Eficacia y seguridad del Zero Balancing como técnica con pretendida finalidad sanitaria en condiciones clínicas seleccionadas / Efficacy and safety of Zero Balancing as a technique with an intended health purpose in selected clinical conditions

Nombre de la técnica con pretendida finalidad sanitária: Eficacia y seguridad del Zero Balancing como técnica con pretendida finalidad sanitaria en condiciones clíni cas selecionadas. Definición de la técnica e indicaciones clínicas: Zero Balancing (ZB) es una técnica o modalidad de trabajo corporal y manual mente/cuerpo que, según su fundador Fritz Frederick Smith, involucra 'energía' y 'estructura' logrando un equilibrio en el individuo. Calidad de la evidencia: No se han localizado estudios científicos, sólo artículos de opinión. Resultados claves: No se han localizado estudios que aporten informa ción científica sobre la eficacia y seguridad del Zero Balancing. Conclusión final: Con la información disponible en el momento actual, no existe evidencia científica sobre la seguridad y efi cacia de la técnica en ninguna condición clínica.

Name of the technique with health purposes: Efficacy and safety of Zero Balancing as a technique with an intented health purpose in selected clinical conditions. Definition of the technique and clinical indication: Zero Balancing (ZB) is a technique or modality of bod work and mind/body manual work that, according to its founder Fritz Frederick Smith, involves 'energy' and 'structure' achieving a balance in the individual. Quality of evidence: No scientific studies have been located, only opinion articles Key results: There are no studies that provide scientific information on the efficacy and safety of Zero Balancing Final conclusion: With the information available at the present time, there is no scientific evidence on the safety and efficacy of the technique in any clinical condition.

A propósito del artículo Evolución clínica en pacientes tratados con Esencias Florales de Bach y costo del tratamiento / About the Article Clinical Evolution and Cost of Treatment in Patients Treated with Bach Flower Essences

Hemos analizado con gran interés el artículo original "Evolución clínica en pacientes tratados con Esencias Florales de Bach y costo del tratamiento" de Martell y otros,1 publicado en la Revista Cubana de Medicina General Integral en el año 2021. Consideramos pertinente notar algunas deficiencias en este trabajo. La medicina alternativa ha recobrado interés y se viene estudiando los últimos años por parte de la comunidad científica, especialmente aquella que emplea extractos de plantas, ya que esta se muestra como una opción a los fármacos usados habitualmente.2 Las flores de Bach se definen como el conjunto de 38 plantas cuyas esencias se obtienen mediante procesos de cocción y solarización, a los cuales se les añade posteriormente una...(AU)

Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study.

BACKGROUND: Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia. METHODS: In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year. FINDINGS: Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23-1·88]) and medical impoverishment (1·75 [1·36-2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group. INTERPRETATION: Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts. FUNDING: None.

Complementary and alternative medicine mention and recommendations in guidelines for anxiety: A systematic review and quality assessment.

BACKGROUND: Up to 43% of patients with anxiety disorders (ADS) use complementary and alternative medicine (CAM), however, many healthcare providers receive little training on this topic. Clinical practice guidelines (CPGs) are relied upon to guide decision-making, especially with respect to topics less familiar to healthcare providers. In the present study, we identified the quantity and assessed the quality of CAM recommendations in CPGs for the treatment and/or management of ADS. METHODS: MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to April 2020 to identify eligible CPGs. In addition, the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible CPGs containing CAM recommendations were evaluated using AGREE II. RESULTS: Eleven CPGs were eligible, of which six made CAM recommendations. Average scaled domain percentages for these six CPGs from highest to lowest were as follows (% overall, % CAM): clarity and presentation (83.3%, 73.6%); scope and purpose (77.8%, 76.4%); editorial independence (69.4%, 36.8%); stakeholder involvement (55.6%, 31.9%); rigour of development (53.1%, 46.9%); and applicability (43.8%, 29.2%). CONCLUSIONS: A need exists to improve the quality of CAM recommendations in anxiety CPGs through insight from AGREE II and other CPG development resources.

Espaço multipics: a utilização das práticas integrativas e complementares como estratégia de cuidado na atenção à saúde do trabalhador / Multipics Space: the use of integrative and complementary practices as a strategy of care in the care of workers' health / Espacio multipics: el uso de prácticas integradoras y complementarias como estrategia de atención en el cuidado de la salud de los trabajadores

Introdução:As Práticas Integrativas e Complementares em Saúde foram regulamentadas no Sistema Único de Saúde,através da portaria nº 971/2006 que aprova a implantação da Política Nacional de Práticas Integrativas e Complementares, com o objetivo de garantir cuidado continuado,humanizado e integral em saúde,com ênfase na atenção primária. Objetivo:Relatar a experiência vivenciada por uma equipe de Residentes Multiprofissionais em Saúde, através do espaço de Práticas Integrativas e Complementares de uma Unidade Hospitalar na região do Seridó, Rio Grande do Norte. Metodologia:Trata-se de um estudo descritivo com abordagem quantitativa e qualitativa do tipo relato de experiência,desenvolvido a partir da vivência de uma equipe de Residentes em Atenção Básica da Universidade Federal do Rio Grande do Norte, atuantes no município de Caicó, em parceria com o Hospital Regional do Seridó. As ações foram realizadas durante os meses de março e abril de 2021. As práticas desenvolvidas foram ventosaterapia, musicoterapia, arteterapia, meditação guiada e aromaterapia. Após as práticas foi aplicado um questionário semi-estruturado, sobre seu conhecimento sobre tais práticas exercidas, nível de satisfação e uma descrição subjetiva da experiência e estado atual pós-prática. Resultados:Participaram das ações propostas 57 profissionais, dentre eles (84,21%) mulheres e (15,79%) homens, de vários setores da unidade hospitalar. 10,53% relataram desconhecer as práticas de um modo geral e 89,47% relataram não conhecer as práticas que foram ofertadas. De acordo com a pesquisa de satisfação, 98,25% dos profissionais relataram sentir-se "muito satisfeitos" e "satisfeitos", enquanto somente 1,75% consideraram as práticas "neutras". Os profissionais referiram, também, sensação de harmonia, bem-estar e de paz interior. Conclusões:Por meio da atuação foi possível ofertar um momento de relaxamento no ambiente de trabalho. Obteve-se após a prática um feedback positivo dos participantes sobre os resultados dessa atuação acerca do seu bem-estar (AU).

Introduction:Integrative and Complementary Health Practices were regulated in the Unified Health System, through Ordinance No. 971/2006 that approves the implementation of the National Policy of Integrative and Complementary Practices, with the objective of ensuring continued, humanized and comprehensive health care, with emphasis on primary care. Objective:To report the experience experienced by a team of Multiprofessional Health Residents, through the space of Integrative and Complementary Practices in a Hospital Unit in the Seridó region, Rio Grande do Norte. Methodology:This is a descriptive study with a quantitative and qualitative approach to the type of experience report,developed from the experience of a team of Residents in Primary Care of Federal University of Rio Grande do Norte, working in the municipality of Caicó in partnership with the Regional Hospital of Seridó. The actions were carried out during the months of March and April 2021. The practices developed were suction cup therapy, music therapy, art therapy, guided meditation and aromatherapy. After the practices, a semi-structured questionnaire was applied about their knowledge about the practices, level of satisfaction and a subjective description of the experience and current state after practice. Results:57 professionals participated in the proposed actions, including (84.21%) women and (15.79%) men, from various sectors of the hospital unit. 10.53% reported not knowing the practices in general and 89.47% reported not knowing the practices that were offered. According to the satisfaction survey, 98.25% of the professionals reported feeling "very satisfied" and "satisfied", while only 1.75% considered the practices "neutral". The professionals also mentioned a sense of harmony, well-being and inner peace. Conclusions:Through the performance it was possible to offer a moment of relaxation in the work environment. After the practice, positive feedback from the participants on the results of this performance about their well-being was obtained after practice.

Introducción:Las Prácticas de Salud Integradoras y Complementarias fueron reguladas en el Sistema Único de Salud, con el objetivo de garantizar una atención de salud continúa, humanizada e integral, con énfasis en la atención primaria. Objetivo: Relatar la experiencia experimentada por un equipo de Residentes de Salud Multiprofesional, a través del espacio Prácticas Integradoras y Complementarias en una Unidad Hospitalaria en la región del Seridó, Rio Grande do Norte. Metodología: Estudio descriptivo, cuantitativo y cualitativo,desarrollado a partir de la experiencia de un equipo de Residentes en Atención Primaria de la Universidad Federal do Rio Grande do Norte, trabajando en el Hospital Regional de Seridó. Las actuaciones se llevaron a cabo durante los meses de marzo y abril de 2021 a través del espacio. Las prácticas desarrolladas fueron terapia de ventosas, musicoterapia, arteterapia, meditación guiada y aromaterapia. Después de las prácticas, se aplicó un cuestionario semiestructurado sobre sus conocimientos sobre las praticas, el nivel de satisfacción y una descripción subjetiva de la experiencia y el estado actual después de la práctica. Resultados: 57 profesionales participaron en las acciones propuestas, entre ellas (84,21%) mujeres y (15,79%) hombres, de diversos sectores de la unidad hospitalaria. 10,53% reportaron no conocer las prácticas en general y 89,47% reportaron no conocer las prácticas que se ofrecieron. Según la encuesta de satisfacción, 98,25% de los profesionales dijeron sentirse "muy satisfechos" y "satisfechos", mientras que sólo 1,75% consideraron las prácticas "neutras". Los profesionales también mencionaron una sensación de armonía, bienestar y paz interior. Conclusiones:A través de la actuación fue posible ofrecer un momento de relajación en el ambiente de trabajo. Después de la práctica, se obtuvo retroalimentación positiva de los participantes sobre los resultados de este desempeño sobre su bienestar después de la práctica (AU).

Patterns of Usage of Complementary and Alternative Medicine Among Adults Visiting Health Care Centers in Mysuru, India: A Questionnaire-Based Survey.

The study intended to assess extent of complementary and alternative medicine use among patients visiting health care facilities in Mysuru, India, and factors influencing its choice. Prevalence of complementary and alternative medicine use was 33% and was not influenced by sociodemographic factors and individual health perceptions and habits.

Complementary and alternative medicines for behavioral and psychological symptoms of dementia: A protocol of overview of systematic reviews.

BACKGROUND: Dementia is causing a huge medical and socioeconomic burden. Along with strategies to delay cognitive decline in dementia, behavioral and psychological symptoms of dementia (BPSD) are major contributing factor to the burden of dementia, and have been an important clinical issue for successful management of dementia. However, pharmacological strategies such as antipsychotics raise concerns in terms of risk-to-benefit ratio in managing BPSD. Therefore, there is a need for an effective and safe alternative in BPSD management. From this point of view, various complementary and alternative medicines (CAMs) are attracting attention in BPSD management. Therefore, the overview will make it possible to evaluate the feasibility of using CAM as a potential treatment strategy for BPSD in terms of evidence-based medicine. METHODS AND ANALYSIS: Comprehensive searching will be performed in 13 bibliographic databases from their inception dates to November 2021. Systematic reviews and/or meta-analyses that examined the effectiveness and safety of CAM modalities including herbal medicine, acupuncture, acupressure, aromatherapy, meditation, and relaxation on BPSD, will be included. The methodological quality of included reviews will be assessed by using the A MeaSurement Tool to Assess systematic Reviews-2. Two independent researchers will conduct study search, study selection, data extraction, and quality assessment processes. RESULTS: The results of overview will be disseminated by the publication of a manuscript in a peer-reviewed journal or presentation at a relevant conference. CONCLUSION: The findings of this overview will help to solve the major public health problem related to dementia, and will provide patients with dementia, their caregivers, clinicians, and health policy makers credible evidence in mitigating the burden of dementia. ETHICS AND DISSEMINATION: As this protocol is for an overview of systematic reviews and meta-analyses, ethical approval is not required. PROTOCOL REGISTRATION NUMBER: Open Science Framework registry (https://osf.io/g5f3m).

Comprehensive study on the administrative, economic, regional, and regulatory prospects of complementary and alternative medicine (CAM) in inflammatory bowel disease (IBD).

Introduction: Due to the high cost, low effectiveness, and adverse effects plus the life-long nature of inflammatory bowel disease (IBD), and misconception on safety, efficacy, and cost-effectiveness of complementary and alternative medicine (CAM), the market demand for CAM has risen over the past decades. A critical review of patients' and physicians' attitudes, market drivers, economic aspects, regulatory roles, and regional distribution is lacking.Areas covered: Through relevant databases, the existing English language literature concerning the association of CAM use with IBD was collected over the past two decades. Data was then analyzed, comprehensively summarized in tables/figures, and justified concerning administrative, organizational, regional, economic, and regulatory perspectives.Expert opinion: Although CAM utilization is more prevalent among younger, female, and high-educated IBD patients, issues concerning weak study designs, limited-time period/regional distribution of recent surveys, and lack of economic evaluations on CAM make it entirely unfeasible to draw a firm conclusion. Regulators are lagging in meeting the dire need of IBD patients, especially the elderly. Lack of legislation regarding registration, sales monitoring, licensing, insurance coverage, efficacy/safety assessments, post-marketing surveillance, quality assurance, and reference pricing alongside the limited support for CAM research are the main matters that should be urgently addressed.

Evaluating traditional and complementary medicines: Where do we go from here?

Traditional and complementary medicines are increasingly considered possible options for prevention and symptomatic treatment of the novel coronavirus, COVID-19. With renewed attention on these therapies from researchers and policy makers alike, the well-documented challenges of evaluating their safety and efficacy are once again of global concern. Between 2005 and 2018, the World Health Organization conducted a series of surveys, in which 88 percent of responding member states confirmed that their biggest challenge in traditional medicine was the need for technical guidance on research and evaluation. As a first step in pursuing this need, our commentary summarizes thirteen international and regional guidance documents by three broad categories on evaluating safety, efficacy, and product quality for market-based approval and distribution of these treatments. We highlight the paucity of updated international recommendations on these subjects and identify gaps that could inform the current evidence base. All available guidance note the need for evidence surrounding the efficacy of these treatments and practices but are also quick to caution against methodological difficulties in the conduct of such evaluations. Evidence suggests that improved evaluation methods on efficacy and effectiveness are crucial toward expanding future research into establishing the cost-effectiveness of these therapies, in the context of shifting acceptance, interest, and integration of traditional medicines into health systems, and as another step toward Universal Health Coverage.

Being in touch: narrative assessment of patients receiving online integrative oncology treatments during COVID-19.

OBJECTIVE: We examined the qualitative impact of an online integrative oncology (IO) treatment program, designed in response to the restrictions created by the current COVID-19 pandemic. METHODS: Patients undergoing chemotherapy were seen by an integrative physician (IP), together co-designing an IO treatment program of ≥ 6 weekly treatments to alleviate symptoms and improve quality of life (QoL). IO practitioners guided patients and their caregivers online in self-treatment with manual/touch, movement, and/or mind-body modalities. Narratives of both patients and IO practitioners were analyzed for systematic coding, identifying barriers and advantages of the online treatment program. RESULTS: Narratives obtained from 30 patients and eight IO-trained practitioners were examined. The patients had undergone 169 online IO sessions with a total of 327 IO interventions during the 3-month study period. Patient narratives included reflections on both non-specific effects (e.g., less of a "sense of isolation") and specific QoL-related outcomes with the online intervention. IO practitioner narratives focused on barriers to providing manual-movement and mind-body modalities, suggesting practical recommendations on how to address specific QoL-related outcomes using the online IO "toolbox." CONCLUSIONS: Effective online IO practitioner-guided treatments are feasible and may induce both specific and non-specific QoL-related effects. Future research needs to explore online IO interventions for additional situations in which access to IO care is limited.

Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context.

Breast cancer is the most frequently diagnosed cancer among women in both transitioned and transitioning countries and has become a major women's health problem. Although recent advances in our understanding of the biological nature of cancer, improved awareness coupled with better early detection facilities, use of chemotherapy, hormone therapy, and targeted therapy have significantly improved survival from cancer, there are many gaps in providing individual-centric, holistic care. Integrative medicine refers to the use of traditional medicine alongside conventional preventive or therapeutic interventions (allopathic medicine) as a comprehensive, individual-centered, evidence-based care. The three pillars of complementary medicine (lifestyle modifications, mind-body practices, and use of natural products) have the potential for cancer prevention and improving quality-of-life and even treatment response in cancer patients when combined with conventional oncology care. Therefore, continued research into integrative therapies is required to extend the benefits to a broader patient population and improve outcomes in breast and other common cancers. In the present review article, the possible role of integrative medicine across the breast cancer care continuum has been discussed along with the concept of integrating complementary practices into mainstream health delivery. We have focused on breast cancer as a model cancer that is well amenable to prevention, early detection and stage appropriate treatment. However, our observations are pertinent for other common cancers, for which there are several opportunities for improving the continuum of care, especially in developing countries like India.

Use of Complementary and Alternative Medicine in Patients with Primary Immunodeficiency: a Multicentric Analysis of 101 Patients.

The term complementary and alternative medicine (CAM) describes a broad spectrum of health care practices that are not an integral part of the conventional health care system. Many patients worldwide use CAM on their own initiative, often in combination with their conventional medical therapy. CAM use is attractive especially to patients with primary immunodeficiency, since they suffer from frequent infections and autoimmunity. Those are frequently addressed by CAM providers. The aim of this multicentric study was to collect information on the use of CAM by these patients and to define characteristics that are associated with the use of CAM. A total of 101 patients with primary immunodeficiencies at German hospitals were surveyed on their CAM use (further 14 patients rejected to participate). Multiple psychological tests (MARS-D, WHO-5, PHQ9, EFQ) were conducted to investigate variations among personality traits associated with CAM use. Additionally, clinical and sociodemographic patient data was collected. A total of 72% of patients used CAM to treat their primary immunodeficiency. The three most frequently used methods were physical exercise or fitness training (65%), dietary supplements (58%), and homeopathy (49%). Most patients did not discuss CAM use with their doctors, mostly because they felt that there was no time for it. CAM plays an important role for patients with primary immunodeficiency in a high-resource health care setting such as Germany. In clinical practice, doctors should create a platform to discuss needs that go beyond conventional therapy.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

Apprehensions about Excessive Belief in Digital Therapeutics: Points of Concern Excluding Merits.

Digital therapeutics (DTx), like drugs or medical devices, 1) must prove their effectiveness and safety through clinical trials; 2) are provided to patients through prescriptions from doctors; and 3) may require the approval of regulatory agencies, though this might not be mandatory. Although DTx will play an important role in the medical field in the near future, some merits of DTx have been exaggerated at this crucial juncture. In the medical field, where safety and effectiveness are important, merely reducing the development time and costs of DTx is not advantageous. The adverse effects of DTx are not yet well-known, and will be identified eventually, with the passage of time. DTx is beneficial for the collection and analysis of real-world data (RWD); however, they require new and distinct work to collect and analyze high-quality RWD. Naturally, whether this is possible must be independently ascertained through scientific methods. Depending on the type of disease, it is not recommended that DTx be prescribed, even if the patient rejects conventional treatment. Prescription of conventional pharmacotherapy is often necessary, and if the prescription of DTx is inadequate, the critical time for initial treatment may be missed. There is no basis for continuing DTx use by patients. Rather, the rate of continuity of DTx use is extremely low. While many conventional pharmacotherapies have undergone numerous verification and safety tests over a long time, barriers to the application of DTx in the medical field are lower than those for conventional pharmacotherapies. Considering these reasons, except for certain special cases, an approach to DTx is needed that complements the prescription of conventional pharmacotherapy by the medical staff. When DTx are prescribed by doctors who clearly know their advantages and disadvantages, the doctors' expertise may undergo further refinement, and the quality of medical care is expected to improve.

Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines.

BACKGROUND: Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. METHODS: A systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections. RESULTS: From 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers. CONCLUSIONS: There are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.

A comparison of the efficacy and safety of complementary and alternative therapies for gastroesophageal reflux disease: A protocol for network meta-analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world and is showing increasing prevalence in some countries. The disease has a chronic course that leads to a significant decline in the quality of life of patients and is associated with a high economic burden worldwide. And complementary and alternative medicine is used to treat the disease. Over the past few decades, a number of randomized controlled trials and systematic evaluations have been conducted to evaluate the effectiveness and safety of different types of complementary and alternative medicine methods, so there is an urgent need to summarize and further evaluate these studies. METHODS: We will search the following sources without restrictions for date, language, or publication status: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, and EMBASE, China National Knowledge Infrastructure, Chinese Bio-medicine Database, VIP Chinese Periodical Database, Wan Fang Database. We will apply a combination of Medical Subject Heading and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on complementary and alternative therapies for GERD and reference lists of included studies will also be searched. RESULTS: This study will provide a reliable basis for the treatment of GERD with complementary and alternative therapies. CONCLUSIONS: The findings will be an available reference to evaluate the efficacy and safety of complementary and alternative therapies on GERD and may provide decision-making reference on which method to choose for clinicians. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020169332.

Associations Between Complementary and Alternative Medicine and Health Care Expenditures Among Adults With Chronic Back Pain.

BACKGROUND: Although complementary and alternative medicine (CAM) has been associated with reduced morbidity among adults with chronic back pain, less is known about the association between CAM use and health care expenditures. OBJECTIVES: The objective of this study was to first estimate health care expenditures of adult CAM users and nonusers with chronic back pain and then assess CAM's influence on health care expenditures. RESEARCH DESIGN: This was an ambidirectional cohort study. DATA: Linked National Health Interview Survey (2012) and Medical Expenditure Panel Survey (2013-2014). MEASURES: CAM use was defined as 3 or more visits to a practitioner in the 12 months before the National Health Interview Survey interview. Covariates included age, sex, race-ethnicity, and body mass index. The outcome was annual health care expenditures (overall and within 8 categories, including office-based visits and prescription medication). ANALYSES: Survey-weighted, covariate adjusted predicted marginal means models were applied to quantify health care expenditures. Survey-weighted, covariate adjusted linear and logistic regression models were used to investigate CAM's influence on expenditures, and the Z mediation test statistic was applied to quantify the independent effects of CAM. RESULTS: Overall, health care expenditures were significantly lower among CAM users with chronic back pain compared with non-CAM users for both 2013 and 2014: $8402 versus $9851 for 2013; $7748 versus $10,227 in 2014, annual differences of -$1499 (95% confidence interval: -$1701 to -$1197) and -$2479 (95% confidence interval: -$2696 to -$2262), respectively (P<0.001). Adult CAM users also had significantly lower prescription medication as well as outpatient expenses (P<0.001). CAM use was identified as a partial mediator to health care expenditures. CONCLUSION: CAM use is associated with lower overall health care expenditures, driven primarily by lower prescription and outpatient expenditures, among adults with chronic back pain in the United States.

Use of GoFundMe® to crowdfund complementary and alternative medicine treatments for cancer.

PURPOSE: Complementary and alternative medicine (CAM) use is common amongst cancer patients. However, there is growing concern about its safety and efficacy. Online crowdfunding campaigns represent a unique avenue to understand the cancer patient's perspective for using CAM or declining conventional cancer therapy (CCT). METHODS: Five hundred GoFundMe campaigns from 2012 to 2019 detailing financial need for cancer treatment were randomly selected and reviewed for endorsement of CAM use, reasons for using CAM, and reasons for declining CCT. Descriptive statistics were used to compare patient and campaign characteristics between 250 CAM users and 250 non-CAM users. RESULTS: Compared to non-CAM users, CAM users were more likely to be female (70% vs. 54%, p < 0.01), to report more stage IV cancer (54% vs. 12%, p < 0.01), and to have a history of delayed, missed, or misdiagnosis (10% vs. 4%, p < 0.01). Reasons for using CAM include endorsing curative/therapeutic effects 212 (85%), pain/stress reduction 137 (55%), and dissatisfaction with current or past medical treatment options 105 (42%). 87 (35%) CAM users that declined CCT reported that they wanted to try to fight off cancer using CAM first 57 (61%), that CCT was too "toxic" to the body 39 (42%), and cancer was already too advanced, so that CCT would be futile or too aggressive 25 (27%). CONCLUSION: Cancer patients on GoFundMe using CAM highly value quality of life, comfort, and autonomy. Physicians should educate themselves on CAM to set realistic expectations and provide comprehensive counseling of the risks and benefits of CAM usage to patients who choose to use CAM to either augment or completely replace CCT.