, used for more than one fourth of all ICD-10 three-digit codes. The Vademecum approach may be relevant for medicinal products from other whole medical systems.
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Affiliation(s)
- Harald Johan Hamre
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany, .,European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany,
| | - Anja Glockmann
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany.,European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany
| | - Jakob Marti
- Association of Anthroposophic Physicians in Germany, Munich, Germany.,Interleave GmbH, Munich, Germany
| | - Georg Soldner
- European Scientific Cooperative on Anthroposophic Medicinal Products, Freiburg, Germany.,Association of Anthroposophic Physicians in Germany, Munich, Germany
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Landman-Reiner A. Complementing reductionism: Goethean science part 1: Qualities and wholeness. Explore (NY) 2020; 17:360-365. [PMID: 32265106 DOI: 10.1016/j.explore.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/18/2022]
Abstract
While integrative practices in health care have grown over the past half-century, life sciences still view nature almost entirely through a reductionist lens. Contemporary research is described that complements this reductionist, non-holistic perspective with the methods of Goethean science. A rigorous approach to qualitative science and to wholeness in nature is outlined.
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Affiliation(s)
- Alicia Landman-Reiner
- Physicians' Association for Anthroposophic Medicine/PAAM Training, P.O. Box 4039, Grand Junction, CO 81502, United States.
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Complementing reductionism: Goethean science part 2: Life's unique principles. Explore (NY) 2020; 17:366-371. [PMID: 32249200 DOI: 10.1016/j.explore.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
Life sciences today approach nature through a reductionist lens. A broadened methodology, known as Goethean science, complements that one-sided perspective. Building on the elements of the qualitative and the wholeness of organisms, novel examples of non-reductionist work in plant growth, animal, and specifically human organization, are described.
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Weinzirl J, Scheffers T, Garnitschnig L, Andrae L, Heusser P. Does the Spleen Have a Function in Digestion? Medical History, Phylogenetic and Embryological Development of the Splenogastric System. Complement Med Res 2020; 27:357-363. [PMID: 32229731 DOI: 10.1159/000506390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 02/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Before the spleen was discovered to be a lymphatic blood organ, it had for centuries been considered to be a digestive organ. Concepts of a regulative, secretory and resorptive function in the digestive system were based mainly on a postulated connection between the stomach and the spleen. Splenogastric vascular connections have recently been rediscovered by modern surgery. SUMMARY To test the hypothesis that the spleen has a digestive function, this article reviews the literature focusing on the interaction between the spleen and the stomach. We examine the historical medical view of the spleen and stomach system and the reasons why a digestive function was abandoned in the 17th and 18th centuries. We then review the rediscovery of the splenogastric system and the present-day state of knowledge (anatomical origin, variability, haemodynamics) and present it in terms of the phylogenetic and embryological development of the spleen and stomach system. Key Message: Splenogastric arteries and gastrosplenic veins form a portal system which directly connects the spleen and stomach parenchyma. Despite its mesodermal anlage, phylogenetically and embryologically the spleen is intimately interconnected with the entodermal stomach parenchyma but detaches from this in the course of development. Further study is required to establish whether the splenogastric system is merely an evolutive remnant or actually a part of a functioning spleen-stomach system as postulated in complementary and integrative medicine.
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Affiliation(s)
- Johannes Weinzirl
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany,
| | - Tom Scheffers
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Lydia Garnitschnig
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Lukas Andrae
- Department of Internal Medicine, Community Hospital Herdecke, Herdecke, Germany
| | - Peter Heusser
- Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
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Ghelman R, Akiyama IY, de Souza VT, Falcão J, Orgolini V, Hosomi JK, Quadros AAJ, Oliveira ASB. A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial to evaluate the efficacy and safety of an anthroposophic multimodal treatment on chronic pain in outpatients with postpolio syndrome. Brain Behav 2020; 10:e01590. [PMID: 32162497 PMCID: PMC7177555 DOI: 10.1002/brb3.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chronic pain and fatigue are the main symptoms of postpoliomyelitis syndrome (PPS). This study aimed to evaluate the efficacy and safety of an anthroposophic multimodal treatment for chronic pain in PPS outpatients. METHODS A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial was designed to compare four groups (n = 48): groups A and B received daily active experimental transdermal gel (ETG) or placebo gel (PTG), respectively; groups C and D received weekly external therapies, art therapies, and neurofunctional reorganization, plus either daily ETG or PTG, respectively. The pain symptoms were evaluated through a visual analogue scale (VAS), the McGill questionnaire, and thermography. Quality of life and resilience were evaluated by the WHOQOL-BREF and Antonovsky sense of coherence questionnaires applied at baseline and after the interventions. RESULTS No related adverse events occurred, and 10% of the patients reports dysphagia improvement. In the groups C and D, pain reduction was statistically significant in both the placebo group (p = .02, d = 1.315) and in the ETG (p = .005, d = 2.035). However, following the week-to-week evolution of pain with the concomitant use of the ETG, this significant pain reduction occurred earlier from the 4th week and continued to decrease (p = .016, d = 1.369). In the group that received the complete multimodal treatment, the greatest significant benefit in increasing quality of life occurred in the physical domain and elevation in resilience with an emphasis on meaning and comprehension domains. CONCLUSIONS The anthroposophic multimodal treatment group presented both safety and efficacy as an analgesic in the groups that received the nonpharmacological therapies, much earlier when associated with the ETG. The multimodal approach corresponded to the pattern of better efficacy for both pain reduction and improvement in quality of life and resilience.
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Affiliation(s)
- Ricardo Ghelman
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil.,Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Ivete Y Akiyama
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Valeria T de Souza
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jussara Falcão
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Vera Orgolini
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jorge K Hosomi
- Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Abrahão A J Quadros
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
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Abstract
The relevance of functional gastrointestinal (GI) disorders and their impact on quality of life for many patients has become an increasingly important topic in gastroenterology. A gastroenterologist can expect to see 40% of patients for motility and functional GI disorders, thus highlighting the necessity for physicians to have a strong foundation of knowledge in treatment strategies for these patients with complex disorders. A significant number of patients who suffer with functional GI disorders turn to complementary and alternative therapies to maintain control over their symptoms and often are happy with therapeutic results. This narrative presents information and treatment algorithms for the gastroenterologist to better understand and use some of the most common complementary and alternative therapies for patients with functional dyspepsia, nausea and vomiting, and irritable bowel syndrome.
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Acceptance of Anxiety through Art Therapy: A Case Report Exploring How Anthroposophic Art Therapy Addresses Emotion Regulation and Executive Functioning. Case Rep Psychiatry 2020; 2019:4875381. [PMID: 32082678 PMCID: PMC6949689 DOI: 10.1155/2019/4875381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 12/17/2022] Open
Abstract
Anxiety is a major problem for many individuals, causing impairment in daily life. Art therapy is often deployed and although positive results are communicated in clinical practice, its effectiveness and working mechanisms have hardly been studied. Therefore, it is important to systematically describe the intervention process and to detect the working mechanisms to be able to evaluate them. Narrative case studies help to understand the intervention in more depth. A typical case file was selected for case reporting according to scientific (CARE & CARE-AAT) guidelines, with the aim to explore the therapeutic elements that contributed to the reduction of anxiety. The report describes the intervention process of a 54-year-old female, suffering from anxiety since childhood and diagnosed with panic disorder, agoraphobia, claustrophobia and hypochondria. After 14 sessions of anthroposophic art therapy, reduction of anxiety was shown, as well as improvements of emotion regulation and executive functioning. The client indicated that she became more tolerant and accepting towards her anxiety. She noted a softened attitude towards herself and her complaints, even one year after art therapy. The course of treatment suggests that aspects of emotion regulation and executive functioning were addressed through implicit learning processes in different art therapy assignments.
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