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1.
Integr Cancer Ther ; 18: 1534735419866908, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31416372

RESUMO

The Standardized Cultured Extract of Lentinula edodes Mycelia (also known as Active Hexose Correlated Compound, AHCC) and Wasabia japonica (Wasabi) are natural nutritional supplements known for their immunomodulatory and anticancer potential. The aim of this study was to evaluate the combinatorial effect of the bioactive immunomodulatory compound (BAIC), obtained by combining Wasabi and AHCC, on human breast (MCF-7) and pancreatic (Panc02) adenocarcinoma cell lines. Data obtained revealed that BAIC determines a striking decline in cancer cell growth at minimal concentrations compared with the use of Wasabi and AHCC as single agents. A significant increase in the G0/G1 subpopulation together with a marked augmentation in the percentage of apoptotic cells was demonstrated by flow cytometry, together with a significant upregulation in the expression of genes associated to the apoptotic cascade in both cell lines. The inhibitory role BAIC plays in mammospheres formation from MCF-7-derived cancer stem cells was shown with a marked reduction in size and number. Interestingly, when BAIC was exposed to monocytic cells, no cytotoxic effects were observed. A monocytes-to-macrophages differentiation was rather observed with the concomitant acquisition of an anti-inflammatory phenotype. Taken together, our findings suggest that BAIC could be used as a potential integration of standard chemotherapy treatments because of the improved inhibitory activity on cancer cell proliferation and reduced potential adverse effects.


Assuntos
Adenoma/tratamento farmacológico , Antineoplásicos/farmacologia , Neoplasias da Mama/tratamento farmacológico , Fatores Imunológicos/farmacologia , Neoplasias Pancreáticas/tratamento farmacológico , Apoptose/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Medicina Integrativa/métodos , Células MCF-7 , Macrófagos/efeitos dos fármacos , Oncologia/métodos , Monócitos/efeitos dos fármacos
2.
J Altern Complement Med ; 25(7): 719-726, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31314560

RESUMO

Objectives: To use a psychosocial framework to examine the pain experiences of low-income, ethnically diverse patients before and after an Integrative Pain Management Program (IPMP). Design and methods: IPMP is a 12-week, multimodal pain group incorporating mindfulness, acupuncture, massage, education, movement, and health coaching. The authors conducted semistructured interviews at the beginning, end, and 3 months following completion of IPMP. Interviews were digitally recorded and transcribed and analyzed using inductive coding methods. Setting: A primary care clinic in San Francisco, CA, serving low-income, ethnically diverse patients, many of whom are marginally housed and living with disabilities. Subjects: Forty-one patients with a diagnosis of chronic pain, currently receiving prescription opioids and referred by their primary care provider, who participated in IPMP. Results: Authors thematically analyzed 104 individual interviews with 41 IPMP participants, including 41 baseline, 35 three-month follow-up, and 28 six-month follow-up. Before IPMP, participants described a psychologic "vicious cycle" of pain symptoms that worsened with movement and anxiety, while increasing their sense of disempowerment and social isolation. Following IPMP, patients reported using new strategies to manage pain, including lowering medication use, resulting in an emerging sense of psychologic resilience, and more social connections. Conclusions: IPMP offers an accessible model for addressing psychosocial aspects of chronic pain. Vulnerable patients engaged with integrative medicine groups and developed new perspectives and tools for managing their pain; they emerged feeling hopeful and resilient. These results support the use of integrative medicine groups for targeting psychosocial aspects of chronic pain within primary care.


Assuntos
Dor Crônica , Medicina Integrativa/métodos , Manejo da Dor/psicologia , Populações Vulneráveis/psicologia , Dor Crônica/psicologia , Dor Crônica/terapia , Terapias Complementares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Pediatr Ann ; 48(6): e216-e219, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185111

RESUMO

Pediatric integrative medicine is an emerging field with significant potential to benefit children's health. It focuses on enhancing modern approaches to preventive health and expanding treatment options in complex or chronic conditions. The field fills important gaps in pediatric care and has accrued a robust body of supporting evidence to support its growth. This article provides an overview of pediatric integrative medicine, including background, scope of practice, strengths and challenges, safety and efficacy issues, and examples of how one might introduce integrative medicine into pediatric practice. [Pediatr Ann. 2019;48(6):e216-e219.].


Assuntos
Terapias Complementares/métodos , Medicina Integrativa/métodos , Comunicação Interdisciplinar , Pediatria/métodos , Criança , Terapias Complementares/organização & administração , Humanos , Medicina Integrativa/organização & administração , Pediatria/organização & administração
6.
Pediatr Ann ; 48(6): e226-e230, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185113

RESUMO

Anxiety is one of the most common psychiatric conditions affecting adolescents and youth in the United States, with over 30% of adolescents having an anxiety disorder of any type. The conventional approach to anxiety management can include medications that in some patient populations can increase the risk of suicidality. Untreated anxiety and sequela of anxiety can have a significant impact on the life of a child and can impact them into adulthood. Integrative treatments in the setting of anxiety and stress management can be used along with conventional approaches to evoke the relaxation response. Integrative approaches can also teach children and youth tools that may serve to help them learn to better manage the symptoms of anxiety and build resilience throughout their lifetime. [Pediatr Ann. 2019;48(6):e226-e230.].


Assuntos
Ansiedade/terapia , Terapias Complementares/métodos , Medicina Integrativa/métodos , Pediatria/métodos , Resiliência Psicológica , Estresse Psicológico/terapia , Adolescente , Ansiedade/psicologia , Criança , Doença Crônica , Humanos , Estresse Psicológico/complicações , Estresse Psicológico/psicologia
7.
Pediatr Ann ; 48(6): e231-e235, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185114

RESUMO

Pediatric primary headache disorders are best treated using a comprehensive and integrative approach, due to the complex interactions between psychosocial and biological processes. Although more quality research is needed for treatment approaches to pediatric headaches, current practice management includes both pharmaceutical and nonpharmaceutical management. This article describes the integrative treatments used in a large regional pediatric headache program. Lifestyle approaches, nutraceuticals and dietary supplements, acupuncture, transcutaneous neurostimulation, relaxation, clinical hypnosis, biofeedback, and psychological services are discussed in detail for clinicians who may consider applying to their practice. [Pediatr Ann. 2019;48(6):e231-e235.].


Assuntos
Terapias Complementares/métodos , Cefaleia/terapia , Medicina Integrativa/métodos , Pediatria/métodos , Adolescente , Criança , Terapia Combinada , Cefaleia/psicologia , Humanos
8.
Pediatr Ann ; 48(6): e236-e242, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185115

RESUMO

Nausea is a bothersome symptom that is commonly seen in the pediatric population. The pathophysiology of nausea is complex and involves the central nervous system, the enteric nervous system, gastrointestinal tract motility, and psychologic influences. Pharmacologic and nonpharmacologic therapies are available for treating nausea. Mind-body interventions (hypnosis, biofeedback), botanicals and supplements (ginger, enteric-coated peppermint oil), aromatherapy, and acupuncture have emerging evidence for effectively treating pediatric nausea. [Pediatr Ann. 2019;48(6):e236-e242.].


Assuntos
Terapias Complementares/métodos , Medicina Integrativa/métodos , Náusea/terapia , Pediatria/métodos , Adolescente , Criança , Terapia Combinada , Humanos , Náusea/etiologia , Náusea/fisiopatologia
9.
Support Care Cancer ; 27(9): 3175-3178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31062108

RESUMO

PURPOSE: As survival after cancer diagnosis increases, patients are increasingly turning toward integrative therapies (e.g., yoga, acupuncture, massage) to manage acute and chronic concerns related to cancer treatment and survivorship. As such, integrative medicine programs devoted to combining conventional Western cancer care with complementary treatments such as yoga, acupuncture, botanicals, and homeopathy are increasingly common in cancer communities around the world. However, few integrative medicine programs have included psycho-oncology providers in order to systematically evaluate and treat psychological and behavioral health factors affecting adjustment to cancer. METHODS: A pilot program was initiated at a large academic medical center to explore benefits of a collaborative clinic visit conducted with psycho-oncology and integrative medicine within an existing supportive oncology clinic. Collaborative medical and psychological interventions were provided to enhance patient quality of life and reduce symptom burden. RESULTS: Forty-nine patients were seen via the dyadic consultation model. Sixty-eight percent of patients rated their emotional distress at or above clinical cutoffs, indicating unmet supportive care needs. The majority of patients seen were White, non-Hispanic, and female. CONCLUSIONS: Many cancer patients and survivors report persistent emotional distress and chronic physical problems associated with their diagnosis and treatment. The types of patients seen in this pilot program raise concern about ongoing inequalities in access to integrative medicine and psycho-oncology services, which may contribute to downstream health disparities and poorer clinical outcomes. Future directions will explore billing practices, financial sustainability, and methods to increase access to this type of program for demographically diverse individuals across cancer populations.


Assuntos
Sobreviventes de Câncer/psicologia , Medicina Integrativa/métodos , Neoplasias/psicologia , Psico-Oncologia/métodos , Qualidade de Vida/psicologia , Apoio Social , Acupuntura , Feminino , Humanos , Masculino , Massagem , Oncologia/métodos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Pesquisa , Ioga
11.
J Evid Based Med ; 12(1): 76-88, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30806495

RESUMO

Acute pancreatitis (AP) is one of the most common acute abdominal diseases. The digestive disease committee, Chinese Association of Integrative Medicine, released Integrated traditional Chinese and Western medicine for diagnosis and treatment of acute pancreatitis in 2010.1 Since then, further studies and great progress have been made by domestic and foreign counterparts from the perspective of both Chinese and Western medicine in AP, including the classification, fluid resuscitation, organ function maintenance, surgery intervention, enteral nutrition (EN), and syndrome differentiation and treatment. It is necessary to update the consensus on diagnosis and treatment of integrated Chinese and Western medicine to meet clinical needs. Therefore, the 2012 Revision of the Atlanta Classification Standard (RAC) by the International AP Consensus,2 the 2013 the Management of Acute Pancreatitis by the American College of Gastroenterology,3, 4 the 2014 Guidelines for diagnosis and treatment of the acute pancreatitis guide (2014) by the Chinese medical association branch,5 the 2014 Guidelines on Integrative Medicine for Severe Acute Pancreatitis by the General Surgery Committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine,6 and Traditional Chinese Medicine Consensus on the Diagnosis and Treatment for Acute Pancreatitis by the Spleen and Stomach committee of China Association of Traditional Chinese Medicine7, 8 were taken into account for the revision of the consensus published in 2010. The digestive specialists in Chinese and Western medicine had a discussion on traditional Chinese medicine (TCM) types, syndrome differentiation, the main points of integrative medicine, and so on. According to the Delphi method, Consensus of Integrative Diagnosis and Treatment of Acute Pancreatitis (the 2017 revision) has been passed after three rounds votes. (The voting options are as follows: (a) totally agree; (b) agree, but with some reservations; (c) agree, but with larger reservations; (d) disagree, but reserved; and (e) absolutely disagree. If more than two out of three choose (a), or over 85% choose (a) + (b), the consensus will be passed.) The final validation was carried out by the core expert group in Taizhou, Jiangsu on June 9, 2017. The full text is as follows.


Assuntos
Medicina Integrativa/métodos , Medicina Integrativa/normas , Pancreatite/diagnóstico , Pancreatite/terapia , Doença Aguda , Humanos , Índice de Gravidade de Doença
13.
Curr Pain Headache Rep ; 23(2): 10, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30790138

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed. RECENT FINDINGS: Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.


Assuntos
Terapias Complementares/métodos , Medicina Integrativa/métodos , Transtornos de Enxaqueca/terapia , Medicina Baseada em Evidências , Humanos , Transtornos de Enxaqueca/psicologia
14.
Complement Ther Med ; 42: 27-32, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30670252

RESUMO

BACKGROUND: Pediatric use of complementary medicine (CM) is common and offers numerous research questions about diverse therapies and conditions. Although research priorities for pediatric CM have been identified, there was a need to update in light of the rapid evolution of the field. METHODS: Building on previous work, we conducted an international, consensus-based 4-step modified Delphi process to develop and refine a pediatric CM research agenda, including on-line questionnaires and an in-person meeting. Participants included health care professionals, researchers, and educators. RESULTS: We received 376 responses; participants included conventional and CM providers, researchers, educators, administrators, and policy-makers from 15 countries (Australia, Bangladesh, Belgium, Canada, China, Germany, India, Israel, Italy, New Zealand, Norway, Sri Lanka, The Netherlands, United Kingdom, and United States). While it was recognized that each region must set their own priorities based on use, access, and expertise, a "minimum set" for a pediatric CM research agenda was identified. After three rounds of surveys, participants identified the highest priorities for pediatric CM research as: (i) safety of CM therapies for infants, children, and adolescents; (ii) conditions for which CM use is highly prevalent and for which conventional medicine lacks safe, cost-effective therapies; iii) therapies/therapists to be examined for quality and reproducibility of interventions, comparative and cost effectiveness, dose, etc.; and iv) identification of relevant outcomes and outcome measurement tools. CONCLUSIONS: The results of our study identify that "first do no harm" is the leading research priority for pediatric CM research, followed by more research on effectiveness of CM therapies for conditions not safely and effectively treated with conventional care. In order to improve pediatric health care, interdisciplinary collaborative approaches are needed between CM and conventional providers and researchers.


Assuntos
Medicina Integrativa/métodos , Adolescente , Terapias Complementares/métodos , Consenso , Técnica Delfos , Pessoal de Saúde , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Reprodutibilidade dos Testes , Pesquisadores , Inquéritos e Questionários
15.
Integr Cancer Ther ; 18: 1534735418817833, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30526124

RESUMO

OBJECTIVES: To assess the clinical evidence for integrative herbal medicine therapy in the management of chemotherapy-induced peripheral neuropathy (CIPN) and hand-foot syndrome (HFS) resulting from treatments for colorectal cancer (CRC). DESIGN: Randomized controlled trials (RCTs) were identified from major English and Chinese databases. Participants had been diagnosed with CRC by pathology and had received or were undergoing chemotherapy. Interventions included herbal medicines administered orally or topically. Controls were placebo, supportive care or conventional chemotherapy for CRC. Methods followed the Cochrane handbook. Meta-analyses were grouped by study design, outcome measure, severity, and chemotherapy. Random-effects models with 95% confidence intervals were used. Heterogeneity was assessed as I2. RESULTS: Sixty-three RCTs (4286 participants) were included. Five used a placebo in the control groups. Fifty-eight studies tested oral herbal medicine, and 5 tested topical herbal medicine. Data were available for CIPN (60 studies) and HFS (12 studies). Fifty-seven studies combined orally administered herbal medicine with chemotherapy compared with the same chemotherapy. For CIPN, 33 studies used World Health Organization (WHO) criteria, 7 used Levi's criteria, and 10 used the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). These were analyzed separately. For grades III + IV CIPN, there was a significant reduction in the integrative groups for WHO (relative risk [RR] 0.42 [0.23, 0.77], I2 = 0%) and Levi's (RR 0.28 [0.11, 0.69], I2 = 0%) but not NCI-CTCAE (RR 0.65 [0.37, 1.13], I2 = 26.4%). Hand and foot baths showed no differences for Levi's grades III + IV CIPN but a significant reduction in all grades (RR 0.69 [0.50, 0.95], I2 = 68.8%). For HFS (all grades) there was a significant reduction in the integrative groups for WHO (RR 0.62 [0.41, 0.96], I2 = 22%) but not for NCI-CTCAE (RR 0.93 [0.55, 1.55], I2 = 75.7%). Sensitivity analyses explored sources of heterogeneity. CONCLUSIONS: Integrative herbal therapy appeared to reduce CIPN and HFS in people receiving chemotherapy for CRC. However, the strength of the evidence was limited by lack of blinding in most studies, potential for bias, and relatively short study durations.


Assuntos
Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Síndrome Mão-Pé/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Medicina Herbária/métodos , Humanos , Medicina Integrativa/métodos , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Plantas Medicinais/química
16.
Support Care Cancer ; 27(8): 2949-2955, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30569264

RESUMO

PURPOSE: To understand patient preferences for integrative therapeutics and/or modalities during cancer care. METHODS: Cancer patients currently going through treatment were recruited from the Mayo Clinic in Arizona. Participants were asked to engage in 1 of 4 focus groups to understand preferences regarding integrative therapeutic modalities in cancer treatment. Focus group data were transcribed and analyzed using thematic analysis. Eighty-five percent of inter-coder reliability was achieved with four team investigators. RESULTS: Nineteen cancer patients participated in four focus groups with mixed cancer types (42% breast cancer), gender (53% female), and age (69% over age 60). Focus group analyses resulted in five themes with respect to preferences regarding integrative therapeutic modalities among cancer patients: (1) preference regarding accurate and congruent information; (2) preference regarding stress and symptom management; (3) preference regarding discussion of integrative therapies with healthcare providers (4) preference regarding support from family and friends; and (5) preference regarding personalized holistic care. CONCLUSIONS: Patients have a desire to discuss integrative therapeutic aspects of their cancer treatment with healthcare providers. Understanding patient preferences allows opportunity for oncology providers to increase awareness/education of integrative therapeutic modalities. Increased integrative therapeutic knowledge may best support recovery and increased quality of life. IMPLICATIONS: Qualitative research may facilitate understanding the scope of cancer patient preferences regarding the desire and use of integrative therapeutic modalities. A conceptual understanding of cancer patient preferences regarding integrative therapies and modalities may best inform successful direction and efficacy of treatment strategies.


Assuntos
Medicina Integrativa/métodos , Neoplasias/psicologia , Neoplasias/terapia , Preferência do Paciente/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Qualidade de Vida , Reprodutibilidade dos Testes
17.
J Sch Nurs ; 35(4): 256-261, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29681230

RESUMO

Complementary, alternative, and integrative therapies (CAIs) involve the use of practices outside of mainstream, conventional medicine. Few studies have been conducted on nurses' perception and knowledge of CAI therapies. There is limited information on the protocols school nurses must follow in their practice on CAI use. The purpose of this study is to assess school nurses' perception and knowledge of CAI therapies. A cross-sectional, nonexperimental survey study design was used, and participants were sampled with a cross-sectional convenience method. Members of four state School Nurses Associations were invited to participate in the study. Of the 290 participants, 100% of certified school nurses and 63% of non-certified school nurses believed CAI therapies have a place in their current practice (χ2 = 1.83, df = 1, p < .05). The study found that school nurses believe CAI therapies have a role in the school setting; however, the participants were not comfortable with assessing and administering these therapies.


Assuntos
Terapias Complementares/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Enfermagem/psicologia , Adulto , Competência Clínica , Terapias Complementares/enfermagem , Estudos Transversais , Feminino , Humanos , Medicina Integrativa/métodos , Masculino , Estados Unidos
18.
Explore (NY) ; 15(1): 61-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30243950

RESUMO

BACKGROUND: Pharmaceuticals such as opioids have routinely been prescribed for pain management. However, there has been an increasing epidemic of prescription opioid abuse, causing demand for nonpharmacologic complementary and integrative therapies for pain management. OBJECTIVE: To determine if integrative medicine services provided to inpatients could help reduce pain posttreatment. In addition, this study aimed to track total services requested and performed over the fourth quarter of 2017. DESIGN, SETTING, AND PARTICIPANTS: This prospective study analyzed documented integrative medicine services requested, indications for the requests, and pre- and posttreatment pain scores. A paired t test was used to determine significance. The study population was inpatients, from October 1, 2017, through December 31, 2017, at Mayo Clinic's Methodist and St. Mary's Hospitals in Rochester, Minnesota. RESULTS: During the study period, 1220 integrative services were provided with a majority being massage therapy (1,064; 87.2%), followed by acupuncture (112; 9.1%). Massage therapy and acupuncture were highly significant (P < 0.00) at reducing pain scores posttreatment to inpatients. Over one-third of patients fell asleep during their therapy service time. CONCLUSION AND RELEVANCE: Integrative therapies are appropriate modalities to help alleviate pain and other symptoms for the inpatient population. Due to the effectiveness of these modalities, integrative therapies may be a complement to opioids prescribed for pain. In addition, with over one-third of the patients falling asleep during therapy, our results suggest that integrative therapies can promote a state of relaxation. Future studies are warranted to determine the impact of integrative medicine therapies on sleep deprivation and other common symptoms of hospitalized patients.


Assuntos
Medicina Integrativa/métodos , Manejo da Dor/métodos , Centros Médicos Acadêmicos , Terapia por Acupuntura/estatística & dados numéricos , Humanos , Pacientes Internados , Medicina Integrativa/estatística & dados numéricos , Massagem/estatística & dados numéricos , Minnesota , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos
19.
Curr Opin Organ Transplant ; 24(1): 87-91, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30540575

RESUMO

PURPOSE OF REVIEW: Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients. RECENT FINDINGS: The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. There is a knowledge gap regarding CIM modalities among healthcare professionals that may contribute to reluctance to discuss CIM use with patients. Patients often do not spontaneously disclose its use, and those that use it may be more likely to be nonadherent to allopathic therapies. Herbal supplements may be nephrotoxic or interact with pharmaceutical agents, including calcineurin inhibitors. More data are needed to assess the potential benefits of other modalities of CIM, including yoga, Tai Chi or meditation, as these modalities have been beneficial for people with diabetes or hypertension, both of which are common in the posttransplant period. SUMMARY: Despite a high prevalence of CIM use in kidney transplant recipients, data are limited regarding risks and benefits. Education of healthcare providers who care for kidney transplant recipients should be encouraged. Intervention studies should be designed to investigate the CIM modalities, including yoga, meditation and Tai Chi that have been shown to be beneficial in other chronic diseases.


Assuntos
Terapias Complementares/métodos , Medicina Integrativa/métodos , Transplante de Rim/métodos , Humanos
20.
BMJ Open ; 8(12): e023758, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552268

RESUMO

OBJECTIVES: The importance of 'whole person' or 'holistic' care is widely recognised, particularly with an increasing prevalence of chronic multimorbidity internationally. This approach to care is a defining feature of general practice. However, its precise meaning remains ambiguous. We aimed to determine how the term 'whole person' care is understood by general practitioners (GPs), and whether it is synonymous with '[w]holistic' and 'biopsychosocial' care. DESIGN: Systematic literature review. METHODS: MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Proquest Dissertations and Theses, Science.gov (Health and Medicine database), Google Scholar and included studies' reference lists were searched with an unlimited date range. Systematic or literature reviews, original research, theoretical articles or books/book chapters; specific to general practice; relevant to the research question; and published in English were included. Included literature was critically appraised, and data were extracted and analysed using thematic synthesis. RESULTS: Fifty publications were included from 4297 non-duplicate records retrieved. Six themes were identified: a multidimensional, integrated approach; the importance of the therapeutic relationship; acknowledging doctors' humanity; recognising patients' individual personhood; viewing health as more than absence of disease; and employing a range of treatment modalities. Whole person, biopsychosocial and holistic terminology were often used interchangeably, but were not synonymous. CONCLUSIONS: Whole person, holistic and biopsychosocial terminology are primarily characterised by a multidimensional approach to care and incorporate additional elements described above. Whole person care probably represents the closest representation of the basis for general practice. Health systems aiming to provide whole person care need to address the challenge of integrating the care of other health professionals, and maintaining the patient-doctor relationship central to the themes identified. Further research is required to clarify the representativeness of the findings, and the relative importance GPs' assign to each theme. PROSPERO REGISTRATION NUMBER: CRD42017058824.


Assuntos
Atitude do Pessoal de Saúde , Medicina Geral/organização & administração , Saúde Holística , Medicina Integrativa/métodos , Austrália , Doença Crônica/terapia , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Linguagem , Masculino , Multimorbidade , Relações Médico-Paciente , Padrões de Prática Médica , Resultado do Tratamento
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