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Background: Liver cirrhosis is an advanced stage of abnormal fibrogenesis of tissues that causes liver injuries. Though cirrhosis can be managed by etiological parameters, its long‐term reversal is still a question. Ayurveda system of medicine diagnoses liver disease under "Kamala" and "Udara" with promising outcomes of treatment. This case series discusses three cases of liver cirrhosis where internal Ayurvedic medications and external therapies including "Panchakarma" (a treatment approach of detoxifying and rejuvenating) resulted in effective management of the disease. Case Presentation: Three cases of decompensated liver cirrhosis were treated at an Ayurveda hospital. Relevant examinations and investigations were done, and patients were monitored at regular intervals. Patients were treated with Ayurvedic therapies and were monitored for changes using standardized tools of assessment. Conclusion: In all three patients, there was an improvement in quality of life and a reduction in symptoms such as abdominal pain, transpyloric diameter, pedal oedema, and fatigue, as well as a significant reduction in liver function test parameters. Decompensated liver cirrhosis can be managed with an Ayurvedic treatment regimen that includes Ayurvedic medications, Panchakarma, along with a proper diet regimen with salt and fluid restrictions. This case series concludes that while cirrhosis is not completely reversible, fibrosis could be reversed. The support of modern medicine for monitoring and emergency care remains paramount. Furthermore, proper documentation of all the observations can help in assessing the outcomes of Ayurveda therapies and aid in developing integrative protocols for the management of liver cirrhosis in the future. [ABSTRACT FROM AUTHOR]

Purpose of Review: Peripheral artery disease (PAD) is a growing global epidemic. Women with PAD are at elevated risk of experiencing psychosocial stressors that influence the diagnosis, management, and course of their illness due to unique sex- and gender-based factors. Recent Findings: We review existing evidence for increased psychosocial risk in women with PAD with a focus on mood disorders, chronic stress, pain experiences, substance use disorders, health behaviors and illness perceptions, and healthcare access. We discuss how these factors exacerbate PAD symptomatology and lead to adverse outcomes. Existing gaps in women's vascular care are reviewed and potential solutions to bridge these gaps through psychosocial care integration are proposed. Summary: Current care paradigms for women's vascular care do not adequately screen for and address psychosocial comorbidities. Clinician education, integration of evidence-based psychological care strategies, implementation of workflows for the management of individuals with PAD and mental health comorbidities, reform to reimbursement structures, and further advocacy are needed in this space. This review provides a construct for integrated behavioral health care for women with PAD and advocates for further integration of care. [ABSTRACT FROM AUTHOR]

This review examines the integration of traditional pharmacological methods with alternative and complementary therapies in chronic pain management. It delves into neurostimulation techniques, highlighting their clinical outcomes and biological bases. Acupuncture's role in modulating pain pathways is explored, illustrating its balance of tradition and clinical application. The paper also covers the pain-relieving potential of herbal medicine, emphasizing natural products' significance in pain relief. Additionally, it discusses the psychological and rehabilitative dimensions of pain through psychosocial therapy and counseling. The conclusion underscores the importance of a multidisciplinary approach, integrating diverse therapies into conventional pain management to effectively treat chronic pain. This synthesis highlights the synergistic potential of combining traditional and innovative therapeutic modalities, offering a comprehensive guide for healthcare professionals in enhancing pain management practices. [ABSTRACT FROM AUTHOR]

Context: Approximately 70,000 Americans miss work annually due to tendinopathies causing pain, disability, and lower quality of life. Various conservative treatments have been demonstrated to improve outcomes in these conditions. Dry needling (DN) and therapeutic exercise are 2 such interventions that have been proposed to be a positive intervention for addressing tendinopathy. Objective: To summarize the best available evidence on the use of DN and exercise combined to treat tendinopathy. Evidence Acquisition: PubMed, EBSCOHost, and Web of Science were systematically searched from inception to March 2021. Articles were assessed to determine eligibility and evaluated for methodological quality using the PEDro scale. The PRISMA guidelines were used for this review. Inclusion criteria consisted of use of DN in combination with therapeutic exercise, human participants, and active tendinopathy pathology. Evidence Synthesis: Seven studies met the inclusion and exclusion criteria, which averaged 6/11 on the PEDro scale. The level of agreement of evaluators was 94%. Current evidence supports the use of DN combined with therapeutic exercises, especially those including eccentric exercises, can improve pain and function for various tendinopathies. However, limited evidence exists regarding specific therapeutic interventions to be combined with DN. Conclusion: There is moderate, level B evidence to suggest the use of DN techniques targeted at the tendon and combined with eccentric therapeutic exercise to improve pain and functional outcomes for tendinopathies. [ABSTRACT FROM AUTHOR]

Purpose: The development and implementation of a provider collaborative (PC) represents an ambitious and complex piece of work to be delivered across a geographical area for a vulnerable patient cohort. The UK East Midlands Children and Adolescent Mental Health Services (CAMHS) PC was established in April 2021, and the current study aimed to explore the views of a variety of staff members about its functioning over the first twelve months. Specifically, it explored whether the intended aims has been achieved and identified the challenges that it faced during its introduction. Design/methodology/approach: Feedback was collected through in-depth qualitative interviews and surveys with frontline (n = 20) and senior staff (n = 19) that were conducted to explore the experiences of a variety of stakeholders within the collaborative. Findings: Two main themes were identified – the achievement of the key aims and the barriers to success. A thematic analysis has shown that whilst the aim of the PC is well intentioned and is generally welcomed by the multiple stakeholders across the geographical region, it is clear that changes are required in order to ensure the inception of an efficient care service that is able to achieve the ultimate goal of providing the ultimate goal of "right care at the right time". Originality/value: This is the first study, to the authors' knowledge, to explore collaborative working in CAMHs services. The study involved staff feedback from Phases 1 and 2 of a 4-years-long evaluation. The findings demonstrate the overall aims are being met as well as identifying areas of concern; this, in turn, allows the authors to develop a series of recommendations to implement and improve collaborative working before assessing their impact in the subsequent phase. [ABSTRACT FROM AUTHOR]

Introduction: Osteopathy was originally introduced in rural America in 1874 as a comprehensive therapeutic approach aimed at promoting health. This approach was distinct and often conflicting with conventional/allopathic therapeutic methods available at that time to fight disease. We argue that, in struggling to achieve recognition within the American healthcare system and within the educational academic field that was about to be structured, the American osteopathic profession tried to protect itself from the charges of sectarism by starting to embrace principles of the biomedical paradigm. Methods: A comparative and historiographic review of the second version of the autobiography of AT Still (1908), the founder of osteopathy, against the first (1897) was chosen as an example of the adaptation of the American osteopathic profession to its evolving academic environment. Results: Although there were only a few substantial variations, we argue that they aimed to dampen the non-biological components of osteopathy, namely, its philosophical, spiritual, religious, emotional, and Native American roots, in an effort to gain respect and recognition within the emerging gold standard of the Western medical system. The shift towards a distinct, fully integrated profession within regulated Western healthcare systems was perceived by many professionals as a threat to AT Still's original ideas, and the trend started when he was alive. Conclusion: Our findings suggest that a crucial conversation regarding the future of the professional identity must take place within the osteopathic community. [ABSTRACT FROM AUTHOR]

Background: To improve the quality of care for Indigenous patients, local Indigenous leaders in the Northwest Territories, Canada have called for more culturally responsive models for Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital. Objective: This study examined how Indigenous patients and biomedical healthcare providers envision Indigenous healing practices working successfully with biomedical hospital care at Stanton Territorial Hospital. Methods: We carried out a qualitative study from May 2018 – June 2022. The study was overseen by an Indigenous Community Advisory Committee and was made up of two methods: (1) interviews (n = 41) with Indigenous Elders, patient advocates, and healthcare providers, and (2) sharing circles with four Indigenous Elders. Results: Participants' responses revealed three conceptual models for Indigenous and biomedical healthcare collaboration: the (1) integration; (2) independence; and (2) revisioning relationship models. In this article, we describe participants' proposed models and examine the extent to which each model is likely to improve care for Indigenous patients at Stanton Territorial Hospital. By surfacing new models for Indigenous and biomedical healthcare collaboration, the study findings deepen and extend understandings of hospital-based Indigenous wellness services and illuminate directions for future research. [ABSTRACT FROM AUTHOR]

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient's advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations. The full text is available online at the following address: essential_steps_inprimary_care_in_older_people_with_diabetes_-_EuGMS-EDWPOP___3_.pdf. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the perceived impact of Project TEACH (Training and Education for the Advancement of Children's Health), a New York State Office of Mental Health funded Child Psychiatric Access Program (CPAP), on pediatric Primary Care Providers (PCPs) and their practice. Practice change over time was assessed in the context of rising mental health needs and in the context of COVID19 pandemic. Methods: Focus groups utilizing a semi-structured format were conducted with pediatric PCPs who have been high utilizers of Project TEACH over the past 5–10 years and PCPs in similar regions who have been low or non-utilizers of the program. The semi-structured interview focused on practice change, asking about pediatric mental health, practice setting and flow, professional development, and changes over time in the context of COVID-19 pandemic and Project TEACH. Results: Themes identified include increasing confidence of PCPs, particularly those who are high utilizers of the phone consultation line, increased routine use of screening and comfort bridging pediatric patients with mental health needs. Challenges include rising mental health needs, inadequate mental health services, difficulties with family follow through and high emotional burden on PCPs caring for these patients. In this context, participants noted that collaboration with Project TEACH provided needed emotional support. Conclusions: Integrated care and CPAPs such as Project TEACH are vital to helping PCPs handle rising mental health needs particularly in current crisis times. Ongoing systemic challenges accessing care remain and contribute to emotional burden placed on pediatric PCPs. [ABSTRACT FROM AUTHOR]

The Pathways Model is an approach guiding the individual to combine self-care, habit change, and positive lifestyle changes, with professional healthcare interventions. There are multiple roles that a social work professional can adopt in guiding the individual in a Pathways recovery plan, including a coaching role, assessment, health education, lifestyle guidance, skills training, counselling, diversity specialist, and integrative care coordination. Spirituality, religious practices, and complementary therapies are important elements in integrative care. The professional social worker with the benefit of social work training is optimally suited to engage in these multiple therapeutic roles. A case narrative of a 49-year-old woman with hypertension and heart disease illustrates how a social worker can utilise various elements of social work practice to facilitate a client's use of the Pathways Model. [ABSTRACT FROM AUTHOR]

Taiwan has been an aging society since 2018. As a result, long-term care, end-of-life autonomy, and hospice care have received increasing attention. The government of Taiwan promotes home-based healthcare through the National Health Insurance System to enable the efficient utilization of medical resources and reduce overall medical costs. Taiwan's community hospice and palliative care network is expected to serve as the main care model supplementing partial hospitalization and institutional care. In this article, we review the history of and policies related to hospice and palliative care in Taiwan using a literature review and examining Pingtung County as a case study. The implementation of home-based palliative care is also outlined and policy revisions are proposed. The results are intended to provide a reference for healthcare authorities and medical institutions to promote community hospice and palliative care policies. The integrated care model can enhance the capacity of community-based palliative care, support patients receiving palliative care and their family members and caregivers, and ensure physical and psychological comfort for patients. This model contributes to the realization of older adults' preference for dying at home, which is especially pronounced in cultures where traditional Chinese ideas are deeply rooted. [ABSTRACT FROM AUTHOR]

Background: Chronic pain negatively affects sleep; it is unclear whether pain relief from acupuncture contributes to sleep quality improvements in cancer survivors. This study aimed to evaluate the effect of acupuncture versus usual care on sleep quality among cancer survivors with comorbid sleep disturbance and chronic musculoskeletal pain. Methods: Sleep outcome data from the Personalized Electroacupuncture Versus Auricular Acupuncture Comparative Effectiveness (PEACE) randomized clinical trial were analyzed. Electroacupuncture or auricular acupuncture was compared with usual care for sleep quality improvement over 10 weeks of treatment among cancer survivors with clinically significant sleep disturbance and chronic musculoskeletal pain at baseline. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) global score. Results: Among 268 participants (mean [standard deviation (SD)] age, 61.4 [12.6] years; 191 women [71.3%]; mean [SD] baseline PSQI global score, 10.3 [3.3] points), electroacupuncture and auricular acupuncture resulted in greater reductions in the PSQI global score from baseline to 10 weeks in comparison with usual care: 1.42 points (95% confidence interval [CI], 0.45–2.38; p =.004) and 1.59 points (95% CI, 0.62–2.55; p =.001), respectively. The improvement in sleep quality for the acupuncture groups was sustained for 24 weeks from randomization. Furthermore, a greater proportion of patients in the electroacupuncture and auricular acupuncture groups had clinically meaningful improvement in sleep quality compared to the usual care group (41.0% and 42.9% vs. 21.4%; p =.044). Conclusions: Among cancer survivors with comorbid sleep disturbance and chronic pain, electroacupuncture and auricular acupuncture produced a clinically relevant and persistent improvement in sleep quality. These findings suggest that acupuncture may be an evidence‐based nonpharmacologic intervention to improve sleep health for cancer survivors with pain. Plain Language Summary: This study analyzed the sleep quality data from a published randomized clinical trial that evaluated the effect of electroacupuncture or auricular acupuncture versus usual care on pain relief among people who survived cancer.This analysis included a prespecified subgroup of 268 participants with co‐occurring sleep disturbance and chronic musculoskeletal pain at baseline and found that patients who used acupuncture for pain relief demonstrated greater improvements in sleep quality compared with patients who received usual care.Sleep quality improvement by acupuncture was sustained after the treatment ended. Among cancer survivors with comorbid sleep disturbance and chronic pain, both electroacupuncture and auricular acupuncture improved sleep quality compared to usual care. The improvement in sleep quality by acupuncture treatment was sustained to 24 weeks after randomization. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the effects of Fil-Rouge Integrated Psycho-Oncological Support (FRIPOS) in a group of women with breast cancer compared with a group receiving treatment as usual (TAU). Methods: The research design was a randomized, monocentric, prospective study with three time points of data collection: after the preoperative phase (T0), in the initial phase of treatments (T1), and 3 months after the start of treatments (T2). The FRIPOS group (N = 103) and the TAU group (N = 79) completed a sociodemographic questionnaire, the Symptom Checklist-90-R (SCL-90-R) at T0; the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-BR23 at T1; and SCL-90-R, EORTC QLQ-C30, and EORTC QLQ-BR23 at T2. Results: A series of independent and paired t tests showed that patients in the FRIPOS group performed better on all scales related to symptomatic manifestations and on some quality of life scales (fatigue, dyspnea, and sleep disturbances) at T2. In addition, a series of ten multiple regressions were performed to predict each SCL subscale at T2 from the SCL score at T0 and the EORTC QLQ-C30 scores at T2. In nine of ten regression models (all except somatization), both FRIPOS group membership and QoL subscale contributed significantly to prediction. Conclusions: This study suggests that patients in the FRIPOS group have more benefits in emotional, psychological, and collateral symptoms than patients in the TAU group and that these improvements are due to integrated psycho-oncology care. [ABSTRACT FROM AUTHOR]

Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development. [ABSTRACT FROM AUTHOR]

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Purpose of Review: The benefits of arts in improving well-being in end-of-life patients have been stated by the WHO. To inspire clinical practice and future research, we performed a mapping review of the current evidence on the effectiveness of art therapy interventions in stage III and IV cancer patients and their relatives. Recent Findings: We identified 14 studies. Benefits reported by the authors were grouped as improved emotional and spiritual condition, symptom relief, perception of well-being, satisfaction, and helpfulness. As a body of evidence, notable limitations were observed: Only 1 study was a randomized controlled trial (RCT), and there was heterogeneity in the interventions and outcome measures. Summary: This mapping review highlights the evidence available on the effectiveness of art therapy in advanced cancer, which remains limited and presents specific challenges. It also provides a visual representation of the reported benefits, encouraging further and more rigorous investigation. [ABSTRACT FROM AUTHOR]

Integrative patient-centered care (PCC) models encompass all dimensions of the patient, including physical well-being, evidence-based shared decision making, and determinants of health as they relate to quality of life. The purpose of this study was to explore parental experiences with the principles of PCC, related to the healthcare of their dependent after interactions with a provider. Using an observational design, our results demonstrated that parents of adolescent athletes rated PCC concepts as "very important" and the care delivered in relation to PCC by providers as "very effective." PCC is perceived as valuable to parents, and therefore, athletic trainers must continue to develop and integrate PCC in the delivery of care within their clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: This article examines the feedback of health care providers within the implementation of an integrative care project in a clinic for pediatric oncology in São Paulo, Brazil. Since 2017, the project has implemented external anthroposophic therapies in the activities of daily nursing. The objective is to evaluate how the project evolved and what impact it had on the daily operation of the hospital. A special focus emphasizes the perspective of study nurses. Materials and Methods: Twelve qualitative semistructured interviews were conducted. Audio files were transcribed, translated to German, and underwent a MAXQDA software-assisted analysis. Using a thematic approach, coherent cross-case topics were defined. Results: Three main topics emerged from analysis of the data. (1) The implementation and its effects on daily patient care demonstrated positive outcomes in patients and were well accepted with minimal changes in daily activities. (2) The perspective of study nurses showed a large motivation due to beneficial and stress-relieving effects of the application and a growing patient–health care provider relationship. (3) Problems and aspirations for improvement were the lack of time and the urge to make the project grow in the future. Conclusion: Not only patients but also health care providers seem to benefit from integrative methods. They have the potential to improve the working atmosphere and to strengthen relations between patients, caregivers, and family members. General feedback was positive and acceptance in the team arose over time when beneficial effects became visible. [ABSTRACT FROM AUTHOR]

Background: Young people in secure services present with multiple vulnerabilities; therefore, transition periods are especially challenging for this group. In this study, we followed up young people discharged from adolescent medium secure services to adult and community settings with the aim to explore transition experiences and outcomes. Methods: Participants were recruited from 15 child and adult mental health services in England. We conducted qualitative semi-structured interviews with 13 young people, aged 18–19 years, moving from adolescent medium secure units 2–6 months post-transition, and five carers 1–3 months pre-transition. Thematic analysis was performed to identify predetermined or data-driven themes elicited from face-to-face interviews. Results: The findings indicated poor transition outcomes for young people with the most severe mental health symptoms and those who committed serious offences. Three overarching themes were identified: (1) unsettling environmental factors within adult services; (2) experiences of transition management and preparation and (3) parental experiences of transition process and engagement with adult services. Conclusion: The findings of this study indicate that young people and carers value ongoing involvement in the transition process by well-informed parallel care. They also highlight the need for a national integrative care model that diverges from the traditional 'one-size-fits-all' approach. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic disease in which the immune system attacks the central nervous system, causing inflammation and neurodegeneration. People living with MS may experience a variety of symptoms as a consequence of this process, including many "invisible" symptoms that are internally manifested and not seen by others. Of the invisible symptoms of MS, which we have reviewed in a companion article, mood and mental health disorders are of particular concern due to their high prevalence and significant impact on patient quality of life. In this review, we showcase the experiences of patient authors alongside perspectives from healthcare provider authors as we promote awareness of the common mental health conditions faced by those living with MS, such as depression, anxiety, adjustment disorder, bipolar disorder, psychosis, and suicidal ideation. Many of these conditions stem in part from the increased stress levels and the many uncertainties that come with managing life with MS, which have been exacerbated by the environment created by the coronavirus disease 2019 (COVID-19) pandemic. A patient-centered interdisciplinary approach, routine screening for mental health changes, and referral to specialists when needed can normalize discussions of mental health and increase the likelihood that people living with MS will receive the support and care they need. Management techniques such as robust social support, cognitive behavioral therapy, mindfulness-based interventions, and/or pharmacotherapy may be implemented to build resilience and promote healthy coping strategies. Increasingly, patients have access to telehealth options as well as digital apps for mental health management. Taken together, these approaches form an integrative care model in which people living with MS benefit from the care of medical professionals, a variety of support networks/resources, and self-management techniques for optimal mental health care. Graphical Plain Language Summary: [ABSTRACT FROM AUTHOR]

Introduction: Current accessibility to child and adolescent mental health services is negatively affected by the shortage of mental health providers. The primary care provider or pediatrician is in a key position to identify behavioral health concerns, coordinate services, and provide treatment to the patient. Aim: This project aimed to improve access to children's mental health care by creating and implementing an educational course on the collaborative care model (CoCM), a model of integrated care that embeds mental health professionals into the primary care setting. Methods: Pre‐ and post‐surveys were embedded in the online CoCM course to track course completion, identify clinical staff knowledge, and identify clinical staff interest in implementing the CoCM in practice. Results: Following project implementation, clinical staffs' responses from the pre‐ and post‐surveys represented an increase in knowledge and interest in implementing the CoCM in practice after taking the online course. Conclusion: This project suggests further exploration of funding and planning to implement a pilot of the CoCM in a primary care practice setting. [ABSTRACT FROM AUTHOR]

While the biopsychosocial nature of inflammatory bowel disease (IBD) is now well accepted by clinicians, the need for integrated multidisciplinary care is not always clear to institutional administrators who serve as decision makers regarding resources provided to clinical programs. In this commentary, we draw on our own experience in building successful integrated care models within a division of pediatric gastroenterology (GI) to highlight key considerations in garnering initial approval, as well as methods to maintain institutional support over time. Specifically, we discuss the importance of making a strong case for the inclusion of a psychologist in pediatric IBD care, justifying an integrated model for delivering care, and addressing finances at the program level. Further, we review the benefit of collecting and reporting program data to support the existing literature and/or theoretical projections, demonstrate outcomes, and build alternative value streams recognized by the institution (e.g., academic, reputation) alongside the value to patients. Ultimately, success in garnering and maintaining institutional support necessitates moving from the theoretical to the practical, while continually framing discussion for a nonclinical/administrative audience. While the process can be time-consuming, ultimately it is worth the effort, enhancing the care experience for both patients and clinicians. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) play an important role in integrated care management and in most cases act as the primary provider and access point for further services. In recent years more and more patients are using complementary and alternative medicine (CAM), including acupuncture, for the management of many health conditions. However, the interaction and collaboration between these two groups in relation to shared health care has not been investigated. Method: The project utilized a mixed methods multiphase design. A nationwide survey of 400 GPs and 250 acupuncturists was conducted. Univariate data was analysed using descriptive statistics. This was followed by individual semi-structured interviews of 13 purposively sampled acupuncturists, and 14 GPs which was analysed using thematic analysis. The project continued to data driven toolkit development and piloting to further address research's aims. Results: The research found that communication was not optimal between the participant groups and identified both facilitators and barriers to integrative care. Key barriers identified were: the lack of suitable pathways and methods for communication to occur, lack of awareness surrounding acupuncturists' scopes of practice, and the difficulties in identification of suitable practitioners. Conclusions: This research demonstrated that it is possible to create a toolkit containing elements which are readily included in routine clinical practice for both GPs and acupuncturists. These tools have clinical utility not only to enhance communication and collaboration between GPs and acupuncturists, but to allow transferability to other groups within health care. [ABSTRACT FROM AUTHOR]

Background: Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment.Methods: We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis.Results: Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable.Conclusions: Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures.Trial Registration: ClinicalTrials.gov identifier: NCT03624829. [ABSTRACT FROM AUTHOR]

Objective: Cancer and diabetes are two severe chronic illnesses that often co-occur. In cancer patients, diabetes increases the risk for treatment complexities and mortality. Yet patient-reported outcomes with co-occurring chronic illness are understudied.Design: This preliminary study investigated the association of diabetes with breast cancer-related morbidity among underserved Latina breast cancer survivors (BCS).Participants: 137 Latina BCS were recruited from the California Cancer Registry and hospitals.Setting and Main Outcome Measure(s): BCS completed a self-administered mailed questionnaire assessing demographic and medical characteristics e.g. Type2 diabetes mellitus (T2DM).Results: 28% Latina BCS reported co-occurring T2DM at twice the general population rate. Diabetes was most prevalent among Latina BCS > 65 years (43%). Latina BCS with diabetes were more likely to report advanced cancer staging at diagnosis (P = 0.036) and more lymphedema symptoms (P = 0.036). Results suggest non-significant but lower general health and greater physical functioning limitations among BCS with T2DM.Conclusions: This study has relevance for precision population medicine by (i) consideration of routine diabetes screening in Latina BCS, (ii) underscoring attention to disease co-occurrence in treatment planning and care delivery and (iii) informing follow-up care and survivorship care planning e.g. patient self-management, oncology and primarily care surveillance and specialty care. Our findings can inform providers, survivors and caregivers about the impact of disease co-occurrence that influence clinically and patient responsive care for both initial treatment and long-term follow-up care to address disparities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to collaborate across disciplines to agree a better map of human development. Design/methodology/approach: This paper used an iterative process of consultation with professionals and specialists in relevant disciplines, and service users, continually refining the diagram and text until a "good enough" consensus was reached to produce a diagrammatic form and explanatory text. Findings: The process revealed a strong commitment across many disciplines to find a common contextual framework within which specialist understandings could be accommodated. The consultation process and iterative development of the diagram and text was marked by widespread interest and many detailed discussions. The substance of this paper is the result of that process. Research limitations/implications: The model places research in different specialist fields onto a single "map of the territory". It can encourage collaboration across disciplines when they are studying similar areas from different perspectives. It indicates the value of collaborative rather than competitive research enterprises. Practical implications: Too often, professionals involved in fields concerning human development become focussed within narrow frameworks of specialisation. The model supports better understanding of how different elements relating to developmental life interrelate. This can facilitate the basis upon which a wide range of training, education and research programmes can be formulated. Social implications: The model proposes greater use of a "whole-person/whole-life" perspective, which should allow greater integration between disparate approaches, and less experience of fragmentation. For a wide range of public sector activities, the quality of relational activity should be central to effective organisational and human outcomes. Without a unifying context, the understanding required to support relational work is weak: this model ad-dresses that deficit. Originality/value: This work is entirely original. It should be of value to all those interested in working in holistic ways; to policy makers wishing to avoid duplication, waste and ineffective interventions; and to researchers interested in working across disciplinary boundaries. Most importantly, it is for staff involved in health, justice, social care and education services at all levels. Their effectiveness relies on relational, as well as procedural working, and this model will support confidence in the primacy of these activities. [ABSTRACT FROM AUTHOR]

Objectives: To describe and contrast the prevalence and trends of sick leave in patients with pain or stress disorders referred to inpatient care that integrates conventional and complementary therapies, that is, integrative care (IC). Methods: County council and social insurance data were used to retrospectively observe cross-sectional sick leave prevalence at four time points: 1 year before the first registered inpatient visit with the target diagnosis, after referral at index, and at 1 and 2 years after index. To contrast the IC findings, observations of patients with similar background characteristics referred to conventional care (CC) were used. Results: The sick leave prevalence of IC pain patients and IC stress patients increased from the preceding year to peak at index, where after it decreased back toward preindex levels over 2 years. Overall sick leave prevalence was higher in IC than in CC, where analogous but lower prevalence trends of sick leave changes were observed. Conclusions: Observed sick leave prevalences, which were higher in IC than in CC, gradually decreased over time following IC or CC referral. While natural recovery or other reasons for change of sick leave cannot be excluded, future prospective and randomized clinical trials are recommended. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the change in the concerns, wellbeing, and lifestyle behaviors of informal caregivers of people with cancer attending Penny Brohn UK's Living Well Course (LWC), a self-management education intervention. Design: A pre–postcourse design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC. Setting/Location: Penny Brohn UK is a United Kingdom-based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer. Subjects: Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer. Intervention: The LWC is a structured 15 h, multimodal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer and their informal caregivers. Outcome measures: Measure Yourself Concern and Wellbeing (MYCaW) completed precourse and at 6 weeks postcourse; and bespoke 6-week follow-up Patient Reported Experience Measure. Results: Four hundred eighty informal caregivers attended a LWC June 2014 to May 2016. One hundred eighteen completed a 6-week follow-up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p < 0.0001), there was no significant improvement in wellbeing. Informal caregivers' most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). Eighty-seven percent of responding informal caregivers stated that the LWC enabled health self-management. Conclusions: The LWC was followed by an improvement in informal caregivers' concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients' health and wellbeing. [ABSTRACT FROM AUTHOR]

Metastatic cancer, especially in the growing population of geriatric patients, presents a big challenge to these patients, as well as to treatment teams and the entire health care system. This article describes some common medical problems faced by patients with metastases to liver and bone, and presents a diagnostic approach, and therapeutic management of various symptoms, relevant to advanced stages of the malignant disease. The article highlights the importance of patient education on various aspects of metastatic cancer, and underscores the unique position of pharmacists practicing pharmaceutical care, which is particularly beneficial in this group of patients with advanced malignancy. Also, this paper emphasizes that achieving a proper balance between managing the malignant disease and maintaining the patients' quality of life, especially in the elderly population, should involve coordinated efforts of the oncology treatment team, primary care physicians, pharmacists, therapists and nurses, as well as patients, their families and caregivers. [ABSTRACT FROM AUTHOR]

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Chronic illnesses challenge established patterns of functioning forcing individuals to develop new ways of coping and adaptation. Living with Multiple Sclerosis (MS) entails feelings of uncertainty, unpredictability and helplessness. This review highlights the need for addressing and focusing upon psychological and emotional burden of MS and creates inroads for interventions. An attempt is made to bring together research documenting the challenges and difficulties of living with MS. The authors hope to emphasize the need for a holistic approach towards diagnosis, treatment and management of MS and chronic health conditions. [ABSTRACT FROM AUTHOR]

Background: Patients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of “caring touch” (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries. Methods: A mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch. Results: Patients reported that caring touch may assist in trauma recovery by functioning as a physical “anchor” on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is “turned off” to becoming “awake”. By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p < 0.001) and IES-R (p 0.002) had decreased 6 months after the accident whereas the EQ-5D index had increased (p < 0.001). There were no statistically significant differences of the SOC or EQ-5D self-rated health scores over time. Conclusions: In the care of patients suffering from a MVA with minor or no physical injuries, a caring touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident. Trial registration: ClinicalTrials.gov Id: NCT02610205. Date 25 November 2015. [ABSTRACT FROM AUTHOR]

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Background: Despite the absence of conclusive evidence of effectiveness, complementary and alternative medicine (CAM) is used by 4 of 10 adults in the US; little is known about the association between CAM use and health status.Objective: To determine the relation between CAM use and self-reported health status and health improvement over time.Design and Participants: We performed a secondary database analysis using data from the 2007 National Health Interview Survey of non-institutionalized US residents conducted by the National Center of Health Statistics of the Center for Disease Control. We identified CAM users and compared them to non-users. We used multivariable logistic regression to model the health status of respondents. We controlled for confounders including socio-demographic, clinical, and behavioral factors. The models were evaluated for discrimination and calibration.Main Measures: The likelihood of respondents to report 'Excellent' current health and 'Better' health than in the prior year.Key Results: Based on 23,393 respondents, we found 37% of U.S. adults used complementary and alternative medicine and 63% did not use any CAM. Compared to those who did not use CAM, CAM users were more likely to rate their health as 'Excellent' (adjusted-odds ratio (AOR) = 1.14, 95% CI = [1.03,1.26]). Similarly, CAM users were more likely to report their health as 'Better' than in the prior year (AOR = 1.64, 95% CI = [1.49,1.83]). The c-statistics for the two models were 0.755 and 0.616, respectively.Conclusion: We found a significant association between CAM use and self-rated excellent health and health improvement over the prior year. Prospective trials are required to determine whether CAM use is causally related to excellent health status and better health than in the prior year. [ABSTRACT FROM AUTHOR]

Medical schools have recognized and endorsed integrative health care. As such, integrated care is becoming more common. Biofeedback practitioners already trained to work in medical settings and those willing to be so trained have a real opportunity to expand their base of services because self-regulation is an important part of integrated care and lifestyle change. Working in medical settings requires a broad base of knowledge and skill, including an understanding of both the formal and informal rules that govern activities in such settings. Having a mentor or supervisor who already possesses the requisite skills can be most useful in helping the practitioner acquire the needed knowledge and skills and to make a shift from focusing on pathology to one of promoting good physical and mental health. Issues of competence, informed consent, and confidentiality must also be addressed and often in ways not common in other settings. [ABSTRACT FROM AUTHOR]

Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals. [ABSTRACT FROM AUTHOR]

Background: The Danish Multiple Sclerosis Society has initiated a research project dealing with bridge building and integrative treatment. Little attention has been paid to research on the experience of conventional and alternative practitioners with bridge building and integrative treatment through teamwork. Objective: The objective of this article is to describe essential features of the preparatory phase of the research project focusing on the process of initiating and developing a team of conventional and alternative practitioners before treating people with Multiple Sclerosis at a specialized MS hospital in Denmark. The team consists of five conventional and five alternative practitioners. Materials and Methods: The preparatory phase took place from August 2004 to May 2005. In-depth, semi-structured interviews were conducted with the ten team practitioners. Each practitioner was interviewed before and eight months after joining the team, and after participating in four practitioner-researcher seminars. Written materials and participatory observations of practitioner-researcher seminars have been used in addition. Results: The team-building process involved motivation, emotions, challenges, professional and personal competences, and the development of a professional team identity. The practitioners assessed the preparatory phase based on researcher-practitioner seminars as an essential basis for moving on to provide treatments to people with MS. [ABSTRACT FROM AUTHOR]

This study used a qualitative approach to explore family physicians’ beliefs, attitudes, and practices regarding the integration of patient spirituality into clinical care. Participants included family medicine residents completing training in the Southwest USA. The qualitative approach drew upon phenomenology and elements of grounded-theory. In-depth interviews were conducted with each participant. Interviews were recorded, transcribed and coded using grounded-theory techniques. Four main themes regarding physicians’ attitudes, beliefs, and practices were apparent from the analyses; (1) nature of spiritual assessment in practice, (2) experience connecting spirituality and medicine, (3) personal barriers to clinical practice, and (4) reflected strengths of an integrated approach. There was an almost unanimous conviction among respondents that openness to discussing spirituality contributes to better health and physician–patient relationships and addressing spiritual issues requires sensitivity, patience, tolerance for ambiguity, dealing with time constraints, and sensitivity to ones “own spiritual place.” The residents’ voices in this study reflect an awareness of religious diversity, a sensitivity to the degree to which their beliefs differ from those of their patients, and a deep respect for the individual beliefs of their patients. Implications for practice and education are discussed. [ABSTRACT FROM AUTHOR]

Background: Spiritual care has been shown to be beneficial for patient in the settings of oncology and intensive care [1-5]. We propose that the quality of care given to the aging or to individuals with chronic illness might also improve as a result of the inclusion of spiritual care interventions in the integrative care models which guide the management of such individuals. The research studies to date that point to a positive impact of spirituality on patient outcomes in this patient population, have been criticized for the lack of a strong theoretical framework [6- 11]. The need for spiritual care is recognized, but a theoretical model has not been developed, and testable spiritual interventions have not been defined. In addition, there are also key reasons that have to do with the conceptualization of integrative care itself -- the focus on the integration of 'services' which have a direct economic component is reflected in the WHO definition of integrated care: "Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency" to the individual [12, p.6]. The person in the WHO scheme is always to be seen as part of an entity and a system of beliefs, culture, religion and a community ecosystem and not to be seen as a "single" person. Similar reports from the IOM (Institute of Medicine) (13, p.20) focus on the essentials of a "systems engineering" approach to fixing an aliening health care system, defining essential and necessary steps best depicted by the following diagram. The individual, labeled as patient, is the white circle with no subscript. Although the word spiritual evokes fears in some people that esoteric concepts undermine the scientific rationality, we would argue that conceptually spiritual care is based on the rational concept of how we define a person in an evidenced based medical world view. We suggest that spiritual care has to be introduced into this ill-defined and poorly understood space, for the benefit of the patient and the broader family/community context. The main goals of this paper are: - to present data defining the key elements of spiritual care; - to identify where in the clinical course of such patients spiritual interventions have been shown to affect patient outcome; and - to develop a paradigm of spiritual care that can be integrated into the care systems across the life span of the individual. Methods: We review the literature from peer reviewed paper and consensus -strategic reports focusing on spiritual care for the aging and patients with chronic illnesses. The review encompasses the period from 2008 through January 2013. These sources have focused on the definitions and theoretical constructs of spirituality and spiritual interventions in relation to aging populations where the aim is not end-of-life care, but, rather, "wellness" care, while living with chronic diseases or aging. At least two researchers have reviewed each document, systematizing evidence on key constructs, processes and outcomes. Results: This comprehensive review enables the development of a paradigmatic model, which we present, that introduces the accepted definitions and interventions components of spiritual care into the care plans for aging patients or those with chronic illnesses. This model comes to add to the new WHO declaration: Primary Health Care: Now More Than Ever [14]. It is intended to help primary care practitioners by developing guidelines for the integrating of spiritual care during the course of their patients' chronic illnesses or aging process [15-16]. Conclusions: There are constructs of spirituality and spiritual interventions that can be applied to the integrative systems of care given to aging patient or those with chronic illnesses during their life cycle. These interventions can be applied throughout the life span and their effectiveness has been tested both in terms of quality of life and socioeconomic variables that contribute to the ever increasing burden and gift of longevity. [ABSTRACT FROM AUTHOR]

Introduction: The project arises from the need to make healthcare systems more efficient, at the same time respond to the population suffering from complex wounds, through a new integrative care model in complex wounds of interdisciplinary clinical care delivery units. After analysing the existing models to address this kind of problem, of a designed structure that seeks to define an optimized model characterized by patient centralization, integrated care, efficient management practices, multidisciplinary competence team and; the resulting model would be designed with the active involvement of stakeholders and policy makers with the objective of guaranteeing the widest possible applicability. Complex wounds are a relevant problem within the existing population in the different levels of care. It is important to note, that it is a multifactorial problem. The approach of these wounds is a great challenge for healthcare teams. Main Objective: Define an innovative integrative care model in complex wounds by interdisciplinary units and management models. Secondary Objectives: Analyse the efficiency of this model, the approach and management of patients with hard-to-heal wounds. Method: The differential diagnosis is the first key in this process. Complex wound units perform accurate filtering of each case, and can make referrals to the indicated specialist, but controlling patients, from its entry into the system until the resolution of the problem. In this way the possible drawbacks or jamming that could arise in the circuit may be detected. The established care plan is agreed and adapted to the individual needs of each patient, always supported by a skilled professional. The empowerment of patients in their health care is the second key to not abandon the plan of care. The team of specialists includes different disciplines, such as: Plastic and Reconstructive Surgery, Vascular Surgery and Angiology, Internal and Infectious Medicine, Dermatology, Nutritionist and Expert Nursing Team. Results: This Project began in February 2013 closing the year with 325 patient visits (n: 44) data that was exceeded in 2014 with 738 visits (n: 81). In September of the current year, we've already reached 900 visits. The average time of evolution of the lesions on arrival to the system (retiring three cases that broke the norm with 15, 9 and 8) were around 12 months, while the average problem resolution time ranged from 2 months. In 2013 we managed to resolve 68% of cases, while 2014 ended with 81% of cases resolved. There were several correlated variables that could be of interest in this part of the study very motivating for future studies. DISCUSSION: It's important to have a clinically effective and cost-effective allocation of health resources, decisions on treatment and prevention of wounds as a result. Reduce length of patient hospital stays. Promote preventive measures that allow reducing the prevalence. The scope of the parameters to be considered, favours the development of an archetype with a high transfer potential to other unit types. Streamline demand improving hospital and primary healthcare. Offer support to care centres so that they can become self-sufficient. Reduce queries of specialized patients derived incorrectly. Nursing plays a new role (in Spain): "Advanced Nursing" may require changes in legislation and regulations to eliminate barriers in the practice. This model of integrated care, works in several fields. A horizontal integration between health services, social services and other providers and a vertical integration model, which includes primary care, community, hospital and geriatrics. This experience has been through some obstacles. Economic: It has been implemented in a time of crisis and budget cuts, which has fought with an internal restructuring of the team that has led to a professional and human effort. Resistance to change: The lack of predisposition to the collaboration of other medical equipment has been a problem that has been waning as was demonstrating the efficiency and professionalism. Professional barrier: A nursing coordinator has the need to interact with other leaderships of higher professional range (mostly medical). Has been created close relations between different disciplines. Distrust to a new management model: Has been increased the effort and steady work, which has generated well results and a special interest in its diffusion. Conclusion: There is the need to develop basic lines of work in different fields. It's necessary to carry out more studies to prove that interdisciplinary wounds units are suitable and a need required by society and expected from the health care system: a low cost, the best possible management and excellent quality of care. [ABSTRACT FROM AUTHOR]

Background: Flexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models. Methods: A multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach’s α coefficient. Results: Ten of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability. Conclusions: The components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models. [ABSTRACT FROM AUTHOR]

An abstract of the article "Music therapy as a medicine of the whole person: What can we learn from Paul Tournier?" by John Habron is presented.