Integrative Approaches in the Treatment of Patients Affected by Lymphoma.

PURPOSE OF REVIEW: Lymphoma is the most frequent hematological malignancy with wide disease spectrum of watchful waiting period, active treatment, survivorship, and palliative care. All these steps impose unmet needs in terms of prevention, symptom alleviation, or prognosis. Complementary and integrative medicine (CIM) is widely used by patients with lymphoma to cope with such issues. Here, we describe the different CIM modalities that may be effective and safe for the management of patients with lymphoma. RECENT FINDINGS: Low inflammatory diet and ginseng seem effective for lymphoma prevention. Pain and neuropathy may be improved using acupuncture, touch therapy and specific dietary supplements. Nausea/vomiting, fatigue, and insomnia may be relieved by acupuncture, mind-body, touch therapy, and certain dietary supplements. Vitamin D, curcumin, and some traditional medicine herbs may positively impact lymphoma prognosis. Finally, safety issues should be considered especially for the concomitant use of dietary supplements and lymphoma-directed therapies. CIM may be beneficial along the continuum of lymphoma management although safety concerns should be considered when used concomitantly with conventional therapy.

Acupuncture and integrative oncology for taxane-induced peripheral neuropathy: a randomized multicentered study.

OBJECTIVE: To compare the effectiveness of acupuncture alone or with additional integrative oncology modalities for taxane-induced peripheral neuropathy-related symptoms in patients with gynecological and breast cancer. METHODS: The study was a prospective evaluation of patients undergoing twice-weekly treatments with either acupuncture alone (single-modality, group A) or with additional manual-movement and mind-body therapies (multimodality, group B), for 6 weeks. Symptom severity was assessed at baseline, 6 weeks, and 9 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool; and von Frey perception thresholds. Additional symptoms were also assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Measure Yourself Concerns and Wellbeing (MYCaW) study tool. RESULTS: For the 120 participants (60 in each study arm), baseline to 6-week scores were similar in both groups for improved FACT-Tax physical wellbeing and scores for hand numbness/tingling; EORTC physical functioning and global health status; and MYCaW scores. FACT-Tax taxane subscales and scores for foot numbness/tingling improved only in group A (p=0.038), while emotional wellbeing FACT-Tax (p=0.02) and EORTC pain (p=0.005) improved only in group B. Group B showed greater improvement for FACT-Tax neuropathy-related concerns than group A at 24 hours (p=0.043) and 7 days (p=0.009) after the first treatment. CONCLUSION: Acupuncture alone or with additional integrative oncology modalities may help reduce neuropathy-related symptoms. The single-modality group demonstrated greater improvement for foot numbness/tingling, and the multimodality group demonstrated improvement for pain and improved emotional wellbeing and neuropathy-related concerns in the first week of treatment. TRIAL REGISTRATION NUMBER: NCT03290976.

Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial.

BACKGROUND: To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients. METHODS: In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds. RESULTS: Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores. CONCLUSIONS: Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.

Acupuncture Treatment of Delirium in Older Adults Hospitalized in Internal Medicine Departments: An Open-Label Pragmatic Randomized-Controlled Trial.

BACKGROUND: Acupuncture seems to improve cognitive function in experimental models and to reduce agitation in dementia. The addition of acupuncture to standard-of-care (SOC) may improve clinical outcomes related to delirium in hospitalized older adults. METHODS: This pragmatic open-label randomized-controlled trial evaluated 81 older adults hospitalized in an internal medicine ward and diagnosed with delirium. Fifty were randomized to daily acupuncture combined with SOC and 31 to SOC only for up to 1 week. Delirium was diagnosed using Confusion Assessment Method (CAM) tool, and its severity was assessed by the long CAM-Severity (CAM-S) tool. The primary study outcome was delirium resolution evaluated as time-to-first delirium remission (over 7 days) and the number of days spent delirium-free. RESULTS: Time-to-first delirium remission was shorter in the acupuncture arm as compared to the SOC only arm (p < 0.001). A multivariate Cox regression analysis showed a shorter time-to-first remission of delirium in the acupuncture arm as compared with SOC arm [Hazard Ratio 0.267 (95% CI 0.098-0.726, p = 0.010)]. In the 7 days of evaluation, a significantly higher number of delirium-free days was found in the acupuncture arm compared to the SOC arm (p < 0.001), and CAM-S sum from day 2 to day 7 of evaluation was significantly lower in the acupuncture group compared to the control group (p = 0.002). No adverse safety event was found in the acupuncture group. CONCLUSION: Acupuncture seems to be safe and effective in the treatment of delirium in older patients hospitalized in internal medicine departments.

First, keep it safe: Integration of a complementary medicine service within a hospital.

OBJECTIVES: This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. METHODS: We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. RESULTS: After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). CONCLUSIONS: Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols.

Adverse events associated with interactions with dietary and herbal supplements among inpatients.

AIMS: Dietary and herbal supplements (DHS) are commonly used among inpatients and may cause interactions with drugs or other DHS. This study explored whether adverse events were actually associated with such interactions and examined specific characteristics among inpatient DHS users prone to such adverse events. METHODS: This was a cross-sectional study of 947 patients hospitalized in 12 departments of a tertiary academic medical centre in Haifa, Israel. It evaluated the rate of DHS use among inpatients, the potential for interactions, and actual adverse events during hospitalization associated with DHS use. It also assessed whether DHS consumption was documented in patients' medical files. Statistical analysis was used to delineate DHS users at risk for adverse events associated with interactions with conventional drugs or other DHS. RESULTS: In 17 (3.7%) of the 458 DHS users, an adverse event may have been caused by DHS-drug-DHS interactions. According to the Drug Interaction Probability Scale, 14 interactions 'probably' caused the adverse events, and 11 'possibly' caused them. Interactions occurred more frequently in older patients (P = 0.025, 95% CI: 2.26-19.7), patients born outside Israel (P = 0.025, 95% CI: 0.03-0.42), those with ophthalmologic (P = 0.032, 95% CI: 0.02-0.37) or gastrointestinal (P = 0.008, 95% CI: 0.05-0.46) comorbidities, and those using higher numbers of DHS (P < 0.0001, 95% CI: 0.52-2.48) or drugs (P = 0.027, 95% CI: 0.23-3.77). CONCLUSIONS: Approximately one in 55 hospitalizations in this study may have been caused by adverse events associated with DHS-drug-DHS interactions. To minimize the actual occurrence of adverse events, medical staff education regarding DHS should be improved.

Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis.

BACKGROUND: Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions. METHODS: Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness. RESULTS: Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported. CONCLUSION: Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.

Perioperative Risks of Dietary and Herbal Supplements.

BACKGROUND: Patients undergoing surgery often use Dietary and Herbal Supplements (DHS). We explored the risk of DHS-drug interactions in the perioperative setting. METHODS: In this cross-sectional prospective study, participants hospitalized for surgery completed a questionnaire regarding DHS use. We used pharmacological databases to assess DHS-drug interactions. We then applied univariate and multivariate logistic regression analyses to characterize patients at risk for DHS-drug interactions. RESULTS: Of 526 interviewees, 230 (44%) patients reported DHS use, with 16.5% reporting using DHS that could potentially interact with anesthesia. Twenty-four (10%) patients used DHS that could potentially interact with antithrombotic drugs taken perioperatively. The medical files of three patients included reports of intraoperative bleeding. The patient files of only 11% of DHS users documented DHS use. CONCLUSIONS: DHS use poses a significant health risk due to potential interactions. Guidelines should emphasize perioperative management of DHS use.

[Dietary supplements use during hospitalization].

INTRODUCTION: Consumption of dietary supplements (DS) by patients in the community is rising. DS affect human health, and safety issues regarding concomitant DS-medication use are underemphasized. Consequently, the Ministry of Health issued a directive regarding the need for assessing DS use in every patient and documenting such use in the medical record. AIMS: To evaluate the rate of DS consumption in hospitalized patients, and to assess documentation of such consumption. METHODS: This was a prospective cross-sectional study. Patients hospitalized in the medical wards of a public-academic hospital in Israel, between the years 2009-2010, were interviewed regarding their use of DS. The medical records were searched for documentation of DS use. RESULTS: A total of 895 hospitalized patients were interviewed; 691 agreed to answer the questionnaire (compliance rate 77%). The analysis referred to 648 fully-completed questionnaires. Of the participants, 359 (55.4%) were DS consumers. On multivariable analysis, DS consumption was associated with older age, female gender, higher education status, and the presence of psychiatric disease. Only 11.4% of DS users had documentation of such use in their medical record. CONCLUSIONS: DS consumption is common amongst hospitalized patients, and is overlooked by the medical team. Patients and doctors should be more aware of the possible adverse effects of DS use and their potential herb-drug interactions. Education regarding appropriate communication on DS use should be established.

[Integration of complementary medicine in hospital departments: implementation model and research outline in the Cardiology Department].

BACKGROUND: Systematic integration of complementary medicine in hospital departments for inpatients is rarely discussed in the medical literature. Positive outcomes from trials in this setting should encourage evaluation of complementary medicine services in hospitals. OBJECTIVE: To identify the potential role of complementary medicine in the Cardiology Department, characterize its implementation process, and conduct a feasibility study in this context. METHODS: A narrative overview of the implementation process of complementary medicine in the Cardiology Department was used alongside a statistical analysis of a feasibility trial This was in order to determine the sample size for a larger pragmatic trial that will assess the effectiveness of complementary medicine, as compared to standard of care, in relieving common symptoms of patients hospitalized in the Cardiology Department. RESULTS: Focus groups consisting of representatives from the Cardiology Department, and the Complementary Medicine Service identified areas for possible integration of complementary medicine in the Cardiology Department. A literature review was conducted in order to assess complementary medicine effectiveness and safety in this setting. Consequently, appropriate treatment protocols were developed. The Complementary Medicine team participated in cardiology patient rounds, and presentations on complementary medicine were provided to the cardiology staff. Treatment indications, and contraindications were mutually developed, and questionnaires to assess treatment effectiveness were developed. A feasibility trial was completed for 237 patients who were treated with complementary medicine. CONCLUSIONS: Integration of complementary medicine in an inpatient setting is possible following a carefully structured implementation process that is shared by champions from the medical department and the Complementary Medicine Service. Results from the feasibility trial indicate the potential positive role that complementary medicine treatments have on common symptoms of inpatients at the Cardiology Department. There is a need for high quality trials that will assess the effectiveness of complementary medicine treatments in this setting.

Acupuncture in the Treatment of Panitumumab Skin Toxicity: A Case Report.

BACKGROUND: Inflammatory skin rash resulting from treatment with epidermal growth factor receptor inhibitors may cause physical and mental disabling to patients treated for their oncologic condition and may, in some cases, lead to the cessation of biological treatment. CASE REPORT: In this case report, acupuncture treatment was provided to a patient with metastatic colorectal carcinoma who developed skin toxicity from panitumumab including rash, itching, and skin inflammation. Itching, infection, and inflammation symptoms improved significantly following acupuncture, subsequently relapsed following treatment cessation, and improved once again following reintroduction of acupuncture. CONCLUSION: Acupuncture may be effective in alleviating panitumumab-related skin inflammatory symptoms.

Treatment of acute exacerbations of chronic obstructive pulmonary disease with acupuncture during hospitalization: a three-arm double-blinded randomized sham-controlled trial.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a healthcare burden. Acupuncture improves dyspnea in patients with chronic obstructive pulmonary disease (COPD) but, to the best of our knowledge, has not been tested in AECOPD. Here, we evaluated the efficacy and safety of true acupuncture added to standard of care (SOC), as compared with both sham procedure plus SOC and SOC only, for the treatment of AECOPD among inpatients. METHODS: This double-blinded randomized sham-controlled trial was set in a tertiary hospital in Israel. Patients with a clinical diagnosis of AECOPD were assigned to true acupuncture with SOC, sham procedure with SOC or SOC only. The primary outcome was dyspnea improvement as measured daily by the validated modified Borg (mBorg) scale. Secondary outcomes included improvement of other patient-reported outcomes and physiologic features, as well as duration of hospitalization and treatment failure. Acupuncture-related side effects were evaluated by the validated Acup-AE questionnaire. RESULTS: Seventy-two patients were randomized: 26 to acupuncture treatment, 24 to sham and 22 to SOC only arms. Baseline characteristics were similar in the three groups. A statistically significant difference in dyspnea intensity was found from the first day of evaluation after treatment (p = 0.014) until day 3 after treatment. Similar results were found for sputum production, but no statistical significance was found when comparing physiologic features between the three arms. Acupuncture was not associated with adverse events. CONCLUSION: Acupuncture seems to be efficacious in the treatment of AECOPD among inpatients hospitalized in internal medicine departments. TRIAL REGISTRATION NUMBER: NCT03398213 (ClinicalTrials.gov).

[Complementary medicine in hemato-oncology care: review of controlled clinical studies].

In this article, we review seven randomized controlled trials (RCTs) that studied efficacy and safety of complementary and alternative medicine (CAM) in hemato-oncology care. The studies examined various CAM modalities in the treatment of general quality of life, mental, sleep, and gastro-intestinal symptoms. In addition, we reviewed in vitro and nonrandomized cLinical trials in herbal medicine and other CAM modalities. The authors recommend focusing future CAM studies on empowering patients in hemato-oncology care while monitoring efficacy and safety of treatment and avoiding harmful interaction with conventional care.

Patterns of patient reluctance to receive complementary-medicine treatments in a hospital setting: A cross-sectional study.

OBJECTIVE: We aim to characterize the patient population that exhibits reluctance to undergo complementary medicine (CM) treatments in a hospital setting. METHODS: We conducted a cross-sectional prospective study among patients prior to hospitalization using structured questionnaires in a single center in Israel. Participants were asked to rate their degree of consent to receiving CM treatments during hospitalization. RESULTS: The CM-reluctant group was 7.1 % of the study cohort. The CM modalities most commonly refused were spiritual guidance, acupuncture, and energy and healing therapies. The CM-reluctant population showed a weaker relation to spiritual content and tended to value complementary medicine's effectiveness less in comparison to the CM-consenting group. The main reason for reluctance was skepticism of the perceived effectiveness of CM. CONCLUSIONS: With skepticism playing a major role in decision making, we should question whether the Stakeholders in the field of CM and public health services are succeeding in explaining the benefits and risks of CM treatments.

The effectiveness of foot reflexology in reducing anxiety and duration of labor in primiparas: An open-label randomized controlled trial.

BACKGROUND AND PURPOSE: Reflexology alleviates anxiety and may shorten the duration of labor. We evaluated the effect of reflexology on anxiety level and duration of labor in primiparas with moderate-to-severe anxiety. MATERIALS AND METHODS: In this open-label randomized-controlled trial, primiparas with moderate-to-severe anxiety were randomized into one of two groups: addition of reflexology to usual care, or usual care only. The primary outcome was a change in the level of anxiety during reflexology treatment. RESULTS: Ninety-nine women were assigned to reflexology treatment while ninety received usual care only. A larger alleviation of anxiety was observed immediately after reflexology treatment as compared to the control group during the 30 min following group assignment. Reflexology did not affect the length of delivery. CONCLUSION: Foot reflexology had a positive short-term anxiolytic effect during labor in primiparas with moderate-to-severe anxiety but did not affect the duration of labor.

Complementary and alternative medicine interventions for perioperative symptoms: A comparative effectiveness study.

INTRODUCTION: Perioperative symptoms such as pain, nausea and anxiety are often inadequately treated. We conducted a pragmatic trial to evaluate the impact of Complementary and Alternative Medicine (CAM) treatments on these symptoms, within the framework of a general surgery department that integrates CAM. METHODS: Patients ≥ 18 years referred to CAM treatments by surgical medical staff were allocated to standard of care with CAM treatment (CAM group) or without, according to patient preference and practitioner availability. CAM treatments included Acupuncture, Reflexology, or Guided Imagery. The primary outcome variable was the change from baseline in symptom severity, measured by Visual Analogue Scale (VAS). Patients and practitioners were asked to report any adverse effects associated with CAM treatments. RESULTS: A total of 1127 patients were enrolled, 916 undergoing 1214 CAM treatments and 211 controls. Socio-demographic characteristics were similar in both groups. Patients in the CAM group had more severe baseline symptoms. Symptom reduction was greater in the CAM group compared with controls, with a mean reduction in pain of -2.17 ±â€¯2.4 vs -0.29 ±â€¯2 (P < 0.0001); nausea -1.2 ±â€¯2.42 vs -0.3 ±â€¯1.94 (P < 0.0001); and anxiety -2.23 ±â€¯2.76 vs -0.03 ±â€¯2.54 (P < 0.0001). Acupuncture was more effective for nausea control. No significant adverse events were reported with any of the CAM therapies. CONCLUSION: CAM treatments provide additional relief to Standard Of Care (SOC) for perioperative symptoms. Larger randomized control trial studies with longer follow-ups are needed to confirm these benefits. The study is registered with clinical trials.gov at (NCT01733771).

The study protocol for a randomized, controlled trial of acupuncture versus a sham procedure versus standard care alone for the treatment of delirium in acutely hospitalized older adults with a medical illness.

BACKGROUND: Many hospitalized older adults experience delirium, but treatment options are limited. Acupuncture has been shown to improve cognitive function and reduce agitation in dementia. We hypothesize that acupuncture, when compared with a sham intervention, will reduce the duration and severity of delirium, normalize delirium biomarkers, and improve clinical outcomes related to delirium in acutely hospitalized older adults with a medical illness. METHODS: This three-arm, prospective, randomized, clinical trial will evaluate adults aged over 65 years who are acutely hospitalized to an internal-medicine ward and diagnosed with delirium or subsyndromal delirium. The 288 patients (96 in each of three groups) will be randomly allocated to receive either daily true acupuncture with usual care, a daily sham procedure with usual care, or usual care only in a 1:1:1 distribution for up to one week or until the patient is delirium-free for over 48 h. Other delirium and clinical interventions will remain unchanged. Delirium will be diagnosed using DSM-5 criteria and its severity will be assessed using the long Confusion Assessment Method Severity (CAM-S) tool. OUTCOMES: The primary study outcome will be the daily CAM-S score over 7 days between the three groups. Secondary outcomes will include time to first resolution of the delirium (over 7 days), the proportion of days spent delirium-free, daily antipsychotic use, daily pain scores, sleep quality, morning serum cortisol and T3 levels, and midnight urinary cortisol/creatinine ratio, all determined twice a week, and delirium-related complications. Hospital mortality, duration of hospital stay and functional status at discharge will also be compared between the three groups. Adverse events potentially related to acupuncture will be evaluated daily. The cost-effectiveness of acupuncture will be estimated. CONCLUSION: This novel randomized study will evaluate both the specific and the non-specific effects of acupuncture on delirium, and related outcomes, and its safety. Potential mechanism(s) of action for acupuncture in reducing delirium will be explored and healthcare-related costs estimated. Positive study results may prove pivotal in facilitating a multimodal, non-pharmacologic, integrative approach to delirium treatment among older, medical inpatients.

Complementary medicine for laboring women: a qualitative study of the effects of reflexology.

Background Despite pharmacological interventions, labor pain and anxiety still remain a challenge, and can carry long-term psychological complications. The goal of this study was to assess the effect of reflexology on these symptoms and to explore the physical and psychological components of women's experience associated with this treatment. Methods This qualitative study was conducted in an Israeli university hospital that offers integrative medicine services. Reflexology was offered to laboring women in the hospital, by the medical staff. In-depth, open interviews were conducted with 36 women, still in hospital, who consented to be interviewed, within 48 h after delivery. Questions referred to their labor experience with reflexology treatment. Results Of the 36 participants, 34 (94%) described a positive and empowering experience. They reported reduced pain and anxiety, and an increased sense of self-efficacy brought about by the ability to become active and manage labor. Conclusions Using reflexology as one of the complementary medicine treatment available can contribute greatly to the entire labor experience as it empowers women and increases self-confidence and ability to self-manage labor and delivery.

Nurses as boundary actors: Promoting integrative medicine in hospital wards.

OBJECTIVE: The objective of the research was to explore attitudes of hospital nurses toward integrative medicine (IM). DESIGN: A special training program was developed in the Bnai-Zion medical center, a public hospital in Israel, where an innovative IM program was launched. METHODS: 65 nurses from 22 wards were asked at the beginning and the end of the program to complete an open-ended questionnaire concerning three major aspects: 1) their attitudes toward complementary medicine and its integration, 2) the importance and impact of the training program and 3) how they perceive their potential role in promoting IM in the wards. RESULTS: Nurses perceive themselves as boundary actors, who can play an important role in promoting IM within the wards. IM training programs for hospital nurses are recommended. This empowers nurses while restoring to clinical practice the essence of nursing as an integrative healing discipline.

Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial.

OBJECTIVE: Inadequate treatment of pain in patients undergoing surgery is associated with unsatisfactory perioperative outcomes. The aim of this study was to examine the role of reflexology in addition to standard analgesic treatment in postoperative pain management. DESIGN: This was a prospective, unblinded pragmatic controlled trial. SETTING/LOCATION: Study participants included patients who were admitted to the general surgery department. INTERVENTIONS: Patients in the intervention group received reflexology while standard analgesic care was administered similarly in both groups. OUTCOME MEASURES: Pain intensity at rest and in motion was evaluated using visual analog scale (VAS [0-10]) at baseline, and 60-90 min after treatment. RESULTS: Pain reduction was clinically and statistically significant in the reflexology group, both for pain at rest (from mean VAS of 4.4 to 3.1, N = 77, p < 0.0001) and for pain in motion (from 6.2 to 4.2, N = 77, p < 0.0001). In the control group, pain at rest was not reduced at follow-up (from 4.7 to 4.6, N = 87, p = 0.92), nor was pain in motion (from 5.8 to 5.7, N = 87, p = 0.65). Comparison of mean difference for pain showed significant improvement in the reflexology group compared to the standard of care group (p < 0.0001). The most significant pain reduction in the reflexology group was observed among patients who had moderate-severe baseline pain (VAS >4). CONCLUSION: Adding reflexology to standard analgesic care is effective in reducing postoperative pain at rest and in motion, especially for patients experiencing moderate to severe pain.