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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 922-927, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912403

RESUMO

OBJECTIVE: To evaluate the clinical effect of integrated traditional Chinese and Western medicine on common type of coronavirus disease 2019 (COVID-19) in Henan Province. METHODS: A prospective single arm clinical study was performed. Patients with common type of COVID-19 admitted to seven designated hospitals for COVID-19 in Henan Province from January 25th to February 26th, 2020 were enrolled, and treated with integrated traditional Chinese and Western medicine. The negative transformation of 2019 novel coronavirus (2019-nCoV) nucleic acid, disease outcome, hospital stay, clinical symptoms and signs scores, and chest imaging performance were observed. RESULTS: Totally 86 cases were included in the analysis, including 48 males (55.8%), aged 43.5 (35.0, 53.3) years old, 24 patients (27.9%) with previous medical history. Fifty-eight patients were primarily diagnosed COVID-19 and 28 patients were transferred. The 2019-nCoV nucleic acid of 86 cases (100%) turned negative, and the median time of turning negative was 10 (7, 14) days. Eighty-six cases (100%) were discharged from hospital, and none turned into the severe type; the average length of hospital stay was (13.8±5.6) days. The scores of fever, cough, chest tightness, shortness of breath, and fatigue decreased with the treatment time, and the scores of 7 days and 14 days after treatment were significantly lower than those before treatment [fever (points): 0 (0, 0), 0 (0, 0) vs. 1 (0, 1); cough (points): 1 (0, 1), 0 (0, 1) vs. 1 (0, 2); chest tightness (points): 0 (0, 0), 0 (0, 0) vs. 0 (0, 1); shortness of breath (points): 0 (0, 0), 0 (0, 0) vs. 0 (0, 1); fatigue (points): 0 (0, 1), 0 (0, 1) vs. 1 (0, 1); all P < 0.05]. The improvement rate of X ray and CT image was 42.9% (12/28) and 81.0% (64/79), respectively. CONCLUSIONS: The treatment with integrated traditional Chinese and Western medicine has good curative effect on common type of COVID-19 in 7 designated hospitals of Henan Province. It can improve the clinical symptoms, promote the absorption of pulmonary inflammation, and to some extent control the progress of disease and shorten the time of turning negative of virus nucleic acid and hospital stay.


Assuntos
Infecções por Coronavirus/terapia , Medicina Integrativa , Medicina Tradicional Chinesa/métodos , Pneumonia Viral/terapia , Adulto , China/epidemiologia , Terapia Combinada , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Resultado do Tratamento
4.
Med Care ; 58 Suppl 2 9S: S80-S87, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826776

RESUMO

BACKGROUND: Veterans Affairs (VA) has rolled out a holistic, multicomponent Whole Health care model nationwide, yet no pragmatic trials have been conducted in real-world clinical settings to compare its effectiveness against other evidence-based approaches for chronic pain management in veterans. OBJECTIVES: We describe the adaptation of the first large pragmatic randomized controlled trial of the Whole Health model for chronic pain care for diverse VA clinical settings. RESEARCH DESIGN: Informed by the Promoting Action on Research Implementation in Health Systems implementation framework, we conducted qualitative semistructured interviews to obtain feedback on trial design from VA leadership, frontline clinicians, and veterans with chronic pain at 5 VA enrollment sites. Next, we convened in-person evidence-based quality improvement (EBQI) meetings with study stakeholders (including frontline clinicians and administrators) at each site to discuss study design; review interview themes; and identify site-specific barriers, facilitators, and approaches to implementation. Ethnographic observations from EBQI meetings provided additional insight into implementation strategies. SUBJECTS: Seventy-four veteran and VA staff stakeholders were interviewed; 71 stakeholders participated in EBQI meetings. RESULTS: At each site, unique clinical contexts and varying resources for Whole Health and pain care delivery affected plans for trial implementation. We present examples of local adaptations that emerged through the formative evaluation process to facilitate implementation and yield a more pragmatic trial design. CONCLUSIONS: A systematic formative evaluation can facilitate engagement and buy-in of study stakeholders. Locally tailored pragmatic implementation strategies may improve the likelihood of successful trial execution as well as future implementation of evidence-based pain care approaches in real-world clinical settings.


Assuntos
Dor Crônica/terapia , Medicina Integrativa/organização & administração , Projetos de Pesquisa , United States Department of Veterans Affairs/organização & administração , Antropologia Cultural , Atitude do Pessoal de Saúde , Medicina Baseada em Evidências , Humanos , Entrevistas como Assunto , Seleção de Pacientes , Melhoria de Qualidade/organização & administração , Estados Unidos , Veteranos , Saúde dos Veteranos
5.
Med Care ; 58 Suppl 2 9S: S116-S124, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826781

RESUMO

BACKGROUND: Long-term opioid therapy for chronic pain arose amid limited availability and awareness of other pain therapies. Although many complementary and integrative health (CIH) and nondrug therapies are effective for chronic pain, little is known about CIH/nondrug therapy use patterns among people prescribed opioid analgesics. OBJECTIVE: The objective of this study was to estimate patterns and predictors of self-reported CIH/nondrug therapy use for chronic pain within a representative national sample of US military veterans prescribed long-term opioids for chronic pain. RESEARCH DESIGN: National two-stage stratified random sample survey combined with electronic medical record data. Data were analyzed using logistic regressions and latent class analysis. SUBJECTS: US military veterans in Veterans Affairs (VA) primary care who received ≥6 months of opioid analgesics. MEASURES: Self-reported use of each of 10 CIH/nondrug therapies to treat or cope with chronic pain in the past year: meditation/mindfulness, relaxation, psychotherapy, yoga, t'ai chi, aerobic exercise, stretching/strengthening, acupuncture, chiropractic, massage; Brief Pain Inventory-Interference (BPI-I) scale as a measure of pain-related function. RESULTS: In total, 8891 (65%) of 13,660 invitees completed the questionnaire. Eighty percent of veterans reported past-year use of at least 1 nondrug therapy for pain. Younger age and female sex were associated with the use of most nondrug therapies. Higher pain interference was associated with lower use of exercise/movement therapies. Nondrug therapy use patterns reflected functional categories (psychological/behavioral, exercise/movement, manual). CONCLUSIONS: Use of CIH/nondrug therapies for pain was common among patients receiving long-term opioids. Future analyses will examine nondrug therapy use in relation to pain and quality of life outcomes over time.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/terapia , Terapias Complementares/estatística & dados numéricos , Medicina Integrativa/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Terapias Complementares/métodos , Feminino , Nível de Saúde , Humanos , Medicina Integrativa/métodos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Percepção da Dor , Qualidade de Vida , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos
6.
Med Care ; 58 Suppl 2 9S: S125-S132, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826782

RESUMO

BACKGROUND: Veterans Affairs is dedicated to providing a Whole Health approach to care, including offering complementary and integrative health (CIH) approaches to Veterans. OBJECTIVE: The objective of this study was to examine the association of CIH participation with Veterans' patient-reported outcomes over time. RESEARCH DESIGN: A survey of patient-reported outcomes at 5 timepoints: baseline, 2, 4, 6, and 12 months. SUBJECTS: Veterans participating in any type of CIH approach at 2 Veterans Affairs medical centers. MEASURES: Mixed hierarchical models with repeated variables were used to test the hypothesis that participating in any CIH approach would be associated with Veterans' overall physical/mental health [Patient-Reported Outcomes Measurement Information System 28 (PROMIS 28)], pain intensity, perceived stress (Perceived Stress Scale-4), and engagement in their care (Patient Activation Measure-13), controlling for age, male sex, site, participation in other CIH approaches, and surveys completed. RESULTS: We received 401 surveys from 119 Veterans (72% male, age range: 29-85 y) across all timepoints. Yoga participation was related to decreases in perceived stress (P<0.001), while tai chi participation was associated with improvements in overall PROMIS 28 physical and mental health functioning (P<0.02). Specific types of CIH were associated with significant improvements in PROMIS 28 subscales: meditation participation with physical functioning at 2, 6, and 12 months; tai chi participation with anxiety at 2 and 6 months, and ability to participate in social role activities at 2 months. No CIH approach was associated with Veterans' pain or engagement in their care. CONCLUSION: As specific CIH approaches are associated with improvements in patient-reported outcomes, clinicians, Veterans, and family members may use this information in discussions of nonpharmacological options to address health and well-being.


Assuntos
Terapias Complementares/estatística & dados numéricos , Medicina Integrativa/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Participação do Paciente , Estresse Psicológico/terapia , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos
8.
Altern Ther Health Med ; 26(5): 8-16, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32663179

RESUMO

Context: Complementary and integrative medicine comprises treatments used along with conventional medical care. Its use within care settings and communities has increased. Objective: We aimed to assess baseline knowledge and use of complementary and integrative medicine among advanced practice providers at an academic medical center and their attitudes toward it. Methods: A 50-question survey was sent to 1018 advanced practice providers at our academic medical center to evaluate their knowledge, attitudes, and utilization of complementary and integrative medicine therapies. Results: The 556 respondents (54.6% response rate) included physician assistants, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse midwives. Respondents reported a positive attitude toward complementary and integrative medicine and were likely to refer their patients to a complementary and integrative medicine practitioner (59%). They agreed that patients whose providers incorporate complementary and integrative medicine into their care have better clinical outcomes (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P = .002) and improved patient satisfaction (all respondents, 84%). Advanced practice providers, especially nurse practitioners, stated that they initiate the conversation to discuss the benefits and harms of complementary and integrative medicine with their patients (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P < .001). Respondents most frequently endorsed overall exercise, massage, and melatonin. Prospective randomized controlled trials were the most influential factor for attitude toward complementary and integrative medicine among physician assistants (50%), and personal experience was the most influential factor among nurse practitioners (52.9%) and certified registered nurse anesthetists (46.8%). Conclusions: Advanced practice providers generally have positive attitudes toward complementary and integrative medicine, but utilization appears limited by a self-report of low knowledge of benefits and risks of various therapies. For patient safety and satisfaction, advanced practice providers require a strong complementary and integrative medicine knowledge base to counsel patients.


Assuntos
Terapias Complementares/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Medicina Integrativa/estatística & dados numéricos , Centros Médicos Acadêmicos , Atitude do Pessoal de Saúde , Humanos
9.
Altern Ther Health Med ; 26(5): 33-37, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32663185

RESUMO

Introduction: Integrative health practices are extensively used in addition to pharmacologic treatments by elderly individuals who has chronic diseases to relieve or overcome symptoms. Methods: This qualitative study was performed on 12 elderly individuals with the aim of determining the reasons for the use of integrative health practices and identifying their thoughts regarding these practices. Face to face interview method was used for data collection. Data were collected with information forms that include informations about elderly individuals and semistuctured interview forms. All interviews with elderly individuals are made with in-depth interview method. The data was evaluated using qualitative content analysis. Results: As a result of in-depth interviews, three main themes and eight sub-themes were identified, with the main themes being the feelings before using integrative health practices, the sources of information, and the experiences after use. The majority of the individuals reported that they used integrative health practices due to feelings of helplessness/hopelessness, depression and fear; that their sources of information were not professional sources; and that, in the end, the majority of them experienced negative emotions. It can hence be recommended that healthcare personnel should carefully evaluate the elderly. Conclusion: In this study; It is determined that elderly individuals were using integrative metods in addition to pharmacologic methods for symptom management. It can hence be recommended that healthcare personnel should carefully evaluate the elderly in geriatric assessment.


Assuntos
Doença Crônica/terapia , Medicina Integrativa/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
10.
Chin J Integr Med ; 26(9): 648-655, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32676976

RESUMO

OBJECTIVES: To develop a new Chinese medicine (CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome (ARDS) in COVID-19 patients. METHODS: A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy (alpha interferon inhalation, 50 µg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy (control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed. RESULTS: An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants (24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution (P=0.035), and a significant reduction in the development of ARDS (P=0.048). CONCLUSIONS: Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients. (Trial registration No. NCT04251871 at www.clinicaltrials.gov ).


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Interferon-alfa/administração & dosagem , Lopinavir/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Administração por Inalação , Adulto , China , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Medicina Integrativa , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Índice de Gravidade de Doença , Taxa de Sobrevida
11.
Medicine (Baltimore) ; 99(21): e20083, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481274

RESUMO

We developed a protocol for a prospective registry to prove the effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. We plan on recruiting 1000 inpatients receiving integrative Korean medicine treatment for lumbar intervertebral disc herniation at four spine specialized Korean medical hospitals. Patients enrolled in the registry will be evaluated at the time of hospitalization, 2 weeks after hospitalization, at discharge, and 6 months after hospitalization on predefined outcome variables such as intensity of back and leg pain, Oswestry Disability Index, quality of life, Patient Global Impression of Change, and adverse effects. The protocol of this study was registered in CRIS (KCT0003709) and Clinical trial gov (NCT03750591). This study is significant in that it cannot only be a basis for safety-related evidence of complementary alternative medicine, which has been lacking, but it also gives clear evidence on the effectiveness and validity of treatment effects such as accompaniment of stenosis, sex, age, and type of disc herniation.


Assuntos
Medicina Integrativa/métodos , Deslocamento do Disco Intervertebral/terapia , Medicina Tradicional Coreana/métodos , Ciática/terapia , Terapia por Acupuntura/métodos , Adulto , Idoso , Humanos , Deslocamento do Disco Intervertebral/complicações , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Sistema de Registros , República da Coreia , Ciática/etiologia , Resultado do Tratamento , Adulto Jovem
12.
Orv Hetil ; 161(27): 1122-1130, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32564003

RESUMO

Integrative medicine is a new approach in the 21st century healthcare system, which integrates conventional medicine and evidence-based, safe and efficient complementary therapies into a unified biomedicine. Medical doctors and complementary therapists work together in partnership with patients to help them recover and live a whole life. Equally important is the maintenance and enhancement of health and well-being in which therapists become role-models. In this article, the authors introduce a proposal for the concept and major elements of a two-year integrative medicine postgraduate training for specialist doctors in Hungary and summarize international progress in the field. Orv Hetil. 2020; 161(27): 1122-1130.


Assuntos
Terapias Complementares , Pessoal de Saúde , Medicina Integrativa , Comportamento Cooperativo , Assistência à Saúde , Humanos , Hungria
13.
Rev Med Suisse ; 16(695): 1102-1105, 2020 May 27.
Artigo em Francês | MEDLINE | ID: mdl-32462839

RESUMO

Integrative medicine combines the virtues of conventional medicine and complementary medicine in order to improve the quality of life of patients suffering from cancer. Thanks to a multidisciplinary and multi-professional team, the Center for integrative and complementary medicine (CEMIC) allows since 2017 cancer patients at CHUV to have access to certain therapies, for which there are sufficient data suggesting a benefit in terms of quality of life. The concepts of tolerance, safety, risk of interactions and potential adverse biological effects remain central. In this article, we discuss acupuncture, art therapy, mindfulness and some natural therapies that are encountered regularly.


Assuntos
Neoplasias da Mama/terapia , Terapias Complementares , Medicina Integrativa , Terapia por Acupuntura , Terapia pela Arte , Neoplasias da Mama/psicologia , Humanos , Atenção Plena , Qualidade de Vida
18.
Am J Chin Med ; 48(3): 737-762, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-8358

RESUMO

As of 22 February 2020, more than 77662 cases of confirmed COVID-19 have been documented globally with over 2360 deaths. Common presentations of confirmed cases include fever, fatigue, dry cough, upper airway congestion, sputum production, shortness of breath, myalgia/arthralgia with lymphopenia, prolonged prothrombin time, elevated C-reactive protein, and elevated lactate dehydrogenase. The reported severe/critical case ratio is approximately 7-10% and median time to intensive care admission is 9.5-10.5 days with mortality of around 1-2% varied geographically. Similar to outbreaks of other newly identified virus, there is no proven regimen from conventional medicine and most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial. In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Medicina Integrativa , Medicina Tradicional Chinesa , Pneumonia Viral/terapia , Betacoronavirus , Ensaios Clínicos como Assunto , Infecções por Coronavirus/patologia , Humanos , Pandemias , Pneumonia Viral/patologia , Guias de Prática Clínica como Assunto
19.
Zhongguo Gu Shang ; 33(1): 27-37, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115921

RESUMO

EDITOR'S NOTE: EDITOR'S NOTE In 2019, the clinical practice guideline of integrated traditional Chinese and western medicine atlantoaxial dislocation (ADD) was developed by the professional committee of spine medicine of the Chinese Association for Integration of Chinese and Western medicine, aiming at the major clinical problems of atlantoaxial dislocation (AAD) endangering the life center of the medulla oblongata in the field of spine surgery. More than 40 experts at home and abroad in the field of cervical spine surgery organized the first guide for the diagnosis and treatment of AAD. Guided by the principles of evidence based medicine and the consensus of experts, this guideline is based on the theory of "combination of disease and syndrome, from supervision to treatment" for the diagnosis and treatment of AAD;based on the treatment principles of "spinal cord decompression, reconstruction of atlantoaxial stability";based on Tan technology, Goel technology, Abumi technology and other core technologies for surgical treatment. The main content includes four parts:AAD diagnosis standard, TCM syndrome differentiation, clinical classification, treatment strategy and method. It provides academic guidance to solve the clinical situation of AAD, which is "unclear definition of diagnosis and classification, confused choice of treatment strategy". ABSTRACT: Clinical Practice Guideline of Integrated Traditional Chinese and Western Medicine:Atlantoaxial Dislocation (AAD) was enacted by the academic committee of spine surgery of integrated traditional Chinese and Western medicine. The guideline's recommendations forms by evidence-based medicine and the expert consensus of Integrative Medicine. The guidement principles is "spinal cord decompression, reconstruction of atlantoaxial stability". The objective of the guideline is providing an academic suggestion. The main contents include diagnostic criteria, traditional Chinese medicine's (TCM) dialectical method, clinical classification, treatment strategies and methods.


Assuntos
Medicina Integrativa , Luxações Articulares , Descompressão Cirúrgica , Humanos , Medicina Tradicional Chinesa
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