Integrative Medicine Summary PDF

Integrative Medicine Complementary Medicine Alternative Medicine CAM It “integrates” conventional...

Integrative Medicine Complementary Medicine Alternative Medicine CAM It “integrates” conventional A group of diverse Integrative Medicine and complementary therapies to achieve optimal medical and A non-mainstream Non-mainstream healthcare systems, health and healing. approach is used along approach used in place practices, and Focuses on a person as a with conventional of conventional products that are not whole, not merely his/her medicine presently considered illness or disease. It uses an part of conventional evidence-based approach to improve your health and medicine”. wellness. J Problems with CAM research Too few studies on some topics Di culties with placebos / blinding e.g., procedures Studies often of poor quality like acupuncture, Small funding, small samples, inexperienced researchers lifestyle interventions and counselling Easier to fund things which are patentable e.g., drugs rather Which outcome measures e.g., disease progression vs. than natural products QoL vs. symptom relief Research design may not re ect clinical practice e.g., many Bias e.g., uncritical acceptance of CAM among CAM therapies are practiced holistically, hence is di cult to isolate practitioners or,rejection among doctors one treatment aspect (Levels of evidence) Evidence-Based Medicine provide answers to : Limitations little evidence to make an E cacy : Can it work informed ,decision E ectiveness :Does it work in practice Practitioners, especially senior E ciency PIs it worth it, E ects can ones, may be less interested in be small and inconsequential changing practice or views based Safety :Is it safe ,Negative e ects on current or recent evidence may be greater than positive Evidence is often ambiguous Mechanisms : How does it work: not suit individual patients Interpretation of evidence can Clinical decision making be in uenced by factors such as researcher ,bias or predominant The best approach to clinical decision opinion making will combine knowledge of the The evidence which is available NOTES best available evidence in association to clinicians can be heavily with: in uenced by, publication bias and Just because something is supported by evidence does not marketing agenda necessarily mean that it is a good or safe treatment Individual clinical circumstances of the The research agenda can be patient, e.g., presence of comorbidities in uenced by what is popular or Heavy use of kava with co-morbid alcohol consumption or Experience and skills of the practitioner patentable and so many important an existing liver condition appears to lead to malnutrition, The patient's preferences topics or interventions receive weight loss, liver damage renal dysfunction, rashes, Clinician's informed judgment and little funding for research pulmonary hypertension, macrocytosis of red cells, intuition lymphocytopenia, and decreasing platelet volumes Safety issues  The ve domains of CAM Use of multivitamins a no Massage Diet I Mindfulness-Based Stress Reduction (MBSR) Qigong (Pronounced Chi-Kung) i Traditional Chinese Medicine (Acupuncture/Acupressure) CM and cancer survival When a cancer patient uses an Lifestyle has bene cial “Although many studies had “e ective" complementary e ects for both, but many encouraging results, none showed therapy do they make the complementary de nitively that a CAM treatment distinction between "e ective" in therapies are speculative with altered disease progression in terms of symptom control and regards to cancer survival patients with breast cancer. "e ective" in terms of prolonged bene t Several modalities seemed to survival? improve other outcomes.” What is a negative nding? The phrase “There is no evidence” clinical points Respect and listen to patient's views Studies suggest that the evidence is negative Think integrative not alternative study was methodologically unsound (not (not helpful or possibly harmful) Check the evidence – even if it necessarily that the product was not useful) Studies suggest that the evidence is inconclusive means asking the patient to come sample was too small to statistically Studies suggest that evidence is positive, but the back when you have had a chance to demonstrate it doctor is unaware of the evidence do more homework Reported as "non-signi cant" Not studied yet Encourage the use of things that are Can mean that there is no e ect proven Can mean that there was a signi cant Discourage disproven, unsafe or negative e ect exorbitantly expensive therapies