External Nursing Applications in the Supportive Management of Prolonged Postoperative Ileus: Description of Interventions and Case Report

Touching body, soul, and spirit? Understanding external applications from integrative medicine: A mixed methods systematic review

Introduction

External applications from anthroposophic medicine (EAAM) are touch-based applications such as rhythmical massages, embrocations, and compresses that serve as components of complementary treatment concepts for various diseases. The aim of this review is to gain an understanding of typical indications and outcomes and to systematically assess the effectiveness and safety of EAAM.

Materials and methods

Medline/PubMed, CINAHL, the Cochrane Library, Embase, and PsycINFO were searched through May 2021 and supplemented by searches in specialized databases and personal requests to experts in the field. Studies and case reports on EAAM in patients, as well as healthy individuals, were included in the qualitative synthesis. Outcome parameters depending on each study were grouped as effect themes and assigned to study clusters using Thematic Analysis for a thematic overview of effect patterns.

Results

Four RCTs, 7 cohort studies, 1 mixed-methods, 1 retrospective, 4 qualitative studies, 3 case series, and 25 case reports on EAAM were identified. The analysis indicated various effects of EAAM on physiological as well as psychological health indicators and patterns of effect development. Study quality was found to be high for only 2 studies, and moderate for 1 study, and all remaining 45 studies showed a moderate or high risk of bias or were not ratable with used rating tools.

Conclusion

The included studies present a wide range of potential indications for EAAM, while showing methodological drawbacks. To determine whether EAAM can be considered an effective treatment option, clinical studies exploring the effect of different EAAM modalities on defined patient groups are recommended for the future.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214030], identifier [CRD42020214030].

Abdominal massage: A review of clinical and experimental studies from 1990 to 2021

OBJECTIVE

To systematically review the current state and holistic application of abdominal massage (AM).

DESIGN

A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved.

DATA SOURCES

The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar.

DATA EXTRACTION AND SYNTHESIS

Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy.

MAIN RESULTS

A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies.

CONCLUSION

The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.

Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine

Background

Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health.

Methods

To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization.

Results

Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health.

Conclusion

The research strategy extends to and complements the prevailing hierarchical system by introducing a broad “evidence house” approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.