Integrative Medicine in General Practice in Australia: A Mixed-Methods Study Exploring Education Pathways and Training Needs.

BACKGROUND: Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice. OBJECTIVE: This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners' IM Specific Interest Network, which is a group of GPs with interest in IM. METHODS: We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined. RESULTS: Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM. CONCLUSION: Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.

The experiences of midwives when caring for obese women in labour, a qualitative study.

BACKGROUND: maternal obesity is a significant public health challenge for maternity services, especially those in developed countries. Obesity presents an increased risk of mortality and morbidity during the childbearing continuum. Caring for the obese woman in labour is challenging for midwives and there is a dearth of qualitative research which examines their experiences. OBJECTIVES: to explore the experiences of midwives caring for obese women in labour. DESIGN: a qualitative, phenomenological approach was used to enable in-depth exploration of midwives' experiences. SETTING: one maternity centre in the North of England. PARTICIPANTS: a purposive sampling approach was used. Eleven midwives who had experience of caring for obese women in labour were interviewed using in depth, digitally recorded semi-structured interviews for data collection. METHODS: interpretative Phenomenological Analysis was performed, and underlying themes emerged from the data resulting in an exhaustive description of midwives' experiences of caring for obese women in labour. FINDINGS: the heart sinking phenomena when caring for obese women in labour emerged from the data from these midwives. Midwives were faced with a constant challenge to promote normality during childbearing in a medicalised environment. Mobilisation of the obese woman was a significant factor for midwives who were striving for normality for the woman. A sense of loss of control and helplessness underlying their care provision was apparent. Perceptions of obesity differed, with confusion between embarrassment and empathy emerging. Difficulties of how and when is the best opportunity to address obesity with the women arose. Different provisions of care amongst midwives were discussed. KEY CONCLUSIONS: the findings suggest that midwives have different levels of understanding of the complexities associated with the condition. There was a sense of frustration at the 'loss' of normality for this group of women. Different provisions of care emerged with the need for more explicit guidelines to guide and support midwives. Communication and education were identified as key concepts when addressing the increasing prevalence of obesity. IMPLICATIONS FOR PRACTICE: it is evident that the maternal obesity phenomenon is growing rapidly and that midwives feel that they are ill equipped to address it. Support must be provided for the practitioners striving for normality for the women. Continuity of care must be encouraged to enable practitioners to build up a rapport with these vulnerable women through the childbirth continuum. Midwives involvement in developing multidisciplinary guidelines should be encouraged to determine the roles and responsibilities of practioners. Antenatal education is key if women are to be made aware of the problems associated with obesity and interdisciplinary learning must be encouraged to ensure support is consistent, appropriate and available to all women.

Integrative management of nausea and vomiting.

Nausea and vomiting are common symptoms seen in general practice. This article provides a brief overview of some integrative therapies that have demonstrated benefit in the management of these symptoms, specifically nausea induced by pregnancy, chemotherapy and surgery.

Premenstrual disorders in adolescent females-- integrative management.

Premenstrual symptoms affect many adolescent females with studies suggesting an incidence range of 31-61% in this age group. The presentation of premenstrual syndrome (PMS) can be varied and can include psychological and/or somatic symptoms.