An exploratory study of communication training for Chinese medicine practitioners in Hong Kong to integrate patients' conventional medical history

BACKGROUND

Despite Traditional Chinese medicine's (TCM) historical roles in Chinese society, few research has been investigated the nature of TCM practitioner-patient interactions. Improved communication skills among TCM practitioners will result higher-quality interactions and better clinical outcomes.

METHODS

To investigate the changes in TCM practitioners' communication practices after communications training focused on promoting their awareness of integrating a patient's medical history from conventional medicine in TCM treatment, Eight registered Cantonese-speaking TCM practitioners in Hong Kong were randomly recruited from local clinics and randomised into control (n = 12) and experimental groups (n = 12), with a total of 24 consultations. The experimental group was given training focused on patient-centred communication, with an internationally recognised and communication framework validated in global consultation settings (i.e. the Calgary-Cambridge Guide) on how to take a patient's medical history from conventional medicine and communicate diagnosis and treatment plans. Consultations before and after training were audio-recorded and rated. The efficacy of the training was evaluated by comparing the two groups before training (pre-test), immediately after training (post-test) and after a 3-month delay (delayed post-test). Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions.

RESULTS

The communication training significantly improved the TCM providers' patient-centred communication and communication proficiency. The results indicate that the team developed an effective communication model for integrating TCM and conventional medicine in Hong Kong. The framework helps trained TCM practitioners to integrate their patients' conventional medical history when delivering patient care. The findings shed light on how interpersonal relationships between TCM practitioners and patients can be constructed after communication training to better care for patients' psychological concerns in addition to their physical needs.

CONCLUSION

Trained TCM practitioners can provide an integrated model that takes patients' conventional medical history into account when delivering a holistic patient-centred care. The findings can enhance our understanding of better ways to train the future TCM practitioners and to develop a continuing professional training for the current TCM practitioners to expand our understanding of TCM communication in acute clinical contexts and, thus offer a firm evidence-based foundation upon which to develop communication strategies that improve their clinical cpractices.

When Eastern Meets Western Medicine to Manage SARS-CoV-2/COVID-19 Patient: a Case Report

Psychological and psychosocial issues are one of the prime areas to be focused on in SARS-CoV-2/COVID-19. However, those patients' mental, social, and emotional parts are still not being focused on while treating the SARS-CoV-2/COVID-19. Thus, we integrated both eastern and western medicine to discuss its impact on the mental and psychological issues of the patient. We treated a 52-year-old man who was infected with COVID-19/SARS-CoV-2 and had a sign and symptoms of fever, sore throat, running nose, cough, and tiredness. The patient was treated with integrated medicine, where we combined both eastern and western medicine to treat all aspects of health, i.e., physical, mental, emotional, and social. With the intervention we applied, his health was getting better day by day, and on the 16th day, his SARS-CoV-2 came negative. In addition, his mental health was also much better than the initial days of intervention. The integrated medicine therapeutic strategy effectively treats COVID-19 patients in all dimensions of health.

Caring for nursing home residents with COVID-19: a "hospital-at-nursing home" intermediate care intervention

Background

Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality.

Aims

To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy.

Methods

The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2.

Results

The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively).

Discussion

Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality.

Conclusions

An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01959-z.

Evaluation of chemotherapy-induced toxicity and health-related quality of life amongst early-stage breast cancer patients receiving Chinese herbal medicine in Malaysia

PURPOSE

This observational study aimed to compare the outcome and health-related quality of life (HRQOL) amongst breast cancer patients using Chinese herbal medicine (CHM) and those not using CHM during chemotherapy.

METHODS

A prospective, non-randomised longitudinal study was conducted in two government integrated hospitals over an 8-month period. Early-stage breast cancer patients who were (1) either already using complementary and alternative medicine (CAM) or not and (2) who were on a regime of 5-fluorouracil, epirubicin, and cyclophosphamide were included in the study. Patients who agreed to receive CHM were assigned to receive individualised CHM prescriptions deemed suitable for the individual at a particular time. Those who were not willing to take Chinese herbal medicines (CHM) were assigned to the non-CHM control group. Blood profile and chemotherapy-induced AE were recorded whilst HRQOL assessment was done using the EORTC QLQ-C30 questionnaire on first, third, and sixth cycles.

RESULTS

Forty-seven patients [32 female vs. 1 male, p = 0.31; mean year of age: 52.2(SD = 7.6), p = 0.28)}] were recruited during the study period. Demographics of both groups were comparable. Fifty percent of respondents reported using some kind of CAM before chemotherapy. Diet supplements (40.6%) were the most common CAM used by the respondents. The study showed that patients using CHM had significantly less fatigue (p = 0.012), nausea (p = 0.04), and anorexia (p = 0.005) during chemotherapy. There were no significant differences in patients' HRQOL (p = 0.79). There were no AEs reported during the study.

CONCLUSION

The use of CHM as an adjunct treatment with conventional chemotherapy have been shown to reduce fatigue, nausea, and anorexia in breast cancer patients but did not reduce chemotherapy-associated hematologic toxicity. The sample size of this study was not powered to assess the significance of HRQOL between two groups of patients.

'Trying to put a square peg into a round hole': a qualitative study of healthcare professionals' views of integrating complementary medicine into primary care for musculoskeletal and mental health comorbidity

BACKGROUND

Comorbidity of musculoskeletal (MSK) and mental health (MH) problems is common but challenging to treat using conventional approaches. Integration of conventional with complementary approaches (CAM) might help address this challenge. Integration can aim to transform biomedicine into a new health paradigm or to selectively incorporate CAM in addition to conventional care. This study explored professionals' experiences and views of CAM for comorbid patients and the potential for integration into UK primary care.

METHODS

We ran focus groups with GPs and CAM practitioners at three sites across England and focus groups and interviews with healthcare commissioners. Topics included experience of co-morbid MSK-MH and CAM/integration, evidence, knowledge and barriers to integration. Sampling was purposive. A framework analysis used frequency, specificity, intensity of data, and disconfirming evidence.

RESULTS

We recruited 36 CAM practitioners (4 focus groups), 20 GPs (3 focus groups) and 8 commissioners (1 focus group, 5 interviews). GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. Exercise- or self-care-based CAMs were most acceptable to GPs. CAM practitioners were generally pro-integration. A prominent theme was different understandings of health between CAM and general practitioners, which was likely to impede integration. Another concern was that integration might fundamentally change the care provided by both professional groups. For CAM practitioners, NHS structural barriers were a major issue. For GPs, their lack of CAM knowledge and the pressures on general practice were barriers to integration, and some felt integrating CAM was beyond their capabilities. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups. There was little consensus on the ideal integration model, particularly in terms of financing. Commissioners suggested CAM could be part of social prescribing.

CONCLUSIONS

CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. Given the challenges of integration, selective incorporation using traditional referral from primary care to CAM may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing or an extension of integrated personal commissioning.

Psychiatry residents' confidence in integrated care skills on a collaborative care rotation at a safety net health care system

OBJECTIVE

This letter to the editor describes how psychiatry residents' confidence in delivering population based care improved after working within a collaborative care system.

METHODS

An anonymous online survey was delivered to 24 psychiatry residents who matriculated through Cambridge Health Alliance residency from 2012 to 2014 and participated in the collaborative care rotation. During the rotation, residents provided direct and indirect consultations, used measurement-based care (MBC) and took a population approach to patient management. Items were asked about residents' level of confidence.

RESULTS

Twenty of 24 residents responded to the survey (83% response rate) with no questions skipped. Among respondents, 80% were confident in the stepped care model, 65% were confident using MBC, 95% were confident communicating and coordinating with primary care teams, 65% felt they were likely to initiate lab checks (such as metabolic monitoring), and 95% had confidence the rotation helped clarify their role as a consultant to primary care teams. Only 30% were confident in providing indirect consultations to primary care teams.

CONCLUSION

After a 6month rotation in a collaborative care model, psychiatry residents have gained confidence in multiple domains of integrated care. However, additional curriculum development and training is required to help residents improve confidence in indirect consultations.

History, aims and present structure of psychosomatic medicine in Germany

Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriented psychotherapy is a core method integrated with other modes of therapy. As a conceptual base for empirical research, non-reductionist accounts of the interactions of (sick) persons with their environment are most important. Germany has developed a model of Psychosomatic Medicine that has conceptualized and integrated psychotherapeutic methods into clinical practice and realized one way to practice bio-psycho-social medicine in the health care system of the country.

Integrated Chinese and Western medicine for treatment of cerebral hemorrhage with gastrointestinal hemorrhage: Curative effect and influence on prognosis

AIM

To observe the clinical effect of integrated Chinese and Western medicine in the treatment of cerebral hemorrhage with gastrointestinal hemorrhage and its influence on prognosis.

METHODS

Seventy patients with cerebral hemorrhage and gastrointestinal bleeding were randomly divided into a control group (n = 35) and an observation group (n = 35). Both groups were treated with hemocoagulase and omeprazole injection, and the observation group was additionally given Xijiao Dihuang decoction. Clinical curative effect and prognosis were compared between the two groups.

RESULTS

The duration of continued bleeding and intracranial hypertension, the amount of blood transfusion, NIHSS score, survival rate, and mortality rate were significantly lower in the observation group than in the control group (t = 17.935, 18.293, 16.386, and 20.915, χ² = 5.193, 7.012, P < 0.05). The hemoglobin level, MBI score, and improvement rate were significantly higher in the observation group than in the control group (t = 21.284, 19.841, χ² = 6.395, P < 0.05).

CONCLUSION

Hemocoagulase and omeprazole injection combined with Xijiao Dihuang decoction are effective in the treatment of cerebral hemorrhage with gastrointestinal bleeding.

Introducing an osteopathic approach into neonatology ward: the NE-O model

BACKGROUND

Several studies showed the effect of osteopathic manipulative treatment on neonatal care in reducing length of stay in hospital, gastrointestinal problems, clubfoot complications and improving cranial asymmetry of infants affected by plagiocephaly. Despite several results obtained, there is still a lack of standardized osteopathic evaluation and treatment procedures for newborns recovered in neonatal intensive care unit (NICU). The aim of this paper is to suggest a protocol on osteopathic approach (NE-O model) in treating hospitalized newborns.

METHODS

The NE-O model is composed by specific evaluation tests and treatments to tailor osteopathic method according to preterm and term infants' needs, NICU environment, medical and paramedical assistance. This model was developed to maximize the effectiveness and the clinical use of osteopathy into NICU.

RESULTS

The NE-O model was adopted in 2006 to evaluate the efficacy of OMT in neonatology. Results from research showed the effectiveness of this osteopathic model in reducing preterms' length of stay and hospital costs. Additionally the present model was demonstrated to be safe.

CONCLUSION

The present paper defines the key steps for a rigorous and effective osteopathic approach into NICU setting, providing a scientific and methodological example of integrated medicine and complex intervention.