Regulation of integrative and complementary medicine Student: Eva Škulková Tutor: PharmDr. Jitka Pokladníková, Ph.D. Dept. of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, the Czech Republic Background: The prevalence of complementary and alternative medicine (CAM) is high 76% and it is rising. In the Czech Republic, there are no legislation or general standards that would ensure uniform requirements for providing CAM. At present, there is a lack of comprehensive understanding of how CAM methods are provided. Aim: To determine the level of regulation of the most commonly used CAM methods in the Czech Republic. Methods: The level of regulation has been evaluated according to regulatory criteria based on requirements for healthcare professionals. The list of the researched methods is based on foreign studies and at the same time specific CAM methods for the Czech Republic were added. Specific methods were selected by the expert group. The data was obtained by searching the Internet using The Google. The obtained data was processed in MS Excel using descriptive statistics. Results: Altogether, 98 CAM methods were searched. Of these, 28 methods were excluded from the evaluation, 70 methods were evaluated according to the criteria, and 2 methods were double...

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-11Bitstream added on 2014-06-13T19:59:14Z : No. of bitstreams: 1 cruz_mz_me_botfm.pdf: 399271 bytes, checksum: 5cacfbb4f0052462d6ff6d30f2bedcbf (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este estudo é uma revisão teórica e uma reflexão crítica que tem como objetivo investigar o campo da psicossomática, incluindo fundamentos teóricos, bases fisiológicas e as implicações na Saúde Coletiva. Ao longo da história, as concepções sobre saúde e doença, assim como o pensamento médico, incluem suposições filosóficas a respeito do problema mente-corpo, que se configuram em perspectivas monistas ou dualistas. O desenvolvimento das neurociências e da psiconeuroimunologia têm sugerido complexas interações bidirecionais entre os sistemas nervoso, imune e endócrino, assim como um papel central dos aspectos emocionais e cognitivos no processo saúde-doença, que questionam a perspectiva dualista. As crescentes pesquisas em psiconeuroimunologia trazem consigo a necessidade de se discutir uma abordagem mais ampla em saúde, para que se possa maximizar os benefícios das intervenções e proporcionar uma maior qualidade de vida. O modelo biopsicossocial proposto por George Engel, que contempla uma abordagem centrada na integralidade do ser humano, demanda estratégias de intervenção que promovam o bem estar físico e psíquico, melhorem as relações sociais e as condições de vida e trabalho, atuando no âmbito da macroestrutura econômica, social e cultural. Estudos no campo da psicossomática mostram-se importantes para fortalecer as bases científicas que contribuirão para a construção e a implementação do paradigma biopsicossocial na Saúde Coletiva, tendo em vista a efetivação do princípio da integralidade / This study is a theoretical review and a critical reflection that aims to investigate the major studies in the psychosomatic field, including theoretical foundations, physiological basis and implications in public health. Throughout history, the concepts of health and illness, as well as the medical thinking, have been influenced by the philosophical discussion of the mind-body problem, which leads to a monistic or dualistic perspective. Development of the neurosciences and psychoneuroimmunology has shown complex bidirectional interactions among the nervous, immune and endocrine systems, as well as the role of emotional and cognitive aspects for the healthdisease process, thus questioning the dualistic concept. Research in psychoneuroimmunology implies the need to discuss a broader approach to health, in order to maximize the benefits of interventions and provide a higher quality of life. The biopsychosocial model proposed by George Engel, an approach that considers the whole of the human being, demands interventional strategies that promote physical and mental well being, improve social relations, living and work conditions and also act within the economic, social and cultural macrostructure. Studies in the psychosomatic field are important to strengthen the scientific basis that will contribute to the building and implementation of the biopsychosocial paradigm in public health, moving towards the realization of the principle of integrality

Orientador: Regina Stella Spagnuolo / Banca: Karina Pavão Patrício / Banca: Marcelo Marcos Piva Demarzo / Resumo: Embora a biomedicina seja indispensável à vida contemporânea, a crescente procura por Práticas Integrativas e Complementares (PIC) denuncia as fragilidades deste modelo em responder integralmente às diversas demandas de saúde da população. Apoiando-se na necessidade de efetivação do principio da integralidade no SUS e atendendo as diretrizes da OMS para implantação das medicinas tradicionais, alternativas e complementares nos sistemas nacionais de saúde, o governo brasileiro lançou em 2006 a Política Nacional de Práticas Integrativas e Complementares no SUS (PNPIC). O presente trabalho se propõe a caracterizar as produções científicas acerca das PIC no SUS antes e após a implantação da PNPIC, destacando as principais fragilidades, potencialidades e perspectivas apontadas pelas pesquisas em relação a este processo. Utiliza-se o método de revisão integrativa, considerando o período temporal entre 2000 e 2013. No período entre Agosto e Novembro de 2013, foram consultadas as bases de dados da Medline, Lilacs, Scielo e Scopus e incluídos 35 artigos, que atenderam os seguintes critérios: trabalhos completos publicados em periódicos, relevantes ao tema e escritos em português, espanhol e/ou inglês. Os dados foram analisados por meio de abordagem quali-quantitativa, apresentados em tabelas e em categorias temáticas e discutidos à luz da integralidade em saúde. Observou-se que a produção sobre PIC no SUS começa a crescer em 2007, que a maioria dos artigos são brasileiros e se concentram na base de dados da Lilacs. A região sudeste concentra o maior volume de artigos sobre o tema e, dentre as universidades, a Universidade Federal de Santa Catarina (UFSC). A maioria dos autores possui graduação na área da saúde e título de doutor. Em relação à abordagem metodológica, os estudos qualitativos possuem maior representatividade e em relação ao desenho de pesquisa destacam-se os estudos descritivos. Os sujeitos... / Abstract: While biomedicine is indispensable to contemporary life, the growing demand for Integrative and Complementary Practices (ICP) denounces the weaknesses of this model to fully meet the diverse health needs of the population. Relying on the need for realization of the principle of comprehensiveness in SUS and meeting the WHO guidelines for deployment of traditional, complementary and alternative medicines in national health systems, the brazilian government launched in 2006 the National Policy on Integrative and Complementary Practices in the Unified Health System (UHS) (NPICP). This study aims to characterize the scientific production about the ICP in the UHS before and after the implementation of NPICP, highlighting the main weaknesses, potential and prospects indicated by the research regarding this process. We use the integrative review method, considering the time period between 2000 and 2013. Between August and November 2013, Medline databases were consulted, Lilacs, SciELO and Scopus and included 35 articles that met the following criteria: full papers published in journals relevant to the topic and written in Portuguese, Spanish and / or English. Data were analyzed using qualitative and quantitative approach, presented in tables and themes and discussed based on health comprehensiveness. It was observed that the production of ICP in UHS begins to grow in 2007, that most articles are Brazilian and are concentrated in the Lilacs database. The southeast region concentrates the largest number of articles on the subject and, among universities, the Federal University of Santa Catarina (FUSC) holds the biggest percentage of articles. Most authors hold a degree in health and doctor's degrees. Regarding the methodological approach, qualitative studies have greater representation and in relation to research design stand out from the descriptive studies. The most studied subjects were UHS users and professionals. It is observed that most of ... / Mestre

Atendendo à premissa de expor a vivência do pesquisador em inovação e empreendedorismo, esse trabalho trata-se de um estudo de caso adaptado que teve como objetivo, propor um quadro de modelo de negócios para uma organização de Medicina Integrativa. A proposta do modelo de negócios atendeu um processo proposto por Kolb, onde através da experiência concreta, observação reflexiva e experimentação ativa, conseguiu-se realizar a conceptualização abstrata para um modelo de negócios inovador. Engajando-se na racionalidade médica contemporânea, que busca encontrar um mecanismo de cuidado com o indivíduo por práticas e protocolos que possam ser eficientes e de menor custo, e impulsionado pela experiência profissional e interesse de um investidor, realizou-se uma sequência de ações que pudessem formar um modelo de negócios estruturado e que atendesse um negócio inovador. Foi possível observar que: A) O modelo de negócios mostra-se bastante eficaz para compreender um negócio inovador; B) A Medicina Integrativa é um conjunto de práticas que envolve o cuidado global do indivíduo; C) APor meio do modelo de negócios, é possível proporcionar subsídios para alcançar investidores e, por fim, D) Por meio do modelo de negócios foi possível que o principal stakeholder, o médico proprietário, pôde obter, após a aplicação da ferramenta, novas ideias e insights a respeito de ações imediatas e futuras. Para os outros, a compreensão estabeleceu clareza e direcionamento maior dos objetivos, assim como, possibilitou a definição das responsabilidades e prioridades de cada um. / Given the premise of exposing the experience of research in innovation and entrepreneurship, this work is an appropriate case study that aimed to propose a business model framework for an organization of Integrative Medicine. The proposed business model attended a process proposed by Kolb, which through concrete experience, reflective observation and active experimentation, was managed to achieve the abstract conceptualization to an innovative business model. Engaging in contemporary medical rationality, which seeks to find a care facility with the individual for practices and protocols that may be efficient and lower-cost, driven by experience and interest of an investor, was held a sequence of actions that could form a structured business model and that meets an innovative business. It was observed that: A) The business model is the most effective way to understand an innovative business; B) The Integrative Medicine is undoubtedly the most effective and involves less cost in the overall individual care; C) Through the business model, it is possible to provide subsidies to reach investors and, finally, D) Through the business model it was possible that the main stakeholder, the physician owner could get, after application of the tool, new ideas and insights regarding immediate and future actions. For others, understanding clearly established and greater targeting of objectives, as well as made possible the definition of responsibilities and priorities of each.

BACKGROUND: Evidence suggests complementary and alternative medicine (CAM) therapies can be effective in treating certain chronic, recurrent, and incurable conditions. Use of CAM in pediatric populations is increasing considerably and uptake is especially evident among hospitalized children. Further, burnout among healthcare providers is increasing, affecting both their wellbeing and patient outcomes. At Banner Children's Diamond Children's Hospital, patients, families, and staff can receive CAM through the Integrative Touch for Kids™ (ITK) Hospital Heroes (HH) program. SIGNIFICANCE: Further study to evaluate HH is vital to understanding the quality of care delivered and recommendations for improvement. OBJECTIVES: Assess feasibility of evaluation of HH by Aim 1: Describing the vision and programmatic structure of the HH program. Aim 2: Achieving therapist consensus on referral, care coordination, and debriefing processes; Aim 3: Evaluating session impact on pain, fear/distress/anxiety, global/overall well-being, and satisfaction. Describe retrospective case studies to highlight valuable outcomes otherwise not represented. FRAMEWORKS & METHODS: The Centers for Disease Control & Prevention Framework for Program Evaluation in Public Health, elements from the Ethnographic Assessment of Evaluation Systems, and elements from Donabedian's Quality Framework were used to create a novel, theory-based, whole practice, program evaluation framework to evaluate HH via the following aims. Aim 1: Structure- Key- informant ethnographic interviews with ITK management (N=2) and self-completed questionnaires by HH therapists (N=4) were used to describe the program vision and structural elements. Interviews were transcribed and all data was de-identified, described, and summarized. Transcripts were converted into culturally-appropriate word clouds validated by participants. Univariate and descriptive statistics were used to assess questionnaire items related to human resources and quality rankings were assigned based on ITK standards. Aim 2: Process- The Delphi method was used by administering self-administered ethnographic questionnaires (N=3) to all HH therapists (N=4) to generate consensus on referrals, care coordination, and debriefing processes. Concept Maps were created for each element and validated by participants. Aim 3: Outcomes- Evaluation instruments were developed and piloted in collaboration with ITK stakeholders and data was collected over a two-month period representing nearly 50% of sessions administered by the HH therapists, from Aims 1 and 2, for 2017. Session and recipient characteristics for all sessions (N=95), regardless of recipient ability to report, were summarized. Pre/post changes were calculated using validated scales for pain, fear/distress/anxiety, global/ overall well-being, and likelihood to recommend the hospital. Session satisfaction rankings were collected post-session. Wilcoxon matched-pair signed-rank tests were done to calculate significant differences between median changes pre/post session for recipients able to respond and stratified by recipient type. Retrospective case studies (N=4) were described from data in the electronic health record and/or ITK records, as well as interviews with HH therapists. RESULTS: The program structure was described and quality of human resources met or exceeded criteria for most indicators of quality. Expert consensus on therapist interactions related to referrals, care-coordination, and debriefing was achieved. Evaluation of the HH program was determined feasible and in alignment with the program model and short-term vision. Strong evidence to support decreases in pain and fear/distress/anxiety, as well as increases in global overall well-being were observed in recipients able to report. High levels of satisfaction (mean≥9.0) and top-box rankings for likelihood to recommend the hospital overall, were reported. Retrospective case studies (N=4) highlighted additional outcomes from multiple perspectives. CONCLUSION: These results help to support ethnographic evaluation of the HH program, a holistic and integrative model of care, as ITK continues expanding and replicating the HH program within and beyond the current setting. Knowledge reported provides a new theory-based, whole practice, program evaluation model and expands existing evidence on CAM use in hospitalized pediatric patients.

PhD / The present healthcare system in South Africa suffers from a number of serious deficiencies. Whilst orthodox bio-medicine is well established in most first world countries, its total introduction and implementation into all communities within South Africa faces many obstacles. The cost of diagnostic techniques, investigative procedures and pharmaceutical products, the availability of competent medical staff in the non-urban areas, and the lack of acceptance of the philosophy and practice of orthodox bio-medicine in rural regions are but some of the factors which conspire against the general application of this orthodox medical paradigm. Another problem confronting healthcare and medical practice in South Africa, particularly at this stage of our historical development, is the absolute focus on orthodox bio-medicine, often to the detriment of other medical paradigms that also have advantages to offer. Can the integration of another medical paradigm, such as Unani-Tibb, enhance the practice of orthodox bio-medicine in this country? The aim of the thesis was to investigate the possibility of integrating Unani-Tibb with orthodox biomedicine (also termed conventional, Western or allopathic medicine) and assess its potential for improving delivery of an effective, affordable and appropriate healthcare system in South Africa. The research questions which the thesis seeks to answer is whether this integration is possible and whether the delivery of healthcare to the South African population can be enhanced. Changes in the provision of medical education are necessary, and occupy a pivotal role in allowing for this integration. Unani-Tibb is a traditional medical system practiced extensively on the Indian sub-continent and in other parts of the world. At present, however, it is minimally practiced in South Africa. Its primary principle is the energetic promotion of health maintenance behaviour and the prevention of disease, through effective application of dietotherapy, pharmacotherapy and other interventions, as well as the empowerment of the patient towards adopting behavioural changes and lifestyle adaptations. One positive aspect of Unani-Tibb is that it has many features in common with both orthodox biomedicine and African Traditional medicine. These commonalities should allow for greater acceptance by orthodox healthcare professionals, as well as the general population.

Chinese Herbal Medicine has been mainstream practice for hundreds of generations, however the merits of herbal therapeutics have been debated in the era of modern medicine. With a shift towards scientific analysis and rigorous testing of conventional pharmaceuticals in the past century, critics have questioned the proclaimed effects of herbal concoctions. Nonetheless, herbal medicines are still used frequently and have spawned clinical studies meant to determine their therapeutic efficacy. This paper aims to evaluate many aspects of Chinese Herbal Medicine applications that have already been analyzed in other papers, then propose a study which explores the effects of the herbal concoction Ban Xia Bai Zhu Tian Ma Pian in lowering blood pressure. Hypertension was chosen as the focus of the study due to its extensive presence in the population and the impact a significant outcome can provide given its prevalence. The ultimate goal is to find a balance between both eastern and western practices of medicine, thus preserving Chinese medical traditions that are concurrently buttressed by scientific research.

Orientador: Alfredo Pereira Junior / Banca: Maria de Lourdes Spazziani / Banca: Sissy Veloso Fontes / Resumo: Este estudo é uma revisão teórica e uma reflexão crítica que tem como objetivo investigar o campo da psicossomática, incluindo fundamentos teóricos, bases fisiológicas e as implicações na Saúde Coletiva. Ao longo da história, as concepções sobre saúde e doença, assim como o pensamento médico, incluem suposições filosóficas a respeito do problema mente-corpo, que se configuram em perspectivas monistas ou dualistas. O desenvolvimento das neurociências e da psiconeuroimunologia têm sugerido complexas interações bidirecionais entre os sistemas nervoso, imune e endócrino, assim como um papel central dos aspectos emocionais e cognitivos no processo saúde-doença, que questionam a perspectiva dualista. As crescentes pesquisas em psiconeuroimunologia trazem consigo a necessidade de se discutir uma abordagem mais ampla em saúde, para que se possa maximizar os benefícios das intervenções e proporcionar uma maior qualidade de vida. O modelo biopsicossocial proposto por George Engel, que contempla uma abordagem centrada na integralidade do ser humano, demanda estratégias de intervenção que promovam o bem estar físico e psíquico, melhorem as relações sociais e as condições de vida e trabalho, atuando no âmbito da macroestrutura econômica, social e cultural. Estudos no campo da psicossomática mostram-se importantes para fortalecer as bases científicas que contribuirão para a construção e a implementação do paradigma biopsicossocial na Saúde Coletiva, tendo em vista a efetivação do princípio da integralidade / Abstract: This study is a theoretical review and a critical reflection that aims to investigate the major studies in the psychosomatic field, including theoretical foundations, physiological basis and implications in public health. Throughout history, the concepts of health and illness, as well as the medical thinking, have been influenced by the philosophical discussion of the mind-body problem, which leads to a monistic or dualistic perspective. Development of the neurosciences and psychoneuroimmunology has shown complex bidirectional interactions among the nervous, immune and endocrine systems, as well as the role of emotional and cognitive aspects for the healthdisease process, thus questioning the dualistic concept. Research in psychoneuroimmunology implies the need to discuss a broader approach to health, in order to maximize the benefits of interventions and provide a higher quality of life. The biopsychosocial model proposed by George Engel, an approach that considers the whole of the human being, demands interventional strategies that promote physical and mental well being, improve social relations, living and work conditions and also act within the economic, social and cultural macrostructure. Studies in the psychosomatic field are important to strengthen the scientific basis that will contribute to the building and implementation of the biopsychosocial paradigm in public health, moving towards the realization of the principle of integrality / Mestre

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In this thesis I examine the debate surrounding Therapeutic Touch, a controversial energetic healing modality being practiced by registered nurses in biomedical institutions across North America. The debate surrounding the therapy takes place within medical journals, popular media articles, and on the internet. Within the debate, definitions of illness etiology, appropriate treatment, patient management, and alternative therapy use are contested by Therapeutic Touch proponents and critics. Through discursive analysis, interviews with local participants in the debate, and participant observation within the TT community, I present an analysis of the issues being contested and of the discursive strategies used by proponents and critics within the debate. The debate is contextualized in two ways: first, as an instance of medical heresy, in which an alternative healing group arises within the orthodox medical community and struggles to maintain itself within biomedical discourse and institutions; second, I contextualize the debate as an example of the wider trend towards integrative medicine in North America. Integrative medicine sees alternative therapies being increasingly used within health care delivery systems, either by alternative practitioners, or by biomedical practitioners who have co-opted alternative techniques. I argue that Therapeutic Touch proponents have utilized several discursive strategies in presenting and arguing for their alternative healing model. These strategies surround the issues of professional legitimacy, scientific validity, and TT’s perception as religious or spiritual. Therapeutic Touch proponents manage their discourse by conforming it to orthodox biomedical discourse and by pursuing a strategy of professionalization. Through this management process, they have been able to maintain a marginal presence within biomedicine. / Thesis / Master of Arts (MA)