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AbstractObjective: People with functional seizures (FS) have frequent and disabling cognitive dysfunction and mental health symptoms, with low quality of life. However, interrelationships among these constructs are poorly understood. In this meta-analysis, we examined associations between objective (i.e. performance-based) cognitive testing and self-reported (i) mental health, (ii) cognition, and (iii) quality of life in FS. Method: We searched MEDLINE, Embase, PsycINFO, and Web of Science, with the final search on June 10, 2024. Inclusion criteria were studies documenting relationships between objective cognitive test scores and self-reported (i.e. subjective) mental health, cognition, and/or quality of life in adults with FS. Exclusion criteria were mixed FS/epilepsy samples. A modified Newcastle-Ottawa Scale evaluated risk of bias. This project is registered as CRD42023392385 in PROSPERO. Results: Initially, 4,054 unique reports were identified, with the final sample including 24 articles of 1,173 people with FS. Mean age was 35.9 (SD = 3.9), mean education was 12.6 (SD = 1.3), and proportion of women was 73.9%. Risk of bias was moderate, due in part to inconsistent reporting of confounding demographic variables. Significant relationships were found between global objective cognition and global self-reported mental health (k = 21, Z = −0.23 [0.04], 95% CI = −0.30, −0.16), depression (k = 11, Z = −0.13 [0.05], 95% CI = −0.21, −0.04), cognition (k = 5, Z = −0.16 [0.05], 95% CI = −0.26, −0.06), and quality of life (k = 5, Z = −0.17 [0.05], 95% CI = −0.24, −0.10). Exploratory analyses showed associations between select cognitive and mental health constructs. Conclusions: Objective cognition is reliably associated with self-reported mental health, cognition, and quality of life in people with FS. Scientific and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

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

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

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

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

The Williams and McCoy Motivational Spirited Cognitive Behavioral Change Communication (MIS-CBC) is an innovative model combining the spirit of motivational interviewing (MI) communication, and cognitive behavioral therapy (CBT) as a patient-centered care model to improve continuity of care while enabling patients to progress during therapy. Incorporating this model into Psychiatric Mental Health Advance Practice Nurse practice allows for provision of best practice with populations experiencing low motivation and subject to dropout. The model aims to improve patient motivation and engagement of CBT to achievement "full dose" CBT with more flexibility to significantly improve patient outcomes, particularly with patient populations subject to interruptions in psychotherapy. The Williams and McCoy MIS-CBC model has implications in areas of both practice and academia addressing episodic psychotherapy in populations where interruptions and dropout frequently occur. [ABSTRACT FROM AUTHOR]

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

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

Background and objectives: Acute encephalitis syndrome is a health burden to a populous country like India. It is characterized by a sudden onset of fever, altered sensorium with or without seizures, irritability, abnormal behavior, or unconsciousness. This study aims to augment further evidence on the effects of add-on homeopathic treatment in reducing mortality and morbidity in children. Methods: This comparative retrospective study included children hospitalized with acute encephalitis syndrome between July 2016 to December 2016. We compared the parameters of children for whom decisions on the Glasgow Outcome scale and Liverpool outcome score aided by add-on homeopathy against those of children from the same year when the add-on homeopathy was not used. All the children were on conventional supportive care and treatment tailored to each child. We also counted the days until the resumption of oral feeding and the length of hospital stay. Results: Ordinal regression analysis on analyses on 622 children (IH + IMP= 329; IMP only=293) was done. Odds of a shift towards increased recovery were superior in the homeopathy-added group than in the IMP group without adjustment (crude OR 2·30, 95% CI 1·66 to 3·20; p=0·0001) and with adjustment (adjusted OR 3.38, 95% CI 2·38 to 4.81; p=0·0001). There was 14.8% less mortality and 17.4% more recovery in the add-on homeopathy group compared to IMP alone. Individualized homeopathic remedies commonly used were Belladonna (n =238), Stramonium (n =17), Opium (n = 14), Sulphur (n=11), and Hyoscyamus niger (n = 7). Conclusion: This retrospective cohort study advocates for add-on homoeopathy in children suffering acute encephalitis which can produce notable improvements in terms of mortality and morbidity. Further studies in different settings are warranted. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Objectives This study aimed to evaluate whether individualized homeopathic medicines have a greater adjunctive effect than adjunctive placebos in the treatment of moderate and severe cases of coronavirus disease 2019 (COVID-19). Methods The study was a randomized, single-blind, prospective, placebo-controlled clinical trial set in the clinical context of standard care. Intervention Patients of either sex, admitted in a tertiary care hospital, suffering from moderate or severe COVID-19 and above 18 years of age were included. In total, 150 patients were recruited and then randomly divided into two groups to receive either individualized homeopathic medicines or placebos, in addition to the standard treatment of COVID-19. Outcome Measures The primary outcome was time taken to achieve RT-PCR-confirmed virus clearance for COVID-19. Secondary outcomes were changes in the Clinical Ordinal Outcomes Scale (COOS) of the World Health Organization, the patient-reported MYMOP2 scale, and several biochemical parameters. Parametric data were analyzed using unpaired t -test. Non-parametric data were analyzed using the Wilcoxon signed rank test. Categorical data were analyzed using Chi-square test. Results In total, 72 participants of the add-on homeopathy (AoH) group showed conversion of RT-PCR status to negative, in an average time of 7.53 ± 4.76 days (mean ± SD), as compared with 11.65 ± 9.54 days in the add-on placebo (AoP) group (p = 0.001). The mean COOS score decreased from 4.26 ± 0.44 to 3.64 ± 1.50 and from 4.3 ± 0.46 to 4.07 ± 1.8 in the AoH and AoP groups respectively (p = 0.130). The mortality rate for the AoH group was 9.7% compared with 17.3% in the AoP group. The MYMOP2 scores between the two groups differed significantly (p = 0.001), in favor of AoH. Inter-group differences in the pre- and post- mean values of C-reactive protein, fibrinogen, total leukocyte count, platelet count and alkaline phosphatase were each found to be statistically significant (p <0.05), favoring AoH; six other biochemical parameters showed no statistically significant differences. Conclusion The study suggests homeopathy may be an effective adjunct to standard care for treating moderate and severe COVID-19 patients. More rigorous, including double-blinded, studies should be performed to confirm or refute these initial findings. [ABSTRACT FROM AUTHOR]

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

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

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

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

Introduction: Integrative and Complementary Health Practices (PICS) bring a subject-centered care proposal that values traditional knowledge and natural mechanisms for health maintenance and recovery and has been expanding in recent decades, following the publication of the National Policy of Integrative and Complementary Practices (PNPIC) and the definition of WHO strategies for Traditional and Complementary Medicines (MTCI). Such political actions can have repercussions on health education and imply a position of resistance and epistemological discussion within the universities by teachers and trainers. Objectives: Know the understanding of coordinators and teachers of undergraduate health courses in the State of Bahia about the insertion of PICS in health education and their interface with public policies. Methodology: Exploratory-descriptive study, constructed from a structured electronic questionnaire, developed at REDCap, applied to coordinators and professors of undergraduate health courses in the state of Bahia. Results/Discussion: Teachers and course coordinators identify PICS as practices that promoting expanded, integrative, complementary, and alternative care, recognizing them as health rationalities distinct from the biomedical model. Final Considerations: This paper analyzes the complexity involved in health education processes and discusses the need to strengthen training actions in PICS in the field of public policies according to the principles of the Public Heath, but also as responses to the care demands of contemporary society, especially weakened by the recent experience of a pandemic. [ABSTRACT FROM AUTHOR]

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

Traditional medical practice in the world has maintained its popularity in spite of the challenges of the rapid development of modern medicine. The World Health Organization observed that 80% of world population still rely on traditional practices of special cultural heritages.In Asia, the traditional practices include mainly that of the Middle East, India and China. The 3000 years of development in the three different regions has resulted in cross-cultural influences and exchanges, particularly revealed in the rich collections of medicinal herbs.Ayurveda medicine has well maintained its traditional philosophy and practice. It has enjoyed very substantial governmental support on the national level and has remained popular. Traditional Chinese Medicine, likewise, has kept its popularity and vibrance. However, with the ever advancing modern medicine which is giving efficient acute care and specific solutions to known target areas of clinical concern, are unavoidable obstacles to an integrative practice.Besides India, China is the only country in the world where Traditional Medicine is still playing a major role in national health care. During the COVID-19 pandemic both Ayurveda and Chinese Medicine practitioners tried hard to contribute by offering integrative treatment to the infected patients. They were getting a lot of national and professional endorsements. One would speculate that with this unknown virus and diverse clinical presentations, a better integrative program would be able to provide better outcome.On the prevention side, medicinal herbs are expected to be able to boost up the innate immunity of the individual so that infection could be better resisted.Given the similarities between the Indian and Chinese Systems of traditional practice, it is suggested that Ayurveda and Chinese Medicine could develop a joint mission with combined efforts, to collaborate in research and trials, with the aim of consolidating Integrative Practice. This article concentrates on the Indian and Chinese areas of traditional practice, viz. Ayurveda and Chinese Medicine.

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

Severe COVID-19 infection requiring oxygen support is reported to have high mortality. Chest Severity Score evaluated through CT scan has a predictive value about future outcomes in such cases. Score value ∼18 is predicted to have poor outcomes. We are presenting here a case of severe COVID-19 with all predictors suggestive of a bad prognosis including IL-6, D-Dimer, Ferritin and CRP in addition to 18/25 Chest Severity Score. Initially treated under ICU care at a tertiary care COVID hospital for about 14 days, the patient was intervened with Ayurveda on his own insistence seeing the unsatisfactory improvements. Ayurveda intervention for 19 days along with standard ICU care resulted in complete clinical recovery of the patient besides the correction of biomarker levels. Rapid clinical and biochemical correction in this severe COVID-19 case against all odds is highly significant and warrants an urgent search for possibility of instituting the integrative management strategies for all those treated in an allopathic facility. This case also advocates an early institution of Ayurveda interventions in COVID-19 in order to prevent deterioration leading to complications.

Introduction: Manual therapy refers to a range of hands-on interventions used by various clinical professionals, such as osteopaths, osteopathic physicians, chiropractors, massage therapists, physiotherapists, and physical therapists, to treat patients experiencing pain., Objectives: To present existing evidence of mechanisms and clinical effectiveness of manual therapy in pain., Methods: This Clinical Update focuses on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care. Current models of manual therapy and examples of integrative manual therapy are discussed., Results: The evolution of concepts in recent years are presented and current gaps in knowledge to guide future research highlighted. Mechanisms of manual therapy are discussed, including specific and contextual effects. Findings from research on animal and humans in manual therapy are presented including on inflammatory markers, fibrosis, and behaviours. There is low to moderate levels of evidence that the effect sizes for manual therapy range from small to large for pain and function in tension headache, cervicogenic headache, fibromyalgia, low back pain, neck pain, knee pain, and hip pain., Conclusion: Manual therapies appear to be effective for a variety of conditions with minimal safety concerns. There are opportunities for manual therapies to integrate new evidence in its educational, clinical, and research models. Manual therapies are also well-suited to fostering a person-centred approach to care, requiring the clinician to relinquish some of their power to the person consulting. Integrated manual therapies have recently demonstrated a fascinating evolution illustrating their adaptability and capacity to address contemporary societal challenges., Competing Interests: J.D.R. has received grants from the Osteopathic Foundation, the University College of Osteopathy, the General Osteopathic Council, and the Institute of Osteopathy; and honororia payments from Kookie Learning, Nordic Osteopathic Alliance, Metropolia University, Centre International d'Ostéopathie, and Osteopathy Europe; and has a leadership role in the Strengthening Osteopathic Leadership and Research programme (UTS Sydney, Australia). D.N. received grants from Research Innovation Fund (UK) and the Chiropractic Research Council. M.F.B. receives fudning from Temple University and NICCH/NINDS. J.B. has no conlict of interests to report.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

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

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

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

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

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

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

People with intellectual disabilities (IDs) often present with challenging behaviors (CBs) mostly due to inappropriate environments and mental and physical disorders. Integrative care is recommended to address CBs. However, in clinical practice, psychotropic drugs are often prescribed off-label for CBs, although the effectiveness is unclear, and side effects frequently occur. We conducted a cluster-randomized controlled study to investigate the effect of integrative care provided by a collaboration of an ID specialized mental healthcare team and participants' own ID service providers' care team on reducing CBs and inappropriate off-label psychotropic drug prescriptions compared with care as usual. Participants ( N = 33, aged 19-81 years) had a moderate, severe, or profound intellectual disability and used off-label psychotropic drugs. The primary outcome measures were the Aberrant Behavior Checklist and the total dose of psychotropic drug prescriptions. At the study endpoint of 40 weeks, we found no effect of the intervention on the total ABC score and on the total dose of psychotropic drug prescriptions. In the intervention group, however, the psychotropic drug dose decreased significantly, while CBs did not change. The small sample size and not-completed interventions due to organizational problems may have affected our findings. This study illustrates the difficulties in the implementation of integrative care.

Purpose: For some years now, a programme for the use of integrative care in paediatric oncology has been established in a German university hospital and offers patients and parents complementary treatment options. According to their medical condition and wishes. A variety of external applications such as medical wraps, warm oil compresses and rhythmic embrocations are offered. This article analyses how patients and parents perceived and experienced the integrative care program. Methods: In this qualitative study, data consists of field notes conducted through participant observation, informal conversations and interviews with parents (n = 25) during the implementation phase of the program. Data was analysed on basis of thematic analysis and organized with the analysis software MAXQDA. Results: Parents and families intuitively developed strategies for dealing with crisis situations such as childhood cancer. In addition, many of the families brought with them a wealth of experience in complementary medicine. Parents perceived the integrative care treatments as soothing, relaxing and pain-relieving for their child. Patients could relax and side effects of chemotherapy were alleviated. However, children, who undergoing chemotherapy were not always open for physical touch and thus sometimes also rejected the treatments sometimes. Conclusion: The analysed integrative care programme is perceived as a strong patient and family-centred approach of support during the oncological paediatric treatment. From a salutogenetic viewpoint, this program aims to strengthen the dimension of manageability within the concept of sense of coherence. Parents are given supportive means to manage side effects and ease their child’s suffering, through touch and attention that can be very beneficial.

Background: Distributive leadership has been proposed as an effective means towards achieving integrated health services. This study draws from the case of 'Foundry', a network of integrated youth health centres in British Columbia, Canada, and explores the function and impact of distributive leadership in the context of a large-scale effort towards integrated service delivery for youth experiencing mental health and substance use challenges. Methods: Qualitative data was obtained from a developmental evaluation of Foundry using a longitudinal, ethnographic approach. Over 150 participants involved in the development of six Foundry centres were interviewed individually or in focus groups. Purposive and theoretical sampling strategies were used to maximize the diversity of perspectives represented in the data set. Results and Discussion: Distributive leadership was observed to be a facilitator for achieving service and system-level integration. Distributive leadership was effective in promoting streamlined service provision, and coordinating efforts towards optimized access to care. A new culture of leadership emerged through collaboration and relationship-building based on a common value system to prioritize youth needs. Conclusion: As Foundry, and other integrated youth services, continues to expand, distributive leadership shows promise in assuring diverse and coordinated input for integrating services.

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

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

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

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

Prognostic factors from naturalistic treatment studies of children with Autism Spectrum Disorder (ASD) remain largely unknown. We aimed to identify baseline and treatment-related prognostic predictors at 1-year follow-up after Integrative Care Practices (ICPs). Eighty-nine preschool children with severe ASD were given ICP combining nine therapeutic workshops based on children's needs. Participants were assessed at baseline and during 12 months follow-up with the Psycho-educational Profile-3-R, Children Autism Rating Scale, Parental Global Impression, and the Autistic Behaviors Scale. We assessed prognostic predictors using multivariable regression models and explored treatment ingredients influencing outcome using Classification and Regression Trees (CART). Multivariable models showed that being a child from first generation immigrant parents predicted increased maladaptive behaviors, whereas play activities had an opposite effect; severity of ASD symptoms and impaired cognitive functions predicted worse autism severity at follow-up; and lower play activities predicted worse parent impression. Regarding treatment effects, more emotion/behavioral interventions predicted better outcomes, and more communication interventions predicted lower autism severity, whereas more education and cognitive interventions had an opposite effect. CART confirmed that more hours of intervention in the emotion/behavioral domain helped classifying cases with better outcomes. More parental support was associated with decreased maladaptive behaviors. Sensorimotor and education interventions also significantly contributed to classifying cases according to outcomes but defined subgroups with opposite prognosis. Children who exhibited the best prognosis following ICPs had less autism severity, better cognition, and non-immigrant parents at baseline. Emotion/behavior interventions appeared key across all outcomes and should be promoted. • Treatment for autism includes behavioral, educational and developmental methods addressing children needs and parenting. • Children who exhibited the best prognosis following treatment had less autism severity, better cognition at baseline and non-migrant parents. • Emotion/behavior interventions appeared key across all outcomes. • Emotion/behavior interventions should be promoted for treatment of ASD in natural setting. • Emotion/behavior interventions appeared to be an important dimension for treatment of ASD children in a natural setting and should be promoted. [ABSTRACT FROM AUTHOR]