Documentation of Complementary and Integrative Health Therapies in the Electronic Health Record: A Scoping Review.

Introduction: Complementary and integrative health (CIH) therapies refers to massage therapy, acupuncture, aromatherapy, and guided imagery. These therapies have gained increased attention in recent years, particularly for their potential to help manage chronic pain and other conditions. National organizations not only recommend the use of CIH therapies but also the documentation of these therapies within electronic health records (EHRs). Yet, how CIH therapies are documented in the EHR is not well understood. The purpose of this scoping review of the literature was to examine and describe research that focused on CIH therapy clinical documentation in the EHR. Methods: The authors conducted a literature search using six electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE, Scopus, Google Scholar, Embase, and PubMed. Predefined search terms included "informatics," "documentation," "complementary and integrative health therapies," "non-pharmacological approaches," and "electronic health records" using AND/OR statements. No restrictions were placed on publication date. The inclusion criteria were as follows: (1) Original peer-reviewed full article in English, (2) focus on CIH therapies, and (3) CIH therapy documentation practice used in the research. Results: The authors identified 1684 articles, of which 33 met the criteria for a full review. A majority of the studies were conducted in the United States (20) and hospitals (19). The most common study design was retrospective (9), and 26 studies used EHR data as a data source for analysis. Documentation practices varied widely across all studies, ranging from the feasibility of documenting integrative therapies (i.e., homeopathy) to create changes in the EHR to support documentation (i.e., flowsheet). Discussion: This scoping review identified varying EHR clinical documentation trends for CIH therapies. Pain was the most frequent reason for use of CIH therapies across all included studies and a broad range of CIH therapies were used. Data standards and templates were suggested as informatics methods to support CIH documentation. A systems approach is needed to enhance and support the current technology infrastructure that will enable consistent CIH therapy documentation in EHRs.

[Obligatory documentation for narcotic drugs over the course of time : the morphine and cocaine book for physicians according to the 1930 parliamentary law gazette]. / Dokumentationspflicht für Betäubungsmittel im Wandel der Zeit : Das Morphin- und Kokainbuch für Arzte nach dem Reichsgesetzblatt 1930.

According to the opium law and prescription statute of 1930, physicians were duty-bound to maintain a stock ledger to allow a traceable record of the location of narcotic drugs. If a simplification of the prescription of opiates was welcomed 10 years ago then 2 years after amendment of the addictive drugs statute thought should be give to safe use, as can be concluded from a morphine logbook from the time of the introduction of the Federal opium law. "Receipt and issue... deliverer and recipient" must be able to be extracted from the documentation, which means the delivery and the dispensing but not the individual application.

Use of complementary and alternative medicine in children with type 1 diabetes mellitus - prevalence, patterns of use, and costs.

BACKGROUND: Complementary and alternative medicine (CAM) is increasingly used in adults and children. Studies on CAM in diabetes have mainly focused on the adult population and its use among children with type 1 diabetes has not been well characterized. OBJECTIVES: This study determines prevalence, parental reasons and motivations, perceived effectiveness, costs, and communication of CAM use. Moreover, caregiver-related variables associated with the use of CAM were investigated. METHODS: A self-completed anonymous questionnaire was administered to parents of children with type 1 diabetes in four pediatric diabetes centers in Germany (Leipzig, Berlin, Stuttgart, and Bonn). RESULTS: Two hundred and twenty eight (65.9%) of 346 families completed the survey. Mean age of the diabetic patients was 11.9 +/- 3.8 yr. Forty two (18.4%) received one or more types of CAM, with the most common types being homeopathy (14.5%), vitamins and minerals (13.7%), modified diet (12.9%), aloe vera (7.3%), and cinnamon (5.6%). Users had a significantly higher family income and parental tertiary education (p < 0.05) and stated a significantly stronger interest in self-care (p < 0.01). Parents' motivations for using CAM were the hope for an improved well-being (92.1%), to try everything (77.8%), and assumption of fewer side effects (55.2%). Costs for the entire treatment varied between less than euro100 and up to euro5000, with mostly no reimbursement. CONCLUSIONS: Use of CAM in children with type 1 diabetes is less common than that documented for adults. Parents using CAM do not question the need for insulin. When using CAM, improved well-being and quality of life are important considerations where CAM can have a role.

A chart review comparing paregoric to methadone in the treatment of neonatal opioid withdrawal.

Neonatal opioid withdrawal often requires treatment but there have been few recent studies of current pharmacological interventions to guide treatment. This retrospective chart review provides an exploratory examination of newborns treated with either methadone or paregoric for opioid withdrawal and outlines dosage ranges and intervals, side effects, and clinical outcomes of the two regimens. The outcome variables examined were time to resolution of withdrawal symptoms, rate of decrease in symptom severity, and length of hospital stay. There were no observed differences in outcome variables between the two treatment groups and side effect profiles were similar. Dosages, dosage intervals, and tapering regimens were consistent with American Academy of Pediatrics recommendations. Although the sample size is small and standardized regimens were not used, this study provides preliminary data about dosing levels and dosing intervals of these two pharmacologic treatment agents. Both groups of infants had favorable outcomes, although given the variation in treatment regimens it is difficult to draw an equation of equivalency. These results are applicable to the design of future studies of pharmacological interventions.

[New documental evidence on the history of homeopathy in Latin America: a case study of links between Rio de Janeiro and Buenos Aires]. / Novas evidências documentais para a história da homeopatia na América Latina: um estudo de caso sobre os vínculos entre Rio de Janeiro e Buenos Aires.

Homeopathy began to spread soon after it was formulated by Samuel Hahnemann in the early 1800s, reaching the Southern Cone in the 1830s. In processes of this kind, one figure is often cited as being responsible for introducing it, often attaining quasi-mythical status. Little is known, however, about how homeopathy reached Argentina at that time. Through archival research, we discovered that medical and lay homeopaths circulated between Rio de Janeiro and Buenos Aires. Given the well-known proselytizing of the circles gravitating around lay homeopaths B. Mure and J.V. Martins in Rio de Janeiro, the documents indicate that this movement actually went as far as Argentina, which had not been confirmed until now.

Anecdotal therapies.

Traditionally, many advances in medicine have been serendipitous. Are serendipitous and anecdotal synonymous? Many of our materia medica today relate to initial probes and anecdotal reports that matured to full investigation and therapeutic indications. The recent situation regarding Skin Cap is one that highlights the downside of this scenario. Several drugs in the US continue usage largely related to anecdotal indications, and anecdotal extension of legend indications is a standard for American Dermatology. The situation with systemic drugs, such as Trental, zinc preparations, imidazoles for extended indications, lysine and melatonin, all will be discussed. Topical preparations such as skin cap, cantharone, Vioform, all also are included in this category. It is important to place this topic in perspective in regards to geographic variation and therapeutic need. Many diseases lacking specific therapy are important targets for anecdotal therapy, and this will foster continued approaches in this area. The growing standardization of medicine and pharmaceutical regulation, threatens the anecdotal approach, but it provides still an important link to the future for some forms of therapy in diseases that are difficult to treat. Traditionally, the anecdote has been the first step in the therapeutic chain. Withering discovery of the benefits of the common fox glove in dropsy, was followed by many other anecdotes arriving via folk-medicine in the New World. This approach of utilizing folk medicine has now reached new heights, with very active searches by major pharmaceutical companies throughout the third world for remedies that may have potential. Couched with this is the history of anecdotal "snake-oil" remedies, that clearly had no benefit to anyone except the huckster marketing same. The excesses in this area of unproven and false therapies, led to the gradual organization of therapeutic trials and the Food and Drug Administration in the US as we know it today. The biggest shot in the arm for enhancing FDA protocols was the thalidomide situation, an outgrowth of an ethically studied and used medication that perhaps had been released too soon, prior to sufficient trials to determine the total patient risk. As in many situations, the pendulum swings in both directions, and after thalidomide, the acceptance of new treatments required more and more rigorous studies, and studies from other countries often were not acceptable unless a small part of a larger, whole proposal. The AIDS crisis has prompted a swing back, away from such expensive and rigorous pre-marketing review, to more expedited processes for the relief of patients with this fatal disease. This has streamlined the FDA, and hopefully the swing of the pendulum will not go too far, to result in problems in the future. Anecdotal therapies and medications are the first step in many parts of the world to therapeutic trials. The most widely used aspects of anecdotal therapies, again, remains in the situation with diseases without good therapies at the present time. The so-called orphan drugs and orphan diseases, while a serious medical problem, do not present a significant volume for effective drug screening in many instances, and the FDA has developed some new approaches to circumvent this very expensive development process for patients suffering from these rare and unusual disorders. The most recent example of anecdotal therapy catching the public fancy in dermatology was the Skin-Cap Spray. This product, over the period of twelve months, got rave reviews in the lay press in the non-peer reviewed dermatologic periodicals, and amassed impressive sales figures in this period of time. It was extremely effective, and most dermatologists who used it have patients who consider it the most effective therapy in the last year. The formulation of a low concentration of zinc pyrithione seemed unusual, and this truly was an anecdotal approach, using a homeopathic dosage of a commonly used p

Novas evidências documentais para a história da homeopatia na América Latina: um estudo de caso sobre os vínculos entre Rio de Janeiro e Buenos Aires / New documental evidence on the history of homeopathy in Latin America: a case study of links between Rio de Janeiro and Buenos Aires

Resumo A homeopatia começou a propagar-se logo após sua formulação por Samuel Hahnemann, nos primeiros anos do século XIX, chegando ao Cone Sul na década de 1830. Esse processo é tradicionalmente vinculado à figura de um “introdutor”, por vezes alcançando estatuto mítico. No entanto, pouco se sabe acerca da chegada da homeopatia à Argentina nesse período. Com base em trabalho de arquivo, identificamos uma clara circulação de homeopatas médicos e leigos no eixo Rio de Janeiro-Buenos Aires. Dada a conhecida atividade proselitista desenvolvida nos círculos ligados aos homeopatas leigos B. Mure e J.V. Martins no Rio de Janeiro, a documentação disponível aponta para a possível extensão desse movimento também na Argentina, o que não tinha sido evidenciado até o presente.

Abstract Homeopathy began to spread soon after it was formulated by Samuel Hahnemann in the early 1800s, reaching the Southern Cone in the 1830s. In processes of this kind, one figure is often cited as being responsible for introducing it, often attaining quasi-mythical status. Little is known, however, about how homeopathy reached Argentina at that time. Through archival research, we discovered that medical and lay homeopaths circulated between Rio de Janeiro and Buenos Aires. Given the well-known proselytizing of the circles gravitating around lay homeopaths B. Mure and J.V. Martins in Rio de Janeiro, the documents indicate that this movement actually went as far as Argentina, which had not been confirmed until now.

The prevalence of natural health product use in patients with acute cardiovascular disease.

BACKGROUND: Natural health products (NHP) use may have implications with respect to adverse effects, drug interactions and adherence yet the prevalence of NHP use by patients with acute cardiovascular disease and the best method to ascertain this information is unknown. OBJECTIVE: To identify the best method to ascertain information on NHP, and the prevalence of use in a population with acute cardiovascular disease. METHODS: Structured interviews were conducted with a convenience sample of consecutive patients admitted with acute cardiovascular disease to the University of Alberta Hospital during January 2009. NHP use was explored using structured and open-ended questions based on Health Canada's definition of NHP. The medical record was reviewed, and documentation of NHP use by physicians, nurses, and pharmacists, compared against the gold-standard structured interview. RESULTS: 88 patients were interviewed (mean age 62 years, standard deviation [SD 14]; 80% male; 41% admitted for acute coronary syndromes). Common co-morbidities included hypertension (59%), diabetes (26%) and renal impairment (19%). NHP use was common (78% of patients) and 75% of NHP users reported daily use. The category of NHP most commonly used was vitamins and minerals (73%) followed by herbal products (20%), traditional medicines including Chinese medicines (9%), homeopathic preparations (1%) and other products including amino acids, essential fatty acids and probiotics (35%). In a multivariable model, only older age was associated with increased NHP use (OR 1.5 per age decile [95%CI 1.03 to 2.2]). When compared to the interview, the highest rate of NHP documentation was the pharmacist history (41%). NHP were documented in 22% of patients by the physician and 19% by the nurse. CONCLUSIONS: NHP use is common in patients admitted with acute cardiovascular disease. However, health professionals do not commonly identify NHP as part of the medication profile despite its potential importance. Structured interview appears to be the best method to accurately identify patient use of NHP.

Novas evidências documentais para a história da homeopatia na América Latina: um estudo de caso sobre os vínculos entre Rio de Janeiro e Buenos Aires / New documentary evidence for the history of homeopathy in Latin America: a case study on the links between Rio de Janeiro and Buenos Aires

A homeopatia começou a propagar-se logo após sua formulação por Samuel Hahnemann, nos primeiros anos do século XIX, chegando ao Cone Sul na década de 1830. Esse processo é tradicionalmente vinculado à figura de um “introdutor”, por vezes alcançando estatuto mítico. No entanto, pouco se sabe acerca da chegada da homeopatia à Argentina nesse período. Com base em trabalho de arquivo, identificamos uma clara circulação de homeopatas médicos e leigos no eixo Rio de Janeiro-Buenos Aires. Dada a conhecida atividade proselitista desenvolvida nos círculos ligados aos homeopatas leigos B. Mure e J.V. Martins no Rio de Janeiro, a documentação disponível aponta para a possível extensão desse movimento também na Argentina, o que não tinha sido evidenciado até o presente. (AU)

Utilização de documentação ortodôntica na identificação humana / Use of orthodontic records in human identification

OBJETIVO: o objetivo deste trabalho é relatar um caso pericial onde um indivíduo encontrado carbonizado foi identificado utilizando-se as informações presentes na sua documentação ortodôntica. MÉTODOS: um indivíduo do sexo masculino foi encontrado carbonizado no interior de um automóvel. Após a realização dos exames periciais no local, exames necroscópicos e radiográficos no Instituto Médico-Legal, identificou-se que a vítima utilizava aparelho ortodôntico fixo, possuía dentes supranumerários nas quatro hemiarcadas, terceiros molares semi-inclusos e restaurações de amálgama em determinadas faces de diversos dentes. Como os tecidos moles do indivíduo apresentavam-se bastante destruídos, uma identificação pela análise das impressões digitais tornou-se inviável. Após a entrega da documentação ortodôntica pela família, foi feita a análise do prontuário clínico, radiografias, fotografias intra e extrabucais e modelos de gesso - confrontando-se essas informações com as obtidas anteriormente. RESULTADOS E CONCLUSÕES: o confronto odontolegal revelou 20 pontos concordantes do exame necroscópico e da documentação ortodôntica, permitindo a determinação de uma correlação positiva entre o cadáver examinado e a identidade da pessoa desaparecida, tornando-se desnecessária a realização de outros exames para a identificação da vítima (exame de DNA).

OBJECTIVE: This study describes a forensic case of incinerated remains of a man that were identified using information found in his orthodontic records. METHODS: Incinerated remains of a man were found inside a car. After forensic crime scene investigation and postmortem and radiographic exams in the Forensic Department, forensic experts found that the victim had a fixed orthodontic appliance, supernumerary teeth in all quadrants, partially erupted third molars and amalgam restorations in some surfaces of several teeth. As the individual's soft tissues were substantially destroyed, identification using fingerprints was not the ideal choice. After orthodontic records were handed in by the family, his clinical chart, radiographs, intra- and extraoral photographs and impressions were analyzed, and these data were compared with previously collected information. RESULTS AND CONCLUSIONS: Forensic dentistry examination revealed 20 concordant points in specimen examination and orthodontic records, which enabled the establishment of a positive correlation between the cadaver under examination and the missing person and eliminated the need for further analyses (DNA tests) to identify the victim.

Traditional toxicity documentation of Chinese Materia Medica--an overview.

Documentation of Chinese materia medica (CMM) dates back to around 1,100 BC when only dozens of drugs were first described. By the end of the 16th century, the number of drugs documented had reached close to 1,900. And by the end of the last century, published records of CMM have reached 12,800 drugs. The recorded traditional information includes toxicities, incompatibilities, cautions, precautions and contraindications. Thus, contrary to a general misconception, toxicity data on Chinese herbs exist and are not meager. If consulted properly before embarking on a study of CMM, it will save researchers much time and efforts and the frustration of not obtaining consistent or expected results. The history of documentation is reviewed with examples of major classic and contemporary works highlighting and emphasizing the manner in which CMM toxicities have traditionally been documented through clinical experience as opposed to most modern toxicity data that are based on animal experimentation.

Documentation of a heroin manufacturing process in Afghanistan.

The present article documents an authentic process of heroin manufacturing in Afghanistan: white heroin hydrochloride produced using simple equipment and a small quantity of chemicals. The quantities of chemicals actually used corresponded to the minimum needed for manufacturing heroin. The only organic solvent used was acetone, and only a very small quantity of it was used. Because the chemicals used in the demonstration were from actual seizures in Afghanistan, some of the chemicals had been disguised or repackaged by smugglers. Others had been put into labelled containers that proved to be counterfeit, and some glass containers used were not the original containers of the manufacturer displayed on the label. The brown heroin base prepared as an intermediate step in the process shares some of the characteristics of the South-West Asia type of heroin preparations often seized in Germany. The final product of the documented heroin manufacturing process was white heroin hydrochloride, which shares the key characteristics of the white heroin occasionally seized in Germany and other countries in Western Europe since 2000. The present article demonstrates that this kind of heroin can be produced in Afghanistan.

[Research in alternative medicine. What is documented, and what is documentation?]. / Forskning i alternativ medisin. Hva er dokumentert, og hva er dokumentasjon?

A study of the literature describing research on alternative medicine showed that, in general, the research was of poor quality. Any clinical effect of kinesiology had not been documented. Only few studies on reflexology had been controlled. Several controlled studies on healing showed significant effect, mainly in patients with psychosomatic disorders, or when the patient had great faith in the healer. Acupuncture seems to be effective against nausea, in patients with chronic pain and in patients who have had stroke. The data do not support the claim that acupuncture is effective for asthma or addiction. In the case of homeopathy the evidence from clinical trials is positive but not sufficient to draw a definite conclusion, for example, is it better than placebo? The majority of studies seems to disregard the principle of homeopathy, i.e. that the treatment should be individualised. Even if the documented effect of alternative medicine is not convincing, the effect is favourable empirically and may in itself be sufficient to give practitioners of alternative medicine an authorization. The term "alternative medicine" should be replaced by "complementary medicine".

A importânicia do prontuário odontológico na clínica de graduação em Odontologia e a responsabilidade ética pela sua guarda / The importance of dental files in the graduation clinic in dentistry and the ethical responsibility for their guard

Introdução - O protuário é o primeiro contato do aluno com o paciente. Este documento oferece, ao professor, a oportunidade de orientá-lo a desenvolver uma postura profissional, além de ser prova da relação jurídica paciente-profissional, apta a gerar direitos e obrigações para o paciente da clínica da faculdade, para a instituição e para os professores. Desta forma, o prontuário odontológico deve ser bem estruturado e devidamente arquivado, pois é o melhor instrumento para que o profissional ou professor responsável pelo aluno possa produzir as provas necessárias à sua defesa. Assim, recomenda-se que as faculdades dêem maior ênfase aos assuntos odonto-legais para salvaguardarem seus egressos de problemas futuros

Percepção a respeito de prontuário dos discentes de Odontologia de Graduação e Pós-graduação, Bauru-SP / Perception about dental records of dental students of undergraduate and post-graduate, Bauru - SP

Prontuário é um conjunto de documentos gerados a partir do tratamento do paciente, pertencente a este sendo o profissional responsável por sua guarda, que deve ser para sempre. Deve ser devidamente elaborado e arquivado pelo profissional por ter importân-cias clínicas, administrativas e jurídicas. Neste trabalho foi avaliado o conhecimento sobre prontuário, dos alunos de Graduação e Pós-graduação de Odontologia, de Bauru - SP. Para tanto, foi aplicado um questionário para 319 alunos, sendo 244 da graduação e 75 da pós-graduação. Consideraram ter bom aprendizado 56,55% e 45,33% dos alunos da graduação e pós-graduação, respectivamente, e 25,00% e 14,67% acreditam ter ótimo conhecimento sobre o assunto. Contudo, 75,40% dos alunos da graduação e 70,67% da pós-graduação não souberam assinalar a quem pertence o prontuário. Uma porcentagem de 81,14% e 89,33% dos alunos de Graduação e Pós-graduação, respectivamente, souberam diferenciar prontuário de ficha clínica, e 33,20% dos alunos da graduação e 34,67% da pós-graduação demonstram ter conhecimento quanto a uma correta elabora-ção do prontuário. Os autores concluem que o conhecimento dos alunos dos cursos de graduação e pós-graduação com relação a prontuário odontológico é insuficiente haven-do necessidade de conscientização da sua importância clínica, administrativa e jurídica na vida do profissional, assim como adequação dos profissionais à realidade de mercado de trabalho frente ao Código de Defesa do Consumidor...

Fontes do arquivo do Instituto Hahnemanniano do Brasil para a historia da homeopatia / Sources from thearchives of the Brazilian Hahnemannian Institute for the history of homeopathy

O crescente interesse pela homeopatia reflete-se na abundancia de estudos que vem sendo produzidos e publicados recentemente. A Fundacao Casa de Rui Barbosa elaborou um catalogo de fontes, ainda nao publicado... (AU)