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For centuries, pharmacologic interventions have been the primary intervention for pain in intensive care patients. Opioid use has significant side effects and long-term risks including addiction and loss of life. Critical care nurses and other health care professionals can include effective nonpharmacological complementary modalities to reduce pain. Approaches discussed include guided imagery, acupuncture, music and sound therapy, cold therapy, massage, and physical and occupational therapy. Evidence-based research that examined the efficacy of these complementary methods found significant reduction in pain, trauma, length of stay, or post-intensive care syndrome in critical care patients., Competing Interests: Disclosure All authors report no commercial or financial conflicts of interest. There was no funding from any source for this publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The coach-athlete relationship is not merely a by-product of the coaching process but serves as its foundation. Coaches today must align their approaches with the characteristics (character, strengths, and growth areas) of a new generation of athletes, commonly referred to as Generation Z (Gen Z). Born between 1995 and 2012, Gen Z's grew up in a digital age, which shaped their character and behaviour. The purpose of the study was to explore coach-athlete relationships, the characteristics of Gen Z athletes that influence this relationship, and the process of building healthy coach-athlete relationships, from the perspectives of coaches., Methods: The study used a qualitative methodology to elicit the perspectives of 11 male rugby union coaches (M ± SD age: 42.09 ± 7.56 years; with 12.83 ± 3.48 years of coaching experience), through semi-structured individual online interviews. We developed the interview script from Jowett's Coach-Athlete Relationship Questionnaire (CART-Q). The interviews were analysed using Merriam and Tisdell's six-step process., Findings: The analysis yielded six super themes (and 17 themes). 1. Coach perspectives on coaching Gen Z players (developmental facilitators and debilitators, Covid-19's effect on development). 2. Closeness between coaches and athletes [loving and caring, getting closer, trusting, (not) respecting some players]. 3. Commitment (personally and towards the team, sacrifices). 4. Complementarity (goal setting, collectively working towards common goals). 5. Co-orientation (communicating, reciprocal relationship views). 6. Developing the coach-athlete relationship (approaches thereto, practical steps)., Discussion: Various facets of the coach-athlete relationship are interlinked and shaped by the characteristics and behaviours of this generation of athletes. Practical recommendations are offered on how to cultivate the coach-athlete relationship on emotional, cognitive, and behavioural levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Landman, Grobbelaar and Kraak.)

Background: The use of herbal products, one component of the growing field of integrative cancer care, is a common yet controversial practice., Objectives: This article distinguishes nursing issues specific to patient safety when herbal products are used during cancer treatment and identifies available evidence-based resources to enhance patient and professional comprehension., Methods: PubMed®, CINAHL®, and Google Scholar™ databases were searched for literature published between 2018 and 2024 specific to the clinical sequelae of the use of herbal products and their interactions with antineoplastic drugs, as well as patient and healthcare providers' perceptions of efficacy and safety., Findings: Patients have misconceptions about the use of herbal products and are generally unaware of these products' potential contraindications when taken in conjunction with antineoplastics. Providers seldom inquire about patients' use of these products and may lack knowledge of their potential interactions with prescription medicines.

Purpose of Review: Traditional, complementary, and integrative medicine (TCIM) modalities are widely employed. However, TCIM, specifically herbal and non-herbal dietary supplements, can pose challenges in the context of organ transplantation. In this review, we discuss common supplements used for psychiatric purposes and highlight important considerations for candidates and recipients of liver transplants., Recent Findings: Ashwagandha, kava kava, green tea extract, skullcap, turmeric, and valerian have known idiosyncratic hepatotoxic potential and may complicate the liver transplantation course. Multiple supplements reportedly carry a lower risk of hepatotoxicity, though evidence for widespread use in those at risk for or with hepatic impairment is limited. Psychiatrists caring for candidates and recipients of liver transplants must recognize that patients may find supplements helpful in alleviating psychiatric symptoms, despite an overall limited evidence base. Evaluating benefit versus risk ratios and reviewing drug-drug interactions is essential to promote transplant candidacy and mitigate the possibility of native or graft liver dysfunction., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: This study aimed to review the literature on complementary and alternative therapies, utilizing text mining and trend analysis in nursing research. As CAM becomes increasingly prevalent in healthcare settings, a comprehensive understanding of the current research landscape is essential to guide evidence-based practice, inform clinical decision-making, and ultimately enhance patient outcomes., Method: This study aimed to identify CAM-related literature published from 2018 to 2023. Using the search terms 'complementary therap*', 'complementary medicine', 'alternative therap*', and 'alternative medicine', we performed a comprehensive search in eight databases, including EMBASE, Cochrane Central, PubMed Central, Korea Education and Research Information Service (RISS), Web of Science, KMbase, KISS, and CINAHL. From the text network and topic modeling analysis of 66,490 documents, 15 topics were identified. These topics were classified into two nursing-related topics through an academic classification process involving three doctors with doctoral degrees, three nurses, and three pharmacists. Based on the classified topics, research trends were comparatively analyzed by re-searching the database for 12 nursing and 22 non-nursing literature., Result: This study found that in nursing literature, yoga is used to improve mental symptoms such as stress and anxiety. In non-nursing literature, most of the experimental studies on complementary and alternative therapies were conducted in a randomized manner, confirming that a variety of physiological and objective indicators were used. Additionally, it was discovered that there were differences in the diversity of research subjects and research design methods for the same intervention method. Therefore, future research should focus on broadening the scope of subjects and measurement tools in nursing studies. Additionally, such studies should be conducted with randomization and generalizability in the experimental design in mind., Conclusion: This study employed text network analysis and text mining to identify domestic and international CAM research trends. Our novel approach combined big data-derived keywords with a systematic classification method, proposing a new methodological strategy for trend analysis. Future nursing research should focus on broadening the scope of subjects, diversifying measurement tools, and emphasizing randomization and generalizability in experimental designs., (© 2024. The Author(s).)

Purpose: Hypertension is the primary cause of mortality. Hence globally, there is a growing interest in complementing antihypertensive drugs with herbs to alleviate blood pressure among hypertensive patients. Thus, this review aimed to evaluate the effectiveness of complementing drugs with herbs on blood pressure and lipid profile outcomes, the associated factors and the types of complementary herbs alongside their consumption regimes., Methods: This review is registered in PROSPERO on the National Institute of Health Database with an ID: CRD42021270481. Using the PICOS (population, intervention, comparison, outcome, study type) mnemonic formula and search strategy, we searched (January 2010 to February 2024) five electronic databases including Pubmed, Scopus, Web of Science, CINAHL (Cumulative Index for Nursing and Allied Health Literature) and Psychology & Behavioral Sciences Collection (PBSC). The inclusion criteria of the review were that all included papers had to be randomised control trials in English among hypertensive adults who complemented antihypertensive drugs with herbs. A Cochrane risk of bias assessment as well as a meta-analysis and narrative synthesis were conducted to answer the objectives., Results: Twenty-five randomised controlled trials involving 1996 participants from 14 countries were included. The risk of bias among included articles was assessed and presented using the Cochrane risk of bias tool and the graphs were generated. The effects of complementing antihypertensive drugs with different herb regimes on blood pressure and lipid profile outcomes were compared to those solely on antihypertensive drugs and placebo via a random model effects meta-analysis using the Revman manager. Systolic blood pressure (SBP) and triglycerides gave a significant reduction in favour of the intervention group which complemented herbs. The overall pooled systolic blood pressure showed a reduction of (SMD=0.81, 95 % CI 0.14-1.47, p < 0.02, p for heterogeneity=0.00001, I 2 =97 %) while triglycerides were (SMD=0.73, 95 % CI 0.17-1.28, p < 0.01, p for heterogeneity=0.00001, I 2 =85 %). However, diastolic blood pressure, total cholesterol, HDL and LDL did not exert significant outcomes., Conclusion: The complemented herbs with antihypertensive drugs did show improvement in overall blood pressure management in the majority of the studies compared to the placebo group. Blood pressure and lipid profiles are the health outcomes that enable access to complementing herbs in controlling high blood pressure. Some limitations of this review are attributed to performance, detection and attrition bias in a few included articles alongside the presence of a high heterogeneity overall., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The prevalence of autism spectrum disorder (ASD) has increased over the last decade. In this regard, many emerging therapies have been described as ASD therapies. Although ASD does not have a cure, there are several management options available that can help reduce symptom severity. ASD is highly variable and, therefore, standard treatment protocols and studies are challenging to perform. Many of these therapies also address comorbidities for which patients with ASD have an increased risk. These concurrent diagnoses can include psychiatric and neurological disorders, including attention deficit and hyperactivity disorder, anxiety disorders, and epilepsy, as well as gastrointestinal symptoms such as chronic constipation and diarrhea. Both the extensive list of ASD-associated disorders and adverse effects from commonly prescribed medications for patients with ASD can impact presenting symptomatology. It is important to keep these potential interactions in mind when considering additional drug treatments or complementary therapies. This review addresses current literature involving novel pharmacological treatments such as oxytocin, bumetanide, acetylcholinesterase inhibitors, and memantine. It also discusses additional therapies such as diet intervention, acupuncture, music therapy, melatonin, and the use of technology to aid education. Notably, several of these therapies require more long-term research to determine efficacy in specific ASD groups within this patient population., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kaye et al.)

Purpose of Review: The goal of this review is to summarize updates to the broad array of complementary therapies available for cancer pain. This paper will serve as a reference for clinicians managing pain in cancer patients., Recent Findings: Patients are embracing integrative therapies in growing numbers; clinicians must be prepared to incorporate these therapies into patients' existing treatment regimens. This requires knowledge regarding risks, benefits, and potential interactions with existing cancer therapies. Integrative cancer pain management strategies have shown promise, with several proven effective for the management of cancer pain. Energy therapies, including acupuncture, and biologicals and nutraceuticals including overall diet and vitamin D, have the highest level of evidence for efficacy. The remaining therapies discussed in this chapter may be beneficial for patients on a case-by-case basis; risks and benefits of each individual therapy as described in the text must be further assessed in future rigorous trials to further clarify the role of these complementary therapies in cancer pain management., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Despite the recognition of the importance of physician knowledge and physician-patient communication about the use of complementary and alternative medicine (CAM), few studies have explored this issue. Therefore, this study aims to assess physicians' knowledge and physician-patient communication regarding CAM., Methods: A cross-sectional study was conducted among physicians working at governmental hospitals and primary healthcare centers in Madinah, Saudi Arabia. The data collection tool was a validated English language questionnaire distributed using social media platforms. The questionnaire included sections to assess physician knowledge and communication about CAM., Results: Of the 373 completed questionnaires, around 151 (40.5%) of the respondents stated that they have a poor level of knowledge about CAM, and 272 (72.9%) need to gain additional knowledge to properly counsel patients on CAM. Medical journals were the main source of knowledge about CAM. There were 121 (32.4%) physicians who believed that <20% of their patients use some form of CAM, and 180 (48.3%) believed that <20% of their patients spontaneously reported their CAM use without prompting or direct questioning. Around 180 (48.3%) of physicians believed that they asked <20% of their patients about using CAM. Regarding barriers that limit communication with the patient about CAM, the highest percentage was insufficient knowledge about CAM (137, 36.7%)., Conclusion: The study showed that a significant number of physicians lack the appropriate knowledge about CAM and most of them agreed to gain additional knowledge to properly counsel their patients. Further research is needed to evaluate physicians' knowledge about CAM using a more objective method., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee, Taibah University, College of Medicine issued approval IRB00010413. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aljardi et al.)

Object: This cross-sectional study aims to investigate migraineurs' preferred complementary and alternative medicine (CAM) types and the factors influencing their usage., Materials and Methods: An anonymous e-survey was distributed to Lithuanian Migraine Association members, and social media migraine support communities. The collected data consisted of demographic, migraine-related questions, personal qualities, CAM habits., Results: 470 respondents were analyzed. 95.96% were women with a median age of 37 (IQR 31, 44). The median duration of migraine was 17.5 years (IQR 10, 25) and the median headache severity was rated 8 (IQR 7, 10) out of 10. 68.90% of participants had one or more headache days per week. 71.49% of respondents were triptan users, 27.66% used medical prophylaxis, and 17.87% used monoclonal antibodies. 52.55% of respondents used CAM in the past 12 months. Physical activity (36.17%), dietary changes/fasting (27.02%), relaxation/meditation (26.60%) were the most used CAM types. Reasons for CAM use included dissatisfaction with conventional treatment effectiveness (42.51%), concerns about safety (48.18%) and adverse effects (37.25%). Factors associated with the decision to explore CAM included longer headache duration ( p  = 0.017, Mann-Whitney U test), frequent sick leaves ( p  < 0.001, Mann-Whitney U test), current preventive medication use ( p  = 0.016, chi-square test), positive views on CAM safety/naturality ( p  = 0.001/ p  < 0.001, Mann-Whitney U test), belief of having a healthy diet (p < 0.001, chi-square test), food-related worries ( p  = 0.011, Mann-Whitney U test) and Big-five personality trait of openness to experience ( p  = 0.049, chi-square test). After logistic regression, the frequent need to take sick leaves, having a healthy diet, food-associated fears maintained statistical significance. CAM use was not associated with non-adherence to conventional medicine. 48.99% of CAM consumers disclosed CAM use to their doctors., Conclusion: CAM is explored by a significant proportion of migraineurs, less than half communicate this to their doctors. In our sample, physical activity, dietary changes, and relaxation techniques were the most common. Many patients opted for CAM due to previously experienced side effects/ineffectiveness of conventional migraine treatment or the fear of potential harm from standard medication. Individual factors, such as openness of personality can be an important contributing factor., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Makarevičius, Dapkutė and Ryliškienė.)

Background: Complementary and alternative medicine (CAM) has emerged to combat the global COVID-19 pandemic. However, no studies have been conducted to evaluate the attitudes, knowledge, and barriers of Chinese clinical and nursing students in implementing CAM during this period., Objective: The aim of this study was to investigate the attitude, knowledge, and barriers of Chinese clinical and nursing students in using CAM in the context of COVID-19., Methods: An online-based cross-sectional survey was carried out among Chinese medical students, majoring in clinical medicine or nursing, in Nanjing, Jiangsu Province, and Zhengzhou, Henan Province from May to July 2022. A total of 402 clinical and 644 nursing students responded to a self-administered questionnaire through the Questionnaire Star and WeChat APPs. SPSS 25 (version 25) was used for data analysis. Proportions were compared by Chi-square test. Level of significance between groups was analyzed using independent student t-test and Mann-Whitney U test., Results: The average score of attitude was 46.63 (SD: 7.38) in clinical students and 49.84 (SD: 6.76) in nursing students. The top four most commonly used CAM treatments in China were proprietary Chinese medicine, diet therapy, decoction, and acupuncture and moxibustion (59.66 %, 22.28 %, 11.66 %, 9.85 %). The students had a good mastery of knowledge about CAM-based prevention and control of COVID-19 (mean score 7.36). The score of CAM knowledge in nursing students was significantly higher than that in clinical students (7.56 VS 7.04, P  = 0.000). Gender, grade, previous use, age, and knowledge score could affect students' attitude towards CAM. The main barriers in spreading CAM use included time-consumption, bad taste, and fear of treatment-related pain (24.5 %). Compared with clinical students, nursing students were more likely to recommend CAM to patients in the future ( P  = 0.002)., Conclusions: During the COVID-19 pandemic, nursing students were more positive towards CAM use, had a better mastery of CAM knowledge than clinical students. CAM is expected to provide better outcomes in COVID-19 patients. Future studies should focus on the changes in students' attitudes over time and exploration of influencing factors on CAM use., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse)., Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings., Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks)., Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial., Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses., (© Dror Ben-Zeev, Anna Larsen, Dzifa A Attah, Kwadwo Obeng, Alexa Beaulieu, Seth M Asafo, Jonathan Kuma Gavi, Arya Kadakia, Emmanuel Quame Sottie, Sammy Ohene, Lola Kola, Kevin Hallgren, Jaime Snyder, Pamela Y Collins, Angela Ofori-Atta, M-Healer Research Team. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking., Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app., Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users., Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=-0.09)., Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app., (©Morgan Snyder, Gary R Elkins. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.03.2024.)

Background: In recent years, advancements in cancer treatment have enabled cancer cell inhibition, leading to improved patient outcomes. However, the side effects of chemotherapy, especially leukopenia, impact patients' ability to tolerate their treatments and affect their quality of life. Traditional Chinese medicine is thought to provide complementary cancer treatment to improve the quality of life and prolong survival time among patients with cancer., Objective: This study aims to evaluate the effectiveness of Chinese herbal medicine (CHM) as a complementary treatment for neutropenia prevention and immunity modulation during chemotherapy in patients with breast cancer., Methods: We will conduct a real-world pragmatic clinical trial to evaluate the effectiveness of CHM as a supplementary therapy to prevent neutropenia in patients with breast cancer undergoing chemotherapy. Patients will be classified into CHM or non-CHM groups based on whether they received CHM during chemotherapy. Using generalized estimating equations or repeated measures ANOVA, we will assess differences in white blood cell counts, absolute neutrophil counts, immune cells, and programmed cell death protein 1 (PD-1) expression levels between the 2 groups., Results: This study was approved by the research ethics committee of Hualien Tzu Chi Hospital (IRB 110-168-A). The enrollment process began in September 2021 and will stop in December 2024. A total of 140 patients will be recruited. Data cleaning and analysis are expected to finish in the middle of 2025., Conclusions: Traditional Chinese medicine is the most commonly used complementary medicine, and it has been reported to significantly alleviate chemotherapy-related side effects. This study's findings may contribute to developing effective interventions targeting chemotherapy-related neutropenia among patients with breast cancer in clinical practice., Trial Registration: International Traditional Medicine Clinical Trial Registry ITMCTR2023000054; https://tinyurl.com/yc353hes., International Registered Report Identifier (irrid): DERR1-10.2196/55662., (©Kai-Hung Wang, Hsuan-Shu Shen, Sung-Chao Chu, Tso-Fu Wang, Ching-Wei Lin, Wei-Han Huang, Yi-Feng Wu, Ching-Chun Ho, Cheng-Yoong Pang, Chi-Cheng Li. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.03.2024.)

Objectives: Music is helpful to young people in healthcare contexts, but less is known about the acceptability of music-based interventions for youth living at home with chronic pain who may be struggling to attend school and participate in social activities. The Songs of Love (SOL) foundation is a national nonprofit organization that creates free, personalized, original songs for youth facing health challenges. The aims of this study were (1) to assess acceptability of SOL from the perspective of youth with chronic pain receiving a song and singer-songwriters who created the songs, and (2) to explore the role of music more generally in the lives of young people living with pain., Methods: Twenty-three people participated. Fifteen youth (mean age 16.8) were interviewed and received a song, and six singer-songwriters were interviewed about creating the songs. (Two additional people participated in pilot interviews.) Acceptability was assessed by (1) proportion of youth who participated in a second interview about their song and (2) results of reflexive thematic analysis (RTA) to determine acceptability. Themes addressing the role of music in the lives of youth with pain were also explored using RTA., Results: The program was acceptable as 12 of 15 youth (80 %) participated in second interviews and themes met the definition of acceptability. Three themes addressing the role of music in the lives of youth living with pain were identified., Conclusions: This is the first report of the acceptability and experience of SOL and contributes to research on the benefits of music for pain management., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: The introduction of complementary food is the most important factor determining the nutritional status of the children in the first 2 years of life. This study aimed to find out the determinants and patterns of complementary feeding practices and their impact on the growth and development of children of 6-24 months of age group. Materials and Methods: A descriptive cross-sectional study was done on immunization out patient department (OPD) in the field practice area of the Department of Community Medicine. The sample size taken was 250 using a systematic random sampling method., Results: One hundred and seven (42.8%) were given the optimum amount of complementary food for their age. One hundred and three (41.2%) were fed with an adequate frequency for their age. One hundred and ninety-five (78.0%) were given food that was appropriate in consistency for their age. Among 183 (73.2%) children who were not fed appropriately during and after their illness episodes, 119 (65.0%) were malnourished. On using logistic regression it was seen that the variables which had statistically significant association with the complementary feeding patterns ( P <0.05) were maternal education, father's age, total members in the family, advice on complementary feeding from health care workers and use of bottle for feeding. Father's education, availability of ration card, antenatal counselling on childcare, birth order and history of repeated illness in the past did not show statistically significant association with complementary feeding practices ( P >0.05)., Conclusion: There was no statistically significant difference between the feeding patterns of normal and malnourished children. The association of complementary feeding practices and the anthropometric status of study children was not found statistically significant in the present study. Advice on complementary feeding from healthcare workers is seen to be having a positive impact on complementary feeding practices ( P < 0.01)., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background Breastfeeding and complementary feeding are essential for baby health and nutrition. Concerning these feeding habits, there is a dearth of information on mother awareness and behaviors in Saudi Arabia. This study intends to evaluate maternal knowledge of breastfeeding and complementary feeding in Al Baha City, Saudi Arabia. Methodology This cross-sectional prospective study was conducted among mothers in Al Baha City, Saudi Arabia. Data were collected using a structured electronic questionnaire and analyzed using descriptive statistics and a chi-square test. Results We received 524 responses. The majority of participants (358, 68.2%) were found to have sufficient understanding of breastfeeding and complementary feeding. Four hundred and forty participants (84%) were aware that breastfeeding should begin immediately after birth, but only 250 (47.7%) participants knew the proper time to start complementary feeding. Three hundred and ninety-six (75.6%) participants were aware of the proper duration of exclusive breastfeeding, whereas 128 (24.4%) of them did not know. The study showed that factors such as occupation, family economic status, and educational level influence maternal knowledge of complementary feeding.  Conclusions The study revealed that the majority of participants had good knowledge about breastfeeding and complementary feeding. The study highlights effective training and public awareness initiatives aimed at improving mothers' knowledge and practices regarding feeding. Additionally, it sheds light on the healthcare providers' exemplary knowledge and attitudes toward appropriate feeding practices among mothers in Al Baha City., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mohammed et al.)

Objective: Since placebo and nocebo-responses during acupuncture therapy are rarely studied in clinical contexts, the objective was to investigate placebo and nocebo-responses in a clinical context through comparing positive and negative side-effects between genuine and sham acupuncture, and to identify factors modifying placebo and nocebo-responses. Methods: Patients reported positive side-effects (non-intended positive effects) or negative side-effects (non-intended negative effects) of genuine (penetrating; n = 109) or sham (telescopic non-penetrating; n = 106) acupuncture during 5 weeks of chemoradiation for cancer. Results: The genuine and the sham acupuncture group reported rather similar frequencies of positive (P -values .223-.800) or negative ( P -values .072-1.0) side-effects: relaxation 59%/57% of the patients, improved mood 46%/38%, improved sleep 38%/38%, pain-reduction 36%/28%, tiredness 42%/42%, feeling cold 37%/31%, sweating 23%/21%, and dizziness 20%/12%. Positive side-effects occurred in 79% of patients who highly believed acupuncture to be effective, compared to in 0% of patients who did not believe. Other factors associated with placebo-response were female sex ( P  = .042), anxious mood ( P  = .007), depressed mood ( P  = .018), and blinding-success ( P  = .033). Factors associated with nocebo response were female sex ( P  = .049), younger age ( P  = .010), and needle-induced pain ( P  = .014). Sham-treated patients experiencing positive side-effects experienced better quality of life at the end of the treatment period (mean, m 64 on a scale 0-100 millimetres, Standard Deviation, SD, ±26.1 mm) than those who did not (m 48 ± 25.5 mm), P  = .048 (adjusted for other characteristics). Conclusions: Clinically significant levels of placebo and nocebo effects commonly occurred during acupuncture therapy in integrative cancer care and this paper identified factors modifying these responses. This implicates that acupuncture-delivering therapists striving to maximize placebo-responses and minimize nocebo-responses may considering strengthen the patient's treatment expectations, and offer a pleasant, pain-free, acupuncture treatment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Integrative medicine takes a holistic approach because it considers multiple aspects of the individual. This includes a person's physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions of wellbeing that contribute to the Whole Person Health. There is increasing interest and popularity of integrative approaches to treating cognitive decline and dementia because of the multifactorial nature of aging and the limited pharmacological interventions available in treating cognitive decline and dementia, particularly Alzheimer's disease, the most common type of dementia. This review summarizes the existing evidence using complementary and integrative medicine therapies in cognitive decline and Alzheimer's disease. This includes the use of mind-body therapies, lifestyle interventions (nutritional, physical exercise, stress reduction), and other integrative modalities. Unfortunately, there are still limited studies available to guide clinicians despite the increasing popularity of integrative treatments.

Women are living a significant portion of their adult lives in the post-reproductive phase, and many seek help for debilitating menopausal symptoms. Every individual's experience of menopausal transition is unique. Adopting a holistic approach to managing the menopause using a combination of lifestyle, hormonal, and non-hormonal interventions is key to maximise the quality of life of affected women. However, many opt to use non hormonal options or have contraindications to using hormonal therapy. Studies have shown that several pharmacological non-hormonal medications such as SSRIs, SSRI/SNRIs, Gabapentin, and Pregabalin are effective for managing vasomotor symptoms as well as other menopausal symptoms. Their main side effects are dry mouth, nausea, constipation, reduced libido, and loss of appetite. Clonidine is the only non-hormonal drug which is licenced for control of vasomotor symptoms in the UK, but has several side effects including dizziness and sleep disturbance. Cognitive Behavioural Therapy is recommended as a treatment for anxiety, sleep problems and vasomotor symptoms related to menopausal transition. Evidence for clinical efficacy and safety of herbal remedies and alternative therapies remains weak. Studies with neurokinin receptor 3 antagonists on women with hot flushes have shown improvement in vasomotor symptoms and results of large-scale studies are awaited., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Diabetic foot ulcer (DFU) is a prevalent complication of diabetes that can result in severe consequences. The cost of treating DFUs is high, and there is a lack of new therapies available in developing countries. This has created a demand for complementary and alternative treatments. The objective of this study was to assess the impact of aloe vera gel on the healing process of diabetic foot ulcers., Materials and Methods: The study was a double-blind, randomized, controlled clinical trial. The study samples were 66 patients with diabetic foot ulcers who were randomly assigned to two groups (intervention and control). All ulcers in both groups were washed with normal saline and dressed in sterile gauze. The ulcers in the intervention group were covered with a thin layer of Aloe Vera gel before the dressing. The Bates-Jensen Wound Assessment Tool (BWAT) was used on three occasions, including before the intervention period and at the end of each week. Data were analyzed using SPSS 16., Results: After three weeks, there was a notable contrast in the recovery pattern of the two groups. The patients who had aloe vera gel added to their dressing showed a more substantial decrease in the mean scores of their BWAT., Conclusion: These findings are promising and suggest that Aloe vera may be a safe and effective adjunctive treatment for diabetic foot ulcers. However, further research is needed to confirm these results and to investigate the underlying mechanisms of aloe vera's therapeutic effect on diabetic foot ulcers., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility., Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy., Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant's levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring., Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%., Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy., (©Donna Balsam, Dawn T Bounds, Amir M Rahmani, Adeline Nyamathi. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 25.12.2023.)

Recent multi-domain processing methods have demonstrated promising performance for monaural speech enhancement tasks. However, few of them explain why they behave better over single-domain approaches. As an attempt to fill this gap, this paper presents a complementary single-channel speech enhancement network (CompNet) that demonstrates promising denoising capabilities and provides a unique perspective to understand the improvements introduced by multi-domain processing. Specifically, the noisy speech is initially enhanced through a time-domain network. However, despite the waveform can be feasibly recovered, the distribution of the time-frequency bins may still be partly different from the target spectrum when we reconsider the problem in the frequency domain. To solve this problem, we design a dedicated dual-path network as a post-processing module to independently filter the magnitude and refine the phase. This further drives the estimated spectrum to closely approximate the target spectrum in the time-frequency domain. We conduct extensive experiments with the WSJ0-SI84 and VoiceBank + Demand datasets. Objective test results show that the performance of the proposed system is highly competitive with existing systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months., Methods: Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers., Results: Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues., Conclusions: All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

The global incidence of renal disorders is on the rise, demanding the implementation of novel and comprehensive strategies for patient care. The present study demonstrates the significance of renal health, offering a comprehensive comprehension of renal physiology and the escalating load of renal illnesses. The relevance of controlling renal illnesses is underscored by a thorough examination of conventional treatments, which encompass pharmaceutical interventions, dialysis, and transplantation. Subsequently, the story redirects its attention towards complementary therapies, classifying them into several categories, such as herbal medicine, acupuncture, dietary supplements, and mind-body activities, among various others. This paper presents a comprehensive examination of the available information, providing a critical study of the effectiveness and safety of alternative therapies in renal care. This study focuses on the central idea of integrative medicine, distinguished by its patient-centered and holistic approach and its seamless integration of conventional and complementary therapies. This study examines several integrative care models, using case studies to illustrate successful integrative approaches that have enhanced patient outcomes. The review thoroughly examines the current body of literature on integrative renal care, including meta-analyses, systematic reviews, and notable research discoveries. This study highlights the need for further research to address knowledge gaps and explore areas that require additional examination. These findings emphasize the importance of future research endeavors in this crucial sector. In addition, the paper thoroughly examines the safety issues and regulatory factors pertaining to complementary therapies, underscoring the importance of making educated decisions and maintaining diligent monitoring to safeguard patients' well-being. Integrating patient perspectives, experiences, and shared decision-making is essential to the integrated healthcare process, promoting a collaborative and patient-centered approach. The study culminates by providing a concise overview of the primary discoveries and delineating the ramifications of implementing therapeutic procedures. This statement underscores the considerable potential of integrative medicine in augmenting renal care, ultimately leading to enhanced patient outcomes and an improved overall quality of life for persons with renal diseases. Also, this literature review provides a thorough and knowledgeable examination of the incorporation of conventional and complementary therapies in the context of renal health. It gives valuable perspectives for healthcare practitioners, researchers, and policymakers interested in enhancing care strategies for individuals with renal conditions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kalariya et al.)

Background: The sharing of health-related information has become increasingly popular on social media. Unregulated information sharing has led to the spread of misinformation, especially regarding complementary, alternative, and integrative medicine (CAIM). This scoping review synthesized evidence surrounding the spread of CAIM-related misinformation on social media during the COVID-19 pandemic., Methods: This review was informed by a modified version of the Arksey and O'Malley scoping review framework. AMED, EMBASE, PsycINFO and MEDLINE databases were searched systematically from inception to January 2022. Eligible articles explored COVID-19 misinformation on social media and contained sufficient information on CAIM therapies. Common themes were identified using an inductive thematic analysis approach., Results: Twenty-eight articles were included. The following themes were synthesized: 1) misinformation prompts unsafe and harmful behaviours, 2) misinformation can be separated into different categories, 3) individuals are capable of identifying and refuting CAIM misinformation, and 4) studies argue governments and social media companies have a responsibility to resolve the spread of COVID-19 misinformation., Conclusions: Misinformation can spread more easily when shared on social media. Our review suggests that misinformation about COVID-19 related to CAIM that is disseminated online contributes to unsafe health behaviours, however, this may be remedied via public education initiatives and stricter media guidelines. The results of this scoping review are crucial to understanding the behavioural impacts of the spread of COVID-19 misinformation about CAIM therapies, and can inform the development of public health policies to mitigate these issues., (© 2023 Korea Institute of Oriental Medicine. Published by Elsevier B.V.)

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.

Objective: Fear of cancer recurrence among cancer survivors is a psychosocial concern that affects recovery and quality of life. They use complementary and alternative medicine to prevent the side effects of drugs and relieve anxiety and fear of cancer recurrence. This study aimed to examine the correlation between the use of complementary and alternative medicine and the fear of cancer recurrence in cancer survivors., Methods: This cross-sectional descriptive correlational study enrolled 280 cancer survivors referred to oncology centers and medical offices in Kerman using convenience sampling. The research tools included complementary and alternative medicine questionnaire and the fear of cancer recurrence inventory. IBM SPSS Statistics version 25 was used to analyze the data., Results: The study findings revealed that 78.2% of the participants used at least one type of complementary and alternative medicine in the last year; 71.8% used medicinal herbs, 19.6% used nutritional supplements, 7.5% used relaxation and meditation, 7.1% used dry cupping, and 5.7% used wet cupping. The mean score of fear of cancer recurrence was 80.72 ​± ​18.46, which was almost near the midpoint of the inventory score (84). The fear of cancer recurrence and its dimensions did not differ between users and nonusers of complementary and alternative medicine., Conclusions: Our results suggested that most of the survivors used at least one type of complementary and alternative medicine in the past year, and medicinal herbs and nutritional supplements were the most used types. Patients with cancer must be aware of the effects of different kinds of complementary and alternative medicine. A moderate level in the mean score of fear of cancer recurrence was found, and no difference was noted between users and nonusers of complementary and alternative medicine. Health managers and planners should conduct effective psychological interventions and strategies to minimize the fear of cancer recurrence among cancer survivors., (© 2023 The Author(s).)

Background: Patients with cancer are increasingly using forums and social media platforms to access health information and share their experiences, particularly in the use of traditional, complementary, and integrative medicine (TCIM). Despite the popularity of TCIM among patients with cancer, few related studies have used data from these web-based sources to explore the use of TCIM among patients with cancer., Objective: This study leveraged multiple forums and social media platforms to explore patients' use, interest, and perception of TCIM for cancer care., Methods: Posts (in English) related to TCIM were collected from Facebook, Twitter, Reddit, and 16 health forums from inception until February 2022. Both manual assessments and natural language processing were performed. Descriptive analyses were performed to explore the most commonly discussed TCIM modalities for each symptom and cancer type. Sentiment analyses were performed to measure the polarity of each post or comment, and themes were identified from posts with positive and negative sentiments. TCIM modalities that are emerging or recommended in the guidelines were identified a priori. Exploratory topic-modeling analyses with latent Dirichlet allocation were conducted to investigate the patients' perceptions of these modalities., Results: Among the 1,620,755 posts available, cancer-related symptoms, such as pain (10/10, 100% cancer types), anxiety and depression (9/10, 90%), and poor sleep (9/10, 90%), were commonly discussed. Cannabis was among the most frequently discussed TCIM modalities for pain in 7 (70%) out of 10 cancer types, as well as nausea and vomiting, loss of appetite, anxiety and depression, and poor sleep. A total of 7 positive and 7 negative themes were also identified. The positive themes included TCIM, making symptoms manageable, and reducing the need for medication and their side effects. The belief that TCIM and conventional treatments were not mutually exclusive and intolerance to conventional treatment may facilitate TCIM use. Conversely, TCIM was viewed as leading to patients' refusal of conventional treatment or delays in diagnosis and treatment. Doctors' ignorance regarding TCIM and the lack of information provided about TCIM may be barriers to its use. Exploratory analyses showed that TCIM recommendations were well discussed among patients; however, these modalities were also used for many other indications. Other notable topics included concerns about the legalization of cannabis, acupressure techniques, and positive experiences of meditation., Conclusions: Using machine learning techniques, social media and health forums provide a valuable resource for patient-generated data regarding the pattern of use and patients' perceptions of TCIM. Such information will help clarify patients' needs and concerns and provide directions for research on integrating TCIM into cancer care. Our results also suggest that effective communication about TCIM should be achieved and that doctors should be more open-minded to actively discuss TCIM use with their patients., (©Chun Sing Lam, Keary Zhou, Herbert Ho-Fung Loong, Vincent Chi-Ho Chung, Chun-Kit Ngan, Yin Ting Cheung. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.04.2023.)

Multiblock data sets and modeling techniques are widely encountered in the chemometric community. Although the currently available techniques, such as sequential orthogonalized partial least squares (SO-PLS) regression are mainly focused on the prediction of a single response and deal with the multiple response(s) case using PLS2 type approach. Recently, a new approach called canonical PLS (CPLS) was proposed for extracting the subspaces efficiently for multiple response(s) cases, supporting both regression and classification. 'Efficiently' here means more information in fewer latent variables. This work suggests a combination of SO-PLS and CPLS, sequential orthogonalized canonical partial least squares (SO-CPLS), to model multiple response(s) for multiblock data sets. The cases of SO-CPLS for modeling multiple response(s) regression and classification were demonstrated on several data sets. Also, the capability of SO-CPLS to incorporate meta-information related to samples for efficient subspace extraction is demonstrated. Furthermore, a comparison with the commonly used sequential modeling technique, called sequential orthogonalized partial least squares (SO-PLS), is also presented. The SO-CPLS approach can benefit both the multiple response(s) regression and classification modeling and can be of high importance when meta-information such as experimental design or sample classes is available., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author. Published by Elsevier B.V. All rights reserved.)

First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: This article provides a comprehensive systematic review and qualitative analysis of the current research investigating Ayurveda chronic rhinosinusitis (CRS) treatment., Content: PRISMA guidelines for systematic reviews was followed and our search utilized MEDLINE, Embase, Ayush Portal, and Cochrane Library databases. Articles published prior to March 2022, 10 or more patients that investigated Ayurveda as a treatment for CRS in humans were included. This resulted in thirteen articles meeting inclusion criteria. Ayurvedic treatments included herbal medications for oral consumption, nasal instillation, and steam inhalation used alone or in combination. All studies concluded that Ayurvedic therapy led to improvements in subjective CRS symptoms and objective radiographic and hematologic criteria. However, all 13 studies had a significant risk of bias due to study design and statistical methods utilized., Summary: Ayurvedic therapy may be a useful CRS treatment for some patients and overall appears to be well tolerated. However, definitive recommendation for when Ayurvedic treatments would be beneficial in the treatment of CRS remains not possible., Outlook: Given the overall positive effects shown in the current published evidence and growing interest in complementary and integrative therapies, Ayurvedic treatments for CRS deserve further investigation in the form of well-designed controlled trials., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Many of the 700,000 American military personnel deployed to the Persian Gulf region in 1990 and 1991 have since reported health symptoms of unknown etiology. This cluster of symptoms has been labeled Gulf War Illness and include chronic musculoskeletal pain, fatigue, headaches, memory and attention difficulties, gastrointestinal complaints, skin abnormalities, breathing problems, and mood and sleep problems [1,2]. There have been few high-quality intervention trials and no strong evidence to support available treatments [3]. Tai Chi is an ancient Chinese martial art with benefits that include enhancing physical and mental health and improving quality of life for those with chronic conditions., Proposed Methods: In this randomized controlled trial, GW Veterans are randomly assigned to either Tai Chi or a Wellness control condition, with both remotely delivered intervention groups meeting twice a week for 12 weeks. The primary aim is to examine if Tai Chi is associated with greater improvements in GWI symptoms in Veterans with GWI compared to a Wellness intervention. Participants will receive assessments at baseline, 12 weeks (post-intervention), and follow-up assessments 3- and 9-months post-intervention. The primary outcome measure is the Brief Pain Inventory that examines pain intensity and pain interference., Conclusion: This trial will produce valuable results that can have a meaningful impact on healthcare practices for GWI. If proven as a helpful treatment for individuals with GWI, it would support the implementation of remotely delivered Tai Chi classes that Veterans can access from their own homes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Background: Despite high use of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear., Objective: To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychologic well-being., Methods: PubMed and Embase were searched to identify English articles containing original data investigating CAM in individuals with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria., Results: Of 1015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective noncontrolled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low-quality evidence for improvement of psychologic and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated., Limitations: Inconsistent or poorly reported study methodology and nonstandardized outcomes limit the conclusions that can be made from these studies., Conclusions: This work serves to inform physician treatment of patients with AA seeking CAM while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Atopic dermatitis (AD) is the most common inflammatory skin disease seen in children. It is a heterogeneous disorder, with a variety of associated manifestations and symptoms. Cases may range from mild to severe. As a result, a spectrum of prescription and nonprescription therapies may be utilized when managing this condition. This article provides an extensive overview of these therapies, with equal consideration provided to current, emerging, and alternative options used in the pediatric population., (© 2022. The Author(s).)

Accurate segmentation of lung nodules from pulmonary computed tomography (CT) slices plays a vital role in the analysis and diagnosis of lung cancer. Convolutional Neural Networks (CNNs) have achieved state-of-the-art performance in the automatic segmentation of lung nodules. However, they are still challenged by the large diversity of segmentation targets, and the small inter-class variances between the nodule and its surrounding tissues. To tackle this issue, we propose a features complementary network according to the process of clinical diagnosis, which made full use of the complementarity and facilitation among lung nodule location information, global coarse area, and edge information. Specifically, we first consider the importance of global features of nodules in segmentation and propose a cross-scale weighted high-level feature decoder module. Then, we develop a low-level feature decoder module for edge feature refinement. Finally, we construct a complementary module to make information complement and promote each other. Furthermore, we weight pixels located at the nodule edge on the loss function and add an edge supervision to the deep supervision, both of which emphasize the importance of edges in segmentation. The experimental results demonstrate that our model achieves robust pulmonary nodule segmentation and more accurate edge segmentation.

Introduction: Atopic dermatitis (AD) is a chronic, recurrent, and inflammatory skin disease experienced mostly in childhood. Chronicity of the disease, relapses, constant need of regular skin care causes seeking for alternative treatments., Aim: The aim of this study is to evaluate the complementary and alternative treatments (CAT) used by parents' caregivers in pediatric patients diagnosed with AD, and the association between CAT use and patient characteristics., Materials and Methods: A questionnaire questioning the sociocultural and demographic characteristics of the family, the clinical findings of the patients, their treatments and CAT applications was recorded., Results: Eighty-three patients were included in the study. 68.7% of the patients used at least one type of CAT. Vitamins and oils were the most commonly used CAT (48.8% and 47%, respectively) and 73.3% of the patients using CAT continued normal AD treatment while using CAT. The biggest factor affecting CAT choice was the advice of the immediate circle (75%), and 40.6% of the patients stated that they benefited from the complementary therapy., Conclusions: CAT are widely used in AD. Physicians should know the socio-cultural structure of the region they are in, the CAT used and their side effects, and inform the families.

CAM is used by about 40% of cancer patients in Western Countries, with peaks of 80% for breast cancer patients. Cancer patients use CAM to boost immune function, to control cancer symptoms and treatment-related side effects, and to improve health-related quality of life (HR-QoL) and survival. Unfortunately, self-prescription of natural remedies in cancer patients can lead to unexpected toxicities and can reduce the effectiveness of cancer therapy. Although CAM usually refers to all the "natural or organic" products/methods that are generally considered less toxic, there are concerns about drug interactions, especially in patients participating in clinical trials with experimental agents. Despite the claims of the promising and potential benefits made by prescribers, many CAMs lack clear scientific evidence of their safety and efficacy. Given the widespread use of CAM-both clearly declared and overt-in this review, we focused on the most important known data on the risk of interactions between biologics and oncology drugs with the goal of opening up CAM in accordance with the meaning of integrative medicine., Competing Interests: The Authors declare no conflict of interest.

Complementary/integrative medicine (CIM) is an evolving area of collaboration between oncology, patient and their beliefs, and practitioners of complementary medicine. Evidence-informed decision-making is necessary to advise patients on which treatments may be incorporated into standard of care treatments for cancer. Patients use CIM for a variety of reasons and often have unrealistic expectations of cure or disease modifications; on the other hand, there is increasing evidence that symptoms, side effects, and dysfunction related to cancer and its treatment can be ameliorated by CIM approaches to improve patient satisfaction and quality of life. Open communication between patients and providers is paramount., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Complementary and alternative medicine (CAM) encompasses a wide range of medication, herbal, dietary and physical therapies that are not usually considered within the realm of conventional therapeutics. Approximately two thirds of the Australian population use CAMs and only around half of this number will discuss their use of these products with their doctor. Clinical use is commonly seen in patients with life-limiting illness, often because they experience a high burden of symptoms. However, it is also the case that many of these therapies do not have demonstrated efficacy, particularly for the often broad list of conditions and symptoms for which they are chosen to be used. Further, depending on whether they are sold as medications, sold as food supplements or imported illegally and distributed via nonstandard therapeutic channels, several products have had reports of toxicity, severe adverse effects, batch irregularities and drug interactions with other therapies. This awareness, together with lack of standardisation of products and lack of interchangeability between brands has made prescribers unwilling to put patients at risk of harm by supporting their use. In this article, we cover general pharmacological principles around use of a small selection of chemicals used in a medical setting to enable some guidance for use., (© 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Pharmacological interventions still form the mainstay of the management of pain, anxiety, sleep problems and discomfort. In Europe, an estimated 100 million people use complementary non-pharmacological interventions (NPIs) for these conditions. In their pre-registration education, nurses do not generally learn about the various types of NPIs and how patients and health care professionals can include NPIs complementary to their standard care. Some nursing schools in Europe offer elective courses on NPIs, often relying on individual initiatives. Little is publicly available about the content of these programmes and how they relate to the current nursing curriculum for EU countries., Objectives: This pilot study aims to explore and map the field of nursing education with regard to complementary NPIs for nurses in Europe., Design: A web-based open-access questionnaire administered through the online survey tool LimeSurvey® was designed by the authors., Participants: The questionnaire was sent to a purposive sample of 49 experts on nurse education and complementary NPIs from 16 European countries. All levels of education were eligible for inclusion., Methods: The questionnaire consisted of 35 items regarding course content, teaching material, teaching methods and methods of assessment. In addition, respondents were invited to perform a strengths, weaknesses, opportunities and threats (SWOT) analysis in relation to their education programme. Qualitative data was analyzed using a directive content analysis approach., Results: Between January and May 2020, thirty-one completed questionnaires from ten different countries were returned (response rate 63.3%). Massage, meditation, mindfulness and relaxation are the most taught interventions. Anxiety, stress, chronic pain, depression and sleep problems are the most common symptoms addressed., Conclusions: Currently, a consistent and European approach to education for nurses on complementary NPIs and integrative nursing is lacking. Although taught at regular nursing educational institutes, the courses discussed here are not yet embedded in mainstream education for nurses., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Conventional and complementary treatments are often used in rehabilitation for persons with stroke. The conventional treatment makes use of medications, physiotherapy, occupational, speech, and diet therapies, while the complementary treatment makes use of homeopathy, naturopathy, massage, and acupuncture. The structure, process, and outcomes of stroke rehabilitation using conventional or complementary treatments have not been empirically investigated in Ghana., Aims: This study aims to investigate the structure, process, and outcomes of stroke rehabilitation at the Korle Bu Teaching Hospital (KBTH) in Accra and Kwayisi Christian Herbal Clinic (KCHC) in Nankese-Ayisaa, Ghana, and to explore the experiences of persons with stroke., Methods: This study involves a mixed methods approach. This study will utilize three study designs, namely, cross-sectional, hospital-based cohort, and qualitative exploratory study designs. The objectives of the study will be achieved using three phases, namely, phase one will recruit health professionals and gather information on the structure and process of stroke rehabilitation at a conventional and complementary hospital using adapted questionnaires; phase two will determine the outcomes of stroke patients attending a conventional and complementary hospital facility at baseline, 2-, 3-, and 6-month follow-up using outcome measures based on the International Classification of Functioning, Disability and Health (ICF) model; and phase three will explore the experiences of stroke patients who use complementary or conventional treatment using an interview guide., Data Analysis: IBM SPSS Statistics Version 27 will be used to analyze the data using descriptive and inferential statistics. Repeated measures of ANOVA will be used to determine the differences between variables at baseline, 2-, 3-, and 6-month post-stroke. The qualitative data will be transcribed and entered into Atlas Ti version 9.0. The data will be coded and analyzed using thematic areas that will be generated from the codes., Conclusion: The study protocol will provide a comprehensive overview of the structure, process, and outcomes of stroke rehabilitation in Ghana, incorporating both conventional and complementary treatment and rehabilitation into the stroke recovery journey. It will also inform clinical practice, with new insights on the experiences of stroke patients based on their choice of rehabilitation pathway., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yarfi, Nyante and Rhoda.)

Capparis ovata is a natural plant that grows widely in Turkey and its flowering buds and berry pickle are used in traditional medicine. Thus, the current study was expanded to evaluate the biochemical, pharmacological, and toxicological aspects of the Capparis ovata water extract (COWE). To determine the biochemical properties of COWE, mineral and fatty acid content, elemental analysis, flavonoid/phenolic content, radical-scavenging capacity, and pesticide analysis were performed. Furthermore, to find out whether it had anti-inflammatory properties, reverse transcription-polymerase chain reaction (RT-PCR) and nuclear factor kappa B (NF-κB) luciferase activity tests were conducted. Whole-genome transcriptomic profiling was carried out at a dose level of 500 mg/kg COWE to understand its pharmacological effect. Transaminases in serum were tested, and quantitative polymerase chain reaction (qPCR) was done using a custom design array that included the stress and molecular toxicology pathway to establish its toxicological qualities. As a result of the evaluations, it was observed that COWE has a high mineral and unsaturated fatty acid content, flavonoid/phenolic content, and radical-scavenging ability. It significantly inhibited NF-κB transcriptional activity as well as inflammatory cytokine expression in T-lymphoblast cells. Whole-genome transcriptomic profiling depicted that COWE modulates immune responses by upregulating natural killer cell activation, cellular response to type I interferon, B-cell proliferation and differentiation, and Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathways. Molecular Toxicology Pathfinder RT 2 Profiler PCR array analysis revealed that COWE at or lower dose of 500 mg/kg/day did not cause a comparatively adverse effect. According to the findings, COWE is a rich source of nutrients and can be used as an adjunct therapy for various inflammatory diseases., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article., (© 2022 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Synbiotics, mixtures of live microbes and substrates selectively utilized by host organisms, are of considerable interest due to their ability to improve gastrointestinal health. However, formulating synbiotics remains challenging, due in part, to the absence of rational strategies to assess these products for synbiotic activities prior to clinical trials. Currently, synbiotics are formulated as either complementary or synergistic. Complementary synbiotics are made by combining probiotics and prebiotics, with each component acting independently and with the combination shown to provide a clinical health benefit. Most commercial synbiotics as well as those used in clinical trials have been of the complementary type. In contrast, synergistic synbiotics require that the added microbe is specifically stimulated or it's persistence or activity are enhanced by the cognate substrate. Although several innovative examples have been described in the past few years based on this principle, in practice, relatively few synbiotic studies have tested for synergism. In this review, selected recent examples of complementary and synergistic synbiotics and the rationale for their formulation will be described. In addition, pre-clinical experimental approaches for identifying combinations that provide a basis for satisfying the requirements for synergism will be discussed., Competing Interests: RH served on the Board of Directors for the International Scientific Association for Probiotics and Prebiotics and was a co-founder of Synbiotic Health, a manufacturer of probiotic microbes. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gomez Quintero, Kok and Hutkins.)

Introduction: It is important that the healthcare professionals who are with the mother at the moment of birth and afterwards, know and apply effective complementary treatment and supportive care methods, and also know their effects and limitations. The aim of this study is to determine the knowledge levels and attitudes of health personnel about complementary therapy and supportive care methods to be used in the management of labor pain and postpartum period., Methods: A cross-sectional study included 142 midwives/nurses and physicians working in the delivery room and maternity services of mother-friendly hospitals in Manisa, Turkey, between August 2018 and April 2019. The questionnaire consisting of 25 questions evaluated the knowledge and attitudes of the participants about complementary therapy and supportive care methods., Results: It was found that 30.6% of the healthcare professionals participating in the study used complementary treatment and supportive care methods in their patients. The least heard method was chiropractic (6.6%), the best-known method was hydrotherapy (water birth) (5.8%) and the most used method was massage (14.0%). It was determined that the mean total attitude score of the healthcare workers on complementary treatment and supportive care methods was 18.57 ± 5.12 (range: 8-40). It was found that the education levels of healthcare professionals (z= -2.144, p<0.05) and the institutions affect (χ 2 =23.417; p<0.05) the attitude scores., Conclusions: One out of every two healthcare professionals did not have information about complementary treatment and supportive care methods. Healthcare professionals mostly have positive opinions about these methods., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2022 Bolsoy N. et al.)

Context: Given the high prevalence of burdensome symptoms in palliative care (PC) and increasing use of complementary and integrative medicine (CIM) therapies, research is needed to determine how often and what types of CIM therapies providers recommend to manage symptoms in PC., Objectives: To document recommendation rates of CIM for target symptoms and assess if, CIM use varies by provider characteristics., Methods: Nationwide survey's of physicians (MD and DO), physician assistants, and nurse practitioners in PC., Results: Participants (N = 404) were mostly female (71.3%), physicians (74.9%), and cared for adults (90.4%). Providers recommended CIM an average of 6.82 times per-month (95% CI: 6.04-7.60) and used an average of 5.13 (95% CI: 4.90-5.36) out of 10 CIM modalities. Respondents recommended mind-body medicines (e.g., meditation, biofeedback) most, followed by massage, and acupuncture and/or acupressure. The most targeted symptoms included pain; followed by anxiety, mood disturbance, and distress. Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g., aromatherapy for constipation) to occasional use (e.g., mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care., Conclusion: To the best of our knowledge, this is the first national survey to characterize PC providers' CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of CIM but do so less frequently than patients report using CIM. These findings should be of interest to any provider caring for patients with serious illness., (Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care., (© 2021 The Authors. CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: The use of complementary and integrative medicine (CIM) continues to grow in palliative care. While research supports the use of many CIM therapies for symptom relief, the scope of provider-focused research on CIM remains poorly characterized., Objectives: We conducted a scoping review to characterize provider-focused research on CIM in palliative care in order to map existing evidence and identify knowledge gaps., Methods: We developed a protocol outlining the study population, concept, and context; then used a validated approach per the JBI manual and searched MEDLINE, EMBASE, CINAHL, and AMED., Results: We identified 34 studies that were conducted primarily in the US (n = 9) and UK (n = 6), focused mostly on nurse (n = 29) and physician (n = 22) providers, and employed questionnaires (n = 16) or qualitative (n = 15) methods. Studies investigated 58 CIM modalities, including massage (n = 13), music therapy (n = 12), and aromatherapy (n = 10), to address common symptoms including pain (n = 17), fatigue (n = 6), and nausea/vomiting (n = 6). Study outcomes included perceived benefits of CIM (n = 17) and types of CIM modalities that providers offer (n = 15). Uncommonly studied phenomena included referral patterns (n = 4), facilitators of provider recommendation of CIM (n = 3), and rates of CIM use (n = 3)., Conclusion: Provider-focused research on CIM in palliative care can expand its scope by addressing perspectives of interdisciplinary providers, examining CIM modalities that patients report using, addressing symptoms commonly encountered in palliative care, and researching provider-use-focused outcomes. We identify these possibilities for future studies in addition to opportunities for systematic investigations to enhance the safe and efficacious delivery of CIM in the palliative care setting.