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.

Hypnosis-induced mental training improves performance on the Fundamentals of Laparoscopic Surgery (FLS) simulator.

BACKGROUND: Mental training (MT) is used extensively by musicians and athletes to improve their performance. Recently, it has been suggested as a training method for surgical trainees. We assessed the influence of MT, induced by hypnosis, on the performance of simulated tasks on a laparoscopic simulator, as compared to a non-specific relaxing intervention. METHODS: 11 surgeons completed a proficiency-based training program on the Fundamentals of Laparoscopic Surgery (FLS) simulator, until they reached performance plateau of the peg transfer task. Thereafter, they received a single music session, as a relaxing intervention, followed by repeating of the peg transfer task. Then they went through a hypnosis session guided by an experienced psychologist, with suggestions of smooth flow of pegs from one position on the board to another, and re-performed the task. RESULTS: Plateau performance was 51.1 ± 6.9 s. After the music session performance improved by 6.3% to 47.9 ± 5.4 s (p = 0.86). After the MT session performance further improved by 15.3% to 40.1 ± 5.8 s (p = 0.009), which was a 21.6% improvement from baseline (p < 0.001). Subject's satisfaction from their performance, without knowledge of the task scores, was 6.0 ± 2.9 on 0-10 VAS after the music and reached as high as 8.5 ± 1.7 after the hypnotic session (p = 0.01). CONCLUSIONS: Hypnosis-induced MT significantly improves performance on the FLS simulator, which cannot be attributed to its relaxing qualities alone. This study contributes evidence to the effectiveness of MT in surgical skills acquisition and suggests that hypnotic techniques should be used in mental preparation processes. There is a need to further study these effects on operating room performance.

[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.

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.

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 effect of music relaxation versus progressive muscular relaxation on insomnia in older people and their relationship to personality traits.

A large percentage of older people suffer from chronic insomnia, affecting many aspects of life quality and well-being. Although insomnia is most often treated with medication, a growing number of studies demonstrate the efficiency of various relaxation techniques. The present study had three aims: first, to compare two relaxation techniques--music relaxation and progressive muscular relaxation--on various objective and subjective measures of sleep quality; second, to examine the effect of these techniques on anxiety and depression; and finally, to explore possible relationships between the efficiency of both techniques and personality variables. Fifteen older adults took part in the study. Following one week of base-line measurements of sleep quality, participants followed one week of music relaxation and one week of progressive muscular relaxation before going to sleep. Order of relaxation techniques was controlled. Results show music relaxation was more efficient in improving sleep. Sleep efficiency was higher after music relaxation than after progressive muscular relaxation. Moreover, anxiety was lower after music relaxation. Progressive muscular relaxation was related to deterioration of sleep quality on subjective measures. Beyond differences between the relaxation techniques, extraverts seemed to benefit more from both music and progressive muscular relaxation. The advantage of non-pharmacological means to treat insomnia, and the importance of taking individual differences into account are discussed.

THE EFFECT OF A HYPNOTIC-BASED ANIMATED VIDEO ON STRESS AND PAIN REDUCTION IN PEDIATRIC SURGERY.

Presurgical stress and its negative influences on postsurgical recovery and pain are well documented in the medical literature. Hence, the reduction of stress is advisable. The present study aimed to reduce stress using a hypnotic-based animated video. Thirty children aged 3 to 16 years hospitalized for ambulatory surgery for undescended testes or umbilical/inguinal hernia were recruited for the study. They watched the video 1 time prior to surgery in the presence of their parents and reported their anxiety and pain pre- and postvideo watching on a visual analogue scale. The results show a statistically significant reduction in both anxiety and pain. The article describes the structuring of the animated video and includes links to English, Hebrew, and Arabic versions of it.

Development and validation of a tool to evaluate Inpatient Beliefs, Expectations and Attitudes toward Reflexology (IBEAR-16).

BACKGROUND: The integration of manual therapies, including reflexology, into conventional care settings is growing extensively. Patients' beliefs, attitudes and expectations toward these therapies interact with their outcomes, but currently there are no validated tools to evaluate these factors. We aimed to design and to validate such a tool specifically targeted into reflexology. METHODS: Following input of a multidisciplinary team of experts, the self-administered Inpatient Beliefs, Expectations and Attitudes toward Reflexology (IBEAR) questionnaire was constructed, containing 25 items, 8 referring to demographics and 17 specifically addressing reflexology. Cronbach's alpha was computed to evaluate the questionnaire's internal reliability, and factor analysis was used for further validation (232 patients). Pearson coefficient and Kappa tests were used to test and retest (within 48 hours) the questionnaire on a group of 199 patients, to assure clarity and reliability. RESULTS: For the 232 questionnaires collected, the computed Cronbach's alpha coefficient was 0.716 (acceptable reliability). Factor analysis pointed to two content areas separated into four items addressing attitudes and expectations and five items focusing on beliefs and attitudes. In the test-retest stage, 199 participants filled in the questionnaire for a second time. The Pearson coefficient for all questions ranged between 0.73 and 0.94 (good to excellent correlation) and Kappa scores ranged between 0.66 and 1.0 (moderate to high reliability). Consequently, one of the questions was removed from the IBEAR. CONCLUSIONS: The present study provides evidence that the proposed IBEAR questionnaire with 16 items is a valid and reliable tool for evaluation of inpatients' beliefs, expectations and attitudes toward reflexology.

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.

Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety.

STUDY OBJECTIVE: Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperative anxiety. This study examined the relative effectiveness of various individual and generic CAM methods combined with standard treatment (ST) in relieving preoperative anxiety, in comparison with ST alone. DESIGN: Randomized controlled trial. SETTING: Holding room area PATIENTS: Three hundred sixty patients. INTERVENTIONS: Patients were randomly divided into 6 equal-sized groups. Group 1 received the standard treatment (ST) for anxiety alleviation with anxiolytics. The five other groups received the following, together with ST (anxiolytics): Compact Disk Recording of Guided Imagery (CDRGI); acupuncture; individual guided imagery; reflexology; and individual guided imagery combined with reflexology, based on medical staff availability. MEASUREMENTS: Assessment of anxiety was taken upon entering the holding room area (surgery preparation room) ('pre-treatment assessment'), and following the treatment, shortly before transfer to the operating room ('post-treatment assessment'), based on the Visual Analogue Scale (VAS) questionnaire. Data processing included comparison of VAS averages in the 'pre' and 'post' stages among the various groups. MAIN RESULTS: Preoperatively, CAM treatments were associated with significant reduction of anxiety level (5.54-2.32, p<0.0001). In contrast, no significant change was noted in the standard treatment group (4.92-5.44, p=0.15). Individualized CAM treatments did not differ significantly in outcomes. However, CDRGI was less effective than individualized CAM (P<0.001), but better than ST (p=0.005). CONCLUSIONS: Individual CAM treatments integrated within ST reduce preoperative anxiety significantly, compared to standard treatment alone, and are more effective than generic CDRGI. In light of the scope of preoperative anxiety and its implications for public health, integration of CAM therapies with ST should be considered for reducing preoperative anxiety.

The effects of music relaxation and muscle relaxation techniques on sleep quality and emotional measures among individuals with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD), an anxiety disorder with lifetime prevalence of 7.8%, is characterized by symptoms that develop following exposure to traumatic life events and that cause an immediate experience of intense fear, helplessness or horror. PTSD is marked by recurrent nightmares typified by the recall of intrusive experiences and by extended disturbance throughout sleep. Individuals with PTSD respond poorly to drug treatments for insomnia. The disadvantages of drug treatment for insomnia underline the importance of non-pharmacological alternatives. Thus, the present study had three aims: first, to compare the efficiency of two relaxation techniques (muscular relaxation and progressive music relaxation) in alleviating insomnia among individuals with PTSD using both objective and subjective measures of sleep quality; second, to examine whether these two techniques have different effects on psychological indicators of PTSD, such as depression and anxiety; and finally, to examine how initial PTSD symptom severity and baseline emotional measures are related to the efficiency of these two relaxation methods. Thirteen PTSD patients with no other major psychiatric or neurological disorders participated in the study. The study comprised one seven-day running-in, no-treatment period, followed by two seven-day experimental periods. The treatments constituted either music relaxation or muscle relaxation techniques at desired bedtime. These treatments were randomly assigned. During each of these three experimental periods, subjects' sleep was continuously monitored with a wrist actigraph (Ambulatory Monitoring, Inc.), and subjects were asked to fill out several questionnaires concerned with a wide spectrum of issues, such as sleep, depression, and anxiety. Analyses revealed a significant increase in objective and subjective sleep efficiency and a significant reduction in depression level following music relaxation. Moreover, following music relaxation, a highly significant negative correlation was found between improvement in objective sleep efficiency and reduction in depression scale. The study's findings provide evidence that music relaxation at bedtime can be used as treatment for insomnia among individuals with PTSD.

Integrating a complementary medicine service within a general surgery department: from contemplation to practice.

This article describes experience in developing a complementary and alternative medicine (CAM) service within a general surgery department in a public academic hospital in Israel. A framework is suggested for integrating CAM services within a hospital, based on the authors' experience, along three themes: the organizational structure of such a service, communication with the conventional team, and self-appraisal using a research-based documentation and assessment process. With the anticipated increase in CAM utilization within medical institutions, it is hoped this article will provide foundations for successful integration of other such services.