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المؤلفون: Yael Keshet, Ofer Lavie, Pesi Israeli, Eran Ben-Arye, Noah Samuels, Yaron River
المصدر: International Journal of Gynecologic Cancer. 28:1045-1049
مصطلحات موضوعية: Bridged-Ring Compounds, Complementary Therapies, medicine.medical_specialty, Genital Neoplasms, Female, MEDLINE, Antineoplastic Agents, Breast Neoplasms, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, medicine, Acupuncture, Humans, 030212 general & internal medicine, Precision Medicine, Aged, Integrative Medicine, Taxane, business.industry, Peripheral Nervous System Diseases, Obstetrics and Gynecology, Middle Aged, Precision medicine, medicine.disease, Peripheral neuropathy, Oncology, 030220 oncology & carcinogenesis, Female, Taxoids, Integrative medicine, business, Complication
الوصف: ObjectivePeripheral neuropathy is a common complication of cancer treatment impairing quality of life and function. This study explored the impact of a complementary and integrative medicine (CIM) program on taxane-induced peripheral neuropathy (TIPN).Materials and MethodsTaxane-treated female patients with breast and gynecological cancer reporting TIPN-related symptoms were referred to an integrative physician, followed by patient-tailored CIM treatments (acupuncture with/without other modalities). Assessment of study outcomes at 6 to 12 weeks was conducted using the Measure Yourself Concerns and Wellbeing, which documented free-text narratives about patients’ experience during the CIM treatment process. Content was analyzed using ATLAS.Ti software.ResultsOf the 125 patients treated with taxanes, 69 had been referred for CIM treatment of TIPN-associated symptoms. Multidisciplinary narrative analysis identified 2 groups of CIM-treated patients: those with an apparently moderate improvement in symptoms (n = 35) and those with either only an apparent mild or no improvement at all. For 10 patients, assessment of their response to treatment was unclear. The 2 identified groups had similar demographic, cancer-related, and quality of life–related parameters at baseline. Content analysis of patients with an apparent moderate improvement suggested a short-term (24–48 hours) effect with acupuncture treatment, either alone or combined with manual, mind-body, and anthroposophic music therapies. Symptoms showing improvement included paresthesia and numbness.ConclusionsAcupuncture and other CIM therapies may result in a short-term and transitory reduction in TIPN-related symptoms.
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المؤلفون: Hayley Thomas, Geoffrey Mitchell, Justin Rich, Megan Best
المصدر: BMJ Open
مصطلحات موضوعية: Male, holistic, Biopsychosocial model, Attitude of Health Personnel, education, MEDLINE, Holistic Health, PsycINFO, CINAHL, whole person care, biopsychosocial, Terminology, primary care, 03 medical and health sciences, 0302 clinical medicine, systematic review, General Practitioners, Humans, Medicine, 030212 general & internal medicine, Practice Patterns, Physicians', Research question, Language, general practice, Integrative Medicine, Physician-Patient Relations, Medical education, business.industry, Research, 030503 health policy & services, Australia, Multimorbidity, General Medicine, Therapeutic relationship, Treatment Outcome, Systematic review, Chronic Disease, Female, General practice / Family practice, 0305 other medical science, business
الوصف: ObjectivesThe importance of ‘whole person’ or ‘holistic’ care is widely recognised, particularly with an increasing prevalence of chronic multimorbidity internationally. This approach to care is a defining feature of general practice. However, its precise meaning remains ambiguous. We aimed to determine how the term ‘whole person’ care is understood by general practitioners (GPs), and whether it is synonymous with ‘[w]holistic’ and ‘biopsychosocial’ care.DesignSystematic literature review.MethodsMEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Proquest Dissertations and Theses, Science.gov (Health and Medicine database), Google Scholar and included studies’ reference lists were searched with an unlimited date range. Systematic or literature reviews, original research, theoretical articles or books/book chapters; specific to general practice; relevant to the research question; and published in English were included. Included literature was critically appraised, and data were extracted and analysed using thematic synthesis.ResultsFifty publications were included from 4297 non-duplicate records retrieved. Six themes were identified: a multidimensional, integrated approach; the importance of the therapeutic relationship; acknowledging doctors’ humanity; recognising patients’ individual personhood; viewing health as more than absence of disease; and employing a range of treatment modalities. Whole person, biopsychosocial and holistic terminology were often used interchangeably, but were not synonymous.ConclusionsWhole person, holistic and biopsychosocial terminology are primarily characterised by a multidimensional approach to care and incorporate additional elements described above. Whole person care probably represents the closest representation of the basis for general practice. Health systems aiming to provide whole person care need to address the challenge of integrating the care of other health professionals, and maintaining the patient–doctor relationship central to the themes identified. Further research is required to clarify the representativeness of the findings, and the relative importance GPs’ assign to each theme.PROSPERO registration numberCRD42017058824.
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المصدر: BMJ Open
مصطلحات موضوعية: medicine.medical_specialty, Alternative medicine, MEDLINE, CINAHL, 03 medical and health sciences, Health Economics, 0302 clinical medicine, medicine, 030212 general & internal medicine, Health policy, Health economics, business.industry, Research, Statistics & Research Methods, Health services research, General Medicine, 030205 complementary & alternative medicine, 3. Good health, Family medicine, Complementary Medicine, Integrative medicine, Health care reform, business
الوصف: Objective: A comprehensive systematic review of economic evaluations of complementary and integrative medicine (CIM) to establish the value of these therapies to health reform efforts. Data sources: PubMed, CINAHL, AMED, PsychInfo, Web of Science and EMBASE were searched from inception through 2010. In addition, bibliographies of found articles and reviews were searched, and key researchers were contacted. Eligibility criteria for selecting studies: Studies of CIM were identified using criteria based on those of the Cochrane complementary and alternative medicine group. All studies of CIM reporting economic outcomes were included. Study appraisal methods: All recent (and likely most cost-relevant) full economic evaluations published 2001–2010 were subjected to several measures of quality. Detailed results of higher-quality studies are reported. Results: A total of 338 economic evaluations of CIM were identified, of which 204, covering a wide variety of CIM for different populations, were published 2001–2010. A total of 114 of these were full economic evaluations. And 90% of these articles covered studies of single CIM therapies and only one compared usual care to usual care plus access to multiple licensed CIM practitioners. Of the recent full evaluations, 31 (27%) met five study-quality criteria, and 22 of these also met the minimum criterion for study transferability (‘generalisability’). Of the 56 comparisons made in the higher-quality studies, 16 (29%) show a health improvement with cost savings for the CIM therapy versus usual care. Study quality of the cost-utility analyses (CUAs) of CIM was generally comparable to that seen in CUAs across all medicine according to several measures, and the quality of the cost-saving studies was slightly, but not significantly, lower than those showing cost increases (85% vs 88%, p=0.460). Conclusions: This comprehensive review identified many CIM economic evaluations missed by previous reviews and emerging evidence of cost-effectiveness and possible cost savings in at least a few clinical populations. Recommendations are made for future studies.
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