Mind-Body Medicine and Immune System Outcomes: A Systematic Review.

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

Home hospice acupuncture: a preliminary report of treatment delivery and outcomes.

In recent years, complementary and alternative medicine modalities, including acupuncture, have been incorporated intohospice careboth to address symptom distress and to enhance quality of life. Beginning in 1997, Kaiser Permanente Northwest Hospice began offering limited acupuncture services to hospice patients and, in some cases, their caregivers. Data collection-comprising a chart review (n = 71) and in-depth interviews with the two program acupuncturists-was initiated to explore in a preliminary fashion both the processes involved in acupuncture delivery and outcomes associated with this intervention. Information culled from the patient charts (representing the year 2003) revealed a median age of 68.5 years, a cancer diagnosis in 63% of cases, and a median hospice length of stay of 102 days. The most commonly cited chief complaints presented to the acupuncturists included pain (70%), anxiety (45%), shortness of breath (27%), and nausea/vomiting (14%). Patients received a median of three acupuncture treatments; excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain, in 31% of anxiety chief complaints, in 22% of shortness-of-breath chief complaints, and in 29% for nausea/vomiting chief complaints. The program acupuncturists described their practice with this group of patients as a departure from how they treat patients in a typical practice context. They described a greater focus on providing comfort through ameliorating symptoms and a diminished focus on more holistic goals, which often are typical elements in an acupuncture intervention. Nonetheless, acupuncturists also observed instances of outcomes in psychologic, social, and spiritual domains, regardless of whether these outcomes were the principal focus of treatment. These data add to the accumulating anecdotal reports suggesting that acupuncture is a promising adjunctive therapy for those nearing the end of life in the home hospice setting. More in-depth and precise assessment is warranted to comprehensively evaluate acupuncture as a viable adjunct to current usual and customary hospice care.

Discriminators of Complementary and Alternative Medicine provider use among men with HIV/AIDS.

OBJECTIVE: To examine comprehensively the potential correlates of Complementary and Alternative Medicine (CAM) practitioner use among men with HIV/AIDS. METHODS: Men (n=122) recruited from HIV/AIDS service organizations completed extensive written surveys. Questions comprised several domains that have been thought or demonstrated to influence individuals to use CAM, and also addressed respondents' social networks. RESULTS: Discriminant analyses revealed 2 social network variables and 2 attitudinal variables proved statistically significant when controlling for relationships among variables. CONCLUSION: The significant contribution of social influence/social networks in choosing CAM modalities demonstrated has not heretofore been examined in CAM user studies; implications for future research are discussed.

Elective induction: an analysis of economic and health consequences.

OBJECTIVE: Our purpose was to assess economic and health consequences of elective induction at term. STUDY DESIGN: A decision-tree model incorporating a Markov analysis was used to compare the decision either to electively induce labor at term or expectantly manage the pregnancy until 42 weeks' gestation. Main outcome measures, stratified by parity, cervical ripeness, and gestational age at induction, were number of cesarean deliveries and costs to the health care system. RESULTS: By use of baseline estimates, induction at any gestational age, regardless of parity and cervical ripeness, required expenditures from the medical system. Although never cost saving, inductions were less expensive at later gestational ages, for multiparous patients, and for those women with a favorable cervix. Sensitivity analysis demonstrated a robust model. CONCLUSIONS: Elective induction of labor at term is not cost saving and results in a large excess of cesarean deliveries. Costs are significantly altered by the timing of the induction, parity, and cervical ripeness.