How should complementary and alternative medicine be taught to medical students in Switzerland? A survey of medical experts and students.

BACKGROUND: In Switzerland and in the whole western world, the growing popularity of CAM is calling for its implementation in the undergraduate medical curriculum. AIMS: To determine whether medical experts and medical students are favorable to complementary and alternative medicine (CAM) education at Swiss medical schools and to investigate their opinion about its form, content and goals. METHODS: Experts in the fields of conventional medicine (COM, n = 106), CAM experts (n = 29) and senior medical students (n = 640) were surveyed by an online questionnaire. RESULTS: 48.7% of the COM experts, 100% of the CAM experts, and 72.6% of the students are favorable to CAM education at Swiss medical schools. The most requested disciplines are acupuncture, phytotherapy, and homeopathy; the most recommended characteristics of CAM education are elective courses, during the clinical years, in the format of seminars and lectures. For the CAM experts, the priority is to improve the students' knowledge of CAM, whereas for the COM experts and the students, the priority is to analyze efficiency, security, interactions, and secondary effects of CAM. CONCLUSIONS: CAM courses should be informative, giving the students sufficient knowledge to provide a critical analysis of efficiency and security of different CAM modalities.

A perspective on Councils on Chiropractic Education accreditation standards and processes from the inside: a narrative description of expert opinion: Part 2: Analyses of particular responses to research findings.

Background: This is the second article reporting on a study that sought the views of people with extensive experience in Councils on Chiropractic Education (CCEs) on research that has raised concerns about variability in accreditation standards and processes for chiropractic programs (CPs) and chiropractic practice in general. Methods: This qualitative study employed in-depth semi-structured interviews that consisted of open-ended questions asking experts about their thoughts and views on a range of issues surrounding accreditation, graduate competency standards and processes. The interviews were audio-recorded, and transcribed verbatim in June and July of 2018. The transcripts were reviewed to develop codes and themes. The study followed the COREQ guidelines for qualitative studies. Results: The interviews revealed that these CCE experts were able to discern positive and negative elements of the accreditation standards and processes. They were, in general, satisfied with CCEs accreditation standards, graduating competencies, and site inspection processes. Most respondents believed that it was not possible to implement an identical set of international accreditation standards because of cultural and jurisdictional differences. This was thought more likely to be achieved if based on the notion of equivalence. Also, they expressed positive views toward an evidence-based CP curriculum and an outcomes-based assessment of student learning. However, they expressed concerns that an evidence-based approach may result in the overlooking of the clinician's experience. Diverse views were found on the presence of vitalism in CPs. These ranged from thinking vitalism should only be taught in an historical context, it was only a minority who held this view and therefore an insignificant issue. Finally, that CCEs should not regulate these personal beliefs, as this was potentially censorship. The notable absence was that the participants omitted any mention of the implications for patient safety, values and outcomes. Conclusions: Expert opinions lead us to conclude that CCEs should embrace and pursue the widely accepted mainstream healthcare standards of an evidence-based approach and place the interests of the patient above that of the profession. Recommendations are made to this end with the intent of improving CCE standards and processes of accreditation.

NHS letter stimulates international dialogue on interpretation and possible implications of CAM research.

Prompted by the open letter by 13 prominent British scientists to National Health Science (NHS) trusts questioning the use of homeopathy, Vinjar Fønnebø, M.D., Ph.D., and Michael Baum, M.B., Ch.M., F.R.C.S., M.D.(Hon) entered into an e-mail exchange about the issues of research and documentation of practices in "complementary," "alternative," and "integrated" medicine. The paper presents the whole exchange unedited. Researchers who are well-acquainted with the field benefit from discussing and challenging, and will achieve a clearer understanding of both the understanding and opinions of the others as well as their own positions.

[Expert assessment of naturopathy, alternative treatment methods and homeopathic practitioners]. / Begutachtung von Naturheilverfahren, alternativen Behandlungsmethoden und Heilpraktikern.

An expert opinion on genuine naturopathy cures which have widely been integrated into so-called "medical-school" treatment usually presents no problem. Difficulties may arise, however, when evaluating so-called alternative or unconventional methods, as it is typical for these to be based on hypothetical thinking patterns, and more so, as there is no proof of action in the postulated fields of indication that would meet current standards. Here, it is the task of the expert to determine whether the assertions of the appliers of these methods are comprehensible and substantiated and whether the methods may be considered medically indicated for the individual case. The claim of those practicing these methods that they are the only ones capable of judging them must be denied in principle. To determine if there is a medical indication for treatment by a non-medical practitioner in any individual case, the criteria applied should be basically the same as for medical treatment by a physician. Also, according to a judgment by the German Federal Court, a non-medical practitioner using invasive methods must meet the same standards of knowledge and advanced training as any general practitioner working in this field.

Dementia: treating patients and caregivers with complementary and alternative medicine--results of a clinical expert conference using the World Café method.

BACKGROUND: In Germany the number of inhabitants with dementia is expected to increase from 1.2 million at present to 2.3 million in 2050. Our aim was to investigate which treatments complementary and alternative medicine (CAM) experts consider to be of therapeutic use in developing treatment strategies and hypotheses for further clinical studies. METHODS: In a participatory group workshop the 'World Café' method was used. As questions we asked: 1) 'Based on your clinical experience, which CAM therapies are effective in the treatment of patients with dementia? 2) Based on your clinical experience, which CAM therapies are effective in the treatment of lay and professional caregivers of patients with dementia?, and 3) How should a CAM treatment program look like?' Further Delphi rounds were used to reach consensus and summarize the results. RESULTS: The 2-day workshop took place in January 2012 in Berlin. A total of 17 experts participated. The most important subject in the treatment was the need to understand patients' biographies in order to individualize the therapy. Therapy itself consists of the therapeutic relationship, nonmedical therapies such as sports, massage, music and arts therapy as well as medical treatment such as herbal or homeopathic medicines. With regard to caregivers the most important aim is to prevent or reduce psychological distress, e.g., by mind-body programs. Instead of single treatments, more general elements such as understanding the patients' biographies, therapeutic relationships, individualizing, networking, and self-care emerged as main results. DISCUSSION: An integrative treatment program should connect outpatient and inpatient care as well as all experts. CAM training courses should be offered to doctors, nurses, and caregivers. Future clinical studies should focus on complex intervention programs integrating these key elements.

Failures in dental prosthesis: dentists perception of the involved legal aspects / Insucessos em prótese dental: percepção dos cirurgiões-dentistas quanto aos aspectos odontolegais envolvidos

This aim of this study was to verify the level of knowledge of prosthodontics specialists from the city of Porto Alegre, Rio Grande do Sul State, concerning the failures of prosthetic works, and to provide a reflection on the type of responsibility assumed by the prosthodontist during the dental treatment. This was a descriptive cross-sectional study with a non-probabilistic sample, conducted through questionnaires with closed and open questions. The data was analyzed using the Fisher's Exact Test (p value < or = 0.005). The sample consisted of 143 questionnaires. The statistical analysis evidenced that the dentists with up to 15 years of professional practice assign the responsibility of failures most often to the laboratory (p = 0.001) and to the patient (p = 0.021), but over the years this trend is reversed. The prosthodontists included in the study proved to have an adequate knowledge of issues that pervade the failures in the prosthodontics specialty. In relation to the parameters of the professional responsibility, it is necessary to consider the type of duty assumed by the prosthodontist as for the responsibility of means.

O objetivo deste estudo foi verificar o grau de conhecimento do CD especialista em prótese dentária da cidade de Porto Alegre/RS sobre aspectos relacionados aos insucessos de trabalhos protéticos, bem como propor uma reflexão sobre o tipo de obrigação assumida pelos protesistas durante o tratamento odontológico. Tratou-se de um estudo transversal descritivo, com amostra não probabilística de indivíduos realizada por meio de questionários, nos quais constavam questões fechadas e abertas. A análise dos dados foi realizada utilizando-se o Teste Exato de Fischer (sendo p < ou = 0,005). A amostra foi composta de 143 questionários. O estudo estatístico mostrou quando interpretado em relação ao tempo de exercício profissional, que até os primeiros 15 anos de formado o profissional tem o entendimento de que os erros advêm mais frequentemente do laboratório (p = 0,001) e dos pacientes (p = 0,021), invertendo esta tendência com o passar dos anos. Os protesistas componentes da amostra mostraram ter um conhecimento adequado das questões relacionadas aos aspectos que permeiam os insucessos na especialidade de prótese. Ao considerarmos os parâmetros da responsabilidade profissional, deve-se considerar o tipo de obrigação assumida pelos protesistas como responsabilidade de meio.