Global trend of nondrug and nonsedativehypnotic treatment forinsomnia: a bibliometric study

OBJECTIVE

To present a bibliometric analysis of global scientific publications on the nondrug and nonsedative hypnotic treatment of insomnia with regard to influential institutions, publications, countries, research hotspots, trends, and frontiers.

METHODS

A literature review was conducted by searching the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases to identify all publications related to the nondrug and nonsedative hypnotic treatment of insomnia from 2000 to 2021. Eligible publications were reviewed, including annual publication increments, citation analyses, international collaborations, and keyword analyses. The data were analysed using CiteSpace (vers5.8.R3, 6.1.R2 and 6.1.6, College of Computing and Informatics, Philadelphia, PA, USA) and virtualized by knowledge maps. RESULTS：In total, 9832 publications were included in this analysis. The results from the WoSCC showed that the United States of America (Count = 2268, 40.33%), Stanford University (Count = 141, 2.51%), and the United States Department of Health and Human Services were the leading country, institute, and funding agency regarding the number of publications, respectively. 'Cognitive-behavioural therapy" was the most popular research topic generated from the cocited reference. The most frequently co-occurring keywords were insomnia, cognitive behavioural therapy, disorder, depression, quality of life, Meta-analysis, older adult, sleep, prevalence and efficacy, while keywords including clinical practice guideline, guideline, and Tai Chi remained popular after 2021. Circadian rhythm was the strongest research frontier for 2000-2021. In China, Chengdu University of Traditional Chinese Medicine (Count = 69, 4.79%) was the most productive institute in this field. The most frequently co-occurring keywords from Chinese literature were sleep disorder, sleep quality, acupuncture and moxibustion, Parkinson's disease, transcranial magnetic stimulation, health education, music therapy, chronic insomnia, quality of life, and nonmotor symptoms. Traditional Chinese medicine was the strongest research frontier for 2019-2021.

CONCLUSION

This bibliometric study provides an exhaustive mapping encompassing pertinent institute, publications, influential articles, researchers and topics of the global trend of nondrug and nonsedative hypnotic treatment for insomnia. The results show that the research trend has shifted from primary studies on the efficacy and safety of nondrug and nonsedative hypnotic treatment for insomnia to comorbidity studies. Clinical practice guidelines will potentially become the research frontier for this field post-2021. The findings are important for researchers, clinicians, journal editors, and policy-makers working in the field of nondrug and nonsedative hypnotic treatment for insomnia to understand the strengths and potentials in the current studies and guide future clinical practice, research, and science policy.

Investigation of usage, attitudes toward complementary and alternative medicine among cancer patients in Turkey during COVID-191

BACKGROUND

Complementary and alternative medicines (CAM) are being uses more often with cancer patients.

OBJECTIVE

This study aimed to investigate attitudes, use and influencing factors of CAM among cancer patients during the COVID-19 pandemic.

METHODS

This descriptive, cross-sectional study was conducted on 407 cancer patients in Turkey. The study was conducted during July-September 2021 using a Questionnaire that included a Complementary, Alternative and Conventional Medicine Attitude Scale (CACMAS). Pearson's Chi-Squared Test, Mann-Whitney U, Kruskal Wallis, and logistic regression were all utilized.

RESULTS

The findings revealed that 76.2% of the participants stated that they used CAM methods while undergoing cancer treatment, and 65.2% of those who did so kept from sharing this information to medical professionals. Phytotherapy was the most common CAM method used by patients. The use of CAM was found to be significantly higher among those who were 55-64 years of age, married, secondary school graduates, non-smokers, CAM users before their cancer diagnosis, and who had a family history of cancer (p <  0.05). The participants' average CACMAS scores were 112.20±16.53. Among those who used CAM during treatment, non-smoking, overweight-obese participants had higher CACMAS scores (p <  0.05).

CONCLUSION

Due to the high prevalence of CAM usage among cancer patients and possible interaction effects with chemotherapy medications, it is important for healthcare professionals to assess and educate cancer patients regarding CAM use. Additional research is needed to determine potential interactions, as well as pros and cons of CAM use during cancer treatment.

Horticultural Therapy for Individuals Coping with Dementia: Practice Recommendations Informed by Related Non-Pharmacological Interventions

Dementia care currently presents a challenge to healthcare providers on many levels. The rapid increase in the number of people with dementia and the costs of care certainly contribute to these challenges. However, managing the behavioral and psychological symptoms of dementia (BPSDs) has become one of the most significant tasks in providing care and can lead to poor health and well-being outcomes, not only for the people living with dementia (PLWD) but also for those providing their care. Cost-effective, easily implemented, highly adaptable, empirically based alternatives are needed. Interventions such as Horticultural Therapy (HT), which is naturally informed by Montessori-Based Methods for Dementia and sensory reminiscence therapies, meets these qualifying factors. This article, based on a review of current best practices and clinical experience, hopes to provide recommendations for such an intervention along with special considerations for PLWD and adaptations for different acuity levels. With additional safe and effective, person-centered, non-pharmacological interventions available for the complex cognitive and neuropsychiatric manifestations of this disease, a better care milieu can be provided, improving the quality of life for both patients and caregivers. This article also identifies the need for continued research into the synergistic effects of person-centered behavioral and psychosocial interventions combined with environmental approaches to provide the optimal healing environment for those coping with dementia.

Complementary and alternative medicine on cognitive defects and neuroinflammation after sepsis

Sepsis-associated encephalopathy (SAE) is a common manifestation of sepsis, ranging from mild confusion and delirium to severe cognitive impairment and deep coma. SAE is associated with higher mortality and long-term outcomes, particularly substantial declines in cognitive function. The mechanisms of SAE probably include neuroinflammation that is mediated by systemic inflammation and ischemic lesions in the brain, a disrupted blood-brain barrier, oxidative stress, neurotransmitter dysfunction, and severe microglial activation. Increasing evidence suggests that complementary and alternative medicine, especially Traditional Chinese Medicine (TCM), is favorable in alleviating cognitive decline after sepsis. Here, we summarized the studies of traditional herbal remedies, TCM formulas and acupuncture therapy in animal models of neurological dysfunctions after sepsis in recent decades and reviewed their potential mechanisms.

Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis

OBJECTIVE

The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence.

METHODS

The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework.

RESULTS

Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate.

CONCLUSION

In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.

Clinical Effects of Yoga and Meditational Practices on the Holistic Health of Chronic Kidney Disease Patients: A Systematic Review

As the world accelerates, sedentary and unhealthy lifestyles have an increasingly negative impact on human physical and emotional well-being. Millions of people globally are thought to have chronic kidney disease (CKD), which is frequently brought on by diabetes, hypertension, and glomerulonephritis. Over time, the illness gets worse and eventually results in irreversible renal failure. A person's life can be seriously affected by CKD in many different ways, including emotionally, socially, physically, and financially. Apart from physiological manifestations like anemia, discomfort, and exhaustion, CKD can also result in psychological problems like anxiety and depression, which can impair one's overall standard of life. Numerous studies have demonstrated the beneficial effects of yoga and meditation on people with chronic renal disease, enhancing their general health and quality of life. Because of therapeutic limitations, familial pressures, financial restraints, and symptoms of end-stage kidney disease, people with CKD frequently experience stress and anxiety. By reducing stress and anxiety, yoga and meditation can help individuals with chronic conditions maintain their health and improve their overall well-being. Recent research has found that yoga can improve blood pressure, sympathetic activity, and basal metabolic rate as well as reduce blood pressure and blood sugar levels by balancing the autonomic nervous system. Furthermore, studies have demonstrated that yoga helps CKD patients live healthier lives by lowering stress, anxiety, and sadness. Healthcare professionals can help patients with chronic renal disease manage their symptoms and enhance their general health and well-being by adding yoga and meditation into their treatment regimens. Modifying lifestyle is essential for both the prevention and treatment of chronic renal disease. CKD often co-occurs with other age-related and sedentary lifestyles and poor diet-related chronic conditions. The dearth of targeted treatment for a large percentage of CKD patients led to the investigation of the therapeutic applications of yoga and meditation in this study. These affordable, non-invasive therapies provide a comprehensive approach to controlling CKD, benefiting both healthy individuals and those with CKD in terms of their physical and mental well-being.

Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Herbal medicines are used by patients with IBD despite limited evidence. We present a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating treatment with herbal medicines in active ulcerative colitis (UC). A search query designed by a library informationist was used to identify potential articles for inclusion. Articles were screened and data were extracted by at least two investigators. Outcomes of interest included clinical response, clinical remission, endoscopic response, endoscopic remission, and safety. We identified 28 RCTs for 18 herbs. In pooled analyses, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97-6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99-2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71-1.26). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18-5.63), but not for AP (RR 1.31, 95% CI 0.86-2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08-2.26) and remission (RR 19.37, 95% CI 2.71-138.42) were significant for CL. CL has evidence supporting its use as an adjuvant therapy in active UC. Research with larger scale and well-designed RCTs, manufacturing regulations, and education are needed.

Chronic pain and the use of complementary and alternative medicine in rural Victoria, Australia

OBJECTIVE

The relationship between chronic pain and complementary and alternative medicine (CAM) use is poorly understood, and the situation in rural Australia is particularly unclear. The objective here was to determine the socio-demographic factors associated with the use of CAM for the treatment of chronic pain in a region of rural Australia.

METHODS

This secondary analysis used data from a population health survey, Crossroads-II, to assess the relationships of various socio-demographic factors with the use of CAM by those suffering from chronic pain.

DESIGN

Face-to-face surveys at households randomly selected from residential address lists.

SETTING

A large regional centre and three nearby rural towns in northern Victoria, Australia.

PARTICIPANTS

Sixteen years of age and older.

MAIN OUTCOME MEASURES

Use of a CAM service to treat chronic pain.

RESULTS

Being female (2.40 [1.47, 3.93], p < 0.001) and having a bachelor's degree (OR 2.24 [1.20, 4.20], p < 0.001) had a significant positive relationship with the use of CAM overall to redress chronic pain and those 50 years and older had greater odds of using manipulation therapies relative to those below 50 years (50-64: OR 0.52 [0.32, 0.86], p = 0.010; 65+: 0.37 [0.18, 0.75], p = 0.005).

CONCLUSION

In the studied region, females and those with university education have the greatest odds of using CAM to treat chronic pain. This study needs to be complemented with more mechanistic investigations into the reasons people make the decisions they make about using CAM for the management of chronic pain.

What is Effective in Massage Therapy? Well, "It Depends…": a Qualitative Study of Experienced Orthopaedic Massage Therapists

Background

Massage has been used as a treatment for musculoskeletal pain throughout history and across cultures, and yet most meta-analyses have only shown weak support for the efficacy of massage. There is a recognised need for more research in foundational questions including: how massage treatments are constructed; what therapists actually do within a treatment, including their clinical reasoning; and what role therapists play in determining the effectiveness of a massage treatment.

Purpose

The aim of this study was to explore what experienced orthopaedic massage therapists consider to be the aspects of their work that contribute to effectiveness.

Setting and Participants

Semi-structured interviews were conducted via Zoom with six experienced orthopaedic massage therapists in Australia.

Research Design

The interviews were analysed using inductive thematic analysis, seeking insights that might be practically applied, rather than theory-driven interpretations.

Results

The participants focused on the underlying differences between clients, between therapists, and between treatments, and clearly indicated that this concept of "difference" was foundational to their view of their work and was the underlying context for the comments they made. Within that frame of "difference", three key themes were interpreted from the data: (1) "Everyone is different so every treatment is different": how they individualised treatment based on these differences; (2) "How therapists cope with difference": how they managed the challenges of working in this context; and (3) "What makes a difference": the problem-solving processes they used to target each treatment to meeting the client's needs.

Conclusions

Participants did not identify specific techniques or modalities as "effective" or not. Rather, a therapist's ability to provide effective treatment was based on an iterative process of treatment and assessment that allowed them to focus on the individual needs of the client. In this case "effectiveness" could be considered a process rather than a specific massage technique.

Non-pharmacological strategies to reduce stress and anxiety in endovascular procedures: A scoping review

AIM

This study aimed to identify and map the production of knowledge on non-pharmacological strategies to reduce stress and anxiety in patients undergoing endovascular procedures.

DESIGN

Scoping review.

METHODS

The review was performed using the PRISMA-ScR guidelines. The searches were conducted in Scopus, PubMed, Web of Science, Wiley Online Library, BVS/BIREME, Lilacs, Gale Academic OneFile, SciELO, Cochrane Library, CAPES Catalog of Dissertations and Theses, Oswaldo Cruz Foundation Portal of Theses and Dissertations, and Theses and Dissertations from Latin America.

RESULTS

Twenty-two articles were selected. The articles were published from 2001 to 2022, mostly in Iran, and there was a predominance of randomized clinical trials. The Spielberger State-Trait Anxiety Inventory was the most used instrument. The findings indicated that music therapy, educational guidelines or videos on the procedure, massage, psychological preparation and aromatherapy were the main non-pharmacological therapies used to reduce anxiety and stress in patients undergoing vascular procedures.

Predictors of Pain Management Strategies in Adults with Low-Back Pain: A Secondary Analysis of Amazon Mechanical Turk Survey Data

Objective: To evaluate the associations between baseline demographics, health conditions, pain management strategies, and health-related quality-of-life (HRQoL) measures with pain management strategies at 3-month follow-up in respondents reporting current low-back pain (LBP). Study design: Cohort study of survey data collected from adults with LBP sampled from Amazon Mechanical Turk crowdsourcing panel. Methods: Demographics, health conditions, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-10 were included in the baseline survey. Respondents reporting LBP completed a more comprehensive survey inquiring about pain management strategies and several HRQoL measures. Bivariate then multivariate logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for the association between baseline characteristics and pain management utilization at 3-month follow-up. Model fit statistics were evaluated to assess the predictive value. Results: The final cohort included 717 respondents with completed surveys. The most prevalent pain management strategy at follow-up was other care (n = 474), followed by no care (n = 94), conservative care only (n = 76), medical care only (n = 51), and medical and conservative care combined (n = 22). The conservative care only group had higher (better) mental and physical health PROMIS-10 scores as opposed to the medical care only and combination care groups, which had lower (worse) physical health scores. In multivariate models, estimated ORs (95% CIs) for the association between baseline and follow-up pain management ranged from 4.6 (2.7-7.8) for conservative care only to 16.8 (6.9-40.7) for medical care only. Additional significant baseline predictors included age, income, education, workman's compensation claim, Oswestry Disability Index score, and Global Chronic Pain Scale grade. Conclusions: This study provides important information regarding the association between patient characteristics, HRQoL measures, and LBP-related pain management utilization.

Guided Imagery for Symptom Management of Patients with Life-Limiting Illnesses: A Systematic Review of Randomized Controlled Trials

Background: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery (GI), a complementary and integrative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of articles was evaluated using the Cochrane Collaboration's Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 14 randomized controlled trials were included in this review. The quality assessment revealed that four studies had a high risk of bias, nine had some concerns, and one had a low risk of bias. Out of the 14 studies, 6 evaluated oncological diagnosis, while the remaining 8 focused on nononcological diagnoses across 6 different diseases. GI was found to be effective in managing symptoms in 10 out of the 14 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, sleep disturbances, and fatigue. Conclusion: GI therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses at different stages.

Long-term follow-up of inpatients with meniscus tears who received integrative Korean medicine treatment: A retrospective analysis and follow-up survey

Evidence regarding the use of Korean medicine (KM) for the conservative treatment of meniscus tears remains lacking. We aimed to evaluate clinical effectiveness and long-term follow-up outcomes in patients undergoing integrative KM treatment for meniscus tears. We analyzed the electronic medical records (EMRs) of 86 patients with meniscus tears and administered a follow-up survey. Patients treated at 1 of 4 KM hospitals between June 1, 2015, and June 30, 2020, were reviewed. KM treatment comprised herbal medicine, acupuncture, pharmacopuncture, bee venom pharmacopuncture, Chuna therapy, and KM physiotherapy. The primary outcome was the numeric rating scale (NRS) score for knee pain; secondary outcomes were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), EuroQol 5-dimension (EQ-5D) score, range of motion, and patient global impression of change. The NRS for knee pain was reduced by an average of 2.49 (95% confidence interval [CI]: 2.03-2.95) at discharge and 1.97 (95% CI: 2.03-2.95) at follow-up. The WOMAC decreased by an average of 15.52 (95% CI: 10.14-20.89) during hospital stay and 30.72 (95% CI: 24.58-36.87) at follow-up. The EQ-5D score increased by an average of 0.06 (95% CI: -0.14 to 0.02) at discharge and 0.19 (95% CI: -0.29 to -0.09) at follow up. KM treatment effectively reduced knee pain, improved knee joint function, and enhanced the quality of life in patients with a meniscus tear for a relatively long period after treatment.

Improving Semen Quality in a Male Partner With Abnormal Seminal Parameters Through Yoga and Yoga Nidra: A Case Report

This research presents a case study involving a 39-year-old male and his 34-year-old female partner seeking fertility consultation in Maharashtra, India, after struggling to conceive for over three years. Despite the male participant's lack of discernible medical conditions and typical lifestyle, semen analysis revealed severe oligozoospermia attributed to elevated stress levels from his physically demanding occupation and infertility-related emotional strain. The female partner exhibited normal blood parameters, including anti-Müllerian hormone (AMH). Embracing holistic approaches, the couple integrated yoga and Yoga Nidra into their daily routine to address stress-induced hormonal imbalances. The customized yoga regimen is aimed at stress reduction and overall well-being, incorporating physical postures, breathing exercises, and meditation. Yoga Nidra, a guided relaxation technique, was employed to induce profound rest and alleviate stress. Over a 12-week period, the male participant diligently adhered to the regimen, reporting heightened relaxation, improved sleep quality, and reduced stress levels. Semen analysis before and after intervention showed significant improvements in sperm count and motility alongside diminished morphological abnormalities. In parallel, the female partner underwent intrauterine insemination (IUI), resulting in a positive beta-human chorionic gonadotropin (β-hCG) analysis. Weekly follow-ups monitored progress, with supplementation administered as needed. While promising, further research with larger sample sizes and controlled trials is warranted to establish definitive efficacy. Overall, yoga and Yoga Nidra offer noninvasive adjuncts to conventional therapies for male infertility, underscoring the importance of integrating holistic practices into comprehensive fertility management strategies.

Nutraceuticals and Pain Disorders of the Gut-Brain Interaction in Infants and Children: A Narrative Review and Practical Insights

Different nutraceuticals are often considered by parents of infants and children with abdominal pain and disorders of the gut-brain interaction. Herb extracts and natural compounds have long been used in traditional medicine, but clinical pediatric trials are very limited. This narrative review based on relevant studies identified through a search of the literature in Pubmed and Medline updated to October 2023 focused on the effect of nutraceuticals in infantile colic, functional abdominal pain, and irritable bowel syndrome in children and adolescents. Significant reductions in colic episodes and crying time were reported in two studies on fennel (seeds oil or tea), in three studies on different multiple herbal extracts (all including fennel), in one study on Mentha piperita, and in at least two double-blind randomized controlled studies on Lactobacillus reuteri DSM 17938 and Bifidobacterium lactis BB-12 (108 CFU/day for at least 21 days) in breast-fed infants. Compared to a placebo, in children with functional abdominal pain or irritable bowel syndrome, a significant reduction in pain was reported in two studies supplementing peppermint oil capsules or psyllium fibers, and in one study on corn fiber cookies, partial hydrolyzed guar gum, a specific multiple herbal extract (STW-5), or vitamin D supplementation. To date, there is moderate-certainty evidence with a weak grade of recommendation on Lactobacillus reuteri DSM 17938 (108 CFU/day) in reducing pain intensity in children with functional abdominal pain and for Lactobacillus rhamnosus GG (1-3 × 109 CFU twice daily) in reducing pain frequency and intensity in children with IBS. Further large and well-designed pediatric studies are needed to prove the efficacy and safety of different herbal extracts and prolonged use of studied products in infants and children with pain disorders of the gut-brain interaction.

Comparison of two methods of complementary medicine on postoperative pain and anxiety: A randomized clinical trial

BACKGROUND

Postoperative pain and anxiety are unpleasant situations that are often experienced by women undergoing cesarean section. Since the routine methods of pain relief after surgery is still inadequate, the need for complementary treatments is felt. Foot Reflexology (FR) and Auricular Acupressure (AA) are two of the most popular and safe procedures of complementary and alternative medicine therapies. So, this study aimed to determine and compare the effectiveness of reflexology and AA on postoperative pain and anxiety.

MATERIALS AND METHODS

This three-group randomized clinical trial study was performed on 101 pregnant women, admitted to Mashhad Omolbanin hospital, for a cesarean section, in 2015. In the intervention groups, 2-3 h after the operation, AA or FR was performed for 20 min. Routine care was provided for the control group. Pain and anxiety were evaluated by VAS and Spielberger anxiety questionnaire before and 1 and 2 h after the intervention.

RESULTS

The results showed that immediately after the intervention, pain intensity was significantly lower in both AA and FR groups (P < 0.001) compared with the control group. In addition, 2 h after the interventions, pain intensity was significantly lower in the AA group compared with the control group (P = 0.006). However, no significant differences were observed between the FR and the control groups (P = 0.095). In addition, 1 and 2 h after the intervention, anxiety was significantly different between the three groups (P = 0.033 and P = 0.018), respectively. The results of the Tukey test showed that this difference was only between FR and control groups (P = 0.025 and P = 0.017), respectively.

CONCLUSION

AA is more effective in reducing post-cesarean pain while FR effectively reduces post-cesarean anxiety. Therefore, these complementary medicine treatments as easy and noninvasive methods are recommended to be used during labor for improving maternal outcomes.

Methods of induction and augmentation of labor in a freestanding birth center: a cross-sectional study

OBJECTIVE

To describe and analyze the use of methods of induction and augmentation of labor in a freestanding birth center (FBC).

METHOD

Cross-sectional study carried out at a FBC located in São Paulo (SP), with all women booked from 2011 to 2021 (n = 3,397).

RESULTS

The majority of women (61.3%) did not receive any method. The methods were used alone or in combination (traditional Chinese medicine, massage, castor oil, stimulating tea, amniotomy, and oxytocin). Traditional Chinese medicine (acupuncture, acupressure, and moxa) was the most used method (14.7%) and oxytocin was the least frequent (5.1%). The longer the water breaking time, the greater the number of methods used (p < 0.001). Amniotomy was associated with maternal transfers (p < 0.001).

CONCLUSION

Induction and augmentation of labor were strictly adopted. The use of natural or non-pharmacological methods prevailed. Robust clinical studies are needed to prove the effectiveness of non-pharmacological methods of stimulation of childbirth, in addition to strategies for their implementation in other childbirth care services, to really prove the effectiveness of non-pharmacological methods in the parturition process, that is, in labor and birth.

Non-pharmacological interventions feasible in the nursing scope of practice for pain relief in palliative care patients: a systematic review

Background

Palliative care patients desire more symptom management interventions that are complementary to their medical treatment. Within the multi-professional team, nurses could help support pain management with non-pharmacological interventions feasible for their practice and adaptable to palliative care patients' needs.

Objectives

The objective was to identify non-pharmacological interventions feasible in the nursing scope of practice affecting pain in palliative care patients.

Design

A systematic review.

Data sources and methods

A defined search strategy was used in PubMed, CINAHL, PsycINFO, and Embase. Search results were screened double-blinded. Methodological quality was double-appraised with the Joanna Briggs Institute Critical Appraisal Tools. Data were extracted from selected studies and the findings were summarized. The methodological quality, quantity of studies evaluating the same intervention, and consistency in the findings were synthesized in a best-evidence synthesis to rank evidence as strong, moderate, limited, mixed, or insufficient.

Results

Out of 2385 articles, 22 studies highlighted non-pharmacological interventions in the nursing scope of practice. Interventions using massage therapy and virtual reality demonstrated most evidentiary support for pain management, while art therapy lacked sufficient evidence. Mindful breathing intervention showed no significant reduction in pain. Hypnosis, progressive muscle-relaxation-interactive-guided imagery, cognitive-behavioral audiotapes, wrapped warm footbath, reflexology, and music therapy exhibited promising results in pain reduction, whereas mindfulness-based stress reduction program, aromatherapy, and aroma-massage therapy did not.

Conclusion

Despite not all studies reaching significant changes in pain scores, non-pharmacological interventions can be clinically relevant to palliative care patients. Its use should be discussed for its potential value and nurses to be trained for safe practice. Methodologically rigorous research for non-pharmacological interventions in nursing scope of practice for pain relief in palliative care patients is necessary.

Trial registration

The protocol for this study is registered in the International Prospective Register of Systematic Review (PROSPERO registration number: CRD42020196781).

Differences in characteristics and use of complementary and alternative methods for coping with endometriosis-associated acyclic pelvic pain across adolescence and adulthood

Introduction

Over four million women in the US alone have been diagnosed with endometriosis. For those living with this disease, surgery and hormonal treatment reduce associated pelvic pain in some, while others continue to experience life impacting pain. Therefore, identification of accessible and cost-effective methods of pain reduction to compliment current treatment is urgently needed. Our objective was to quantify the prevalence of complementary and alternative methods used to manage acyclic pelvic pain and their reported benefit among women of different age groups living with endometriosis.

Methods

We used baseline questionnaire data from laparoscopically-confirmed endometriosis cases who completed a WERF EPHect compliant questionnaire in the longitudinal cohort of The Women's Health Study: From Adolescence to Adulthood (A2A). Participants with acyclic pelvic pain were asked to indicate specific methods or activities that either helped or worsened their pelvic/lower abdominal pain. Differences among age groups [adolescent (<18 years), young adult (18-25 years), and adult (>25 years)] were assessed using Fisher's exact test.

Results

Of the 357 participants included in analysis, sleep for coping was reported more frequently among adolescents (n = 59, 57.3%) compared to young adults (n = 40, 44.0%) and adults (n = 19, 31.1%; p = 0.004). Adolescents also reported more frequent use of music (n = 29, 21.2%) than young adults (n = 10, 7.0%) and adults (n = 7, 9.1%; p = 0.001). Exercise worsened pain most commonly among adolescents (n = 82, 59.9%), followed by younger adults (n = 67, 46.9%), and adults (n = 27, 35.1%; p = 0.002).

Discussion

Our analysis of participants in the A2A cohort showed that the prevalence of complementary and alternative methods used for coping with endometriosis-associated acyclic pelvic pain varied by age group. Future studies should aim to provide information that will further inform decisions in making care plans for managing endometriosis-associated pain that is effective, accessible, and tailored to the preferences of the patient.

Effect of Integrated Yoga as an Adjuvant to Standard Care for Panic Disorder: A Randomized Control Trial Study

BACKGROUND

Individuals wrestling with panic disorder (PD) know all too well its debilitating impact. Sudden, intense fear episodes disrupt lives and erode well-being. Fortunately, integrating complementary therapies like yoga with standard treatment offers a glimmer of hope for improved outcomes. Yoga's unique blend of physical postures (asanas), breathing exercises (pranayama), and meditative practices holds promise for mitigating anxiety and fostering a sense of inner peace, potentially making it a valuable tool in the fight against panic disorder.

METHODS AND MATERIALS

This study investigated the effect of yoga as an adjuvant to standard care for panic disorder. Sixty-four panic disorder patients of both genders previously diagnosed with panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were randomly assigned to the yoga group (n = 32) and the control group. The yoga group participated in integrated yoga sessions lasting 60 minutes, five days a week, for 12 weeks. Both groups received standard care. Pre- and post-intervention data were collected for HAM-A and WHOQOL-BREF.

RESULTS

The yoga group exhibited a significant reduction in HAM-A scores (Pre: 49.13 ± 4.55, Post: 13.53 ± 5.54, p < 0.001) with a substantial effect size of 7.02. Quality of life significantly improved across all domains (physical, psychological, social, and environmental) in the yoga group (p < 0.001), demonstrating effect sizes ranging from 4.11 to 4.57. Control group participants also experienced improvements, though less pronounced. Between-group comparisons revealed significant differences in anxiety reduction (p = 0.042) and quality of life enhancement (p < 0.001), favouring the yoga group.

CONCLUSION

The results suggest that yoga can be a valuable complementary or alternative approach to traditional treatments for anxiety disorders.

Efficacy and Safety of Traditional Chinese Medicines as a Complementary Therapy Combined With Chemotherapy in the Treatment of Gastric Cancer: An Overview of Systematic Reviews and Meta-Analyses

BACKGROUND

In China, traditional Chinese medicines (TCMs), as a complementary therapy combined with chemotherapy, is widely used in the treatment of gastric cancer (GC). In order to systematically evaluate and synthesize existing evidence to provide a scientific basis for the efficacy and safety of this complementary therapy, we present an overview of systematic reviews (SRs) and meta-analyses (MAs) on the topic of TCMs as a complementary therapy in combination with chemotherapy for the treatment of GC.

METHODS

SRs/MAs on TCMs combined with chemotherapy for GC were comprehensively searched in 8 databases. Methodological quality, risk of bias, reporting quality, and quality of evidence were assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020), as well as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

Thirteen published SRs/MAs were included in our study. In terms of methodology, all SRs/MAs were considered to be of very low quality. Only 3 SRs/MAs has been assessed as low risk of bias. None of the SRs/MAs has been fully reported on the checklist. A total of 97 outcome indicators extracted from the included SRs/MAs were evaluated, and only 1 item was assessed as high quality.

CONCLUSIONS

TCMs may be an effective and safe complementary therapy in combination with chemotherapy for the treatment of GC. However, this conclusion must be treated with caution as the quality of the evidence provided by SRs/MAs is generally low.

Integrated multicomponent interventions to support healthy aging of the whole person

Healthy aging is an integrated "whole person" process that involves an individual's biology, behavior, and social/physical environment. With the recent development of antiaging drugs, careful consideration of the respective roles of pharmacologic and nonpharmacologic approaches to both health and aging is in order. Recent advances in understanding the cellular and molecular mechanisms of aging are providing new measures that can be used as clinical outcomes in studying the impact of antiaging interventions in humans. This paper outlines the strategic interest of the National Center for Complementary and Integrative Health (NCCIH) in supporting the development, testing, and implementation of effective, scalable, and integrated multicomponent interventions to support healthy aging of the whole person.

Complementary and Alternative Medicine Use, Cancer Screening, and Medical Checkups in Japan from 2001 to 2013: A Repeated Cross-Sectional Study

Introduction: The association between complementary and alternative medicine (CAM) use and other health-related behaviors is an important issue. A previous study reported that complementary medicine use is related to greater use of cancer screening, whereas alternative medicine use is related to lower use of cancer screening. Given the sparse evidence from Japan, we aimed to examine the association of CAM use with cancer screening and medical checkups. We used a repeated cross-sectional survey of a nationally representative sample of Japanese people and conducted age-period-cohort analysis. Methods: The study population was 68,217 of 83,827 individuals observed from 2001 to 2013 who received cancer screening. CAM users were defined as individuals who received acupuncture, moxibustion, anma/massage/shiatsu, or judo therapy for their most worrisome symptom. The outcomes of interest were receiving stomach, lung, colorectal, uterine, and breast cancer screenings and medical checkups. Using crossclassified multilevel logistic regression models, we estimated odds ratios (ORs) and 95% credible intervals (CIs) for cancer screening and medical checkups. Results: For CAM users of complementary medicine, the adjusted ORs for stomach, lung, and colorectal cancer screening were 1.40 (95% CI: 1.35-1.44), 1.37 (95% CI: 1.34-1.40), and 1.52 (95% CI: 1.49-1.54), respectively. We found similar results for uterine and breast cancer screening, and medical checkups. Conclusions: Irrespective of whether they use CAM, CAM users in Japan tend to receive a variety of cancer screenings and medical checkups.

Therapeutic Applications of Plant and Nutraceutical-Based Compounds for the Management of Type 2 Diabetes Mellitus: A Narrative Review

Diabetes mellitus is a condition caused by a deficiency in insulin production or sensitivity that is defined by persistent hyperglycemia as well as disturbances in glucose, lipid, and protein metabolism. Uncurbed diabetes or incessant hyperglycemic condition can lead to severe complications, including renal damage, visual impairment, cardiovascular disease, neuropathy, etc., which promotes diabetes-associated morbidity and mortality rates. The therapeutic management of diabetes includes conventional medications and nutraceuticals as complementary therapies. Nutraceuticals are bioactive compounds derived from food sources that have health-promoting properties and are instrumental in the management and treatment of various maladies. Nutraceuticals are clinically exploited to tackle DM pathogenesis, and the clinical evidence suggests that nutraceuticals can modulate biochemical parameters related to diabetes pathogenesis and comorbidities. Hypoglycemic medicines are designed to mitigate DM in traditional medicinal practice. This review intends to emphasize and comment on the various therapeutic strategies available to manage this chronic condition, conventional drugs, and the potential role of nutraceuticals in managing the complexity of the disease and reducing the risk of complications. In contrast to conventional antihyperglycemic drugs, nutraceutical supplements offer a higher efficacy and lesser adverse effects. To substantiate the efficacy and safety of various functional foods in conjunction with conventional hypoglycemic medicines, additional data from clinical studies are required.

Complementary Therapies and Their Association with Problems in Therapeutic Adherence to Conventional Synthetic DMARDs in Rheumatoid Arthritis: A Cross-Sectional Study

The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky-Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (p = 0.019), the presence of other comorbidities (p = 0.047), and the use of complementary therapies (p = 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06-7.63, p = 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies.

Virtual Reality for Decreasing Procedural Pain during Botulinum Toxin Injection Related to Spasticity Treatment in Adults: A Pilot Study

BACKGROUND AND OBJECTIVES

Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin.

MATERIALS AND METHODS

Seventeen adult patients receiving botulinum toxin injections were included. A numerical rating scale was used to assess pain and anxiety during the injection procedure. The patients reported the pain experienced during previous injections without VR before injection and the pain experienced in the current procedure with VR after the end of the procedure. The level of satisfaction of VR experience, whether or not they agreed to reuse VR for the subsequent toxin botulinum injection, and whether or not they would recommend VR to other patients were assessed.

RESULTS

The use of virtual reality led to a decrease of 1.8 pain-related points compared to the procedure without technology. No significant improvement in the level of anxiety was reported. Patients were very satisfied with their VR experiences (7.9 out of 10), and many would agree to reuse VR in their next injection procedure (88%) and to recommend the use of VR in other patients (100%).

CONCLUSION

VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.

Electro-Acupuncture Effects Measured by Functional Magnetic Resonance Imaging-A Systematic Review of Randomized Clinical Trials

INTRODUCTION

Electro-acupuncture, an innovative adaptation of traditional acupuncture, combines electrical stimulation with acupuncture needles to enhance therapeutic effects. While acupuncture is widely used, its biological mechanisms remain incompletely understood. Recent research has explored the neurophysiological aspects of acupuncture, particularly through functional magnetic resonance imaging (fMRI) to investigate its effects on brain activity.

METHODS

In this systematic review, we conducted an extensive search for randomized clinical trials examining electro-acupuncture effects measured by fMRI. We employed strict eligibility criteria, quality assessment, and data extraction.

RESULTS

Five studies met our inclusion criteria and were analyzed. The selected studies investigated electro-acupuncture in various medical conditions, including carpal tunnel syndrome, fibromyalgia, Crohn's disease, irritable bowel syndrome, and obesity. Notably, electro-acupuncture was found to modulate brain activity and connectivity in regions associated with pain perception, emotional regulation, and cognitive processing. These findings align with the holistic approach of traditional Chinese medicine, emphasizing the interconnectedness of body and mind.

DISCUSSION

In carpal tunnel syndrome, electro-acupuncture at both local and distal sites showed neurophysiological improvements, suggesting distinct neuroplasticity mechanisms. In fibromyalgia, somatosensory electro-acupuncture correlated with reduced pain severity, enhanced brain connectivity, and increased gamma-aminobutyric acid levels. For Crohn's disease, electro-acupuncture influenced the homeostatic afferent processing network, potentially mitigating gut inflammation. Electro-acupuncture for irritable bowel syndrome led to decreased activity in the anterior cingulate cortex, offering pain relief, while electro-acupuncture for obesity impacted brain regions associated with dietary inhibition and emotional regulation.

CONCLUSION

This systematic review provides evidence that electro-acupuncture can positively impact a range of medical conditions, possibly by modulating brain activity and connectivity. While the quality of the reviewed studies is generally good, further research with larger sample sizes and longer-term assessments is needed to better understand the mechanisms and optimize electro-acupuncture protocols for specific health conditions. The limited number of studies in this review emphasizes the need for broader investigations in this promising field. The research protocol was registered in PROSPERO (CRD42023465866).

Early ambulation and dhikr complementary therapies effect on intestinal peristaltic in post-open cholecystectomy patients

OBJECTIVES

to analyze and determine the effect of a combination intervention of early ambulation and dhikr therapy on intestinal peristaltic recovery in post-open cholecystectomy patients.

METHODS

a pre-experimental design with one group pre and post-test design was used. The samples were 15 post-open cholecystectomy patients which were selected using the purposive sampling technique. The data were collected using the instrument observation sheet and analyzed using the Wilcoxon test. Early ambulation used standard operational procedure in the hospital and dhikr therapy was carried out at 2 hours post-operation for 10-15 minutes.

RESULTS

there was an effect of early ambulation and dhikr therapy on intestinal peristaltic recovery in post-open cholecystectomy patients with general anesthesia (Z=-3.442; p=0.001).

CONCLUSIONS

a combination of early ambulation and dhikr therapy can be recommended as interventions to improve intestinal peristaltic in a post-open cholecystectomy patient with general anesthesia.

Voices of Musicians: Virtual Live Bedside Music Concerts in Inpatient Care

The COVID-19 pandemic presented unprecedented challenges to patients, family members, and healthcare staff that resulted in increased stress and isolation and decreased quality of life. We evaluate the impact of a novel virtual concert program, the Vital Sounds Initiative (VSI) of Project: Music Heals Us (PMHU), which began at the beginning of the pandemic to combat patient isolation and provide employment to professional musicians. Using a qualitative analysis of VSI data, we examined post-concert written responses by musicians. These responses were coded by independent coders via inductive coding and thematic analysis. Between 7 April 2020 and 20 July 2022, 192 musicians played 2203 h of music for 11,222 audience members in 39 care facilities nationwide. A total of 114 musicians submitted a total of 658 responses. Three main themes (with corresponding subthemes) arose: (1) Patient Experience; (2) Musician Experience; (3) Caregiver (family or staff) Experience. The responses offered valuable insight into the overwhelmingly positive aspects of the virtual concerts. Overall, we found that VSI favorably impacts individuals at every level, including the patients, musician, and caregivers. These findings provide preliminary evidence for the benefits of virtual music concerts. Upscaling similar virtual music interventions/programs should be considered.

"There Is No One Way to Get Over It": An Examination of Psychotherapy and Complementary Therapy Use Within a Sample of Survivors Who Experienced Sexual Violence

Literature on sexual violence survivors' service utilization is limited due to examination of singular therapies or narrow timeframes. Using surveys (n = 303) and interviews (n = 20), this study increases understanding of survivors' healing. Results show varied therapy use including psychotherapy (76.9%), yoga (50.2%), and massage (32.1%), among others. Mean number of therapies used was over three. Service utilization was delayed over a decade on average. Latent class analysis divided respondents into classes: psychotherapy and bodywork use (42.66%), high therapy use (9.14%), and minimal therapy use (48.20%). Interviews provide additional insight and describe barriers. Recommendations for policy, practice, and future research are discussed.

Effects of Dietary Modification Based on Complementary and Alternative Iranian Medicine in Patients with Secondary-Progressive Multiple Sclerosis: A Randomized Controlled Clinical Trial

Objectives: To evaluate the efficacy of dietary modifications based on complementary and alternative Iranian medicine (CAIM) in patients with secondary-progressive multiple sclerosis (SPMS). Design: In this randomized controlled trial, 70 SPMS patients were randomized to receive either a moderate-nature diet based on Persian medicine (as intervention) or usual diet plus health-related diet recommendations (as control) for 2 months. Serum high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), Expanded Disability Status Scale (EDSS), Modified Fatigue Impact Scale (MFIS), State-Trait Anxiety Inventory (STAI), Global Pain Scale (GPS), Gastrointestinal Symptom Rating Scale (GSRS), anthropometric measurements, and quality of life (QOL) were assessed at baseline and end of trial. Analysis of covariance was performed, and the results were adjusted for potential confounders using SPSS v.14. Results: All participants completed the study for 2 months. There were significant improvements across the mean changes of hs-CRP (-0.1 ± 0.2 mg/L for intervention vs. -0.01 ± 0.13 mg/L for control; padjusted = 0.012), MFIS (-11.0 ± 11.8 vs. -0.7 ± 9.9; padjusted <0.001), GSRS (-19.9 ± 16.3 to 1.2 ± 17.5; padjusted <0.001), GPS (padjusted = 0.032), and QOL (padjusted <0.05). No significant difference was observed across the ESR, EDSS, STAI, and anthropometric measurements. Conclusion: Dietary modifications based on CAIM may improve inflammation and clinical manifestations in SPMS patients. Nonetheless, further trials are required to confirm these findings. Clinical Trial Registration: IRCT20181113041641N2.

The prevalence and pattern of complementary and alternative medicine use among cancer patients in a tertiary oncology center: a cross-sectional study

Background

Complementary and alternative medicine (CAM) is widely used nationally and internationally for multiple medical conditions, including different stages of cancer. It is used by the patients for multiple purposes, including to cure diseases or resolve symptoms, as patients have the misconception that natural remedies are safer than radiotherapy and chemotherapy.

Objectives

The aim of this research is to investigate the prevalence, pattern, and purpose of CAM use by cancer patients at Princess Noorah Oncology Center (PNOC), King Abdulaziz Medical City, in Jeddah (KAMC-JD).

Methods

This was a cross-sectional study that examined 293 patients (selected through random computerized sampling) who were seen at PNOC during the study period. To be eligible for the study, participants had to be cancer patients over the age of 18 who were seen at PNOC. The authors excluded patients who had privacy requests or did not fit our inclusion criteria.

Results

Of the sample, 52.9% [95% confidence interval (CI), 47.0-58.7] used CAM. Only 5.8% of patients delayed their medical treatment to use CAM. A significantly higher proportion of females used CAM than males (61.8% vs. 40.0%, P<0.001). The most common types of CAM were Zamzam water (67.7%), Quran recitation (42.6%), water read upon Quran (41.3%), and black seed (Nigella sativa) (41.3%). The most frequently reported reasons for CAM use were to treat cancer (53.5%), increase immunity (34.2%), and religious beliefs (23.9%). Generally, 57.4% of CAM users felt improvement with CAM modalities.

Conclusion

In conclusion, more than 50% of our sample used CAM; 5.8% of patients delayed the medical treatment to use CAM. The most common type of CAM was Zamzam water, and the most frequently reported reason for CAM use was to treat cancer. Of CAM users, 57.4% felt improvement with CAM modalities. Further studies that involve qualitative designs and include a more diverse sample are recommended in the Kingdom of Saudi Arabia to understand CAM utilization patterns.

Implementing music therapy interventions in a dementia inpatient unit: reflections and practicalities

There is a growing evidence base to suggest that music therapy is an effective clinical intervention for people with dementia, having positive effects on mood, emotion, communication and memory, and reducing agitation, anxiety and apathy. However, the evidence to support this is predominantly from community settings such as residential care homes or people's own homes. This article captures the authors' experiences and reflections regarding their implementation of a music therapy intervention in a dementia inpatient unit. It explores some of the considerations and learning points gained from their experience, including the practicalities around engaging individuals and staff, the use of space, the timing of sessions, available resources and the potential benefits for patients, family members and the unit as a whole. The authors' experiences suggest that the benefits of music therapy appear to be transferable to the dementia inpatient setting.

Current complementary and alternative therapy forgastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations of current GERD treatment modalities, and complementary and alternative therapy (CAT) is a promising option to fill in the gap. Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms. Traditional Chinese medicine and brain-gut behavior therapy, particularly transcutaneous electrical acustimulation and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD. CAT may help to relieve GERD symptoms, minimize medication dosage, and slow the demand for surgery. The aim of this review was to summarize the existing evidence of some common CATs in treating symptomatic GERD, including dietary modification, lifestyle change, traditional Chinese medicine, and brain-gut behavior therapy.

Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry

SUMMARY

There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.

Clinical effectiveness of medical ozone therapy in COVID-19: the evidence and gaps map

Ozone therapy (OT), a medical procedure, has been showing good results during the coronavirus disease (COVID-19). We aimed to build an evidence and gaps map (EGM) of OT in the COVID-19 ranking the articles found according to levels of evidence and outcomes. The EGM brings bubbles of different sizes and different colors according to the articles. The OT intervention used was major or minor autohemotherapy, rectal insufflation and ozonized saline solution. EGM was based on 13 clinical studies using OT for COVID-19 involving a total of 271 patients. We found 30 outcomes related to OT in COVID-19. Our EGM divided the outcomes into six groups: 1-clinical improvement; 2-hospitalization; 3-inflammatory, thromboembolic, infectious, or metabolic markers; 4-radiological aspects, 5-viral infection and 6-adverse events. Major autohemotherapy was present in 19 outcomes, followed by rectal insufflation. Improvement in clinical symptoms of COVID-19, improvement of respiratory function, improvement of oxygen saturation, reduction in hospital internment, decrease in C-reactive protein, decrease in ferritin, decrease in lactate dehydrogenase, decrease in interleukin 6, decrease in D-dimer, radiological improvement of lung lesions and absence of reported adverse events were related in the papers. The most commonly used concentrations of OT in major autohemotherapy and in rectal insufflation were 40 μg/mL and 35 μg/mL, respectively. Here, we bring the first EGM showing the efficacy and safety of OT in the treatment of COVID-19. OT can be used as integrative medical therapy in COVID-19 at a low cost and improve the health conditions of the patients.

Non-pharmacological therapies for cancer patients in Portugal and Brazil: an experience report

OBJECTIVE

To describe the experience of nurses from a center in Portugal and two in Brazil regarding the use of non-pharmacological therapies in cancer patients.

METHOD

This is a professional experience report.

RESULTS

In the Portuguese institution, a group of nurses has been performing massage therapy, reflexology, postural teaching, thermotherapy, relaxation, guided imagery, Reiki, music therapy, aromatherapy, among others, for 17 years, with significant results in pain and vital signs with satisfactory perceptions. In Brazil, the clinical application is incipient, clinical studies with auriculotherapy, relaxation with guided imagery and floral therapy are taking place, with significant results for physical symptoms, anxiety, and quality of life improvement.

CONCLUSION

In both countries, nurses have made efforts to implement non-pharmacological therapies. While in the Portuguese reality they have been formally institutionalized in care, in Brazil the therapies take place with voluntary work and through intervention research. This report can encourage the translation of autonomous practice to clinical studies for proposing evidence of therapies in Integrative Oncology.

The psychosocial impact of migraines on women and alternative therapies for migraine management

Background

Migraines are one of the leading causes of disability globally and in South Africa. There is a paucity of local empirical literature regarding the psychosocial impact of migraines on women. Although there are a variety of treatment approaches, many women prefer alternative and holistic treatment for their migraines.

Aim

The aim of this study was to explore the psychosocial impact of migraines on women and their use of complementary and alternative therapies for migraine pain management.

Setting

The study was conducted in the eThekwini region of KwaZulu-Natal, South Africa.

Methods

The study adopted a qualitative descriptive design. Purposive sampling was used to recruit participants for the study. Data were collected through 12 semi-structured interviews and subsequently analysed using thematic analysis.

Results

Theme 1 related to the psychological and cognitive effects experienced by the participants. Theme 2 focused on the effects migraines had on personal, family and social relationships. Theme 3 discussed the self-management of migraines.

Conclusion

The pertinent psychological effects of migraines were depression, anxiety, feelings of hopelessness and withdrawal, fear-avoidance behaviour, lifestyle changes, and acceptance of migraines. The participants experienced a lack of understanding about their migraine severity from co-workers, family and social networks. The alternative therapies that were sought to alleviate migraine symptoms included chiropractic, massage, meditation, reflexology, yoga, cupping and acupuncture.

Contribution

The awareness of the effectiveness of complementary and alternative therapies for women may be beneficial for healthcare providers seeking a multidisciplinary approach to migraine management.

Communication About Complementary and Alternative Medicine When Patients Decline Conventional Cancer Treatment: Patients' and Physicians' Experiences

BACKGROUND

Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients' and physicians' experiences from situations when patients decline recommended cancer treatment and consider using CAM.

MATERIALS AND METHODS

Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used.

RESULTS

Regarding treatment choices, there was a dissonance between physicians' focus on medical reasoning and patients' expression of complex values. Physicians' difficulty in understanding patients' treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial.

CONCLUSIONS

This study highlights the difficulty of shared decision-making in practice when patients' and physicians' views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients' values, and improve knowledge among physicians about CAM.

Traditional Chinese medicine-based integrated health interventions for depression: A systematic review and meta-analysis

BACKGROUND

Some traditional Chinese medicine (TCM)-based integrated health interventions have been used for depression, but pooled efficacy remains unknown.

AIMS AND OBJECTIVES

This study aimed to systematically evaluate the efficacy of TCM-based integrated health interventions for relieving depression.

DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk-of-bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.

RESULTS

Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM-based integrated health interventions. The pooled results showed that TCM-based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = -2.05; 95% CI: -2.74, -1.37; p < .00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p = .31). However, the overall evidence was low.

CONCLUSIONS

The meta-analysis results indicated that TCM-based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM-based integrated health interventions in treating depression.

RELEVANCE TO CLINICAL PRACTICE

TCM-based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM-based integrated nursing interventions for patients with depression.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a systematic review and meta-analysis based on data from previous studies.

The Development, Validity, and Responsiveness of a Patient-Centred Outcome Measurement Tool for Evaluating Integrative Medicine Interventions

Background

The paper sets out the development, validity, and responsiveness of the Integrative Medicine Treatment Evaluation Form (IMTEF), which has been designed to measure the effects of complementary and integrative therapy (CIT) interventions in cancer and palliative care (PC) patients in a National Health Service (NHS) hospital setting. Treatment evaluation is essential for ensuring safety and quality of services, for meeting NHS governance requirements. It also helps to add to the evidence base for complementary and integrative therapies through collecting data about treatments.

Methods

A number of different Patient Reported Outcome Measures (PROMs) tools were reviewed in order to design the IMTEF, which details questions that captures both quantitative and qualitative data. The IMTEF was reviewed by patients and a range of health care practitioners.

Results

IMTEF's validity is supported by feedback from health care practitioners and patients, by its ability to detect different degrees of change in relation to change scores, and by its correlations with Visual Analog Scale (VAS) scores.

Conclusion

The IMTEF can be used to assess the effects of therapeutic bodywork and CITs when many of the patients do not have the capacity or the time to answer many questions, and when therapists do not know in advance the number of treatments that patients will be able to receive. Because of the way it is structured, it can also assess the effects after a number of sessions.

Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review

AIMS

To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature.

METHODS

A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report.

RESULTS

A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence.

CONCLUSION

The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods.

RELEVANCE TO CLINICAL PRACTICE

Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.

Building Bridges Toward Common Goals - A Call for Greater Collaboration Between Public Health and Integrative, Complementary and Traditional Health Providers

This commentary makes the case for greater collaboration between public health professionals and integrative, complementary and traditional health practitioners (ICTHP). Previous partnerships have been successful, and more such collaborative work is needed to help overcome division, enhance the health workforce, and move all involved toward shared goals. ICTHP providers may be uniquely able to work across ideological differences and engage individuals and communities who are less trusting of public health, including those who are vaccine hesitant. Diverse partnerships can be difficult to maintain, but the application of equitable processes may aid their success. In the face of highly complex public health challenges, partnerships with ICTHP are critical.

Nature Photographs as Complementary Care in Chemotherapy: A Randomized Clinical Trial

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being.

OBJECTIVE

This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy.

METHODS

A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants' connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention.

RESULTS

Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

Exploring Young Adults' Perspectives of Participation in a Mindfulness-Based Music Therapy Intervention Before and During the COVID-19 Pandemic

Purpose: To explore adolescent and young adults' (AYAs) experiences with participation in a mindfulness-based music therapy intervention during cancer treatment before and during the COVID-19 pandemic. Methods: Sixteen young adults (20-39 years old) who received cancer treatment and participated in a mindfulness-based music therapy intervention for anxiety and stress were interviewed using a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. The interview guide contained prompts about reasons for joining the study, usual coping strategies, experience with the in-person and virtual delivery formats of the intervention, and suggestions for improvement. Themes were derived from the data using inductive content analysis methods. Results: Findings from the interviews included the following: (1) virtual group participants reported difficulty finding a private place to attend the intervention sessions, (2) participants experienced a sense of relaxation in response to intervention participation, (3) in-person group participants felt a sense of connection to the music and their family members who were present during the intervention, while virtual group participants felt a sense of connection to mindfulness, (4) virtual group participants reported that practicing music and mindfulness together was synergistic, and (5) in-person intervention delivery was preferred to virtual intervention delivery. Conclusion: This study provides insight into the contextual factors that impact satisfaction with the intervention and the effect of the intervention on anxiety and stress. Overall, while virtual mindfulness-based music therapy delivery may be more feasible, there are still important advantages to in-person delivery that should be considered in the design of future mindfulness-based music therapy interventions. ClinicalTrials.gov Identifier: NCT03709225.

Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic

AIM

Osteopathy and chiropractic techniques are used for babies for different reasons, but it is unclear how effective they are. The aim of this study was to evaluate their effectiveness in reducing crying time and increasing sleeping time in babies with infantile colic.

METHODS

A systematic review and meta-analysis was conducted on infantile colic studies that used complementary and alternative medicine techniques as interventions. The outcome measures were hours spent crying and/or sleeping. We used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database and Google Scholar databases from inception to 11 November 2022.

RESULTS

The methodological quality of the randomised control trials ranged from fair to high. We focused on five studies with 422 babies. Complementary treatments failed to decrease the crying time (mean difference -1.08, 95% CI: -2.17 to 0.01, I2  = 92%) and to increase sleeping time (mean difference 1.11, 95% CI: -0.20 to 2.41; I2 : 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures.

CONCLUSION

Osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared with no additional intervention.

Unravelling Vaccine Scepticism in South Tyrol, Italy: A Qualitative Analysis of Personal, Relational, and Structural Factors Influencing Vaccination Decisions

Low vaccine uptake in South Tyrol, particularly for non-coronavirus and SARS-CoV-2 vaccines, poses a significant public health challenge in the northernmost province of Italy. This qualitative study conducted in-depth interviews with a purposive sample of vaccine-sceptical parents to examine the factors that contribute to their vaccination decisions. The ten participants' children had varied vaccination statuses, ranging from unvaccinated to partially vaccinated or vaccinated as late as possible. Only one adult participant received the SARS-CoV-2 vaccine. Using Grounded Theory analysis, the emergent meta-category of 'self-relatedness' was identified, highlighting the importance of individual experiences and the social context. The study found that participants' social circles consisted of individuals with similar vaccination attitudes, often characterized by a shared affinity for nature. Although they accepted individuals with different views, they remained uninfluenced. Participants perceived healthcare professionals as one-sided and uncritical, expressing distrust toward state orders. They believed that parents should be responsible for their children's well-being rather than the state. Distrust in the state and healthcare system, exacerbated by the SARS-CoV-2 pandemic, was rooted in negative experiences. In contrast, the participants had positive experiences with natural healing, homeopathy, and trusting the natural course of events. They perceived themselves as tolerant, non-radical, curious, health-conscious, yet critical and questioning. Participants resisted coercion, fear-mongering, and state sanctions and sought alternatives to mandatory vaccination. To address the complex social and behavioural factors underlying vaccination refusal, this study suggests that vaccination advocates, policymakers, and information providers should engage in appreciative, personal, and well-founded information exchanges with vaccine-hesitant individuals. Broad and comprehensible information dissemination, flexibility, and freedom of decision are essential for increasing informed decision making. Further research is required to better understand the epistemic basis of vaccine hesitancy.

Auriculotherapy for reducing chronic spinal pain in health workers: a clinical trial

OBJECTIVE

to evaluate the effectiveness of auriculotherapy in reducing chronic musculoskeletal pain in the spine of health workers.

METHOD

a randomized, triple-blind clinical trial conducted with health workers diagnosed with chronic spinal pain. Eight sessions of auriculotherapy with seeds were applied, two per week. The outcomes were measured with the Numerical Pain Scale, Brief Pain Inventory, Rolland-Morris Disability Questionnaire and SF-36 instruments, in the 1st, 4th and 8th session, and in the 15-day follow-up period. Descriptive and inferential analyses were performed.

RESULTS

34 workers took part in the Intervention Group and 33 in the Control Group, and both presented reduced pain intensity (p>0.05). In the follow-up period, there was a greater reduction in the Intervention Group (3.32 ± 0.42), when compared to the Control Group (5.00 ± 0.43) (p=0.007). In quality of life, there was improved vitality (p=0.012) and limitation due to emotional aspects (p=0.025). The relationship between auriculotherapy, physical disability and pain interference did not differ between the groups (p>0.05). Medication use in the follow-up period remained unchanged in the Control Group (77.8%) when compared to the Intervention Group (22.2%) (p=0.013).

CONCLUSION

auriculotherapy exerted the same effect between the groups on pain intensity, lasting longer in the follow-up period. There was an improvement in quality of life and a reduction in medication use. REBEC: RBR-3jvmdn.

Treatment of the common cold with herbs used in Ayurveda and Jamu: monograph review and the science of ginger, liquorice, turmeric and peppermint

Background

The common cold is typically managed with decongestants, antihistamines, antitussives and antipyretics. In addition to these established medications, herbal ingredients have been used over centuries to help treat common cold symptoms. The Ayurveda and Jamu systems of medicine, originating from India and Indonesia, respectively, have leveraged herbal therapies to treat many illnesses.

Method

An expert roundtable discussion comprising specialists in Ayurveda, Jamu, pharmacology and surgery along with a literature review was conducted to evaluate the use of four herbs - ginger, liquorice, turmeric and peppermint - for common cold symptom management in Ayurvedic texts, Jamu publications and monographs from the World Health Organization, Health Canada and various European guidelines.

Discussion

Due to a lack of antivirals, common cold management revolves around maintaining personal hygiene and symptom management. Herbal medicines have been an integral part of many cultures worldwide. Despite its growing acceptance, there is a perception that healthcare providers lack interest and may prevent patients from discussing the use of herbal medicines. Limited education and training may also widen the communication gap between patients and healthcare providers, hindering effective management.

Conclusion

Evaluation of scientific evidence and the standing in international monographs can offer perspectives on the use of herbal medicines for common cold management.

Feasibility and Efficacy of Craniosacral Therapy on Sleep Quality in Fibromyalgia Syndrome: a Pre-Post Pilot Trial

Background

Sleep disturbance is one of the key symptoms of fibromyalgia syndrome (FMS), which negatively affects the participants' quality of life. Craniosacral therapy (CST) is a gentle manual technique found to have significant effects on pain and function in chronic pain participants. However, limited evidence exists on its effectiveness on sleep quality in FMS participants.

Purpose

To evaluate the feasibility and effectiveness of CST on sleep quality in FMS participants.

Setting

Outpatient physiotherapy department of a hospital in Bangalore.

Participants

Participants diagnosed with FMS.

Research Design

A pre/post pilot trial.

Intervention

Once weekly, 45-minute sessions of CST for 12 weeks. The participants continued the standard medical care prescribed by the physician.

Main Outcome Measure

The sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) at baseline and 12 weeks. The data analysis was carried out using paired t test.

Results

9 out of 10 included participants completed the treatment and were included for analysis. The results of the paired t test showed significant improvement in the global PSQI score (p = .001, mean difference = 5.44±3.28, 95% CI = 2.92-7.97), as well as the 5 components of PSQI (p < .05).

Conclusion

CST was feasible to deliver with high retention, acceptability, and minimal adverse events. It significantly improved sleep quality in FMS participants along with standard medical care. However, future studies with larger sample sizes and appropriate control groups are required to confirm the findings.