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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2007.01.011 Byline: Claudia M. Witt (a), Michael Bluth (b), Henning Albrecht (c), Thorolf E.R. WeiAhuhn (a), Stephan Baumgartner (d), Stefan N. Willich (a) Keywords: Homeopathy; Potency; Dynamization; Basic research; Quality assessment; Quality score; Modified SAPEH; BEPEV; Cell-free systems; Non-cellular; Cultured cells; Basophiles; Neutrophiles; Lymphocytes; In vitro Abstract: Systematic assessment of the in vitro research on high potency effects. Author Affiliation: (a) Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Center, D-10098 Berlin, Germany (b) Klinik fur Tumorbiologie, D-Freiburg/Br, Germany (c) Karl and Veronica Carstens-Foundation, D-Essen, Germany (d) Institute for Complementary Medicine (KIKOM), University of Bern, CH-Bern, Germany

Abstract Introduction Extraction of a third molar is painful for patients, and this clinical condition can be used to evaluate the analgesic effects of pain treatments. For reduction of pain during third molar extraction, hypnosis can be beneficial. Under hypnosis and during follow up, patients receiving hypnosis showed less pain than patients not receiving hypnosis, and postoperative analgesic use was lower in patients with additional hypnosis during third molar extraction. The aim of this monocentric randomized controlled study is to test the effectiveness of hypnosis in patients with third molar extraction, taking into account patients' expectations, treatment preferences and hypnotic depth. Methods A total of 33 patients with molar extractions on both sides will receive two types of pain-reducing interventions (randomized crossover trial) in order to investigate the effects of hypnosis. During one extraction, the patient will first receive hypnosis as an add-on intervention (the Dave Elman technique) and reduced medication during the third molar extraction. In the other molar extractions, patients will receive regular medication without hypnosis. The order of interventions and side of the third molar will be randomized. The primary outcome of the intervention is the area under the curve of pain intensity after the extraction (measured after extraction, 3 h after extraction, in the evening, and at the first and second day after extraction). Secondary outcomes are pain medication and the preferred treatment after two appointments. Discussion We expect that the results of this study will improve knowledge about the effectiveness of hypnosis in a dental setting with a sound methodology. We can also explore working mechanisms such as treatment expectations and preferences about treatment outcomes. [ABSTRACT FROM AUTHOR]

Introduction Fatigue plays an important role in the daily activity of patients with multiple sclerosis (MS) and strongly influences their quality of life. Numerous clinical trials evaluating various interventions for fatigue in MS have shown only minor benefits. The main aim of the present trial is to evaluate whether 1) acupuncture or 2) mindfulness-based stress reduction (MBSR) in addition to usual care are effective in reducing fatigue in MS patients compared to usual care alone. Methods Within a randomized, three-arm, controlled trial we aim to include 141 MS patients aged 18–65 years with fatigue for at least 3 months and an average score of ≥4 on the Fatigue Severity Scale (FSS). Patients will be randomized into three groups: an acupuncture group receiving 12 weeks of acupuncture in addition to usual care, a MBSR group receiving 12 weeks of MBSR in addition to usual care, and a usual care group continuing their previous treatment. Primary outcome is the Fatigue Severity Scale (FSS) after 12 weeks. To assess the trial’s characteristics regarding efficacy and effectiveness we used the pragmatic explanatory continuum summary (PRECIS-2). Discussion This trial addresses new therapeutic approaches for fatigue in MS. The resulting design is a compromise between scientific rigor and pragmatism. Due to difficulties with recruitment we had to scale down our trial to the groups of usual care and acupuncture. The trial's results will give first evidence whether acupuncture is effective in patients with MS associated fatigue. Trial registration ClinicalTrials.gov identifier NCT01864707, registered on 2 April 2013. [ABSTRACT FROM AUTHOR]

Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for 4 chronic pain conditions. We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm. We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. Although factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain after acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominantly by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.Perspective: Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of this study was to assess the effectiveness of the reduction of chronic lower back pain in older adults using either yoga classes or qigong classes compared with no intervention. Older adults (65 years of age and older) with chronic low back pain were enrolled in and randomly allocated to: 1) yoga (24 classes, 45 minutes each, during 3 months), 2) qigong (12 classes, 90 minutes each, during 3 months), or 3) a control group who received no additional intervention. The pain intensity item of the Functional Rating Index after 3 months was used as primary outcome parameter. A total of 176 patients were randomized (n = 61 yoga, n = 58 qigong, n = 57 control; mean age 73 ± 5.6 years, 89% female). The mean adjusted pain intensity after 3 months was 1.71 for the yoga group (95% confidence interval [CI], 1.54-1.89), 1.67 for the qigong group (95% CI, 1.45-1.89), and 1.89 for no intervention (95% CI, 1.67-2.11). No statistically significant group differences were observed. Possible explanations for this lack of pain relief might include the ineffectiveness of interventions, inappropriate outcomes, or differences in pain perception and processing in older adults.Perspective: The aim of this study was to assess the effectiveness of the reduction of chronic lower back pain in older adults using either yoga classes or qigong classes compared with no intervention. This 3-armed randomized trial with 176 older adults showed that yoga and qigong were not superior to no treatment in reducing pain and increasing quality of life. [ABSTRACT FROM AUTHOR]

Unlabelled: Our study aimed to identify patient-provider clusters with different patterns of expectations for treatment outcomes. All patients (n = 885) received acupuncture treatment from physicians for their migraine, headache, osteoarthritis, or chronic low back pain. We identified 6 robust patient-provider expectation clusters (PPECs; interclassification reliability >.89) showing differences between patients and providers in their expected treatment responses (eg, unrealistic optimists, optimistic doubters). For example, the optimistic doubters had high expectations for their treatment outcomes but were skeptical of the benefits of acupuncture in general. The providers expected good improvements for these patients. These 6 PPECs differed in their clinical characteristics and in the associated treatment responses. For example, unrealistic optimists showed the weakest treatment benefits after 6 months; other PPECs and clinical patterns are also presented in the report. Our study suggests that comparing the expectations of patients and providers is a valuable approach to identify groups of patients with greater responsiveness and those with limited treatment benefits.Perspective: Patients and providers of acupuncture might vary in their expectation of the treatment effect and in clinical practice the overlap of expectations of patients and providers should be considered as important in initial consultations. [ABSTRACT FROM AUTHOR]

Background: The aim of this project was to identify strategies for increasing learner engagement and knowledge retention in clinical research training of complementary and integrative medicine (CIM) practitioners, and to offer a conceptual framework to address clinical research training for CIM practitioners. Methods: In a featured large-group discussion (15min presentation and 30min discussion), two questions (strategies that are recommended to overcome these barriers; relevant aspects for a framework for building sustainable knowledge) were put to the audience. The sample consisted of 43 participants at the International Congress of Educators in Complementary and Alternative Medicine, in Washington, DC, in October 2012. The featured discussion was moderated and detailed notes were taken. Notes were synthesized and discussed by both authors until consensus was reached. Based on the results from the featured discussion session and a focused literature search, a framework for building sustainable knowledge and skills in clinical research for CIM practitioners was developed. Results: Participants' responses to the questions of engagement and sustainability included curricular structures, pedagogical strategies for instruction, the use of digital tools to extend the learning experience, the necessity to ground instruction firmly in the medical literature of the field, and the relevance of mentoring. Key considerations for building sustainable knowledge in clinical research for CIM practitioners are as follows: (1) prioritizing clinical research training, (2) issues of curriculum and pedagogy, (3) technology/digital tools, (4) administrative challenges, (5) supporting the formation of communities of practice, and (6) cultural perspectives of CIM practitioners. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: In the traditional context, herbs are often used as herbal whole system therapies, however, most clinical trials included highly selected patients and applied standardized treatment protocols with the aim to exclude as much bias as possible. These studies have contributed important information on the efficacy of herbal medicine extracts; however, their results are only marginally helpful to understand the value of herbal medicine and food items in a more traditional usual care context. Methods: The new development of comparative effectiveness research (CER) will be introduced and synergies with ethnopharmacology will be outlined. Results: CER provides great opportunities for guiding researchers and clinicians in improving management of disease. CER compares two or more health interventions in order to determine which of these options works best for which types of patients in settings that are similar to those in which the intervention will be used in practice. CER uses a broad spectrum of methodologies including randomized pragmatic trials that can also be applied to herbal whole system therapies. Ethnopharmacological research can provide highly relevant information for CER including data on characteristics of typical patients as well as traditional usage including methods of collection, extraction, and preparation. Recommendations for future research on traditional herbal medicine and food items are (1) a systematic cooperation between ethnopharmacology and clinical researchers and (2) a call for more CER on traditional herbal medicines and food items. Conclusion: Multiple stakeholders, including ethnopharmacologists, should cooperate to identify relevant study questions as well share their knowledge to determine the optimal placement of a clinical trial in the efficacy–effectiveness–continuum. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this paper was to quantify the influence of the physician''s training and experience in the field of acupuncture on the outcome in patients with chronic pain. Patients visiting their physician because of chronic low back pain, headache, pain due to osteoarthritis of the knee or hip, or neck pain, were included in 4 multicenter, randomized, controlled studies. All patients received routine care; patients in the acupuncture groups received additional acupuncture treatment (on average 10 sessions). The data was pooled, and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined. A total of 9,990 patients (mean age 49.6 ± 13.6 years, 68% female) treated by 2,781 physicians (mean age 46.3 ± 7 years, 37% female) were analyzed. The physicians had 7.3 ± 5.2 (mean ± sd) years of experience in acupuncture and their mean duration of formal acupuncture training had been 287 ± 321 hours. The outcome was markedly improved in the acupuncture group. We identified only 1 physician characteristic with a significant influence on the outcome: Internists performed better (odds ratio OR = 1.49, confidence interval CI: 1.01;2.18; P = .043); orthopedists worse (OR = .79, CI: .62;1; P = .043) than the average physician. Neither the duration of training nor the duration of experience had any impact on the extent of the acupuncture effect. Perspective: In this analysis, physician characteristics such as training did not influence patients'' outcome after acupuncture, suggesting that formal training parameters have only a limited influence on treatment effect. Other skills such as the therapeutic relationship, which are difficult to measure, may probably play a more important role and should be taken into consideration. [Copyright &y& Elsevier]

Abstract: In July 2009, the first Sino-German symposium on acupuncture and moxibustion took place in Chengdu. With the title “future of acupuncture clinical research and integration of acupuncture treatment into health care” the symposium aimed to stimulate the dialogue between East and West. The following article will provide some insights into the topics of the symposium. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate the effectiveness of qigong compared with exercise therapy and no treatment. Elderly patients with chronic neck pain (>6 months) were randomly assigned to qigong or exercise therapy (each 24 sessions over a period of 3 months) or to a waiting list control. Patients completed standardized questionnaires at baseline and after 3 and 6 months. The main outcome measure was average neck pain on the visual analogue scale after 3 months. Secondary outcomes were neck pain and disability (NPAD) and quality of life (SF-36). One hundred seventeen patients (age, 76 ± 8 years, 95% women) were included in the intention-to-treat analysis. The average duration of neck pain was 19.0 ± 14.9 years. After 3 months, no significant differences were observed between the qigong group and the waiting list control group (visual analogue scale mean difference, −11 mm [CI, −24.0; 2.1], P = .099) or between the qigong group and the exercise therapy group (−2.5 mm [ − 15.4; 10.3], P = .699). Results for the NPAD were similar (qigong vs waiting list −6.7 (−15.4; 2.1), P = .135; qigong vs exercise therapy 2.3 (−6.2; 10.8); P = .600). We found no significant effect after 3 months of qigong or exercise therapy compared with no treatment. Further studies should include outcomes more suitable to elderly patients, longer treatment, and patients with less chronic pain. Perspective: In a randomized controlled study, we evaluated whether a treatment of 24 qigong sessions over a period of 3 months is (1) superior to no treatment and (2) superior to the same amount of exercise therapy in elderly patients (age, 76 ± 8 years, 95% women) with long-term chronic neck pain (19.0 ± 14.9 years). After 3 and 6 months, we found no significant differences for pain, neck pain, disability, and quality of life among the 3 groups. [Copyright &y& Elsevier]

Background: Anthroposophic art therapy (painting, clay modeling, music, and speech exercises) is used in 28 countries but has not yet been studied in primary care. Objective: To study clinical outcomes in patients treated with anthroposophic art therapy for chronic diseases. Design: Prospective cohort study. Setting: Fifty-four medical practices in Germany. Participants and Interventions: One hundred sixty-one consecutive outpatients (primary care: n = 150), aged 5-71 years, were treated by 52 different art therapists. Main outcome measures: Disease and symptom scores (physician and patient assessment, respectively, 0-10) and quality of life (adults: SF-36 Health Survey, children: KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents). Outcomes were measured after 3, 6, 12, 18, and 24 months; SF-36 and symptom scores were also measured after 48 months. Results: Most common indications were mental disorders (60.9% of patients, primarily depression, fatigue, and anxiety) and neurological diseases (6.8%). The median number of therapy sessions was 15; median therapy duration was 161 days. All outcomes except KINDL improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: disease score from (mean ± standard deviation) 6.69 ± 1.72 to 2.46 ± 1.90 (P < .001), symptom score from 5.99 ± 1.69 to 3.40 ± 2.08 (P < .001), SF-36 physical component summary measure from 44.12 ± 10.03 to 48.68 ± 9.47 (P < .001), and SF-36 mental component summary measure from 35.07 ± 12.23 to 42.13 ± 11.51 (P < .001). All these improvements were maintained until last follow-up. Conclusion: Patients receiving anthroposophic art therapy had long-term reduction of chronic disease symptoms and improvement of quality of life. [Copyright &y& Elsevier]

Abstract: A group of German physicians was invited to accompany an acupuncture anesthesia in Beijing Guang’anmen Hospital. This case report presents the observations of this group during a bilateral turbinat outfracture operation of the nose with acupuncture assisted local anesthesia in a 38-year-old patient. [Copyright &y& Elsevier]

Complementary therapy is implemented in Switzerland on a legal basis (i.e. by constitution) and can be reimbursed if offered either by physicians or by private health insurance coverage from non-medical therapists. This survey wanted to explore different types of interventions across Switzerland and to identify the most relevant complaints treated by therapists, their job satisfaction and satisfaction concerning the collaboration with medical doctors. This cross sectional study of therapists registered in the Experience Medicine Register (EMR) was conducted as online survey in 2017 in Switzerland in three different languages. Therapists first selected one possible treatment option as their most often used intervention for their patients. Afterwards, they indicated the complaints treated with this kind of intervention. Data were analysed descriptively. Of 17,647 initially invited therapists 3942 responded (22.3%) and data from 3638 therapists could be analysed. Therapists were often females in their own practice and they had high job satisfaction, but were less satisfied with the collaboration with medical doctors. Therapists stated that they most often provide classical massage, craniosacral therapy, Traditional Chinese Medicine, naturopathic practices and medical massage. French speaking therapists stated that they more often provided osteopathy and manual lymphatic drainage but less often craniosacral therapy compared with the German speaking therapists. Headache and back pain were named as the most common treated complaints. Therapies used by non-medical complementary therapists varied across the different regions in Switzerland. However, we found no regional differences in the complaints being treated by therapists. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea is common among women of reproductive age. Nonsteroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20% to 25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies.Objective: We aimed to investigate the effectiveness of app-based self-acupressure in women with menstrual pain.Materials and Methods: A 2-armed, randomized, pragmatic trial was conducted from December 2012 to April 2015 with recruitment until August 2014 in Berlin, Germany, among women aged 18 to 34 years with self-reported cramping pain of 6 or more on a numeric rating scale (NRS) for the worst pain intensity during the previous menstruation. After randomization, women performed either app-based self-acupressure (n = 111) or followed usual care only (n = 110) for 6 consecutive menstruation cycles. The primary outcome was the mean pain intensity (NRS 0-10) on the days with pain during the third menstruation. Secondary outcomes included worst pain intensity during menstruation, duration of pain, 50% responder rates (reduction of mean pain by at least 50%), medication intake, sick leave days, and body efficacy expectation assessed at the first, second, third, and sixth menstruation cycles.Results: We included 221 women (mean age, 24.0 years; standard deviation [SD], 3.6 years). The mean pain intensity difference during the third menstruation was statistically significant in favor of acupressure (acupressure: 4.4; 95% confidence interval [CI], 4.0-4.7; usual care 5.0; 95% CI, 4.6-5.3; mean difference -0.6; 95% CI, - 1.2 to -0.1; P = .026). At the sixth cycle, the mean difference between the groups (-1.4; 95% CI, -2.0 to -0.8; P < .001) reached clinical relevance. At the third and sixth menstruation cycles, responder rates were 37% and 58%, respectively, in the acupressure group, in contrast to 23% and 24% in the usual care group. Moreover, the worst pain intensity (group difference -0.6; 95% CI, -1.2 to -0.02; and -1.4; 95% CI, -2.0 to -0.7), the number of days with pain (-0.4; 95% CI, -0.9 to -0.01; and -1.2; 95% CI, -1.6 to -0.7) and the proportion of women with pain medication at the third and sixth menstruation cycles (odds ratio [OR], 0.5; 95% CI, 0.3-0.9] and 0.3 (95% CI, 0.2-0.5) were lower in the acupressure group. At the third cycle, hormonal contraceptive use was more common in the usual care group than in the acupressure group (OR, 0.5; 95% CI, 0.3-0.97) but not statistically significantly different at the sixth cycle (OR, 0.6; 95% CI, 0.3-1.1]). The number of sick leave days and body efficacy expectation (self-efficacy scale) did not differ between groups. On a scale of 0 to 6, mean satisfaction with the intervention at the third cycle was 3.7 (SD 1.3), recommendation of the intervention to others 4.3 (1.5), appropriateness of acupressure for menstrual pain 3.9 (1.4), and application of acupressure for other pain 4.3 (1.5). The intervention was safe, and after the sixth cycle, two-thirds of the women (67.6%) still applied acupressure on all days with pain.Conclusion: Smartphone app-delivered self-acupressure resulted in a reduction of menstrual pain compared to usual care only. Effects were increasing over time, and adherence was good. Future trials should include comparisons with other active treatment options. [ABSTRACT FROM AUTHOR]

To examine the effects of six relaxation techniques on perceived momentary relaxation and a possible association of relaxation effects with time and practice experience in people with cancer. We used data from participants with cancer in a larger study practicing app-based relaxation techniques over 10 weeks, assessed momentary relaxation before and after every third relaxation practice, and analyzed momentary relaxation changes with a linear mixed-effects model. The sample included 611 before-after observations from 91 participants (70 females (76.9%)) with a mean age of 55.43 years (SD 10.88). We found moderate evidence for variations in momentary relaxation changes across different techniques (P =.026), with short meditation, mindfulness meditation, guided imagery, and progressive muscle relaxation more frequently observed and leading to more relaxation than body scan and walking meditation. Furthermore, we found moderate evidence for increasing momentary relaxation changes over time (P =.046), but no evidence for an association between momentary relaxation and the number of previous observations (proxy for practice experience; P =.47). We compared six app-based relaxation techniques in a real-life setting of people with cancer. The observed variations in perceived momentary relaxation appear to correspond with the popularity of the techniques used: The most popular relaxation techniques were the most effective and the least popular were the least effective. The effects increased over time, likely caused by dropout of individuals who gained no immediate benefit. Our findings open an interesting avenue for future research to better understand which relaxation techniques work best for whom in which situations. DRKS00027546; https://drks.de/search/en/trial/DRKS00027546 • Relaxation techniques can reduce cancer-related distress in the long term. • It is unclear if relaxation techniques give immediate benefit to people with cancer. • We show that different relaxation techniques have different immediate effects. • Popular relaxation techniques relax people with cancer, unpopular techniques do not. • Relaxation apps should offer a variety of relaxation techniques to choose from. [ABSTRACT FROM AUTHOR]

Objective: Some people might be more prone to placebo and nocebo responses than others depending on their personality traits. We aimed to provide a systematic review on the influence of personality traits on placebo and nocebo responses in controlled and uncontrolled studies.Methods: We conducted a systematic literature search in the databases CINAHL, AMED, PsycINFO and EMBASE for relevant publications published between January 1997 and March 2018. For all included papers, we conducted an additional forward search.Results: After screening 407 references, we identified 24 studies. The Big Five (i.e., neuroticism, extraversion, openness to experience, agreeableness and conscientiousness) and optimism were the most frequently investigated personality traits. Several studies found a positive association between optimism and the placebo response. Furthermore, we found that higher anxiety was associated with increased nocebo responses.Conclusion: Evidence points to a possible association between optimism and the placebo response. Therefore, further emphasising the investigation of the influence of optimism on the placebo/nocebo response seems warranted. For clinical practice, the impact of anxiety on the nocebo response might be important to identify patients who might be more prone to experiencing side effects of medical treatments. [ABSTRACT FROM AUTHOR]

Abstract Ethnopharmacological relevance Passiflora incarnata Linnaeus (Passiflora incarnata) was established as a medicinal plant in Europe in the middle of the 19th century. Since then, it has been used for the treatment of anxiety, sleep disorders and restlessness in Western European phytotherapy. This study provides insights into how Passiflora incarnata is currently used and experienced as a medicinal plant by German-speaking patients in Switzerland. Aim This qualitative study aimed to explore patients' experiences and the values, views and interpretive processes that formed their perceptions of the use of an ethanolic extract of Passiflora incarnata. Methods A total of 8 patients participated in this exploratory, qualitative observational study. The patients filled in pre- and posttreatment questionnaires, kept diaries and were interviewed in a face-to-face setting. For the data analysis, descriptive statistics, qualitative content analysis, narrative inquiry and documentary methods were applied. Results This is the first qualitative study of patients' real-life experiences with an ethanolic extract of Passiflora incarnata. We identified three distinct types of patient biographical narratives attributed to different experiences when using Passiflora incarnata. Patients with type 1 narratives described moving from a performance orientation to resetting priorities and attaining calmness. Patients with type 2 narratives maintained a performance orientation while adopting calmness. Patients with type 3 narratives maintained a performance orientation and suffered from persistent illness. Conclusion The distinct biographical narratives of the patients associated with their specific experiences of taking Passiflora incarnata provide an additional perspective on the use of Passiflora incarnata as a medicinal plant. Graphical abstract Three types of patient biographical narratives attributed to the experiences of using Passiflora incarnata fx1 [ABSTRACT FROM AUTHOR]

Context: Chinese medicine modalities, including acupuncture and Chinese herbal medicine (CHM), have been used as palliative interventions among cancer patients. More research should be conducted to confirm their effectiveness.Objectives: The objective of this study was to prioritize Chinese medicine clinical research questions for cancer palliative care.Methods: Twelve international experts, including physicians, Chinese medicine practitioners, nurses, and clinical research methodologists (n = 3 from each category), from Asia, North America, Australia, and Europe participated in a two-round Delphi survey for prioritizing 29 research questions identified from existing systematic reviews. The experts were asked to 1) rate clinical importance of answering the questions on a nine-point Likert scale; 2) provide qualitative comments on their ratings; and 3) suggest outcome measurement approaches.Results: Eight research priorities reached positive consensus after the two-round Delphi survey. Six of the priorities focused on acupuncture and related therapies, of which median ratings on importance ranged from 7.0 to 8.0 (interquartile range: 1.00 to 2.50), and the percentage agreement ranged from 75.0% to 91.7%. The remaining two priorities related to CHM, with median ratings ranged from 7.0 to 8.0 (interquartile range: 1.00 to 1.50) and percentage agreement ranged from 75.0% to 83.3%. Neither positive nor negative consensus was established among the remaining 21 questions.Conclusion: The findings will inform rational allocation of scarce research funding for evaluating the effectiveness of Chinese medicine for cancer palliative care, especially on acupuncture and related therapies. Further research on herb safety and herb-drug interaction should be performed before conducting international trials on CHM. [ABSTRACT FROM AUTHOR]