World Congress Integrative Medicine & Health 2017: part two
- Carolyn Ee1,
- Sharmala Thuraisingam2,
- Marie Pirotta2,
- Simon French3,
- Charlie Xue4,
- Helena Teede5,
- Agnete E. Kristoffersen6,
- Fuschia Sirois7,
- Trine Stub8,
- Jennifer Engler9,
- Stefanie Joos10,
- Corina Güthlin9,
- Jennifer Felenda11,
- Christiane Beckmann11,
- Florian Stintzing12,
- Roni Evans13,
- Gert Bronfort13,
- Daniel Keefe13,
- Anna Taberko14,
- Linda Hanson13,
- Alex Haley13,
- Haiwei Ma13,
- Joseph Jolton14,
- Lana Yarosh13,
- Francis Keefe13, 15,
- Jung Nam13,
- Roni Evans16,
- Liwanag Ojala17,
- Mary J. Kreitzer16,
- Linda Hanson16,
- Careen Fink18,
- Karin Kraft19,
- Andrew Flower20,
- George Lewith20,
- Kim Harman20,
- Beth Stuart20,
- Felicity L. Bishop21,
- Jane Frawley22,
- Lilla Füleki23,
- Eva Kiss23,
- Tamas Vancsik23,
- Tibor Krenacs23,
- Martha Funabashi24Email author,
- Katherine A. Pohlman24, 25,
- Silvano Mior26,
- Haymo Thiel27,
- Michael D. Hill28,
- David J. Cassidy29,
- Michael Westaway28,
- Jerome Yager24,
- Eric Hurwitz30,
- Gregory N. Kawchuk24,
- Maeve O’Beirne28,
- Sunita Vohra24,
- Isabelle Gaboury31,
- Chantal Morin31,
- Katharina Gaertner32,
- Loredana Torchetti32,
- Martin Frei-Erb32,
- Michael Kundi33,
- Michael Frass34,
- Eugenia Gallo35, 36, 37,
- Valentina Maggini35, 36, 37,
- Mattia Comite36, 37,
- Francesco Sofi35,
- Sonia Baccetti38,
- Alfredo Vannacci35,
- Mariella Di Stefano38,
- Maria V. Monechi38,
- Luigi Gori36, 37,
- Elio Rossi38,
- Fabio Firenzuoli36, 37, 38,
- Rocco D. Mediati39,
- Giovanna Ballerini39,
- Paula Gardiner40, 41,
- Anna S. Lestoquoy40,
- Lily Negash40,
- Sarah Stillman40,
- Prachi Shah40,
- Jane Liebschutz40, 41,
- Pamela Adelstein42,
- Christine Farrell-Riley42,
- Ivy Brackup43,
- Brian Penti40,
- Robert Saper40, 41,
- Isabel Giralt Sampedro44, 45,
- Gilda Carvajal44,
- Andreas Gleiss46,
- Marie M. Gross47,
- Dorothea Brendlin47,
- Jonas Röttger47,
- Wiebke Stritter47,
- Georg Seifert47,
- Noelle Grzanna48,
- Rainer Stange49,
- Peter W. Guendling48,
- Wen Gu50,
- Yan Lu51,
- Jie Wang52,
- Chengcheng Zhang53,
- Hua Bai54,
- Yuxi He52,
- Xiaoxu Zhang52,
- Zhengju Zhang52,
- Dali Wang52,
- Fengxian Meng52Email author,
- Alexander Hagel55,
- Heinz Albrecht55,
- Claudia Vollbracht56,
- Wolfgang Dauth57,
- Wolfgang Hagel58,
- Francesco Vitali55,
- Ingo Ganzleben55,
- Hans Schultis59,
- Peter Konturek60,
- Jürgen Stein61,
- Markus Neurath55,
- Martin Raithel55,
- Alexander Hagel62,
- Claudia Vollbracht63,
- Martin Raithel62,
- Peter Konturek64,
- Bianka Krick63,
- Heidemarie Haller65,
- Petra Klose65,
- Gustav Dobos65,
- Sherko Kümmel66,
- Holger Cramer65,
- Heidemarie Haller67,
- Felix J. Saha67,
- Anna Kowoll67,
- Barbara Ebner67,
- Bettina Berger68,
- Gustav Dobos67,
- Kyung-Eun Choi67,
- Lisha He69,
- Han Wang69,
- X. He69,
- C. Gu69,
- Y. Zhang69,
- Linhua Zhao69Email author,
- Xiaolin Tong69,
- Lisha He70,
- Han Wang70,
- Xinhui He70,
- Chengjuan Gu70,
- Ying Zhang70,
- Linhua Zhao70,
- Xiaolin Tong70,
- Lisha He71,
- Han Wang71,
- Xinhui He71,
- Chengjuan Gu71,
- Ying Zhang71,
- Linhua Zhao71,
- Xiaolin Tong71,
- Robin S. T. Ho72,
- Vincent C. H. Chung72, 73,
- Xinyin Wu73,
- Charlene H. L. Wong73,
- Justin C. Y. Wu73,
- Samuel Y. S. Wong72,
- Alexander Y. L. Lau73,
- Regina W. S. Sit72, 73,
- Wendy Wong73,
- Michelle Holmes74,
- Felicity Bishop74,
- Lynn Calman75,
- Michelle Holmes76,
- Felicity Bishop76,
- George Lewith77,
- Dave Newell78,
- Jonathan Field79,
- Win L. Htut80,
- Dongwoon Han80,
- Da I. Choi80,
- Soo J. Choi80,
- Ha Y. Kim80,
- Jung H. Hwang80,
- Ching W. Huang81, 82Email author,
- Bo H. Jang81, 82,
- Fang P. Chen83,
- Seong G. Ko81, 82,
- Wenjing Huang84,
- De Jin84,
- Fengmei Lian84,
- Soobin Jang85,
- Kyeong H. Kim85,
- Eun K. Lee85,
- Seung H. Sun86,
- Ho Y. Go87,
- Youme Ko85,
- Sunju Park88,
- Bo H. Jang85,
- Yong C. Shin85,
- Seong G. Ko85,
- Hubert Janik89,
- Natalie Greiffenhagen89,
- Jürgen Bolte90,
- Karin Kraft89,
- Mariusz Jaworski91,
- Miroslawa Adamus91,
- Aleksandra Dobrzynska91,
- Michael Jeitler92,
- Jessica Jaspers93,
- Christel von Scheidt92,
- Barbara Koch92,
- Andreas Michalsen92, 93,
- Nico Steckhan93,
- Christian Kessler92, 93,
- De Jin94,
- Wen-jing Huang94,
- Bing Pang94,
- Feng-Mei Lian94,
- Miek Jong95,
- Erik Baars95,
- Anja Glockmann96,
- Harald Hamre96,
- Mosaburo Kainuma97, 98,
- Aya Murakami97, 98,
- Toshio Kubota97, 98,
- Daisuke Kobayashi97, 98,
- Yasuhiro Sumoto97, 98,
- Norihiro Furusyo99,
- Shin-Ichi Ando100,
- Takao Shimazoe97, 98,
- Olaf Kelber101Email author,
- S. Verjee102,
- Eva Gorgus102,
- Dieter Schrenk102,
- Kathi Kemper103,
- Ellie Hill103,
- Kathi Kemper104,
- Nisha Rao105,
- Gregg Gascon104,
- John Mahan104,
- Gunver Kienle106,
- Jörg Dietrich107,
- Claudia Schmoor108,
- Roman Huber106,
- Weon H. Kim109,
- Dongwoon Han110,
- Mansoor Ahmed110,
- Luzhu He110,
- Jung Hye Hwang110,
- Eva Kiss111,
- Tamas Vancsik111,
- Nora Meggyeshazi111,
- Csaba Kovago112,
- Tibor Krenacs111,
- Anne K. Klaus113, 114Email author,
- Roland Zerm113, 114,
- Danilo Pranga113,
- Thomas Ostermann115, 116,
- Marcus Reif117,
- Hans Broder von Laue113,
- Benno Brinkhaus118,
- Matthias Kröz113,
- Anne K. Klaus119, 120Email author,
- Roland Zerm119, 119,
- Danilo Pranga119,
- Daniela Rodrigues Recchia121,
- Thomas Ostermann121, 122,
- Marcus Reif123,
- Hans B. von Laue119,
- Benno Brinkhaus124,
- Matthias Kröz119, 120, 121, 124,
- Christien T. Klein-Laansma125,
- Mats Jong126,
- Cornelia von Hagens127,
- Jean P. Jansen125,
- Herman van Wietmarschen125,
- Miek C. Jong125,
- Youme Ko128,
- Seung-Ho Sun129,
- Ho-Yeon Go130,
- Chan-Yong Jeon131,
- Yun-Kyung Song132,
- Seong-Gyu Ko128,
- Anna K. Koch133, 134,
- Sybille Rabsilber135, 136,
- Romy Lauche133, 137,
- Sherko Kümmel136,
- Gustav Dobos133,
- Jost Langhorst133, 134,
- Holger Cramer133, 137,
- Anna K. Koch138, 139,
- Milena Trifunovic-Koenig138, 139,
- Petra Klose138,
- Holger Cramer138, 140,
- Gustav Dobos138,
- Jost Langhorst138, 139,
- Evi Koster141,
- Erik Baars141,
- Diana Delnoij142,
- Lena Kroll143Email author,
- Kathrin Weiss143,
- Ai Kubo144,
- Sarah Hendlish144,
- Andrea Altschuler144,
- Nancy Connolly144,
- Andy Avins144, 145,
- Romy Lauche146,
- Daniela Rodrigues Recchia147,
- Holger Cramer146,
- Jon Wardle146,
- David Lee148,
- David Sibbritt146,
- Jon Adams146,
- Thomas Ostermann147,
- Romy Lauche149,
- David Sibbritt149,
- Crystal Park150,
- Gita Mishra151,
- Jon Adams149,
- Holger Cramer149, 152,
- Johann Lechner153,
- Inseon Lee154,
- Younbyoung Chae155,
- Jisu Lee156,
- Seung H. Cho157,
- Yujin Choi157,
- Jee Y. Lee158,
- Han S. Ryu158,
- Sung S. Yoon158,
- Hye K. Oh158,
- Lyun K. Hyun158,
- Jin O. Kim158,
- Seong W. Yoon158,
- Ju-Yeon Lee159,
- Sang-Hoon Shin160,
- Min Jang160,
- Indra Müller159,
- So-Hyun Janson Park159,
- Anna S. Lestoquoy161,
- Lance Laird162,
- Lily Negash161,
- Suzanne Mitchell162,
- Paula Gardiner161,
- Xiaofei Li163, 164,
- Yunhui Wang163,
- Jianhua Zhen163, 165,
- He Yu163Email author,
- Tiegang Liu163,
- Xiaohong Gu163,
- Hui Liu166,
- Weiguo Ma166,
- Chengcheng Zhang166,
- Xuezheng Shang166,
- Yu Bai166,
- Fengxian Meng166,
- Wei Liu167,
- Collin Rooney168,
- Amos Smith169,
- Shirlene Lopes170,
- Marcelo Demarzo171,
- Maria do Patrocínio Nunes170,
- Peter Lorenz172,
- Carsten Gründemann173,
- Miriam Heinrich172,
- Manuel Garcia-Käufer173,
- Franziska Grunewald173,
- Silke Messerschmidt172,
- Anja Herrick174,
- Kim Gruber174Email author,
- Christiane Beckmann174,
- Matthias Knödler172,
- Roman Huber173,
- Carmen Steinborn173,
- Florian Stintzing172, 174,
- Taoying Lu175,
- Lixin Wang176,
- Darong Wu175,
- Christina M Luberto177, 178Email author,
- Daniel L. Hall177, 178,
- Emma Chad-Friedman178,
- Suzanne Lechner179,
- Elyse R. Park177, 178,
- Christina M. Luberto180Email author,
- Elyse Park180,
- Janice Goodman180,
- Sonja Luer181,
- Matthias Heri182,
- Klaus von Ammon182,
- Martin Frei-Erb182,
- Weiguo Ma183,
- Fengxian Meng183,
- Valentina Maggini184, 186,
- Eugenia Gallo184, 186,
- Ida Landini184,
- Andrea Lapucci184,
- Stefania Nobili185,
- Enrico Mini184,
- Fabio Firenzuoli186,
- Clare McDermott187,
- George Lewith187,
- Selwyn Richards188,
- Diane Cox188,
- Sarah Frossell190,
- Geraldine Leydon187,
- Caroline Eyles187,
- Hilly Raphael190,
- Rachael Rogers191,
- Michelle Selby188,
- Charlotte Adler188,
- Jo Allam188,
- Fengxian Meng192,
- Wen Gu193,
- Chengcheng Zhang194,
- Hua Bai195,
- Zhengju Zhang192,
- Dali Wang192,
- Xiangwei Bu192,
- Honghong Zhang192,
- Jianpeng Zhang192,
- Hui Liu192,
- Michael Mikolasek196,
- Jonas Berg196,
- Claudia Witt196,
- Jürgen Barth196,
- Ivan Miskulin197,
- Zdenka Lalic198,
- Maja Miskulin197, 199,
- Albina Dumic200,
- Damir Sebo197,
- Aleksandar Vcev200,
- Nasr A. A. Mohammed201,
- Dongwoon Han201,
- Mansoor Ahmed202,
- Soo Jeung Choi522,
- Hyea Bin Im522,
- Jung Hye Hwang522,
- Anwesha Mukherjee203,
- Amit Kandhare203,
- Subhash Bodhankar203,
- Anwesha Mukherjee204,
- Amit Kandhare204,
- Prasad Thakurdesai205,
- Subhash Bodhankar204,
- Niki Munk206,
- Erica Evans206,
- Amanda Froman207,
- Matthew Kline207,
- Matthew J. Bair206,
- Frauke Musial208,
- Agnete E. Kristoffersen208,
- Terje Alræk1,
- Harald J. Hamre209,
- Trine Stub208,
- Lars Björkman210,
- Vinjar M. Fønnebø208,
- Bing Pang211,
- Feng-mei Lian211,
- Qing Ni211,
- Xiao-lin Tong211,
- Xin-long Li212,
- Wen-ke Liu211,
- Shuo Feng213,
- Xi-yan Zhao211,
- Yu-jiao Zheng211,
- Xue-min Zhao211,
- Yi-qun Lin211,
- Bing Pang214,
- Feng-mei Lian214,
- Xiao-lin Tong214,
- Tian-yu Zhao215,
- Xi-Yan Zhao214,
- Hui Che Phd216,
- Chen Zhang214,
- Bing Pang217,
- Feng Liu218,
- Xiao-lin Tong217,
- Lin-hua Zhao217,
- Xue-min Zhao217,
- Ru Ye217,
- Cheng-juan Gu217,
- Bing Pang219,
- Qing Ni220,
- Xiao-lin Tong220,
- Feng-mei Lian220,
- Xi-yan Zhao220,
- De Jin220,
- Xue-min Zhao220,
- Yu-jiao Zheng220,
- Yi-qun Lin220,
- Wenbo Peng221,
- Romy Lauche221,
- David Sibbritt221,
- Jon Adams221,
- Wenbo Peng222,
- Jon Wardle222,
- Holger Cramer223,
- Gita Mishra224,
- Romy Lauche222,
- Katherine A. Pohlman225, 226,
- Silvano Mior227,
- Martha Funabashi225Email author,
- Diana De Carvalho228,
- Mohamed El-Bayoumi229,
- Bob Haig230,
- Kimbalin Kelly230,
- Darrell J. Wade231,
- Maeve O’Beirne232,
- Sunita Vohra225,
- Emanuela Portalupi233, 234,
- Giampietro Gobo235,
- Luigi Bellavita233, 236,
- Chiara Guglielmetti237,
- Christa Raak238,
- Myriam Teuber239, 240,
- Friedrich Molsberger239, 240, 241,
- Ulrich von Rath242,
- Ulrike Reichelt243,
- Uta Schwanebeck244,
- Sabine Zeil245,
- Christian Vogelberg245,
- Dolores Rodríguez Veintimilla246,
- Claudia Vollbracht247,
- Guerrero Tapia Mery246,
- Marisol Maldonado Villavicencio246,
- Sandra Herrera Moran246,
- Christian Sachse248Email author,
- Peter W Gündlin249,
- Rainer Stange248,
- Monirsadat Sahebkarkhorasani250,
- Hoda Azizi251,
- Dania Schumann252,
- Romy Lauche253,
- Tobias Sundberg253, 254,
- Matthew J. Leach253,
- Holger Cramer252, 253,
- Susana Seca255, 256Email author,
- Henry Greten257,
- Sugir Selliah258,
- Anu Shakya259,
- Dongwoon Han259,
- Ha Yun Kim260,
- Da I. Choi523,
- Hyea B. Im523,
- Soo J. Choi523,
- Anna Sherbakova261, 262,
- Gudrun Ulrich-Merzenich261,
- Olaf Kelber263,
- Heba Abdel-Aziz264,
- Erica Sibinga265,
- Lindsey Webb266,
- Jonathan Ellen267,
- Kari Skrautvol268,
- Dagfinn Nåden268,
- Rhayun Song269Email author,
- Weronika Grabowska270,
- Kamila Osypiuk270,
- Gloria V. Diaz271,
- Paolo Bonato271,
- Moonkyoung Park272,
- Jeffrey Hausdorff273,
- Michael Fox274,
- Lewis R. Sudarsky275,
- Daniel Tarsy274,
- James Novakowski270,
- Eric A. Macklin276,
- Peter M. Wayne270,
- Rhayun Song277Email author,
- Inok Hwang278,
- Sukhee Ahn277,
- Myung-Ah Lee279,
- Peter M. Wayne280,
- Min K. Sohn278,
- Oleg Sorokin281,
- Nico Steckhan282,
- Dagmar Heydeck283,
- Astrid Borchert283,
- Christoph-Daniel Hohmann282,
- Harmut Kühn283,
- Andreas Michalsen282,
- Christian Kessler282,
- Nico Steckhan284,
- Christoph-Daniel Hohmann284,
- Holger Cramer284,
- Andreas Michalsen284,
- Gustav Dobos284,
- Christel von Scheidt284,
- Clemens Kirschbaum284,
- Tobias Stalder284,
- Barbara Stöckigt285Email author,
- Michael Teut285,
- Ralf Suhr285,
- Daniela Sulmann285,
- Benno Brinkhaus285,
- Chris Streeter286, 287,
- Patrica Gerbarg288,
- Marisa Silveri286, 287,
- Richard Brown289,
- John Jensen287,
- Wiebke Stritter290,
- Britta Rutert290, 291,
- Angelika Eggert290,
- Alfred Längler292,
- Georg Seifert290,
- Christine Holmberg291,
- Jin Sun293,
- Xin Deng294,
- Wen-Yuan Li293,
- Bin Wen294,
- Nicola Robinson295,
- Jian-Ping Liu293,
- Hyun K. Sung296,
- Narae Yang296,
- Ho Y. Go297,
- Seon M. Shin298,
- Hee Jung299,
- Young J. Kim297,
- Woo S. Jung300,
- Tae Y. Park296,
- Kiyoshi Suzuki301,
- Toshinori Ito302,
- Seiya Uchida303,
- Seika Kamohara304,
- Naoya Ono304,
- Mitsuyuki Takamura305,
- Ayumu Yokochi306,
- Kazuo Maruyama305, 306,
- Patricio Tapia307,
- Katarzyna Thabaut308Email author,
- Benno Brinkhaus308,
- Barbara Stöckigt308,
- Anja Thronicke309,
- Matthias Kröz309, 310, 311,
- Megan Steele309,
- Harald Matthes310, 310,
- Cornelia Herbstreit310,
- Friedemann Schad309, 310,
- Jiaxing Tian312,
- Fengmei Lian312,
- Libo Yang313,
- Xiaolin Tong312,
- Tian Tian314,
- Hewei Zhang314,
- Xia Tian315,
- CongCong Wang315,
- Qian Yun Chai315,
- Lijuan Zhang316,
- Ruyu Xia315,
- Na Huang315,
- Yutong Fei315,
- Jianpin Liu315,
- Natalie Trent317, 318,
- Mindy Miraglia319,
- Jeffrey Dusek320,
- Edi Pasalis319,
- Sat B. Khalsa317, 318,
- Milena Trifunovic-König321, 322Email author,
- Petra Klose322,
- Holger Cramer322, 323,
- Romy Lauche322, 323,
- Anna Koch321, 322,
- Gustav Dobos322,
- Jost Langhorst321, 322,
- Lisa Uebelacker324, 325,
- Geoffrey Tremont325, 326,
- Lee Gillette327,
- Gary Epstein-Lubow324, 325, 328,
- David Strong328,
- Ana Abrantes324, 325,
- Audrey Tyrka324, 325,
- Tanya Tran326,
- Brandon Gaudiano324, 325,
- Ivan Miller324, 325,
- Gerhild Ullmann329,
- Gerhild Ullmann330,
- Yuhua Li331,
- Sujata Vaidya332,
- Vinod Marathe332, 333,
- Ana C. Vale334,
- Jacquelyne Motta334,
- Fabíola Donadão334,
- Angela C. Valente335,
- Luana C. Carvalho Valente335,
- Ricardo Ghelman335,
- Dusan Vesovic336,
- Dragan Jevdic337,
- Aleksandar Jevdic338,
- Katarina Jevdic339,
- Mihael Djacic339,
- Dragica Letic340,
- Drago Bozic340,
- Marija Markovic340,
- Slobodan Dunjic341,
- Dusan Vesovic342,
- Dragan Jevdic343,
- Aleksandar Jevdic344,
- Katarina Jevdic345,
- Mihael Djacic345,
- Dragica Letic346,
- Drago Bozic346,
- Marija Markovic346,
- Gordana Ruscuklic347,
- Dezire Baksa347,
- Slobodan Dunjic348,
- Dusan Vesovic349,
- Dragan Jevdic350,
- Aleksandar Jevdic351,
- Katarina Jevdic352,
- Mihael Djacic352,
- Dragica Letic353,
- Drago Bozic353,
- Marija Markovic353,
- Gordana Ruscuklic354,
- Dezire Baksa354,
- Slobodan Dunjic355,
- Dusan Vesovic356,
- Dragan Jevdic357,
- Aleksandar Jevdic358,
- Katarina Jevdic359,
- Mihael Djacic359,
- Dragica Letic360,
- Drago Bozic360,
- Marija Markovic360,
- Gordana Ruscuklic361,
- Dezire Baksa361,
- Slobodan Dunjic362,
- Dusan Vesovic363,
- Dragan Jevdic364,
- Aleksandar Jevdic365,
- Katarina Jevdic366,
- Mihael Djacic366,
- Dragica Letic367,
- Drago Bozic367,
- Marija Markovic367,
- Kenan Vrca368,
- Slobodan Dunjic369,
- Ann Vincent370,
- Dietlind Wahner-Roedler370,
- Mary Whipple370,
- Maria M. Vogelius371,
- Claudia Vollbracht372,
- Iris Friesecke372, 373,
- Peter W. Gündling372,
- Dietlind Wahner-Roedler374,
- Saswati Mahapatra374,
- Rebecca Hynes374,
- Kimberly Van Rooy374,
- Sherry Looker374,
- Aditya Ghosh374,
- Brent Bauer374,
- Susanne Cutshall374,
- Harald Walach375Email author,
- Ana Borges Flores376,
- Harald Walach377,
- Michael Ofner378,
- Andreas Kastner379,
- Gerhard Schwarzl380,
- Hermann Schwameder381,
- Nathalie Alexander381,
- Gerda Strutzenberger381,
- Jie Wang382,
- Yan Lu383,
- Wen Gu384,
- Chengcheng Zhang385,
- Xianwei Bu382,
- Honghong Zhang382,
- Jianping Zhang382,
- Yuxi He382,
- Xiaoxu Zhang382,
- Fengxian Meng382,
- Shang Wang386,
- He Yu386,
- Jinfeng Shi386,
- Yu Hao386,
- Tiegang Liu386,
- Jun Wu386,
- Zeji Qiu386,
- Xiaohong Gu386,
- Yuh-Hai Wang387,
- Chi-Jung Lou387,
- Sam Watts388,
- Peter Wayne389,
- Kamila Osypiuk389,
- Gloria Vergara-Diaz390,
- Paolo Bonato390,
- Brian Gow389,
- Jeffrey Hausdorff391,
- Jose Miranda392,
- Lewis Sudarsky393,
- Daniel Tarsy394,
- Michael Fox395,
- Eric Macklin396,
- Kathrin Wode397,
- Jenny Bergqvist398,
- Britt-Marie Bernhardsson399,
- Johanna Hök Nordberg397, 399,
- Gunver Kienle400,
- Lena Sharp397,
- Roger Henriksson397, 401,
- Yeonju Woo402,
- Min K. Hyun403,
- Hao Wu404,
- Tian-Fang Wang404Email author,
- Yan Zhao404,
- Yu Wei404,
- Lei Tian404,
- Lei He404,
- Xue Wang404,
- Ruohan Wu405,
- Shuo Feng405,
- Mei Han405,
- Patrina H. Y. Caldwell406,
- Shigang Liu407,
- Jing Zhang408,
- Jianping Liu405,
- Ruyu Xia409,
- Qianyun Chai410,
- Yutong Fei411,
- Zhongning Guo412,
- Congcong Wang413,
- Zhijun Liu414,
- Xun Li409,
- Ying Zhang409,
- Jianping Liu409,
- I. J. Yang415,
- V. Ruberio Lincha415,
- S. H. Ahn416,
- D. U. Lee417,
- H. M. Shin415, 418,
- Lu Yang419Email author,
- David Sibbritt419,
- Wenbo Peng419,
- Jon Adams419,
- N. Yang420,
- H. Sung421,
- S. M. Shin422,
- H. Y. Go421,
- H. Jung423,
- Y. Kim421,
- T. Y. Park424,
- Angela Yap425,
- Yu H. Kwan425,
- Chuen S. Tan426,
- Syed Ibrahim427,
- Seng B. Ang428,
- Alfred Yayi429,
- Dongwoon Han429,
- Hyea Bin Im429,
- Jung Hye Hwang429,
- Soo Jeung Choi429,
- Jeong E. Yoo430,
- Ho R. Yoo431,
- Sae B. Jang430,
- Hye L. Lee432,
- Ala’a Youssef433,
- Shahira Ezzat434,
- Amira Abdel Motaal434,
- Hesham El-Askary434,
- Xiaotong Yu435, 436,
- Yashan Cui435,
- Ying Zhang436,
- Fengmei Lian435,
- Younghee Yun437,
- Youme Ko438,
- Jin-Hyang Ahn437,
- Bo-Hyung Jang438,
- Kyu-Seok Kim439,
- Seong-Gyu Ko438,
- Inhwa Choi437,
- Roland Zerm440, 441,
- Augustina Glinz440,
- Danilo Pranga440,
- Bettina Berger442,
- Fadime ten Brink443,
- Marcus Reif444,
- Arnd Büssing441,
- Christoph Gutenbrunner444,
- Matthias Kröz440, 441, 442, 445,
- Roland Zerm446, 447,
- Bert Helbrecht446,
- Danilo Pranga446,
- Benno Brinkhaus448,
- Andreas Michalsen448,
- Matthias Kröz446, 447, 448, 449,
- Honghong Zhang450,
- Tiesheng Fang451,
- Jie Wang450,
- Chengcheng Zhang452,
- Yuxi He450,
- Xiaoxu Zhang450,
- Zhengju Zhang450,
- Dali Wang450,
- Fengxion Meng450,
- Jianping Zhang453, 454,
- Chengcheng Zhang453, 454, 455,
- Hua Bai455,
- Zhiming Shen456, 457,
- Weiguo Ma456, 457,
- Hui Liu456, 457,
- Yu Bai456, 457,
- Xuezheng Shang456, 457,
- Fengxian Meng456, 457,
- Ruixin Zhang458,
- Fan Wu459,
- Ming Li459,
- Xinyun Xuan458,
- Xueyong Shen459,
- Ke Ren460,
- Brian Berman458,
- Jianhua Zhen461,
- Xiaofei Li461,
- Xiaohong Gu461,
- He Yu461,
- Zian Zheng461,
- Yuxiang Wan461,
- Yunhui Wang461,
- Xueyan Ma461,
- Fei Dong461,
- Tiegang Liu461,
- Jianhua Zhen462,
- Xiaofei Li462,
- Xiaohong Gu462,
- He Yu462,
- Zian Zheng462,
- Yuxiang Wan462,
- Yunhui Wang462,
- Xueyan Ma462,
- Fei Dong462,
- Tiegang Liu462,
- Suzie Zick463,
- Richard Harris463,
- Go E. Bae464,
- Jung N. Kwon464,
- Hye Y. Lee464,
- Jong K. Nam465,
- Sang D. Lee465,
- Dong H. Lee465,
- Ji Y. Han465,
- Young J. Yun464,
- Ji H. Lee464,
- Hye L. Park464,
- Seong H. Park464,
- Chiara Bocci466,
- Giovanni B. Ivaldi466,
- Ilaria Vietti466,
- Ilaria Meaglia466,
- Marta Guffi466,
- Rubina Ruggiero466,
- Marita Gualea466,
- Emanuela Longa466,
- Massimo Bonucci467,
- Sarah Croke468Email author,
- Lourdes Diaz Rodriguez469,
- Juan C. Caracuel-Martínez470,
- Manuel F. Fajardo-Rodríguez470,
- Angélica Ariza-García470,
- Francisca García-De la Fuente470,
- Manuel Arroyo-Morales469,
- Maria S. Estrems471Email author,
- Vicente G. Gómez472,
- Maria S. Estrems473Email author,
- Mónica Valero Sabater474,
- Rosaria Ferreri475,
- Simonetta Bernardini475,
- Roberto Pulcri475,
- Franco Cracolici475,
- Massimo Rinaldi475,
- Claudio Porciani475,
- Fabio Firenzuoli476, 477,
- Sonia Baccetti477,
- Mariella Di Stefano477,
- Maria V. Monechi477,
- Eugenia Gallo476,
- Valentina Maggini476,
- Luigi Gori476,
- Elio Rossi477,
- Peter Fisher478Email author,
- John Hughes478,
- Ariadna Mendoza479,
- Hugh MacPherson480,
- Claudia Witt481,
- Jacqueline Filshie482,
- George Lewith483,
- Antonia Di Francesco484Email author,
- Alberto Bernardini484,
- Monica Messe484,
- Vincenzo Primitivo484,
- Piera A. Iasella484,
- Ricardo Ghelman485Email author,
- Monica Taminato485,
- Jaqueline Do Carmo Alcantara485,
- Katia R. De Oliveira485,
- Debora C. De Azevedo Rodrigues485,
- Juliana R. Campana Mumme485,
- Olga K. Matsumoto Sunakozawa485,
- Vicente Odone Filho485,
- Georg Seifert486,
- Joshua Goldenberg487, 488,
- Andrew Day487,
- Masa Sasagawa487,
- Lesley Ward488, 489,
- Kieran Cooley488, 490,
- Thora Gunnarsdottir491Email author,
- Ingibjorg Hjaltadottir491,
- Mahdie Hajimonfarednejad492Email author,
- Nicole Hannan493Email author,
- Rut Hellsing494,
- Kathrin Wode494,
- Johanna Hök Nordberg495,
- Johanna Hök Nordberg496,
- Susanne Andermo496,
- Maria Arman496,
- Iris von Hörsten497,
- Patricia Vásquez Torrielo497,
- Carmen L. Andrade Vilaró497,
- Francisco Cerda Cabrera498,
- Roman Huber499,
- Henny Hui500,
- Eric Ziea500,
- Dora Tsui500,
- Joyce Hsieh500,
- Christine Lam500,
- Edith Chan500,
- Mark P. Jensen501,
- Samuel L. Battalio501,
- Joy Chan501,
- Karlyn A. Edwards501,
- Kevin J. Gertz501,
- Melissa A. Day502,
- Leslie H. Sherlin503,
- Dawn M. Ehde501,
- Kyeong H. Kim504,
- Soobin Jang504,
- Bo-Hyoung Jang504,
- Ho-Yeon Go504,
- Sunju Park504,
- Seong-Gyu Ko504,
- Karin Kraft505,
- Hubert Janik505,
- Anja Börner506,
- Jihong Lee507,
- Boram Lee507Email author,
- Gyu T. Chang507,
- Alejandra Menassa508Email author,
- Yoshiharu Motoo509Email author,
- Jürgen Müller510,
- Sabine Rabini511,
- Bettina Vinson510,
- Olaf Kelber510Email author,
- Martin Storr512, 513,
- Karin Kraft514,
- Martin Niemeijer515,
- Erik Baars515,
- Joop Hoekman515,
- Wied Ruijssenaaars515,
- Faith C. Njoku516Email author,
- Petra Klose517,
- Benno Brinkhaus518,
- Andreas Michalsen518,
- Gustav Dobos517,
- Holger Cramer517,
- Arne J. Norheim519Email author,
- Terje Alræk519,
- Filiz Okumus520Email author and
- Halime Oncu-Celik521
© The Author(s). 2017
Published: 30 June 2017
P44 Expectancy did not predict treatment response in a randomised sham-controlled trial of acupuncture for menopausal hot flushes
Carolyn Ee1, Sharmala Thuraisingam2, Marie Pirotta2, Simon French3, Charlie Xue4, Helena Teede5
1 National Institute of Complementary Medicine, Western Sydney University, Sydney, Australia; 2 Department of General Practice, University of Melbourne, Melbourne, Australia; 3 School of Rehabilitation Therapy, Queens University, Ontario, Canada; 4 School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; 5 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Correspondence: Carolyn Ee
Evidence on the impact of expectancy on acupuncture treatment response is conflicting. We conducted a secondary analysis of a randomised sham-controlled trial on acupuncture for menopausal hot flushes. We aimed to evaluate whether baseline expectancy is correlated with hot flush score at end-of-treatment, and determine factors associated with baseline treatment expectancy.
Women experiencing moderate-severe hot flushes were randomised to receive real or sham acupuncture for eight weeks. We measured expectancy using the Credibility and Expectancy Questionnaire immediately after the first treatment, and hot flush score using a seven-day hot flush diary. A complete mediation analysis using linear mixed-effects models with random intercepts was performed, adjusted by baseline hot flush score, to identify associations between independent variables, expectancy levels and hot flush score at end-of-treatment. Because there was no difference between real and sham acupuncture for the primary outcome of hot flush score, both arms were combined in the analysis (n = 285).
Treatment credibility, perceived allocation to real acupuncture or uncertainty about treatment allocation, and previous positive response to acupuncture predicted higher baseline expectancy. There was no evidence for an association between expectancy and hot flush score at end-of-treatment. Hot flush scores at end-of-treatment were 8.1 (95%CI, 3.03 to 13.20; P = 0.002) points lower in regular smokers compared to those who had never smoked.
In our study of acupuncture for menopausal hot flushes, we did not find an association between expectancy levels and treatment outcome. The association between smoking and improvement in hot flushes warrants further exploration.
This trial was registered with the Australia New Zealand Clinical Trials
Registry ACTRN12611000393954 on 14/04/2011
P45 Prevalence and associations for use of Complementary and Alternative Medicine (CAM) among people diagnosed with, or with a family risk for Coronary Heart Disease (CHD) in the 6th Tromsø Study
Agnete E Kristoffersen1, Fuschia Sirois2, Trine Stub3
1 NAFKAM, UiT, The arctic university of Norway, Tromsø, 9019, Norway; 2 Department of Psychology, University of Sheffield, Sheffield, S1 1HD, United Kingdom; 3 Department of community medicine, UiT The arctic university of Norway, Tromsø, 9019, Norway
Correspondence: Agnete E Kristoffersen
The aim of this study was to examine prevalence and associations for use of CAM among People diagnosed with, or with a family risk for CHD in the 6th Tromsø Study.
A total of 12982 men and women (response rate 65.7%) filled in a self-administrated questionnaire with questions about life style and health issues. Eight hundred and thirty of those had been diagnosed with either heart attack and/or angina pectoris while 4830 had a family risk for such disease due to close family members diagnosed with such disease.
CAM use (CAM provider, OTC CAM products and/or CAM techniques) was found in 30.2% of the participants diagnosed with CHD and 35.8% of the participants with family risk of CHD (p < 0.001). Self-rated health, expectations for future health, preventive health beliefs and health behaviour were significant predictors of CAM use for those at risk of CHD. In the CHD patient group only health behaviour and self-rated health were significantly associated with CAM use.
Risk for CHD disease seems to be a stronger predictor for CAM use than the diagnosis of CHD itself.
P46 Addressing training needs of general practitioners working with cancer patients – trial protocol
Jennifer Engler1, Stefanie Joos2, Corina Güthlin1
1 Institue of General Practice, Goethe University Frankfurt, Frankfurt, 60590, Germany; 2 Department of General Practice, University of Tübingen, Tübingen, Germany
Correspondence: Jennifer Engler
During the years 2012–2015 we collected data on training needs of health care personnel working with cancer patients within the research network KOKON. 70% of general practitioners felt it was important for their work to stay informed about CAM, but only 31% felt safe when talking about CAM options. GPs wished to get more information on a variety of CAM options with homeopathy, mistletoe and mind-body-techniques being of highest interest. In a separate study within KOKON it was shown that not only information on CAM but also the issue of how to communicate CAM options mattered to physicians during their training on CAM. Therefore, we plan to offer blended learning training to GPs (e-learning courses on CAM options, i.e. benefits and potential problems AND communication training). We will show the training and the evaluation concept.
We will conduct an exploratory pilot study with wait-list controlled design in order to study feasibility of the training concept in GPs, but also effects of the training by analyzing real-life communication using vignettes. Roter Interaction Analysis System (RIAS) will be used to evaluate communication training. 15 GPS will be trained first and 15 GPs will be trained after finishing waitlist-control.
The trial protocol will be presented in detail.
Training on CAM options will not suffice unless not incorporated into communication training. We will show an innovative blended-learning concept and an evaluation design explicitly addressing both aspects adequately.
P47 Treatment of patients with digestive disorders with Gentiana Magen Globuli velati (GMGv) – results from a non-interventional study
Jennifer Felenda1, Christiane Beckmann1, Florian Stintzing2
1 Med.-pharm. Information / Klinische Forschung, WALA Heilmittel GmbH, Bad Boll/ Eckwälden, 73087, Germany; 2 Ressortleitung Wissenschaft, WALA Heilmittel GmbH, Bad Boll/ Eckwälden, 73087, Germany
Correspondence: Florian Stintzing
GMGv is an anthroposophical drug used to harmonize the motility and secretion of the gastrointestinal tract, containing Artemisia absinthium, Gentiana lutea, Taraxacum officinale and potentized Strychnos nux-vomica. In Europe the prevalence of unspecific digestive disorders reaches 14% to 25% . According to physicians” expertise, GMGv is an effective medicine, especially for treatment of dyspepsia with the main symptoms digestive weakness, gastric pressure and anorexia .
A national non-interventional study observed 319 adult patients with digestive disorders treated with GMGv. 29 physicians assessed the individual treatment considering diagnostic findings and patients’ preference.
The main aim was to evaluate the application modalities of GMGv: diagnosis, reason of application, duration of therapy and dosage. Secondly, the course of therapy and the patient’s acceptance were monitored.
The intention-to-treat analysis of 292 out of 319 patients (71% females, mean age 47.3 years) showed patients suffering from functional dyspepsia (34%), psychosomatic disorders (21%), colon irritable (13%) and gastroenteritis (9%). The physicians prescribed GMGv to 53% of the patients as single therapy and to 27% because of insufficient efficacy of other drugs, mainly 3×5-10 globules/day for over 22 days. 68% of the patients were cured after completion of the treatment.
Patients’ status of health, evaluated by development of symptoms, global general condition, severity level of the main diagnosis, improved statistically significant.
151 of 195 patients (78%) were satisfied with the treatment and 143 of 165 (87%) would use GMGv again.
GMGv reduce symptoms and the severity level of the main indication, e.g. digestive disorders and improve the global general condition of the patients.
1. Mahadeva S., Goh KL. Epidemiology of functional dyspepsia: a global perspective. World Journal of Gastroenterology, 2006. 12: 2661–2666
2. Felenda J., Beckmann C., Stintzing F., Meyer U. Gentiana Magen Globuli velati in der ärztlichen Praxis- Ergebnisse einer Umfrage. Der Merkurstab, 2012. 65: 465–470
P48 Virtual reality environments for supporting mindfulness based healing of low back pain
Roni Evans1, Gert Bronfort1, Daniel Keefe1, Anna Taberko2, Linda Hanson1, Alex Haley1, Haiwei Ma1, Joseph Jolton2, Lana Yarosh1, Francis Keefe1,3, Jung Nam1
1 University of Minnnesota, Minneapolis, 55455, MN, United States; 2 Minneapolis College of Art and Design, Minneapolis, MN, United States; 3 Duke University, Durham, NC, United States
Correspondence: Roni Evans
Low back pain (LBP) is among the most common and burdensome pain conditions worldwide. Mindfulness based interventions (MBIs) are a promising form of self-management which can help LBP patients develop the skills to self-regulate pain responses. However, similar to other self-management interventions, it can be difficult to motivate participants to engage in MBIs. Virtual Reality (VR) can provide individualized, appealing, and immersive environments that motivate patients to practice mindfulness. Our group is conducting a pilot study. One of the questions it will answer is: Can a multi-sensory VR intervention be designed to facilitate engagement in mindfulness practices in patients with LBP?
A multidisciplinary group of individuals from the fields of mindfulness, psychology, computer science, clinical research, and art and design is using an adapted intervention mapping approach to develop a prototype VR-MBI intervention. A total of 10 participants with chronic, mechanical LBP will use the VR-MBI for 8 weeks. Self-report outcomes (e.g. pain, disability, fear-avoidance, mindfulness, medication use) will be measured pre- and post- intervention; engagement in VR-MBI will be measured via diary and satisfaction, barriers, and facilitators will be assessed through qualitative interviews.
A series of iterative design prototypes including imagery, narration, 3D models, and user interface techniques has been created to explore options for the VR environment that can best support mindfulness practices around pain. Special attention has been given to color, forms, and visual texture to align with the pain narrative, mindfulness exercises, and target outcomes. Patient enrollment and data collection will be completed by 2017.
As VR becomes increasingly affordable and available, it could become a very practical and engaging home-based self-management intervention for patients with persistent pain and other chronic conditions.
P49 Understanding facilitators and barriers to compassionate technology
Roni Evans1, Liwanag Ojala2, Mary J Kreitzer1, Linda Hanson1
1 University of Minnesota, Minneapolis, 55455, MN, United States; 2 Caring Bridge, Minneapolis, MN, United States
Correspondence: Roni Evans
Established in 1997, CaringBridge is a web-based social network serving over 500,000 people daily and over 43 million people annually in over 230 countries. By using personal, protected websites for communities to share, connect, and rally support for people navigating challenging health journeys, CaringBridge sites offer a space for compassion, the natural emotional response to suffering and authentic desire to help. Our overall objective is to use technology to enhance social connectedness, and bring people together to help overcome the isolation that comes with illness. One of our questions examines What are the key characteristics, facilitators, and barriers of compassionate technology that can inform future optimization of web based social networks?
As part of a larger multi-phase project addressing the range of stakeholders, we conducted an electronic qualitative survey using Qualtrics. This survey was sent to CaringBridge staff and leadership and queried individuals regarding their perceptions of why people use CaringBridge, barriers to engagement, and unique characteristics of the CaringBridge experience and platform. Content analysis of text responses was performed to identify major themes.
A total of 38/62 (62%) individuals affiliated with CaringBridge responded to the survey. Eight individuals each identified themselves as having used CaringBridge themselves as a patient (21%) or a caregiver (21%); 84% also identified as active visitors. Perceived motivators to using CaringBridge included ease of communication and the opportunity to see and feel much needed social support. Potential barriers to using CaringBridge included discomfort with technology, privacy concerns, a lack of awareness or understanding the goals of the site, and not knowing how to participate or what to say. Among the unique features mentioned was the journal component, where patient authors share their thoughts and emotions, and be vulnerable in a safe space, cultivating a powerful sense of community and shared experience.
As expressed by key stakeholders, compassionate technology sites, like CaringBridge, can meet important social needs associated with serious illness. Through identification of facilitators and barriers, implementation and accessibility of this potentially impactful social networking resource can be optimized for greater reach.
P50 Althaea officinalis cough preparations: Data from two independent consumer surveys underlining efficacy and tolerability for the treatment of irritative cough
Careen Fink1, Karin Kraft2
1 Phytomedicines Supply and Development Center, Innovation & Development, Bayer Consumer Health Steigerwald Arzneimittelwerk GmbH, Darmstadt, 68526, Germany; 2 University Medicine of Rostock, Rostock, 18055, Germany
Correspondence: Careen Fink
Cough preparations containing aqueous Marshmallow root extracts (Althaea officinalis) are well established as medicinal products in Germany. Measuring the consumer experience and satisfaction is the key factor to their understanding. Especially for non-prescribed over-the-counter (OTC) medication, the experiences and needs of consumers are the key resource for information
Material and Methods
Two independent prospective, non-interventional pharmacy surveys were performed in German pharmacies on consumers buying either lozenges (winter season 2014/15) or a syrup (winter 2015/2016) of the aqueous Marshmallow root extract STW42. They were requested to complete a questionnaire on the course of cough symptoms, onset of effect, global assessment of efficacy, and tolerability during a 7 days treatment.
These two prospective, non-interventional pharmacy surveys focussed on creating a better understanding of the patient’s impression of the efficacy, tolerability and satisfaction. A total of 822 questionnaires (syrup: n = 516, lozenges n = 306) consumers were evaluated. The median duration for recovery from symptoms was five days. Relief of oral or pharyngeal irritation and associated dry cough started within 10 min after application in >58% of the consumer, efficacy was rated at least as good by >83%.
The studies confirmed a good efficacy for the symptomatic treatment of oral or pharyngeal irritation and associated dry cough with a very quick onset of action: in the majority of cases the effect was stated within 10 minutes or less.
The surveys justify the long-standing use of Marshmallow preparations in cough treatment, and confirm the excellent tolerability of corresponding preparations.
P51 The RUTI trial: a multi-centred, 16 week, randomised, double blind, placebo controlled feasibility study of Chinese herbal medicine (CHM) for women with Recurrent Urinary Tract Infections (RUTIs)
Andrew Flower1, George Lewith1, Kim Harman1, Beth Stuart1, Felicity L Bishop2
1 Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom; 2 Psychology, University of Southampton, Southampton, United Kingdom
Correspondence: Andrew Flower
Recurrent urinary tract infections (RUTIs) are an unpleasant, disabling and expensive condition affecting an estimated 3–4% of adult women. Usual treatment involves long-term antibiotics. The growing threat of antimicrobial resistance has resulted in an interest in herbal alternatives to antibiotics. Chinese herbal medicine (CHM) may be a useful treatment for RUTIs. This trial explores the feasibility of CHM for RUTIs in UK primary care with particular reference to (1) obtaining UK regulatory approval for CHM as a Clinical Trial of an Investigational Medicinal Product (CTIMP); (2) comparing the effect sizes of individualised CHM, standardised CHM and placebo treatments; (3) investigating the feasibility and acceptability of administering CHM in UK GP practices; (4) exploring the impact of different therapeutic environments on contextual treatment effects.
16 week, multi-site, double blinded, randomized, placebo controlled, mixed methods, pilot/feasibility trial, involving up to 80 women aged between 18–65 designed to compare standardized CHM remedies administered via GP practices, with individualized CHM formulae administered by an experienced TCM practitioner. Feasibility outcomes include the viability of developing, implementing and evaluating a CHM intervention within UK primary care with respect to recruitment, referral patterns, patient compliance, the use of a herbal placebo, and drop out rates. Quantitative outcomes included changes in the duration, severity and recurrence of acute UTI. Qualitative outcomes will explore the experience of patients and practice nurses during the delivery of CHM.
After a protracted process MHRA and NHS regulatory approval was obtained for the first Clinical Trial of an Investigational Medicinal Product (CTIMP) of CHM in the UK. In total so far 41 primary care sites have participated in the identification of recruits in the individualised arm recruiting 21 women; and 18 sites have been set up (with 6 active) in the standardised arm recruiting 15 women.
We have shown it is feasible to conduct a CTIMP trial in the UK and to recruit via NHS primary care sites. Important lessons have already been learned that could inform a more definitive future trial. A full quantitative and qualitative analysis of the final data will be available in March 2017.
P52 Consultations with complementary medicine practitioners and childhood vaccine uptake: is there cause for concern
Faculty of Health, University of Technology Sydney, Sydney, 2007, Australia
Is there an association between complementary medicine (CM) use and vaccine uptake in Australian children? Data from the US and Canada demonstrates that parents who use CM are more likely to delay or forgo vaccination, however this association has not been examined in an Australian paediatric population.
An online survey (n = 149) was carried out to determine parent’s attitudes and decision-making regarding their children’s health care needs, including vaccination.
A total of 73.8% of children had visited a complementary medicine (CM) practitioner (48.3%) or used a CM product (68.5%) in the previous 12 months. Many children had also consulted a general practitioner (89.9%), community health nurse (31.29%), paediatrician (30.3%), and other medical specialist (38.8%). Children had also visited a naturopath/herbalist (30.4%), chiropractor (18.4%), homeopath (11.6%), nutritionist (6.8%) or traditional Chinese medicine practitioner (8.2%) and 52% of parents did not disclose the use of CM to their primary health care physician. A high number of children (35.6%) were not vaccinated with safety concerns being the most common reason (76.6%). Visits to a CM practitioner (OR 0.16; CI 0.07, 0.36; p < 0.001) and the use of CM products (OR 0.25; CI 0.09, 0.64; p = 0.004) were more likely if childhood vaccinations were not up to date.
Poor vaccination uptake is associated with the use of CM in this sample and nationally representative studies are needed to confirm these findings. Research is also needed to determine if these associations are due to CM practitioner attitudes to vaccination or parental health beliefs.
P53 The effects of modulated electro-hyperthermia on hepatocellular carcinoma in vitro and in vivo models
Lilla Füleki, Eva Kiss, Tamas Vancsik, Tibor Krenacs
1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, 1085, Hungary
Correspondence: Lilla Füleki
Modulated electro-hyperthermia (mEHT) is an integrative approach to chemo- and radiotherapy. Electromagnetic field and the concomitant heat (<42 °C) can target malignancies due to their elevated ion-concentration (Warburg-effect) and electric conductivity. We tested the effects of mEHT on a hepatocellular carcinoma cell line (HepG2) in vitro and in vivo.
HepG2 culture was treated in vitro three times for 60 minutes (42 °C) during two days. Heat-stress was measured by western blot for Hsp70. Cells were counted for viability in Bürker-chamber using resazurin assay. Tumor cell proliferation was assessed using Ki67 immunocytochemistry. Flow cytometry for annexin-V/propidium iodide (PI) was used to determine the apoptotic per necrotic rates. HepG2 xenografts in SCID mice were treated with mEHT for 30 minutes. Formalin-fixed, paraffin.embedded tumors were tested 24 and 96 hours after treatment using hematoxillin-eosin based morphometry and immunhistochemistry to identify proliferating (Ki67) and apoptotic (cleaved caspase-3) cell fractions.
mEHT treatment in vitro resulted in a significant destruction and loss of tumor cells. Elevated release of stress-associated Hsp70 was also observed. Annexin-V/PI measurements confirmed elevated apoptotic cell death rate. Directly after mEHT treatment there was a transitional elevation of resazurin uptake in tumor cells which later decreased to the control level. This phenomenon could be a residual effect on enzyme activity after the thermal impact. The proliferation of the tumor cells was reduced based on the Ki67 assessment. In vivo, mEHT treatment induced caspase-3-mediated tumor-destruction and reduced tumor cell proliferation. Further studies are under way to clarify the mechanism of action of mEHT on HEPG2 cells.
P54 Preliminary findings from an active surveillance reporting system among spinal manipulative therapy providers
Martha Funabashi1, Katherine A Pohlman1,2, Silvano Mior3, Haymo Thiel4, Michael D Hill5, David J Cassidy6, Michael Westaway5, Jerome Yager1, Eric Hurwitz7, Gregory N Kawchuk1, Maeve O’Beirne5, Sunita Vohra1
1 University of Alberta, Edmonton, Canada; 2 Parker University, Dallas, TX, United States; 3 Canadian Memorial Chiropractic College, Toronto, Canada; 4 Anglo-European College of Chiropractic, Bournemouth, United Kingdom; 5 University of Calgary, Calgary, Canada, ; 6 University of Toronto, Toronto, Canada; 7 University of Hawaii at Manoa, Honolulu, Hawai’I, United States
Correspondence: Martha Funabashi (firstname.lastname@example.org)
Patient safety is one of the leading healthcare challenges globally. The aim of this study was to evaluate initial findings from an active surveillance reporting system to identify adverse events (AEs) following spinal manipulative therapy (SMT).
Chiropractors and physiotherapists were recruited for this study. Chiropractors were asked to collect data from 100 consecutive, unique patients and physiotherapists from 50. Data collected included relevant health history, medication list, treatment provided (including SMT), and symptoms before and immediately after SMT. Patients were also asked to describe symptom changes up to one week after the treatment. Any worsened or new symptom following SMT was considered an AE.
To date, 4 chiropractors and 2 physiotherapists collected data from 500 patients with 299 patients providing post-treatment data 4.4 days after treatment (average, range: 0–29 days). The most common reason for care was low back pain (24.2%) then neck pain (21.2%). On an 11-point scale, patients reported an average decrease of 0.88 points after treatment. For pre-existing symptoms, 48.3% of patients reported symptom improvement, 47.4% no change in symptoms, and 4.3% reported worsened symptoms. Eighteen patients (3.6%) reported a total of 50 new symptoms after SMT of which 37 were rated as mild, 10 moderate and 3 severe.
Although a small percentage of patients reported new or aggravated symptoms, most reported symptom improvement after care. Further investigations are recommended, however, to determine if these new/aggravated symptoms are related to care or reflect the natural history of the presenting conditions.
P55 Scientific production on the efficacy of osteopathy: a bibliometric analysis from 1980 to 2015
Isabelle Gaboury, Chantal Morin
Family Medicine, Universite de Sherbrooke, Sherbrooke, J1H 5N4, Canada
Correspondence: Isabelle Gaboury
In the last two decades, osteopathy has gained interest among the general population as well as among the scientific community. To better understanding publishing on this topic, we conducted a bibliometric analysis to describe the scientific production of empirical studies on osteopathic interventions, analyze its trends, and identify research gaps.
Articles published between 1980 and 2015 were retrieved from Medline and CINAHL. Keywords used to identify the articles of interest were a combination of osteopath*, manipulation, and treatment or synonyms as well as a list of manual techniques used by osteopaths and terms referring to empirical study designs. Three rounds of reviews were conducted (reviewing titles, abstracts, and full articles) to determine eligibility for inclusion of articles. Bibliometric indicators, such as scientific productivity, research design, and treated conditions were extracted.
3103 articles were retrieved by the literature search, and 426 were considered in the analysis. Scientific production is following an increasing trend, with the number of publications doubling every 5 years. 111 journals published empirical results of osteopathic interventions, with four of the top five journals (representing almost 2/3 of the articles) dedicated to an osteopathic readership. Most popular research designs are randomized controlled trial (37%), followed by case study (26%). Neck, thoracic and low back pain (20%) and visceral-related issues (18%) were the most often treated conditions.
This study identifies trends and gaps that could contribute to the development of rigorous studies evaluating the efficacy of osteopathic interventions. Dissemination strategies are relatively limited to the community of osteopaths.
P56 Meta-analysis of clinical trials in homeopathy: anything left to learn? – protocol for a new approach
Katharina Gaertner1, Loredana Torchetti1, Martin Frei-Erb1, Michael Kundi2, Michael Frass3
1 Institute for Complementary Medicine, University of Bern, Bern, 3008, Switzerland; 2 Institute of Environmental Health, Medical University of Vienna, Vienna, 1090, Austria; 3 Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, 1090, Austria
Correspondence: Katharina Gaertner
A systematic review with meta-analyses of the various homeopathic interventions and their effects in specific pathologies is outstanding.
The study protocol provides a new methodological bottom-up approach, including grey literature and observational studies, the assessment of study quality regarding internal, external and model validity as well as a refinement of the overall analysis by gradual detection of differences by means of subgroup and sensitivity analyses. Available studies are allocated into three meta-analyses that try to identify: Clinical effects of homeopathic medicines (HOM) in randomized controlled trials (RCT), in observational studies (OS) and in preventive use; each compared to placebo or to conventional treatment in 9 pathology-based subgroups. An initial set of 535 Studies has been reviewed and screened for inclusion. 1,216 master theses have been identified as suitable for further evaluation. A second literature search, especially for the years 2013–2015, is ongoing.
380 studies were included for further data-extraction. 72.5% of the included studies use RCT, 27.5% OS techniques. The studies, which apply HOM for preventive purpose (19.6%) will be analyzed separately. In the study-set of therapeutic use, the investigations of individualized and complex homeopathy count around 35%, clinical homeopathy approximately 25%, and isopathy 5%. In one third of studies the comparator is standard therapy, in two thirds placebo.
Investigating clinical studies of HOM with meta-analytical means by subgrouping of homeopathic methods, study designs and pathologies may contribute to a better understanding of the clinical effects of HOM and may open new perspectives for homeopathic research.
P57 SENeCA Study: observational study on the effect of medicinal cannabis on quality of life and nutritional outcomes
Eugenia Gallo1,2,3, Valentina Maggini1,2,3, Mattia Comite2,3, Francesco Sofi1, Sonia Baccetti4, Alfredo Vannacci1, Mariella Di Stefano4, Maria V Monechi4, Luigi Gori2,3, Elio Rossi4, Fabio Firenzuoli2,3,4, Rocco D Mediati5, Giovanna Ballerini5
1 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 2 Center for Integrative Medicine, Careggi Universtary Hospital, Florence, Italy; 3 Referring Centre for Phytoterapy, Region Tuscany, Florence, Italy; 4 Tuscan Network of Integrative Medicine, Region of Tuscany, Florence, Italy; 5 Cure Palliative e Terapia Del Dolore, Careggi Universitary Hospital, Florence, Italy
Correspondence: Eugenia Gallo
The Tuscany Health System offers the medicinal use of Cannabis especially for the treatment of oncologic or neuropathic chronic pain, resistant to conventional therapy. Our Centre has promoted this retrospective study to evaluate the efficacy and safety profile of Cannabis. In particular, the effects on pain, quality of life (QoL), anxiety, nausea, fatigue, and nutritional assessment of the patients will be taken into account.
Hospital Pharmacy has prepared Cannabis flos (19% THC) dispensed for decoction or as an oil extract. A total of 40 patients (32.5% male/ 67.5% females), age mean di 57,10 who had taken cannabis for 250 days was observed. Clinical data, QoL, lifestyle, drugs use and adverse effects were assessed by administering an appropriate questionnaire to the patients treated with cannabis.
All 40 patients (mean age 57,1 ± 13,6 years) have been included in the study. Seventy percent of the oncologic and neurologic patients has received Cannabis for pain relief. Pain symptoms are improved in the 60% of subjects in 10–15 days. QoL is improved in the 50% of patients, in particular for mood and sleep; the abdominal swelling is reduced in the 41% of subjects. Seventy-one percent of patients with nausea is improved, with an increase in weight in 45% of the cases. Adverse effects are reported for the 27% of the patients.
Preliminary results of study suggest that Cannabis treatment in patients with conventional treatment-resistant chronic pain may result in improved pain, QoL and appetite as well as reduced opioids and NSAIDs use.
P58 Lessons learned during the Integrative Medical Group Visits (IMGV): randomized controlled trial for recruiting low-income racial/ ethnic minority research study participants
Paula Gardiner1,2, Anna S Lestoquoy1, Lily Negash1, Sarah Stillman1, Prachi Shah1, Jane Liebschutz1,2, Pamela Adelstein3, Christine Farrell-Riley3, Ivy Brackup4, Brian Penti1, Robert Saper1,2
1 Family Medicine, Boston University Medical Center, Boston, 02118, MA, United States; 2 Boston University School of Medicine, Boston, MA, United States; 3 Codman Square Health Center, Dorchester, MA, United States; 4 Dothouse Health Center, Dorchester, MA, United States
Correspondence: Anna S Lestoquoy
Integrative Medical Group Visits (IMGV) are an innovative program for delivering chronic pain and depression care. This randomized control trial compares the IMGV model to primary care appointments across three inner city clinics in Boston. Our participants largely identify as racial/ ethnic minorities, a historically challenging population for research recruitment. This poster will share our methods and strategies in overcoming barriers related to recruitment of this patient population.
Participants were recruited through provider referral, warm handoffs (face to face encounters with a research assistant during a clinical session), targeted letters or self-referred after seeing flyers or other study recruitment related materials. Trained research assistants either contacted or were contacted by patients for screening and consenting procedures.
A total of 331 patients were consented and screened for inclusion in the study, and 154 enrolled. Seventeen percent of those screened were male; fifty-nine percent identified as Black; with the site specific demographics similar to each site’s patient population. Over the course of the study, in order to ensure a representative sample we changed our recruitment methods to enroll a greater number of male participants. Different patients responded to different recruitment methods, with older patients responding largely to targeted letters and younger patients responding to self-referral and provider referral (p = 0.0003, α = 0.05). The most common reasons for declining participation was not being interested in groups or having scheduling conflicts with the group schedule.
Different populations of patients respond to different forms of recruitment. Our varied approaches resulted in successfully recruiting our target number of participants.
P59 Acupuncture as a complementary technique in assisted reproduction patients in an integrative way: the results from 6 years’ experience
Isabel Giralt Sampedro1,2, Gilda Carvajal1
1 ENERGIMED, Barcelona, 08007, Spain; 2 Ginecology, Obstetrics and Reproduction, Hospital Universitari Quiron Dexeus, Barcelona, Spain
Correspondence: Isabel Giralt Sampedro
We would like to present our work in the Clinic “Salut de la Dona Dexeus” in Barcelona over more than 6 years using Acupuncture as a complementary treatment during IVF. Our experience is an Integrative Medicine experience as we are working in a cooperation way in the Fertility Department of this Gynecology Clinic.
Treatments such as In vitro Fertilization (IVF) have always been associated with high monetary costs, anxiety and secondary effects. Because of this, there is a demand to increase success rates while lowering the overall costs. Previous studies on the application of acupuncture with IVF have showed positive effects on pregnancy rates. The combination of these techniques in an Integrative form could be a possible solution for increasing benefits and lowering costs.
In our study 135 women were undergoing IVF accepted Acupuncture treatment during the application. Acupuncture was applied twice before oocyte extraction and in an immediately after embryo transfer or at list within a 24 hour time frame. We compared the results of the Acupuncture group with the results of the IVF performances without Acupuncture.
In our Acupuncture treatments we use some standard points and some other individual points related to the energetic woman disease according to an individualized medicine.
We are currently waiting on the complete study results from our clinic. However there are some results from our preliminary study from which some suggestions can be made: Acupuncture is very useful especially when we apply in women who receive a frozen embryo transfer with a 57% positive response while the global clinical rates in our Clinic are39 % . Results in the Acupuncture group for direct IVF ( embryo fresh ) are not presenting so significant differences.
In our speech we will explain points and techniques in our Acupuncture treatments and how it was combined with the conventional treatments in an Integrative way. We will update the results with new cases because we will continuous working in this issue until the Congress.
P60 Identifiability of components of complex interventions
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, 1090, Austria
During the last years interventions in complementary and alternative medicine (CAM) were increasingly viewed as complex interventions. The ‘active ingredients’, i.e. the intervention’s multiple components, were classified as specific or non-specific, characteristic or incidental, and their possible interactions were discussed. Various trials were conducted in, e.g., homeopathy or acupuncture to shed some light on the importance of these components.
Many of these CAMstudies exhibit the structure of factorial designs. In this class of designs all possible combinations of the levels of two or more treatments occur together. In this talk, complex interventions are viewed as factorial combinations of their components.
The application of well-known concepts from experimental design helps to recognize which components or sums or interactions of components are identifiable within a given study design. The question of identifiability, i.e. unique estimability of the components effects from the observed data, arises particularly if some combinations are not or cannot be observed (e.g. individualized homeopathic prescription without consultation). Furthermore, it will be demonstrated, using study designs from published CAM studies, that the factorial design view enables a clear and correct interpretation of the studied components.
In conclusion, some recommendations are given concerning the design and analysis of complex intervention studies. Multi-component intervention studies should be designed in such a way that the effects of interest are identifiable and can thus be uniquely estimated from empirical data once the study has been conducted.
P61 Spicing up warming compresses – the influence of ginger on the perception of warmth and relaxation through warming compresses
Marie M Gross, Dorothea Brendlin, Jonas Röttger, Wiebke Stritter, Georg Seifert
AG für Integrative Medizin in der Pädiatrischen Onkologie, Charité Universitätsmedizin, Berlin, 13353, Germany
Though external ginger applications such as warming compresses are commonly used in anthroposophical care, practice and clinical application are mainly based on experience. There is little empirical data on their effect. The aim of this study was to separate factors such as quietness, attentiveness and external thermal application from the effectiveness of ginger powder itself.
In a controlled study design we applied different compresses to healthy adults, adding another factor with every application. Physiological and psychometric data was collected and we conducted phenomenological interviews, which were analyzed according to thematic analysis. Here we focused on reported sensation of warmth and relaxation.
In comparison to the hot-water compress, the ginger compress had less influence on temperature perception, and this influence was more diverse. During the application warmth developed differently. A second thermal peak was described after moments of chillness, especially during the resting period with the ginger compress, giving a sensation of burning sun.
While participants felt more relaxed, balanced and reported a greater peace of mind after the ginger compress, they experienced an impulse to move, wandering thoughts and a feeling of agitation especially in the resting period during the hot-water compress.
The ginger powder seemed to have an impact on the participants perception of temperature, influencing especially the thermal development. Referring to relaxation the ginger powder might have an additional calming influence compared to the hot-water compress.
P62 Relevance and acceptance of naturopathic and complementary medicine in women suffering from endometriosis
Noelle Grzanna1, Rainer Stange2, Peter W Guendling1
1 Complementary Medicine, Hochschule Fresenius, München, 80798, Germany; 2 Naturheilkunde, Immanuel-Krankenhaus, Berlin, 14109, Germany
Correspondence: Noelle Grzanna
Endometriosis describes a gynaecological disease that should be regarded as chronic relapsing. It occurs in women of childbearing age. Characteristic of this disease is the appearance of cell aggregates like the endometrium outside their eutopic localization in the uterine cavity. The current estimated prevalence is about 10–15%. In which about 40% of affected women have endometriosis requiring therapy.
The cardinal symptoms of endometriosis are secondary dysmenorrhea, pelvic pain and dyspareunia, the clinical picture is dominated by the localization of endometriosis lesions.
Survey of the relevance and acceptance of naturopathic and complementary procedures (CAM) with women who are affected by endometriosis.
An anonymous cross-sectional survey with women who have had a secured endometriosis diagnosis. Patients answered a comprehensive questionnaire of 40 questions, either in paper format or as an online version. The questionnaires were distributed in paper format over 14 doctors’ offices and clinics across Germany to potential study participants. The link to the online version of the questionnaire was passed on to women in endometriosis support groups, patients organizations and women’s health centres. The data were subjected to descriptive statistical analysis.
133 patients answered the questions. 86.2% of them had already applied one or more naturopathic and / or complementary procedures for the treatment of endometriosis. Where 77.2% applying subjectively as ‘very important’ rated. Dissatisfaction with the conventional endometriosis treatment moved 61.5% of women to apply naturopathic and / or complementary procedures. Next led the symptoms of endometriosis (53.8%) and infertility (46.9%) for this process selection. TCM (51.1%), acupuncture (60.3%) and SART (40.8%), which contains these therapies were used most frequently. Homeopathy (52.7%) and osteopathy (40.5%) were often used as well. 91.8% of women described an improvement in their symptoms and quality of life through the use of CAM.
Patients of endometriosis seem to benefit significantly from the use of naturopathic and complementary procedures. Randomised controlled studies to further investigate the effectiveness of naturopathic and complementary procedures are highly warranted.
P63 Effects of the Qinlingye extraction on PGC-1a and related inflammatory factors in vitro
Wen Gu1, Yan Lu2, Jie Wang3, Chengcheng Zhang4, Hua Bai5, Yuxi He3, Xiaoxu Zhang3, Zhengju Zhang3, Dali Wang3, Fengxian Meng3
1 Beijing Hospital of Traditional Chinese Medicine , Rheumatism, Beijing, China; 2 Xiyuan Hospital, Emergency Department, Beijing, China; 3 Dongfang Hospital, Beijing University of Chinese Medicine, Rheumatism, Beijing, China; 4 Dongfang Hospital, Beijing University of Chinese Medicine, Nephrology, Beijing, China; 5 Xiluoyuan Community Health Service Centre, Rehabilitation Department, Beijing, China
Correspondence: Fengxian Meng (email@example.com)
To study the effect of Qinlingye extraction (QLYE) on PGC-1a, IL-18 and IL-1β in vitro, and to explore the mechanism of inhibiting immune inflammatory injury from hyperuricemic nephropathy.
Human renal tubular epithelial cells (HKC) and macrophage cells in mice (RAW264.7) were cultured respectively. HKC cells were induced by uric acid (UA) in the model group. While stimulated by UA, the administered groups were intervened by high-, middle- and low-dose of QLYE. After 24, 36 and 48 hours intervention, the total RNA and protein were extracted, and the mRNA transcription and protein expression of PGC-1a were detected. RAW264.7 cells were induced by lipopolysaccharide (LPS) in the model group. While stimulated by LPS, the administered groups were intervened by high-, middle- and low-dose of QLYE. After 24, 36 and 48 hours intervention, the total RNA and protein were extracted, and the mRNA transcription and protein expression of IL-18 and IL-1β were detected.
(1)HKC cell experiments: In the model groups, the PGC-1a gene expression level was down-regulated at 24th hour, and the significant reduction of PGC-1a protein content were observed at both the 36th and 48th hour. Compared with the model groups, the PGC-1a gene expression level were upregulated in the medium- and high- dosage group at the 36th and 48th hour respectively. At the 36th hour the PGC-1a protein content were elevated in all three herbal groups and at the 48th hour, the PGC-1a protein content were elevated in both medium- and lower- dosage groups respectively. (2)RAW264.7 cell experiments: In the model groups, the IL-1β gene expression level was up-regulated at the 6th hour, the IL-1β and IL-18 gene expression level were up-regulated at the 12th hour. The significant increase of PGC-1a protein content were observed at 6th, 12th and 24th hour. Compared with the model group, the IL-1β gene expression level were down-regulated in the high- dosage group at the 6th hour, the IL-18 gene expression level in high- dosage group and the IL-1β gene expression level in high- and low- dosage groups were all down- regulated at the 12th hour. The IL-18、IL-1β protein content were down-regulated in all three administered groups at the 6th, 12th and 24th hour.
The mechanism how Qinlingye extraction inhibit immune inflammatory injury from hyperuricemic nephropathy may be associated with the upregulation of PGC-1a and the inhibition of its related inflammatory factors——IL-18, IL-1β.
P64 Plasma concentrations of ascorbic acid in a cross section of the German population
Alexander Hagel1, Heinz Albrecht1, Claudia Vollbracht2, Wolfgang Dauth3, Wolfgang Hagel 4, Francesco Vitali1, Ingo Ganzleben1, Hans Schultis5, Peter Konturek6, Jürgen Stein7, Markus Neurath1, Martin Raithel1
1 University of Erlangen, Erlangen, 91054, Germany; 2 Pascoe Naturmedizin, Gießen, 35394, Germany; 3 Institute of Employment Research, Nuremberg, Germany; 4 Martha Maria, Nuremberg, Germany; 5 Synlab, Weiden, Germany; 6 Thuringia Clinic, Saalfeld, Germany; 7 Department of Nutritional Medicine, Sachsenhausen , Germany
Correspondence: Heinz Albrecht; Claudia Vollbracht
In modern industrialized countries, vitamin C deficiency is commonly conceived to be extremely rare. The aim of the present study was to assess vitamin C levels in the German population.
As part of a consultant-patient seminar on nutrition and food intolerances, patients were asked to participate in the study on a voluntary basis. Blood samples were taken for analysis of serum vitamin C and patients were asked to complete a questionnaire. Vitamin C levels were determined by high performance liquid chromatography.
Of approximately 300 patients attending the seminar, 188 (62.6%) consented to blood sample analysis for vitamin C and 178 (59.3%) answered the questionnaire. Mean vitamin C level was 7.98 mg/L (range 0.5–17.4; reference value 5–15 mg/L). Low plasma levels with risk of vitamin C deficiency (<5 mg/L) was found in 31 (17.4%), and a potential scorbutogenic deficiency (<1.5 mg/L) in 6 subjects (3.3%). Body mass index correlated inversely with vitamin C levels.
In accordance with older studies, potential vitamin C deficiency was found to be common. A high BMI was associated with reduced vitamin C levels, particularly in older females. It is therefore possible, even in modern developed populations, that certain individuals may require a higher intake of vitamin C.
P65 Intravenous vitamin C in the treatment of allergies: an interim subgroup analysis of a long-term observational study
Alexander Hagel1, Claudia Vollbracht2, Martin Raithel1, Peter Konturek3, Bianka Krick2
1 University of Erlangen, Erlangen, 91054, Germany; 2 Pascoe Naturmedizin, Gießen, 35394, Germany; 3 Thuringia Clinic, Saalfeld, Germany
Correspondence: Alexander Hagel
Oxidative stress in allergic diseases appears to play not only a key factor in the pathogenesis of the disease but also represents a promising therapeutic target. Allergic diseases have been reported as being associated with reduced plasma ascorbate levels, which is a key physiological antioxidant. Hereby it prevents excessive inflammatory reactions without reducing the defensive function of the immune system.
An interim analysis of a multicentre prospective observational study was conducted to investigate the change in disease-specific and non-specific symptoms (tiredness/fatigue, sleep disorders, depression, lack of concentration) during adjuvant treatment with vitamin C infusions (Pascorbin®) in 71 patients with allergy-related respiratory or cutaneous indications. Symptoms atbaseline/visit 1 vs.end of observation period were compared. Change in sum scores of the 3 most prominent disease-specific symptoms and the 4non-specific symptoms were calculated.
The mean sum score (0–9) of the disease-specific symptoms decreased significantly by 4.71 points between start (5.9) and end (1.2) of treatment (p
Our descriptive statistical data suggests that a treatment with intravenous high-dose vitamin C reduces allergy-related symptoms. This observational study provides information on allergy-related vitamin C deficiency, effective vitamin C dosages and relevant outcomes for conducting a controlled clinical study with more definitive, clinically-relevant endpoints.
Trial registration: Clinical Trials NCT02422901
P66 Mindfulness-based stress reduction for women with breast cancer: an updated systematic review and meta-analysis
Heidemarie Haller1, Petra Klose1, Gustav Dobos1, Sherko Kümmel2, Holger Cramer1
1 Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, 45276, Germany; 2 Breast Unit, Kliniken Essen-Mitte, Essen, Germany
Correspondence: Heidemarie Haller
The aim of this meta-analysis was to systematically update the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer.
Medline/PubMed, Scopus and Central were searched through October 2016 for randomized controlled trials (RCTs) assessing the effects of MBSR/MBCT in adult women with breast cancer. Primary outcomes were quality of life, fatigue and sleep. Stress, depression, anxiety and safety were secondary outcomes. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Risk of bias was assessed using the Cochrane risk of bias tool.
Literature search revealed 15 articles on 11 studies including 1772 participants. Overall risk of bias was at least unclear, except for low attrition and low other bias. Compared to usual care, significant short-term effects of MBSR / MBCT were found for quality of life (SMD = 0.21; 95%CI = [0.04│0.39]), fatigue (SMD = -0.28; 95%CI = [−0.43│−0.14]), sleep (SMD = −0.23; 95%CI = [−0.40│−0.05]), stress (SMD = −0.33; 95%CI = [−0.61│−0.05]), anxiety (SMD = −0.28; 95%CI = [−0.39│−0.16]), and depression (SMD = −0.34; 95%CI = [−0.46│−0.21]). Medium-term effects were significant for anxiety (SMD = −0.28; 95%CI = [−0.47│−0.09]) and depression (SMD = −0.26; 95%CI = [−0.47│−0.04]); long term-effects for anxiety (SMD = −0.21; 95%CI = [−0.40│−0.03]). Compared to other active interventions, significant effects were only found for short-term and only for anxiety (SMD = −0.45; 95%CI = [−0.71│−0.18]) and depression (SMD = −0.39; 95%CI = [−0.65│−0.14]). Subgroup analysis revealed no differences between MBSR and MBCT, cancer stages, or women during versus finishing adjuvant treatment. Effects were robust against potential methodological bias. Adverse events were reported insufficiently.
There is promising evidence for short-term effectiveness and safety of MBSR/MBCT in women with breast cancer. However, concerning the small number of available RCTs for medium- and long-term comparisons, more research is needed to draw further conclusions.
P67 Physical and emotional release effects of Neural Therapy: a qualitative analysis of therapeutic mechanisms and health outcomes
Heidemarie Haller1, Felix J. Saha1, Anna Kowoll1, Barbara Ebner1, Bettina Berger2, Gustav Dobos1, Kyung-Eun Choi1
1 Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, 45276, Germany; 2 Department of Health, Institute for Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
Correspondence: Heidemarie Haller
Research on neural therapy is limited and mainly focused on physical outcomes. This study aimed at describing heterogeneous experiences of patients treated with procaine injections.
Maximum variation sampling was used to collect 22 inpatients aged 59.6 ± 14.9 years (81.8% female) undergoing integrative treatment including neural therapy. With 9.4 ± 6.9 diagnoses patients were mostly multi-morbid. Semi-structured interviews were analyzed in MAXQDA using qualitative content analysis.
With injection, patients described anesthetic effects and increased local warmth; sometimes followed by vagotonic responses of weakness or dizziness as well as temporary aggravation of existing symptoms or appearance of new, concealed or phantom symptoms. Thereupon, pain and associated symptoms decreased. Treated areas were perceived as more vivid and reintegrated within the body image. In several cases, injections triggered memories with suppressed emotions. Emotional release was often accompanied by weeping and experienced as initially overwhelming. However, recalled images could be perceived from a distant observer perspective helping patients to reevaluate and reintegrate them into a new emotional context. This led to emotional relief, increased pain acceptance and empowerment. Other patients did not report distinct emotional events, but were surprised at the feelings of happiness, confidence and regained enjoyment of life after treatment. Adverse events included pain due to injection, vegetative complaints and emotional turmoil lasting minutes or hours with a maximum of two days.
Neural therapy suggested promising effects on various chronic symptoms, improved daily functioning and mental quality of life. Further studies on its specific efficacy and safety are needed.
P68 Blinding, easier said than done: experiences from trials of Chinese Herbal Medicine
Lisha He, Han Wang, X. He, C. Gu, Y. Zhang, Linhua Zhao, Xiaolin Tong
Guang’anmen Hospital, China Acadamy of Chinese Medicine Sciences, Beijing, China
Correspondence: Linhua Zhao (firstname.lastname@example.org)
With the development of evidence-based medicine, a number of RCTs had been carried out to confirm the efficacy of Chinese Herbal Medicine (CHM). Blinding is a strategy to control measurement bias in clinical trials. But it has certain challenges in the implementation of blinding in placebo-controlled trial of CHM, especially the placebo presentation, so we had made some efforts on it in several studies.
Staffs who had been involved in the procedure of randomization code generation and concealment or drug blinding will work independent of the data collection and analysis. Both participants and investigators were kept in blinding status to the allocations until the trial was completed. For placebo preparation of CHM decoction, the placebo was prepared by 0.9% of the high-dose group in the trial of GQD treatment of diabetes. For placebo preparation of CHM granules, the placebo was prepared by adding bitters, caramel pigment and additives to ensure the same color, appearance and taste as the treatment drug in another trial of GQD. When the control group was treated with Western Medicine, we applied the double-blind double-dummy method. We prepared both simulation agents for CHM granules and western medicine in a trial of Shenzhuo formula (SZF) treatment of DN.
Blinding had been strictly implemented and followed in several trials of CHM formula. Some strategies and standard operations were proposed.
There are many similarities between trials of CHM and other complementary and alternative medicines. The practical strategies could be shared and inspired by each other.
This study was funded by the Key Project of the National Natural Foundation of China (Grant No: 81430097), and The Innovation Funding for PhD Students at China Academy of Chinese Medical Sciences.
P69 How to administrate placebo to patients with diabetes in RCTs of Chinese Herbal Medicine? Practicable and ethical issues
Lisha He, Han Wang, Xinhui He, Chengjuan Gu, Ying Zhang, Linhua Zhao, Xiaolin Tong
Guang’anmen Hospital, China Acadamy of Chinese Medicine Sciences, Beijing, China
Correspondence: Lisha He
Placebo-controlled design is necessary for evaluation efficacy of interventions. However, it will meet many challenges to administrate placebo in chronic diseases such as diabetes considering routine treatments. Challenges may be more serious in Chinese Herbal Medicine (CHM) researches because of placebo preparation for CHM is quiet difficult, which leads to the deficiency of the implementation of blinding. Maintain patients compliance and relative ethical issues also need to be carefully considered. In our ongoing trial, we made several efforts to make it practicable and ethical.
This study is a randomized, double-blinded, and placebo-controlled clinical trial. 120 diabetes patients were randomly allocated to receive either Gegen Qinlian Decoction (GQD) or placebo for 12 weeks. The HbA1c, FPG, 2hPG, blood lipids, HOMA-IR and HOMA-β were evaluated. The placebo was prepared by adding bitters, caramel pigment and additives to ensure the same color, appearance and taste as the treatment drug. In order to ensure patients compliance, they all received face-to-face lifestyle education, including dietary and exercise education every 4 weeks. A safety assessment will be performed at every 4 weeks to monitor patients’ safety.
This study had been approved by the ethics committee of Guang’anmen hospital (Beijing) before initiation. According to the monitoring data, the overall dropout rate is less than 20%. Most of the adverse reactions are mild, including nausea, flatulence and diarrhea etc.
In order to evaluate efficacy and safety of GQD, good management strategies to patients often plays an important role in the placebo-controlled CHM clinical trials.
This study was funded by the Key Project of the National Natural Foundation of China (Grant No: 81430097), and The Innovation Funding for PhD Students at China Academy of Chinese Medical Sciences.
P70 Sample size calculations: perspectives from investigators of Chinese Herbal Medicine
Lisha He, Han Wang, Xinhui He, Chengjuan Gu, Ying Zhang, Linhua Zhao, Xiaolin Tong
Guang’anmen Hospital, China Acadamy of Chinese Medicine Sciences, Beijing, China
Correspondence: Lisha He
The sample size calculation is to determine the minimum number of observed cases, which ensure the reliability of research conclusions with enough statistical power. The sample size is determined by several aspects including types of study design, central and dispersion tendency of main outcomes, group allocation ratio, dropout and other attrition rate etc. The clinical research of Chinese Herbal Medicine (CHM) has its own characteristics, we made several efforts in our clinical trial.
We conducted a randomized, double-blinded, and placebo-controlled clinical trial to determine the efficiency of Gegen Qinlian Decoction (GQD) on the treatment of diabetes. The sample size was estimated based on results from our preliminary trial. HbA1c was selected as the primary main point which was also the basis of null and alternative hypothesis for statistics. Preliminary study results showed that the mean difference of HbA1c between the GQD group and the placebo group was between 0.6% and 0.8%. According to the previous results, the standard deviation (SD) of the placebo group was calculated to be 1.02%.
Finally, the sample size was estimated to be 50 in each group, with 90% power to detect the 0.66% difference of HbA1c between two groups at the 2-sided significance level of 0.05. Assuming the total attrition rate of 20%, sample size was planned to be 120 totally.
To achieve a well-designed trial, investigators should give more attention to sample size estimation. It may involve many efforts from different roles, including investigators, statisticians, monitors, staffs of data management etc.
This study was funded by the Key Project of the National Natural Foundation of China (Grant No: 81430097), and The Innovation Funding for PhD Students at China Academy of Chinese Medical Sciences.
P71 Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis
Robin ST Ho1, Vincent CH Chung1,2, Xinyin Wu2, Charlene HL Wong2, Justin CY Wu2, Samuel YS Wong1, Alexander YL Lau2, Regina WS Sit1,2, Wendy Wong2
1 Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 852, Hong Kong; 2 Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, 852, Hong Kong
Correspondence: Robin ST Ho
Prokinetics for functional dyspepsia (FD) have relatively higher number needed to treat values. Acupuncture and related therapies could be used as an add-on or alternative. An overview of systematic reviews (SRs) and network meta-analyses (NMA) were performed to evaluate the comparative effectiveness of different acupuncture and related therapies.
We conducted a comprehensive literature search for SRs of randomized controlled trials (RCTs) in eight international and Chinese databases from their inception till November 2015. Methodological quality of included SRs was assessed with the validated AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Instrument. Data from eligible RCTs were extracted for random effect pairwise meta-analyses. NMA was used to explore the most effective form of treatment among acupuncture and related therapies used alone or as an add-on to prokinetics, compared to prokinetics alone.
From five SRs, 22 RCTs (n = 1727) assessing various acupuncture and related therapies were included. Methodological quality of included SRs were mediocre. No serious adverse events were reported. Five pairwise meta-analyses showed that manual acupuncture has marginally stronger effect in alleviating global FD symptoms, as compared to domperidone (6 RCTs) or itopride (3 RCTs). There were no significant differences in the following comparisons: moxibustion versus domperidone (3 RCTs); manual acupuncture plus moxibustion versus domperidone (2 RCTs); and electroacupuncture versus itopride (2 RCTs). Results from NMA showed that the combination of manual acupuncture, moxibustion and clebopride has the highest probability (95.0%) of being the best option for alleviating patient reported global FD symptom. This is followed by the combination of manual acupuncture, moxibustion and domperidone (76.1%), clebopride alone (74.5%), manual acupuncture alone (62.6%) and moxibustion alone (62.3%).
Combination of manual acupuncture, moxibustion and clebopride might be the most effective treatment for FD symptoms. Patients who are contraindicated for prokinetics may use manual acupuncture and moxibustion as an alternative. Future confirmatory comparative effectiveness trials should compare clebopride with domperidone, when used as an add-on to manual acupuncture and moxibustion. The potential synergistic effect of proton pump inhibitor and acupuncture should also be explored.
P72 Exploring breast cancer survivors’ use of the internet to find information on complementary medicine
Michelle Holmes1, Felicity Bishop1, Lynn Calman2
1 Psychology, University of Southampton, Southampton, SO17 1BJ, United Kingdom; 2 Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
Correspondence: Michelle Holmes
Breast cancer survivors often turn to the internet as an information resource as part of the decision-making process to use complementary and alternative medicine (CAM). The objective was to explore breast cancer survivors’ use of the internet when making decisions about CAM use.
A purposive sample of 11 breast cancer survivors (mean age = 56) who had used the internet to find information on CAM completed a quantitative questionnaire and a qualitative telephone interview. The theory of planned behaviour (TPB) was used to guide interview questions. Framework analysis and descriptive statistics were used.
All participants had used some form of CAM after their diagnosis. Themes from the interviews went beyond the standard definitions of the TPB areas. Participants’ cancer diagnosis transformed how they experienced the internet with their perceptions of internet use changing due to their needs as cancer survivors. Despite the lack of approval from their social network and healthcare team surrounding both CAM and internet use, participants used the internet to find information on CAM.
Participants’ use of the internet was more complex than can easily be explained by the TPB and was inherently connected to the experience of self-management for the consequences of cancer and its treatment. Healthcare professionals need to be aware that the information available on the internet plays a role in the decision-making process to use CAM, as breast cancer survivors may not disclose their use of the internet to their healthcare team.
P73 The feasibility of conducting a cluster-randomised trial on patient-reported outcome measures in chiropractic care
Michelle Holmes1, Felicity Bishop1, George Lewith2, Dave Newell3, Jonathan Field4
1 Psychology, University of Southampton, Southampton, SO17 1BJ, United Kingdom; 2 Primary Medical Care, University of Southampton, Southampton, SO16 5ST, United Kingdom; 3 Anglo-European College of Chiropractic, Bournemouth, BH5 2DF, United Kingdom; 4 Back2Health, Southsea, PO4 0DW, United Kingdom
Correspondence: Michelle Holmes
Patient-reported outcome measures (PROMs) are being increasingly utilised in routine clinical practice. The literature indicates PROMs may impact clinically and psychologically on patients, however there is limited evidence to currently support this. The purpose of this study was to explore the feasibility of conducting a cluster-randomised controlled trial on PROMs in chiropractic clinics for low back pain.
This feasibility study used a mixed methods approach, combining a cluster-randomised controlled trial (n = 8 patients, n = 3 chiropractors), audio recordings of treatment sessions, and qualitative interviews with stakeholders who are involved with PROMs – patients, chiropractors and reception staff (n = 18). Thematic analysis and descriptive statistics were used.
55 eligible patients were invited to take part; 46 declined to participate. Of the nine patients registered to take part in the trial, five were lost to follow up. Despite PROMs being routinely used in chiropractic settings, no participants completed the intervention. The qualitative interviews identified improvements for the development of PROMs as an intervention. This included: selecting relevant PROMs, improving patient engagement with PROMs, and educating clinicians over their use.
Patients’ and chiropractors’ views on participating in a trial identified several recommendations on the evaluation of PROMs. The study identified that patients and clinicians need to understand the value of PROMs within the process of patient care. Further development of PROMs as an intervention is also necessary, in the choice, application and timing of PROMs, to ensure PROMs are meaningful to patients and chiropractors and improve engagement.
P74 Use of traditional, complementary and alternative medicine (TCAM) among stroke patients in Yangon, Myanmar
Win L Htut, Dongwoon Han, Da I Choi, Soo J Choi, Ha Y Kim, Jung H Hwang
Global Health and Development, Hanyang University, College of Medicine, Seoul, 133-791, South Korea
Correspondence: Dongwoon Han
Stroke is major public health concern worldwide due to its significant motility and morbidity. Lack of comprehensive rehabilitation care and chronic consequences of stroke, long-term care by using Traditional, Complementary and Alternative Medicine (TCAM), is very common in stroke patients. Stroke patients own sense of severity and functional limitation has been proven to be essential in effective rehabilitation care. However, association between patients self-reported severity and choice of TCAM has not been still documented.
A cross-sectional study was conducted among 310 stroke rehabilitation patients attending outpatient clinics of National Rehabilitation Hospital, Yangon, Myanmar. Data was collected by face-to-face interview with structured questionnaires, containing 35items. Descriptive analysis was done and both univariate and multivariable analysis were used to determine the TCAM use among stroke patients according to their different characteristics.
70.3% of the patients used TCAM for their symptom management (55.96%). The main reason for using these treatments was their belief on integrated treatment (42.66%). Stroke patients self-reported severity as less severe used high TCAM (p < 0.01). Moreover, presence of high blood pressure (p < 0.01), having some problem in walking (p < 0.01), self-care (p < 0.05) and usual activities (p < 0.01), feeling moderate anxiety (p < 0.01) were significantly associated with higher TCAM usage. But patients without self-reported pain used more TCAM (p < 0.01).
Significant proportion of stroke patients is using TCAM because of their belief in the effectiveness of combined treatments. Hence, physicians should be aware of using TCAM and have to understand its potential risk. Furthermore, provide education among their patients.
Keywords: Traditional, complementary and alternative medicines (TCAM), stroke, Myanmar
P75 Differences in the use of traditional medicine between South Korea and Taiwan: a preliminary study
Ching W Huang1,2, Bo H Jang1,2, Fang P Chen3, Seong G Ko1,2
1 Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, 02447, South Korea; 2 Institute of Safety, Efficacy and Effectiveness Evaluation for Korean Medicine, Kyung Hee University, Seoul, South Korea; 3 Taipei Veterans General Hospital, Taipei, Taiwan
Correspondence: Ching W Huang (email@example.com)
As more people realize the important of the traditional medicine, many people are turning to choose traditional medicine (TM) as a primary healthcare treatment. Herein, this study is the first nationwide study which is comparing two countries—South Korea and Taiwan—in terms of the using pattern of traditional medicine.
To compare the TM utilization patterns between South Korea and Taiwan, we used the million sampling data from national health insurance data of each country.
There were 138,119 people in South Korea, and 259,897 in Taiwan were recorded to use traditional medicine service more than one time in 2011. In Korea, women, 40y-60y generation and high income level individuals with the highest frequency to use TM service. In Taiwan, women, 20y-40y generation and middle-high income level is the biggest group to use TM service. The two countries did not have significantly different in terms of either number or season of using TM service. But in South Korea, acupuncture is the most common TM treatment while in Taiwan powdered herbal preparations are most often used treatment in TM system.
Under the different health insurance system, there were some different patterns of TM use between South Korea and Taiwan. We surmise one of the important influences was the different coverage between the national health insurance systems of each country.
P76 Investigation and Analysis on the intention of using traditional Chinese medicine in patients with diabetes
Wenjing Huang, De Jin, Fengmei Lian
Department of Endocrinology, Guang’anmen hospital China Academy of Chinese Medical Sciences, Beijing, 100053, China
Correspondence: Fengmei Lian
Investigate the treatment intention of diabetics, to learn the development of TCM therapy in the field of diabetes, to provide a basis for clinical medical decision-making.
Juneto August 2016,600 questionnaires were sendedto diabetics in Beijing Chao-Yang Hospital (BCYH) and Guang’anmen Hospital of China Academy of Chinese Medical Sciences (CAMH),592 questionnaires were recovery (296 questionnaires each), investigate the intentions and reasons for the choose TCM.
In the questionnaires, there were 279 (47.1%) patients had used TCM treatment, 255 (91.4%) patients of them will continue using, while 72.2% of 255 patients who thought TCM treatment have curative effect (including improving blood glucose and symptoms), 68.6% patients thought good safety (including no side effects and can reduce the side effects of Western medicine); there were 24 (8.6%) patients did not intend to continue using TCM treatment, while 29.2% patients of them thought that inconvenient to take TCM,12.5% patients did not like to drinking. 313 (52.9%) patients never had used TCM treatment, but there were 149 (47.6%) of 313 patients would use TCM treatment in the future, they believed that security of TCM is good and TCM could make them better, 164 (52.4%) of 313 patients stilled did not choose TCM treatment, they thought TCM is not curative effect and safety, they felt inconvenient to take TCM and did not like to drink . In CAMH, there were 213 (76.3%) of 279 patients of had used TCM treatment, while 203 (97.7%) of 213 patients prefered to continue using TCM. There were 172 (91.48%) patients of BCYH in 188 patients who did not intend to use TCM treatment.
Patients’ intention in hospital of TCM and western medicine hospital maybe related to physician’s medical decision-making and treatment-oriented. Through popularize TCM formula granule and improve the taste, to make more diabetics receive TCM treatment.
P77 Attitudes and knowledge on herbal medicine among the Koreans: a cross-sectional survey
Soobin Jang1, Kyeong H Kim1, Eun K Lee1, Seung H Sun2, Ho Y Go3, Youme Ko1, Sunju Park4, Bo H Jang1, Yong C Shin1, Seong G Ko1
1 Kyung Hee University, Seoul, 02447, South Korea; 2 Sangji University Korean Medicine Hospital, Wonju, South Korea; 3 Semyung University, Jecheon, South Korea; 4 Daejeon University, Daejeon, South Korea
Correspondence: Soobin Jang
The global herbal medicines market is growing by 5–15% in every year. However, regulations on herbal medicines of safety are still insufficient and there are many cases that perceptions of general population about herbal medicines are wrong. This study aimed to investigate the opinions about herbal medicines.
The survey was conducted via Macromill Embrain (http://www.embrain.com), which is the online research company. The questionnaire was developed by five traditional Korean medicine experts, and the questions consisted of attitude toward herbal medicine, and knowledge status about herbal medicines. Statistical analyses were performed by IBM SPSS statistics program ver.18.0. The entire process of this survey was approved by Institutional Review Board of Kyung Hee University (IRB No. KHSIRB1-15-039).
Among the total 1,134 participants, 726 (64.0%) responded that they thought herbal medicines is safe and the remaining 408 (36.0%) responded herbal medicines is not safe. The main reasons of their thoughts were uncertainty of origins (342, 82.8% of 408 those who thought that herbal medicines is not safe), anxiety for harmful substances (289, 70.8%), management insufficiency of herbs (235, 57.6%), and adverse events (190, 46.6%). Of the total respondents, only 308 (27.2%) correctly knew that the difference of herbs for medicine and herbs for food.
This survey suggests that proper education to correct misunderstanding on herbal medicines is needed. Also, the results of survey will be basis of establishing national policies on herbal medicines.
Keywords: herbal medicines, survey, safety, attitude, knowledge
P78 Correlations between pulse wave velocity, age, anxiety and depression of cardiologic patients
Hubert Janik1, Natalie Greiffenhagen1, Jürgen Bolte2, Karin Kraft1
1 Complementary Medicine, University of Medicine Rostock, Rostock, 18057, Germany; 2 Strandklinik Boltenhagen, Boltenhagen, Germany
Correspondence: Hubert Janik
It’s known that cardiovascular events and mortality follow to advanced aortic stiffness. High pulse wave velocity (PWV) may provide evidence to aortic stiffness. The aim of this study was to examine correlations between PWV, age and psychometric scores.
PWV of N = 25 male patients (age: 59.2 ± 6.9 years, BMI: 28.2 ± 3.9 kg/m2; mean ± SD) was investigated in addition to the standard procedure in a cardiologic rehabilitation clinic. Absolute arrhythmia, pacemaker, treatment with insulin and acute inflammation are some exclusion criteria. The Mobil-O-Graph (IEM, Stolberg, Germany) is a portable 24 h blood pressure recorder with the ability to calculate PWV by use of curve analysis. The Hospital Anxiety and Depression Scale (HADS-D) comprises the dimensions anxiety (A) and depression (D) with a range from 0 to 21 for each dimension.
Mean PWV was 8.1 ± 1.2 m/s. Mean outputs of the HADS-D were 7.2 ± 3.5 for A and 5.0 ± 3.4 for D. Spearman’s rank correlation coefficients were (A & D) = 0.76, (A & age) = 0.62, (A & PWV) = 0.58, (D & age) = 0.54, (D & PWV) = 0.55 and (age & PWV) = 0.90, p < 0.01 for all specified correlations.
High correlations between age, A, D and PWV indicate that these parameters are important for detection of patients with cardiovascular risk and are relevant for prevention and treatment of cardiovascular diseases.
Informed consent was signed.
P79 Sense of responsibility for the health and anxiety in patients with Irritable Bowel Syndrome in context of selected dietary restrictions
Mariusz Jaworski, Miroslawa Adamus, Aleksandra Dobrzynska
Department of Medical Psychology, Medical University of Warsaw, Warsaw, 02-091, Poland
Correspondence: Mariusz Jaworski
Currently, there is a small percentage of studies which analyse the relationship between sense of responsibility for health, and healthy behaviour. Therefore, purpose of this study was to analyse the correlation between the level of sense of responsibility for the health and level of anxiety on the one hand, and selected dietary restrictions on the other hand, in patients with Irritable Bowel Syndrome (IBS). Currently, in the literature review, there is no study about this problem.
Cross-sectional study involving 60 patients with Irritable Bowel Syndrome was carried out. In this study, Information about sociodemographic variables, and standardised measure of psychological variables were collected. The level of sense of responsibility for the health was measured using The Sense of Responsibility for Health Scale (HSRS), but level of anxiety by using The State-Trait Anxiety Inventory (STAI). For calculations there was used the statistical package SPSS version 21.
The level of anxiety has a negative correlation with the global level of Sense of Responsibility for Health (HSR), and its two dimensions: Active Involvement (HSR-AI), and Adequate Behaviour (HSR-AB). Moreover, Sense of Responsibility for Health has positive relationship with reduced consumption of vegetables, meat, fried foods and foods that may cause flatulence (e.g. bean, peas).
The level of anxiety, and sense of responsibility for health play a key role in human food behaviour in patients with IBS. This has important practical and clinical implications.
P80 Mind-Body Medicine and Lifestyle modification in Supportive Cancer Care: a cohort study on a day care clinic program for cancer patients
Michael Jeitler1, Jessica Jaspers2, Christel von Scheidt1, Barbara Koch1, Andreas Michalsen1,2, Nico Steckhan2, Christian Kessler1,2
1 Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, 14109, Germany; 2 Charité - University Medical Center, Berlin, 10117, Germany
Correspondence: Michael Jeitler
We developed an integrative day care clinic program for cancer patients focusing on Mind-Body Medicine techniques (meditation, yoga, mindfulness), health-promoting lifestyle modification and self empowerment. The intervention program consisted of 7 h once-per-week group sessions over 12 weeks (84 h intervention time in total).
A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning (baseline), at the end of the active program (12 weeks), and at a 6 month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression and anxiety (HADS) and mood states (ASTS). A per protocol analysis using mixed linear models was performed.
100 patients were screened on-site for eligibility, of which 86 patients were included into the study. 86 cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer; 7% colon cancer; mean time since first diagnosis 55.06 ± 28.75 months) participated in the program. 62 patients were allocated to the intervention group, 24 patients were allocated to the waiting group (mean waiting time 5 ± 1 weeks). 14 patients in the intervention group discontinued the intervention. 6 data sets were not complete. 66 data sets were included in the final per protocol analysis.
Significant improvements were observed in favour of the intervention group after 12 weeks compared to the waiting group at the end of the waiting list period for quality of life (WHO-5: 3.94 (1.7, 6.1), p = .001; FACT-G: 6.4 (2.3, 10.5), p = .02, FACT-B: 13 (4.5, 21.5), p = .0004), decreased anxiety/depression (HADS -2.8 (−5.3, −0.4, p = .01) and decreased fatigue symptoms (FACIT-F: 6 (1.3, 10.8), p = .02). Results from the 6 month follow-up for the whole study population showed lasting improvement of quality of life. Most practiced Mind-Body techniques were yoga and meditation. The overall effect of the day care clinic program was rated positive from >90% of all participants.
This integrative day care clinic program can be considered as an effective means to improve quality of life, fatigue and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
Trial registration: DRKS00011027
P81 Research on key techniques of clinical evaluation of qi deficiency and blood stasis syndrome based on literature research and expert questionnaire
De Jin, Wen-jing Huang, Bing Pang, Feng-Mei Lian
Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, 100053, China
Correspondence: Feng-Mei Lian
To explore the essential factors of clinical evaluation in treating qi deficiency blood stasis syndrome (QDBSS) and find out the reasonable way and scientific method of diagnosis and effect appraisal of QDBSS through literature retrieval and expert questionnaire.
A search strategy was designed to select published literature focusing on QDBSS from CNKI database and Wanfang database according to certain. The frequency of key information in these search strategies were calculated, summarized and analyzed by SPSS 19.0. And related apartments physicians mentioned in the literature research results were incorporated into the questionnaire investigation, which physicians in Guang’anmen Hospital, Xiyuan Hospital, and Beijing traditional Chinese medicine hospital were selected to be investigated.
The physicians were investigated in these three hospitals from January to March 2015. A total of 440 questionnaires were conducted to face-to-face interviews, and 439 questionnaires were returned (response rate 99.77%). Main representative diseases of QDBSS were coronary heart disease, stroke, lung cancer, and diabetic nephropathy etc. The characteristic signs and symptoms of QDBSS include tingling, fatigue, tongue with teeth marks, etc. The focus of symptoms were switched from qi deficiency syndrome to blood stasis syndrome, with the improvement of physician level. Average duration of QDBSS is 2.82 months. The multiple symptoms improved with four classification methods (42.79%) and all symptoms of the whole syndrome improved with four classification method (24.59%) were mainly selected as a curative effect valuation.
Combination with disease, symptom and syndrome is the precondition of curative effect evaluation of QDBSS, and the treatment course is the key to the clinical evaluation process of QDBBS. Meanwhile, symptom index makes up the fundamental elements of curative effect evaluation. The preliminary results reveal the evaluation factors of the key technology of QDBSS, to provide a new idea for the clinical syndrome efficacy evaluation of traditional Chinese medicine.
P82 Development of monographs for anthroposophic medicinal products, the example of citrus/cydonia
Miek Jong1, Erik Baars1, Anja Glockmann2, Harald Hamre2
1 Louis Bolk Institute, Driebergen, 3972LA, Netherlands; 2 IFAEMM at the Witten/Herdecke University, Freiburg, Germany
Correspondence: Miek Jong
Monographs are condensed reviews of medicinal products that provide information on their pharmaceutical quality, safety and effectiveness. Monographs give guidance to regulators and healthcare professionals. Existing monographs for Anthroposophic Medicinal Products (AMPs) are not adequate according to current standards. The objective of this study is to develop monographs for AMPs, in order to support their scientific and regulatory assessment.
Standards for scientific assessment of safety and effectiveness of AMPs in monographs were developed and implemented, starting with the AMP Citrus/Cydonia. A systematic literature review of existing data on quality, prescription/use, safety and effectiveness were carried out.
Searches in EMbase, Pubmed, CAMbase and Anthromedlit demonstrated that Citrus/Cydonia is manufactured and prescribed according to Anthroposophic Medicine (AM) principles, predominantly for the treatment or prophylaxis of hay fever. Citrus Cydonia is used in children (<18 years, n = 417 patients documented), adults (≥18 years, n = 461) and elderly (≥65 years, n = 25). The effectiveness of Citrus/Cydonia for hay fever was supported by three clinical studies and four immunological studies in cell systems. The overall frequency of Adverse Drug Reactions (ADRs) to Citrus/Cydonia in all studies was 1.4% of users (n = 12/879). No serious ADRs were reported.
It is possible to develop AMP monographs that reflect the specific characteristics of AM and adhere to contemporary scientific standards for quality, safety and effectiveness documentation. Standards presented are of interest to other whole medical systems such as Homeopathy and Traditional Chinese Medicine.
P83 Heart rate variability as a predictor of the effectiveness of the Bupleuri Radix (saiko) contained in Kampo Medicines
Mosaburo Kainuma1, Aya Murakami1, Toshio Kubota1, Daisuke Kobayashi1, Yasuhiro Sumoto1, Norihiro Furusyo2, Shin-Ichi Ando3, Takao Shimazoe1
1 Community Medicine Education Unit, Graduate School Of Medical Science, Kyushu University, Fukuoka, 812-8582, Japan / Department of Clinical Pharmacy and Pharmaceutical Care, Graduate School of Pharmaceutical Sciences,kyushu University, , Fukuoka, Japan; 2 Department of General Internal Medicine, Kyushu University, , Fukuoka, Japan; 3 Sleep Apnea Center, Kyushu University Hospital, , Fukuoka, Japan
Kampo prescriptions that include Bupleuri Radix (saiko) are used for neurosis, insomnia, and symptoms that have a strong association with autonomic nervous system disorders, especially for female patients. However, little is known about the objective efficacy of saiko on the autonomic nervous system.
Methods and Results
We retrospectively analyzed the heart rate variability (HRV) data of 54 new female patients (≥20 years) who visited our Kampo Medicine Clinic from 2008 to 2013 to determine if the index of HRV as a surrogate marker of autonomic nervous system is related to the efficacy of saiko and thus can be used to determine for which patients saiko is most effective. The HRV data of patients prescribed medicines that included saiko at their initial visit were divided into effective and ineffective groups (27 patients each) based on the recorded changes of symptoms after two weeks. We found that Very Low Frequency (VLF) (0.003–0.04Hz)/Total Frequency (TF) was significantly higher (p = 0.009) and Ultra Low Frequency (ULF)-1 (0.0001–0.0003Hz)/TF was significantly lower (p = 0.006) in the effective group. The cut-off values for VLF/TF and for ULF-1/TF were 0.35 (Sensitivity, 63%; Specificity, 78%; AUC, 0.71) and 0.24 (Sensitivity, 78%; Specificity, 56%: AUC, 0.71).
Our data suggest that ULF-1/TF and VLF/TF have potential as predictors of the effectiveness of medicines containing saiko.
P84 Ethanol exposure in children: food more relevant than phytomedicines
Olaf Kelber1, S Verjee2, Eva Gorgus2, Dieter Schrenk2
1 Innovation & Development, Phytomedicines Supply and development Center, Steigerwald Arzneimittelwerk GmbH, Bayer Consumer Health, Darmstadt, 64295, Germany; 2 Food Chemistry and Toxicology, University of Kaiserslautern, Kaiserslautern, 67663, Germany
Correspondence: Olaf Kelber (firstname.lastname@example.org)
Liquid dosage forms of medicinal products are well suitable for children, as they allow to adapt the dose to the age group. But as in many cases they contain ethanol, they have been repeatedly triggering critical questions.
The aim was therefore to assess to which extent medicinal products contribute to the ethanol exposition in this age group, in comparison to the normal uptake with usual food items.
By evaluation of data from the use of herbal medicinal products in liquid form and by generation of a scenario for the exposure by food items based on new analytical data, exposition values for a 6 years old child were estimated.
When using herbal medicinal products, in a 6 years old child amounts of ethanol between 70 and 180 mg are applied with a single dose. With 3 times daily dosing this is 210–540 mg. Related to a body weight [b.w.] of 20 kg, this is 10.1 – 27.0 mg/kg b.w. .
An evaluation of side effects of these medicinal products, collected in non interventional studies in more than 50.000 children, and of the spontaneous reports from their use in about 3 Mio. children, did not reveal ethanol related side effects.
For evaluation of the uptake of ethanol with food items commonly used in children, the ethanol content of these items was determined by gas chromatography. E.g. in fruit juices, up to 770 mg/L were found, in bakery products up to 1200 mg/100 g . Based on these data a scenario for the mean ethanol exposure was developed, using data on nutritional habits from USA and Germany.
The resulting mean ethanol exposure was 10.3 mg/kg b.w.. Assuming an ethanol exposure in the upper range of this scenario, it was 12.5 – 23.3 mg/kg b.w..
According to these data, the ethanol uptake with herbal medicinal products in children is in an order of magnitude comparable to everydays exposure with usual food items.
From this point of view, it is conclusive that no ethanol related side effects due to an exposure exceeding the average daily intake via food can be expected after the use of these medicinal products. The exposure to ethanol resulting from the use of these products therefore is no cause for toxicological concerns.
1. Kelber O et al. 2008, PharmInd; 70, 1124–1127
2. Kelber O et al. 2016, Wien Med Wochenschr, in press;
3. Gorgus E et al. 2016, J Analyt Toxicol, doi:10.1093/jat/bkw046
P85 Training in integrative therapies increases self-efficacy in providing non-drug therapies and self-confidence in offering compassionate care
Kathi Kemper, Ellie Hill
OSU, Blacklick, 43004, OH, United States
Correspondence: Kathi Kemper
This proof of concept project evaluated the feasibility and preliminary impact of training nurses and other health professionals in introductory workshops about complementary therapies.
We conducted a prospective cohort study of training in acupressure, guided imagery, massage, and Reiki on clinicians sense of self-efficacy in providing non-drug therapies, self-confidence in providing compassionate care, and engagement with work. The training was voluntary as was completion of anonymous online pre- and post-trainng surveys.
All topics except massage met minimum enrollment numbers; 22 of 24 participants completed follow-up as well as pre-training surveys. All would recommend the training to others and planned changes in personal and professional care. There were significant improvements in self-efficacy in using non-drug therapies, confidence in providing compassionate care, and unplanned absenteeism (P < 0.05 for each).
Training in integrative therapies is feasible and associated with significant improvements in clinicians sense of self-efficacy, confidence in providing compassionate care, and engagement with work. Additional studies are needed to determine the impact on quality of care and long-term workforce engagement.
P86 Engaging in online training in Mind-Body practices has long-term benefits
Kathi Kemper1, Nisha Rao2, Gregg Gascon1, John Mahan1
1 OSU, Blacklick, 43004, OH, United States; 2 College of Medicine, OSU, Columbus, 43210, OH, United States
Assess the dose-response relationship between the number of hours of online mind-body skills training for health professionals and outcomes one year later.
Among 1438 registrants for online training (including up to 12 hours of training on mind-body practices) between December, 2013 and December, 2015, we analyzed responses from the first 10% who responded to an anonymous online survey by February 1, 2016. Questions included the type and frequency of mind-body practice in the past 30 days and whether the online training had any impact on personal life or professional practice. Standardized measures were used to assess stress, mindfulness, confidence in providing compassionate care, and burnout.
The 149 respondents represented a variety of ages and health professions; 55% completed one or more mind-body training modules an average of 14 months previously. Most (78%) engaged in one or more mind-body practices in the 30 days before the survey; 79% reported changes in self-care and 71% reported changes in the care of others as a result of participating. Increasing doses of training were significantly associated with practicing mind-body skills more frequently; increasing practice frequency was associated with less stress and burnout, which were in turn associated with missing less work. Greater practice frequency was also associated with improvements in stress, mindfulness, and resilience, which in turn were associated with increased confidence in providing compassionate care.
Online training in mind-body therapies is associated with changes in self-reported behavior; increasing doses of training are associated with more frequent practice which is associated with less stress, burnout, and missing work, and higher levels of mindfulness, resilience and confidence in providing compassionate care. Additional studies are needed to compare mind-body skills training with other interventions designed to improve resilience and compassion while decreasing burnout in health professionals.
P87 Phase II clinical trial on efficacy and safety of additive mistletoe extract therapy in combination with standard radiotherapy and chemotherapy in patients with newly diagnosed glioblastoma after surgical resection (GLIOMIS-trial) – a trial protocol
Gunver Kienle1, Jörg Dietrich2, Claudia Schmoor3 , Roman Huber1
1 Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Center – University of Freiburg, Freiburg, 79106, Germany; 2 Massachusetts General Hospital, Boston, MA, United States; 3 Clinical Trials Unit Freiburg, Medical Center – University of Freiburg, Freiburg, Germany
Correspondence: Gunver Kienle
Glioblastoma multiforme (GBM) is the most common primary malignant intracranial neoplasm. Despite surgery, radiotherapy and Temozolomide intervention, GBM cannot be cured and the median survival is 16 months. Treatments are desperately needed that improve the results of standard treatments without further impairing the quality of life. Mistletoe extracts (ME) are widely used in integrative cancer care and show promising preclinical effects in GBM cells but have hardly been investigated in GBM patients.
Do ME improve progression-free survival, quality of life, cognitive functioning and influence local immune response in GBM patients?
Prospective randomised, double-blind, placebo-controlled, parallel-group, multicentre trial; stratified for center, 1:1 randomization. 150 patients with newly diagnosed, supratentorial glioblastoma, after surgical resection, starting radiotherapy and Temozolomid will be included in 5 US American and German centers. They will be randomized to receive either ME (Iscador Qu®, 0.01–10 mg, sc, 3/week in an individually adapted, dose-escalating scheme), or isotonic saline solution (identical scheme, sc, 3/week), until tumor progression. Primary outcome is progression-free survival, assessed by magnetic resonance imaging as per standard of care (every three months in Germany, every two months in the US) or earlier when clinically indicated, allowing for a one month surveillance period, to account for possible pseudo-progressions. Key secondary endpoints are health-related quality of life (EORTC QLQ-C30, EORTC QLQ BN20), neurocognitive assessment (IPCG battery, MMSE), overall survival, neutropenia due to chemotherapy, safety, immune parameters gene expression profiles in the tumor microenvironment before and after treatment (subgroup of patients).
Public and private.
P88 Use of complementary and alternative medicine among patients attending spine specialty hospitals in South Korea
Weon H Kim1, Dongwoon Han2, Mansoor Ahmed2, Luzhu He2, Jung Hye Hwang2
1 Graduate School of Public Policy, Hanyang University, Seoul, 133-791, South Korea; 2 Global Health and Development, Hanyang University, College of Medicine, Seoul, 04763, South Korea
Correspondence: Weon H Kim
The purpose of the study is to describe the use of CAM among patients with chronic diseases, who visiting spine speciality hospitals in Seoul. This study also explored the characteristics of CAM user, the prevalence of CAM use, perceived effectiveness of CAM, and variables associated with CAM use and patients perception on the symptoms of chronic disease.
The data were collected with a questionnaire for this study from 26 November, 2015 to 5 December, 2015. A cross sectional survey design was use to carry out face-to-face interviews and self administered questionnaire. Data of subject on general demographic and perception of health status and disease and the experiences of health service use and CAM modalities used. Data were analyzed using SPSS (Statistical Package for the Social Science) 21.0 program to compare.
The total numbers of participants were 322 with chronic disease. The result shows that 47.8% were using some form of CAM. The most commonly used therapies were acupuncture (response rate = 52.4%). The result of the logistic regression analysis of the factors related to the use of CAM showed that variables associated with CAM use were: subjective health status, perceived level of pain and effectiveness of traditional Korean medicine.
Prevalence of CAM use among outpatients with chronic diseases, attending spinal speciality hospitals was comparable with previous studies in developing and developed countries. The predictors of CAM use among the patients helps explain why the patients attending the specialty hospital turn to use CAM. Health professionals may need to identify patients” history of CAM use more carefully so as to better screen for possible adverse clinical interactions.
P89 Tumor destructive and immune response effect of modulated electro-hyperthermia
Eva Kiss1, Tamas Vancsik1, Nora Meggyeshazi1, Csaba Kovago2, Tibor Krenacs1
1 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, 1085, Hungary; 2 Department of Pharmacology and Toxicology, Szent Istvan University Faculty of Veterinary Science, Budapest, 1078, Hungary
Correspondence: Eva Kiss
Modulated electro-hyperthermia (mEHT, oncothermia) generates electric field which can interfere with malignant tumors at 42 °C resulting in destruction of neoplastic cells. The tumor selectivity of mEHT is due to increased metabolite content and permittivity of tumors compared to normal tissues. mEHT treatment can provoke apoptosis and immune cell infiltration in HT29 colorectal cancer xenografts of immunocompromised mice.
In this study C26 mouse colorectal adeno-carcinoma cell line was injected to both femoral regions of BalbC mice. The treatment groups were 1) mEHT treatment for 30 minutes on the right side tumor, 2) application of Marsdenia tenacissima (MTE, Chinese Xiao-Aiping decoctum), 3) combination of MTE and mEHT, 4) sham control. Tumor samples were tested for mEHT related tumor destruction, stress and immune response (Ki67, cleaved caspase-3, cytochrome c, AIF, TRAIL, Hsp70, HMGB1, CD3, S100).
Significant caspase-3 dependent tumor destruction were observed both in the mEHT group and in the combination group. Expression of TRAIL receptor and mitochondrial release of cytochrome c could also be seen in the treated tumors. The absence of AIF and the positive TUNEL assay also indicated the extrinsic way of apoptosis. Significant elevation of S100 positive dendritic cells and CD3 positive cells in the treated tumors of mEHT group and in the combination group both sides may refer to immunogenic cell death.
mEHT in combination with MTE can induce caspase-dependent programmed cell death. Additionally the elevated dendritic cells and the appearance of T cells indicate immunogenic tumor cell death response in C26 colorectal tumor allograft model.
P90 Internal coherence scale – cross sectional study to investigate reliability and validity in a geriatric population
Anne K Klaus1,2, Roland Zerm1,2, Danilo Pranga1, Thomas Ostermann3,4, Marcus Reif5, Hans Broder von Laue1, Benno Brinkhaus6, Matthias Kröz1
1 Research Institute Havelhöhe, Berlin, 14089, Germany; 2 Internal Medicine, Hospital Havelhöhe, Berlin, Germany; 3 Integrative Medicine, Witten/Herdecke University, Witten/Herdecke, Germany; 4 Methodology and Statistics in Psychology and Psychotherapy, Witten/Herdecke University, Witten/Herdecke, Germany; 5 Society for Clinical Research, Berlin, Germany; 6 Institute for Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, 10117, Germany
Correspondence: Anne K Klaus (email@example.com)
The Sense of Coherence Scale (SOC) has been increasingly used in epidemiological studies with promising results. Nevertheless, because of its retrospective focus the SOC is not applicable as a clinical questionnaire. Therefore, the compact 10-item Internal Coherence Scale (ICS) has been validated in patients with chronic conditions, and in healthy people between 30 and 83 years. The aim of this study was to evaluate the reliability and validity of the ICS in elderly people.
The cross sectional study was conducted in a German geriatric population from 2013–2015. Elderly people older than 70 years were retested up 2 until 4 weeks later in at least 50% of all participants. To apply for convergent validity SOC, Short Form Health Survey (SF-12), and Geriatric Depression Scale (GDS) have been administered beside the ICS.
104 people (age 70–96 years; cancer patients (n = 32), diabetes mellitus type 2 patients (n = 22), and age-matched relative healthy controls (n = 51) have been included. The 10-item ICS showed sufficient reliability (Cronbach”s alpha: r = 0.72, test-retest reliability: r = 0.52, p < 0.01). Sufficient construct and convergent validity were shown with moderate correlations to SOC, SF-12, and GDS (0.34–0.45, p < 0.01). In the factor analysis the subscale structure (Inner Coherence and Thermo Coherence) as published in the German validation within a younger sample was confirmed.
In this study ICS is featured by sufficient reliability, robust validity with health-markers and stable subscale structure in elderly people confirming the results of a prior study in a younger population.
P91 Validation of the trait autonomic regulation questionnaire in a geriatric population
Anne K Klaus1,2, Roland Zerm1,2, Danilo Pranga1, Daniela Rodrigues Recchia3, Thomas Ostermann3,4, Marcus Reif5, Hans B von Laue1, Benno Brinkhaus6, Matthias Kröz1,2,3,6
1 Research Institute Havelhöhe, Berlin, 14089, Germany; 2 Internal Medicine, Hospital Havelhöhe, Berlin, Germany; 3 Integrative Medicine, Witten/Herdecke University, Witten/Herdecke, Germany; 4 Methodology and Statistics in Psychology and Psychotherapy, Witten/Herdecke University, Witten/Herdecke, Germany; 5 Society for Clinical Research, Berlin, Germany; 6 Institute for Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, Germany
Correspondence: Anne K Klaus (firstname.lastname@example.org)
Geriatric assessment is an important issue to capture symptom burden, functional limitations, and rehabilitative need of old people. Nevertheless, because of its multidimensional approach and often described limitations of geriatric patients it needs important time resources. Hence, it is of interest to develop pre-screening instruments. The questionnaire of autonomic regulation (aR) captures different items on autonomic functions with sufficient validity in German language for people between 18 and 85 years and correlations to health, and in case of loss of regulation with chronic conditions.
We report the reliability and validity results of the Trait version of aR-scale in a German geriatric population with a test-retest time-span of 2–4 weeks. Cumulative illness rating scale (CIRS), physical self-maintenance scale (PSMS), and geriatric depression scale (GDS) have been applied for convergent validity as geriatric assessment standard scales.
104 peoplebetween 70 and 96 years (32 cancer, 22 diabetes mellitus type 2 patients, and 51 age-matched relative healthy controls) have been included. For the 18-item aR questionnaire sufficient until good reliability (Cronbach”s alpha r = 0.70, test-retest reliability r = 0.83) can be documented with robust construct, convergent validity with correlations to CIRS, PSMS and GDS: r = 0.27–0.31, p
Autonomic regulation is a reliable and valid questionnaire for a geriatric group capturing correlations with health, chronic conditions and geriatric assessment, but subscales differences demands clarification. AR could be a useful geriatric pre-screening instrument.
P92 An international pragmatic, randomised controlled pilot study comparing individualised homeopathic add-on treatment and usual care only in women with premenstrual disorders (PMD)
Christien T Klein-Laansma1, Mats Jong2, Cornelia von Hagens3, Jean P Jansen1, Herman van Wietmarschen1, Miek C Jong1
1 Health Care and Nutrition, Louis Bolk Institute, Driebergen, 3972LA, Netherlands; 2 Nursing, Mid-Sweden University, Sundsvall, Sweden; 3 Naturopathy and Integrative Medicine, Department of Gynaecological Endocrinology and Reproductive Medicine, University Women’s Hospital Heidelberg, Heidelberg, Germany
Correspondence: Christien T Klein-Laansma
A multi-centre, international, randomised, controlled pragmatic study with two parallel groups.
October 2012–July 2016.
To investigate the feasibility of organizing an international multi-centre pragmatic trial on an individualised homeopathic add-on treatment (HT) in women with premenstrual disorders (PMS/PMDD), compared to usual care only (UC).
After a two months’ screening phase, women diagnosed with PMS or PMDD were randomized to UC or HT for a 4 months’ treatment.
In the Netherlands, recruitment took 2 years, 38 women were included. In Sweden, ethical approval was difficult to obtain, recruitment was slow and stopped after 3 years, 22 women were randomized. In Germany, even non-randomized case series with individualized homeopathy were classified as drug trial by the authorities.
Of 244 interested women, 114 started screening, 60 were randomized (HT: 28; UC: 32), 47 completed the study. 83% women preferred homeopathy; 75% had objections to antidepressants, 82% to Oral Contraceptive Pills (OCPs). Women in the UC group were advised to take OCPs, Intra Uterine Device (IUD), antidepressants or were referred. In the HT group, Sepia officinalis was most prescribed.
After four months, the relative mean change of premenstrual symptom scores in the HT group was significantly better than in the UC group (Ancova; p = 0.0028). No confounders were identified.
With respect to recruitment and different legal status, it seems not feasible to perform a larger randomized controlled clinical trial on individual homeopathic treatment for PMS in Europe. Final results will be presented at the conference.
Trial registration nb NTR3560
P93 Predicting characteristics of Korean female subjects with hands and feet coldness: Korea-based multi-center pilot registry
Youme Ko1, Seung-Ho Sun2, Ho-Yeon Go3, Chan-Yong Jeon4, Yun-Kyung Song5, Seong-Gyu Ko1
1 Preventive medicine, Kyung Hee university, Seoul, 02447, South Korea; 2 Korean Internal Medicine, Sangji University, Wonju, South Korea; 3 Korean Internal Medicine, Semyung University, Jecheon, South Korea; 4 Korean Internal Medicine, Gachon University, Seongnam, South Korea; 5 Rehabilitation Medicine, Gachon University, Seongnam, South Korea
Correspondence: Youme Ko
The aim of this pilot study is to analyze the characteristics of Korean women with symptom of cold hands and feet (CHF) through the patient registry.
This study is prospective observational study which was conducted in 6 different Korean medicine hospitals in Korea. Each institution received approval from their own institutionalreview board. Before enrolling, researchers obtained and gave consent for research purposes. We recruited 134 female healthy participants who aged over 19 years and less than 59 years. The patient”s demographics, symptom characteristics of CHF and degree of symptoms were collected from all participants at baseline.
134 female participants were enrolled within 6 months recruitment period and no dropouts during trial. 70 participants (52.2%) had complaint of cold extremities, and 64 (47.8%) did not suffer from coldness. The visual analogue scale score for CHF and skin temperature in acupoint PC8 between 2 groups were statistically significant. Identifying symptom patterns of pattern identification questionnaire by frequency analysis, skin and mouth dryness and preference for warmth in any condition were most common symptoms in CHF participants. The result of pattern diagnosis by Korean medicine experts showed that deficiency pattern were the most frequent cause of CHF, especially blood and qi deficiency patterns.
Through this trial, we explored the characteristics of CHF patients in Korea. This data will be used to specify the target population and develop an appropriate design of the experimental trial that will be conducted in near future.
P94 The role of yoga and self-esteem for menopausal symptoms and quality of life in breast cancer survivors - a mediation analysis
Anna K Koch1,2, Sybille Rabsilber3,4, Romy Lauche1,5, Sherko Kümmel4, Gustav Dobos1, Jost Langhorst1,2, Holger Cramer1,5
1 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Essen, 45276, Germany; 2 Centre of Integrative Gastroenterology, Kliniken Essen-Mitte, Essen, Germany; 3 Department of Gynecology, Malteser Hospital St. Anna, Duisburg, Germany; 4 Interdisclipinary Breast Cancer Center, Kliniken Essen-Mitte, Essen, Germany; 5 Australian Research Center in Complementary and Integrative Medicine, Faculty of Health, Sydney, Australia
Correspondence: Anna K Koch
When undergoing menopausal transition, breast cancer survivors cannot take hormonal medicine used for treatment of menopausal symptoms. Yoga as a hormone free alternative has been shown to enhance quality of life and ease menopausal symptoms of breast cancer survivors. The present study tested the mediating effects of self-esteem in the relationships between yoga, quality of life, fatigue and menopausal symptoms.
Analyses were based on a previously published open-label, randomized controlled clinical trial assessing the longitudinal effect of yoga in comparison to usual care in 40 breast cancer survivors who suffered from menopausal symptoms. Self-esteem was assessed by the Rosenberg Self-Esteem Scale at week 12 after randomization. Outcomes included menopausal symptoms (Menopause Rating Scale), quality of life (Functional Assessment of Cancer Therapy-Breast), and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) at week 24. Mediation analyses were performed using SPSS and applying bootstrapping.
Self-esteem mediated the effect between yoga and quality of life (B = 8.04, 95% BCI [3.15 to 17.03]), social well-being (B = 1.80, 95% BCI [.54 to 4.21]), emotional well-being (B = 1.62, 95% BCI [.70 to 3.34]), functional well-being (B = 1.84, 95% BCI [.59 to 4.13]), fatigue (B = 4.34, 95% BCI [1.28 to 9.55]), total menopausal symptoms (B = -2.11, 95% BCI [-5.40 to -.37]), psychological menopausal symptoms (B = -.94, 95% BCI [−2.30 to−.01]), and urogenital menopausal symptoms (B = -.66, 95% BCI [−1.65 to −.15]). The effects on physical well-being (B = .79, 95% BCI n.s.), and somatovegetative menopausal symptoms (B = -.50, 95% BCI n.s.) were not mediated by self-esteem.
Findings support the assumption that self-esteem plays a vital role in the process of the beneficial effect of yoga. Yoga can have long-term benefits for women who suffered from former breast cancer undergoing menopausal transition.
Trial registration: clinicaltrials.gov (registration number NCT01908270)
P95 Herbal medicine in the treatment of irritable bowel syndrome – a systematic review
Anna K Koch1,2, Milena Trifunovic-Koenig1,2, Petra Klose1, Holger Cramer1,3, Gustav Dobos1, Jost Langhorst1,2
1 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Essen, 45276, Germany; 2 Centre of Integrative Gastroenterology, Kliniken Essen-Mitte, Essen, Germany; 3 Australian Research Center in Complementary and Integrative Medicine, Faculty of Health, Sydney, Australia
Correspondence: Anna K Koch
Herbal medicine is a promising alternative in the treatment of irritable bowel syndrome (IBS). We performed a systematic review for herbal treatments of IBS.
A computerized search of databases Cochrane Library, PubMed, Psychinfo, and Scopus through July 20th 2016 was performed. Randomized controlled trials (RCT) and controlled trials (CT) evaluating adults diagnosed with IBS were included. No language restriction was applied. Trials on traditional Chinese medicine were not included.
A total of 26 trials with 20 different herbal treatments and a total of 1915 patients with IBS met the inclusion criteria. Herbal medications were compared with placebo or conventional pharmacologic therapy or tested combined with conventional therapy. Compared with placebo, red pepper, peppermint oil, ispaghula, caraway oil, STW 5, STW 5-II, and Dinggui Oil showed beneficial effects. Compared with placebo, also berberine hydrochloride was beneficial in releasing symptoms. However, even though berberine is an herbal medicine, an extract was used in the study. Ayurvedic therapy consisting of aegle marmelos correa plus bacopa monniere linn was particularly beneficial in diarrhoea predominant form. Compared with conventional therapy, an herbal preparation (mentha longifolia, cyperus rotundus and zingiber officinale) and supermint showed beneficial effects. Combined with conventional therapy, Gwakhyangjeonggisan (GJS), an herbal preparation (melissa officinalis, mentha spicata, and coriandrum sativum) showed additional benefit compared with conventional therapy alone. No evidence for the efficacy of ayurvedic herbs consisting of murraya koenigii, punica granatum and curcuma longa, bitter candytuft, St John’s wort, ginger, curcuma, furmitory, and aloe vera was found. A differentiation between IBS-subtypes was not possible due to inconsistent reporting within the trials. No serious adverse events regarding the herbal treatments were reported.
Various herbal preparations show promising effects in the treatment of IBS. Especially peppermint oil is well evaluated and effective. Further studies regarding the other herbal medicines and a more stringent attention regarding the different IBS subtypes are necessary.
P96 Measuring patient-perceived quality of care in integrative medicine
Evi Koster1, Erik Baars1, Diana Delnoij2
1 University of Applied Sciences Leiden, Leiden, 2333CK, Netherlands; 2 Scientific Centre for Transformation in Care and Welfare (Tranzo), Tilburg University, Leiden, Netherlands
Correspondence: Evi Koster
This study aimed at measuring patient-perceived quality of care in Integrative Medicine (IM). Patient-perceived quality of care is becoming increasingly important in evaluating healthcare. Specific methodologies have been developed, such as Consumer Quality-Index (CQ-Index) and other PREMs (Patient Reported Experiences Measures) for measuring process aspects, and PROMs (Patient Reported Outcome Measures) for measuring outcomes. Because (IM) has a holistic and individual-oriented approach, and applies specific patient-relevant aspects, it is unknown whether current “conventional” methodologies are able to measure patient-perceived quality of IM adequately.
IM is addressed by focusing on Anthroposophic Medicine (AM).
To measure patient-perceived quality of AM, methods used are: existing conventional methodologies, extended conventional methodologies with patient-relevant AM aspects, and newly developed methodologies to measure patient-relevant AM aspects.
To identify patient-relevant aspects, methods used are: focus groups, semi-structured interviews, surveys, qualitative triangulation and literature research. Comparative statistical analyses are performed to compare patient experiences in AM and conventional care.
Patient-relevant aspects regarding quality of care of AM are identified.
Patient-relevant domains on quality of life (QOL) are constructed and prioritised. Contributions of AM to self-management from patients” perspectives are explored. In the AM children”s healthcare centre in Zeist parent-perceived additional values are evaluated. The standard CQ-Index General Practice is extended with AM-specific items.
Relevant quality aspects of AM partly overlap with and partly differ from aspects in conventional care. Patients particularly value aspects regarding individual tailored treatment and possibilities, natural healing and patient-provider relationship. Patient-perceived quality of AM is good.
P97 Health competence as key to longterm disease prevention
Lena Kroll, Kathrin Weiss
Sport sciences, University of Augsburg, Augsburg, 86135, Germany
Correspondence: Lena Kroll (email@example.com)
Health literacy has become an important term for long-term disease prevention over the last 20 years. Still, almost 50% of Europeans show low rates in health literacy and new approaches for its promotion have to be developed.
At Augsburg University, a longitudinal survey examines from 2015–2017 the influences of an intervention on health literacy of University staff. The intervention focusing on Yoga consists of three standardized modules, “1 - the health-related basis” (Yoga classes), “2 - the transfer into working life” (individualized support at working place) and “3 - the integration in working and everyday life” (self-dependent) and is oriented at the theoretical concept of “health competence”.
The survey consists of a longitudinal quasi-experimental control trial (t0: Nov.2015; t1: Feb.2016, t2: July 2016, t3: Nov.2016) using validated scales on health (WHOQOL-Bref, WHO, 2000), on work-related behavior and experience patterns (AVEM, Schaarschmidt & Fischer, 2008), on health literacy / competence (Lenartz, 2012), and on the actual physical well-being (WKV-20, Kleinert, 2006). The sample at t2 included 92 individuals in the intervention group and 129 participants in the control group.
There have been significant improvements within the intervention-group in almost all aspects measured in the survey. Out of 16 dimensions, 13 changed significantly or highly significantly in a positive way. The results for the control-group did not change significantly in any dimension.
Especially the long-term trend shows interesting results and allows an optimistic view on the promotion of health competence / literacy in University staff with Yoga.
P98 Mobile app-based mindfulness intervention for cancer patients and their caregivers - a feasibility study within an integrated health care delivery system
Ai Kubo1, Sarah Hendlish1, Andrea Altschuler1, Nancy Connolly1, Andy Avins1,2
1 Division of Research, Kaiser Permanente, Oakland, CA 94612, United States; 2 University of California, Department of Medicine, San Francisco, CA, United States
Correspondence: Ai Kubo
Is a mobile-based mindfulness intervention feasible and accepted among cancer patients undergoing chemotherapy and their primary caregivers?
Eight-week single-arm pilot trial within Kaiser Permanente, Northern California oncology clinics. Participants were cancer patients with ≥8 weeks of remaining chemotherapy and their primary unpaid caregivers, where neither had a regular meditation practice. Participants were given access to a commercially available mindfulness program, HeadspaceTM, via smartphone application or home computer, and were asked to listen to meditation instruction for 10–20 minutes daily, for 8 weeks. Data on depression, anxiety, sleep, fatigue, quality of life, caregiver burden, and satisfaction with care were collected at baseline, at 4 weeks and following the intervention. Paired t-tests were used to assess before-after changes.
28 patients (median age 65.5y; female 71%) and 15 caregivers (median age 61y; female 60%) were enrolled. Among them, 19 patients (68%) and 9 caregivers (60%) completed the study. Of these, 71% practiced meditation >50% of the days; 39% practiced >70% of the days. Participants experienced significant reduction in levels of depression (p = 0.009) and anxiety (p = 0.003), improvement in physical (p = 0.005) and mental domains of quality of life (p = 0.0001), sleep quality (p = 0.03), and fatigue (p = 0.02). In qualitative interviews, participants reported feeling more relaxed, positive, and resilient, sleeping better, and having less pain.
This pilot trial of a mobile-app/online mindfulness program shows promise in reducing anxiety and depression and improving quality of life among cancer patients and caregivers unable to attend traditional in-person classes. Larger, randomized studies could fully assess efficacy.
P99 Using a cluster-analytic approach to identify profiles and predictors of healthcare utilization typical users across conventional, allied and complementary medicine and self-care
Romy Lauche1, Daniela Rodrigues Recchia2, Holger Cramer1, Jon Wardle1, David Lee3, David Sibbritt1, Jon Adams1, Thomas Ostermann2
1 Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, 2007, Australia; 2 Department of Psychology and Psychotherapy, University of Witten/Herdecke, Witten, Germany; 3 Department of Public Health Sciences, University of Miami, Miami, FL, United States
Correspondence: Holger Cramer
Cluster analytic techniques can identify health care utilization patterns, and define typologies of consumers and their specific characteristics based on the similarity of their behaviour. This study aims to examine health care utilization patterns using a cluster analytic approach; and the associations of health care user types with sociodemographic, health-related and health-system related factors.
Cross-sectional data from the 2012 National Health Interview Survey were used (n = 32,017). Twelve-month self-reported health care utilization behaviours were assessed across a variety of medical, allied and complementary healthcare modalities including self-care interventions (exercise, diet, supplementation etc.). A model-based clustering based on finite normal mixture modelling, and several indices of cluster fit were determined. Health care utilization within the cluster was described descriptively, and independent predictors of belonging in the respective clusters were analysed using logistic regression models including sociodemographic, health- and health insurance-related factors.
A 9-cluster solution describing 9 different health care user types, from nearly non-use of health care modalities, to over-utilization of medical, allied and complementary health care including self-care was found. Several sociodemographic and health-related characteristics were associated with cluster membership, including age and gender, health status, education, income, ethnic origin, and health care coverage.
Cluster analysis can be used to identify typical health care utilization patterns based on empirical data, and those typologies are related to a variety of sociodemographic and health-related characteristics. Those findings may provide information for future health research and policy.
P100 Is the use of yoga and meditation associated with a healthy lifestyle? Results of a national cross-sectional survey of 28,695 Australian women
Romy Lauche1, David Sibbritt1, Crystal Park2, Gita Mishra3, Jon Adams1, Holger Cramer1,4
1 Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, 2007, Australia; 2 Department of Psychology, University of Connecticut, Storrs CT, United States; 3 School of Public Health, University of Queensland, Herston QLD, Australia; 4 Department of Internal and Integrative Medicine, University of Duisburg-Essen, Essen, Germany
Correspondence: Holger Cramer
Rooted in Indian philosophical, spiritual, and health practice yoga has become a popular avenue to promote physical and mental well-being. Traditionally yoga not only consists of physical exercises, but incorporates advice for an ethical and healthy lifestyle. This study aimed to examine the relationship between yoga/meditation practice and health behavior in three age cohorts of Australian women.
Women aged 19–25 years, 31–36 years, and 62–67 years from the Australian Longitudinal Study on Womens Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behavior; and whether they practiced yoga/meditation on a regular basis. Associations of those health behaviors with yoga/meditation practice were analyzed using multiple logistic regression modelling.
11344, 8200, and 9151 women aged 19–25 years, 31–36 years, and 62–67 years, respectively, were included in the analysis of which 29.0%, 21.7%, and 20.7%, respectively, practiced yoga/meditation. Women practicing yoga/meditation were less likely to smoke regularly (OR = 0.41–0.47), and more likely to be physically active (OR = 1.50–2.79) and to follow a vegetarian (OR = 1.72–3.22) or vegan (OR = 2.26–3.68) diet. Women practicing yoga/meditation were also more likely to use marijuana (OR = 1.28–1.89) and illicit drugs (OR = 1.23–1.98).
Yoga/meditation practice was associated with a higher likelihood of non-smoking, regular physical activity, and vegetarian/vegan diet. While health professionals need to keep the potential vulnerability of yoga/meditation practitioners to drug use in mind, the positive associations of yoga/meditation with a variety of positive health behaviors warrant its consideration in preventive medicine and healthcare.
P101 Oncogenetic key signal RANTES/CCL5 - Cytokine cross talk in tumors and silent inflammation of jawbone
Praxisklinik München, Munich, 81547, Germany
Despite significant therapeutic advances most malignancies, as well as adenocarcinomas of the breast, remained incurable. At the same time, the importance of the microenvironment surrounding the tumor cells with “silent inflammation” increases.
To check the suspected tumor-relevant inflammatory cytokine sources in fatty-degenerative osteonecrotic jawbone (FDOJ), we analyze these conspicuously altered jawbone areas to assess the expression and quantification of cytokine expression.
Material and Method
In 38 tumor patients we determine the levels of cytokines by bead-based Luminex® analysis in samples of FDOJ.
Striking is the high content of chemokine RANTES/CCL5 (R/C) in all 38 tissue samples. A single case is characterized by high R/C levels in FDOJ sample and simultaneously by metastasizing cells inside the FDOJ sample. The R/C expression in all 38 FDOJ samples is on average at 35 fold higher compared to healthy jawbone.
R/C interacts on several levels in immune responses and is considered in scientific literature as pathogenetic key point in tumor growth. The study supports a potential mechanism where FDOJ is a mediating link specifically in breast cancer (MaCa) and its metastasis. R/C is thus involved intensively in oncogenic propulsion progress developments.
The authors conclude from the data of FDOJ analysis that these areas express hyperactivated signal transduction of the chemokine R/C, induce pathogenetic autoimmune processes in tumors, MaCa and its metastasis and serve as a possible cause. Combining the R/C signal induction of tumors and the information we collect illustrated, it may be suggested to involve FDOJ in an integrative therapy concept for tumor therapy.
P102 Acupuncture for autism spectrum disorder: a systematic review and meta-analysis
Boram Lee1, Jihong Lee1, Jinhong Cheon2, Hyun K Sung3, Seunghun Cho4, Gyu T Chang1
1 Departments of Pediatrics, Kyung Hee University, College of Korean Medicine, Gangdong-gu Seoul, South Korea; 2 Departments of Pediatrics, Pusan National University, College of Korean Medicine, Pusan, South Korea; 3 Departments of Pediatrics, Semyung University, College of Korean Medicine, Chungju, South Korea; 4 Departments of Neuropsychiatry, Kyung Hee University, College of Korean Medicine, Seoul, South Korea
Correspondence: Boram Lee
Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests or activities. Parents of children with ASD have been concerned about potential adverse effects of drug and are seeking for treatments which are more secure. Therefore, acupuncture, one of the forms of Complementary and Alternative Medicine, with fewer adverse effects has been increasingly looked out. There were systematic reviews about acupuncture for ASD, but they concluded that acupuncture had limited or no evidence until 2012. Since then, many researches about acupuncture for ASD have been published. So we aimed to summarize and evaluate the up-dated evidence of efficacy and safety on acupuncture for ASD.
We searched 13 electronic databases up to December 2016. Randomized Controlled Trials (RCTs) assessing the efficacy of acupuncture for ASD were included. The details on acupuncture procedure of the included studies were reported based on the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines. The risk of bias was assessed using the Cochrane risk of bias assessment tool. Data analysis was performed using RevMan software version 5.3.
33 RCTs involving 2002 patients with ASD were included. Data from 23 RCTs was used for meta-analysis. When added to conventional treatment, acupuncture group had significantly low Childhood Autism Rating Scale (CARS) (MD = −8.48, 95% CI −12.29 to −4.68) and Aberrant Behavior Checklist (ABC) (MD = −7.98, 95% CI −10.25 to −5.72) scores after intervention compared with the conventional treatment group. Also acupuncture group lowered Autism Treatment Evaluation Checklist (ATEC) (MD = −10.71, 95% CI −15.57 to −5.84), improved Functional Independence Measure for Children (WeeFIM) (MD = 3.23, 95% CI 1.46 to 5.01) and had a high total effective rate (OR = 5.28, 95% CI 3.53 to 7.91) compared with the control group. Acupuncture lowered CARS more than conventional treatment and improved WeeFIM