A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background Infertility, or impaired fecundity, affects 11.8% of women between the ages of 15 and 44, which translates to 7.3 million women. The use of assisted reproductive techniques has doubled over the past decade, with 148,055 cycles performed during 2008 resulting in 46,326 live births and the delivery of 61,426 infants. Acupuncture has been used in China to treat numerous and disparate medical conditions for thousands of years. Many anecdotal reports and non-randomized studies have claimed that acupuncture improves fertility, but the number of high-quality randomized controlled clinical trials and cohorts is much thinner. Objectives To determine whether the use of acupuncture results in higher pregnancy rates in patients undergoing in vitro fertilization compared with placebo acupuncture or no treatment. Search strategy All randomized controlled trials and prospective cohort reports of acupuncture and assisted reproductive technology were obtained through a systematic search of Medline and the MeSH database (1996 to February 2011). Selection criteria Prospective, randomized controlled trials comparing acupuncture treatment versus no treatment, placebo acupuncture, sham acupuncture at non-acupoints, and sham acupuncture at non-fertility-related acupoints during IVF treatment with or without intracytoplasmic sperm injection (ICSI). Inclusion criteria: - primary or secondary subfertility - undergoing IVF with or without ICSI - timing of acupuncture for before and after embryo transfer Exclusion criteria: - frozen embryo transfer - acupuncture used as adjunct to analgesia - electroacupuncture - donor oocytes - non-randomized trials, case-controls, case studies - studies included in the 2009 Cochrane review Data collection and analysis Thirteen randomized controlled trials were identified that involved acupuncture and in vitro fertilization with embryo transfer. Trials were analyzed for the following methodological details and quality criteria: study characteristics (randomization, blinding, power analysis, intention-to-treat analysis), patient characteristics (demographics, inclusion and exclusion criteria), interventions (IVF stimulation protocols, timing of acupuncture or control, acupoints chosen), and outcomes (ongoing pregnancy rates, live birth rates). Main results Only one of the trials demonstrated a result that achieved statistical significance. So 2009 showed that placebo acupuncture resulted in significantly higher overall birth rate when compared to true acupuncture. Even with adequate power, none of the other trials showed a difference that achieved statistical significance in pregnancy rate or live birth rates between acupuncture and control groups. Conclusions Acupuncture does not improve IVF outcomes and should not be offered routinely as an adjunct to fertility treatment. The evidence from the current literature suggests a positive effect of sham and placebo acupuncture on IVF outcomes, and therefore merits further study with adequately powered RCTs.

This study sought to understand how practitioners of the traditional systems of complementary medicine (CM) were responding to the adoption of their traditional medicine therapies by the mainstream health care practitioners. The occupational domain of traditional CMPs is undergoing significant changes as a result of the continuing popularity of CM with health consumers and the market environment of contemporary health care. Although CM itself has become popular as a topic of research in mainstream health and medical journals, little is known about the perspectives of traditional CMPs or their response to the changes taking place in their occupational domain. / In depth interviews were used as the principle source of data, 20 interviews were conducted with 19 participants who were defined as non-mainstream practitioners from five traditional systems of medicine. Field notes form participant observation at CMP association meetings and professional literature sourced from within the CM sector were also used in the study. This was supported with secondary data sourced from relevant academic literature, accessed after the identification of the main concern of the participants and the formation of the central categories from the interview data. / Thesis (PhD)--University of South Australia, 2006.

Thesis (M.A.)--Bowling Green State University, 2005. / Document formatted into pages; contains vi, 45 p. Includes bibliographical references.

Class of 2007 Abstract / Objectives: The objective of this study was to determine the need for an integrative medicine continuing education (CE) program for pharmacists and what pharmacists are looking for in such a CE program. Methods: A focus group was conducted with four pharmacists. They were led on a discussion about their experiences with alternative/herbal medicines and desire to learn more, opinions on CE for pharmacists, and compensation for CE credits. The members of the focus group were also given a demographics questionnaire about their gender, age, years in practice, and practice setting. Results: The focus group thought that most pharmacists would want to learn more about integrative medicine, including alternative and herbal products. They would like to have a CE program that is structured around disease states and presents evidence based medicine. It was agreed that inclusion of law CE credits would make the program more desirable. The length of the program could be between 2 hours (if presented on-line) to an entire day (if conducted with presentations). The major limitation in this study was the generalizability of the results due to the small size of the focus group and its members being form the same practice site. Conclusions: It was determined that there is a need for an integrative medicine CE program for pharmacists. If remuneration is sought for the program, then pharmacists will expect certification upon completion. More studies should be conducted to determine the ideal content in herbal/alternative medicine CE programs.

Complementary and alternative medicine (CAM) is increasingly in demand and utilized by the public, specifically by families and their children who are being cared for by current mainstream in-hospital services. Integrative medicine (IM) is a strategy by which conventional health care is attempting to address the use of CAM and explore considerations to implement a pediatric integrative medical (PIM) service. This study will add the otherwise unexplored perspectives of CAM practitioners and hospital administrators to current literature. Semi-structured interviews with 10 CAM practitioners and 4 administrators were conducted. A qualitative comparative content analysis explored considerations for CAM integration in a pediatric hospital, including varied attitudes; levels of understanding and experiences with CAM; communication between professionals; expectations; skepticism and resistance to change; gaining knowledge about CAM; opposing health care ideologies; adapting to different health care environments; funding; safety; redistribution of care; therapeutic milieu; and patient centered care. There is a reservation toward IM in pediatric hospitals, despite generally positive personal and professional experiences and attitudes towards CAM. The realities and challenges of IM are identified. Implications for inclusion of key stakeholder perspectives are discussed in the context of IM for pediatric patients. / Graduate

Thesis (Ph.D.)--Cornell University, August, 2008. / Includes bibliographical references (leaves 117-129).

For several centuries, Punica granatum L. has been utilized in traditional medicine to treat various ailments including diabetes, diarrhea, and parasitic and microbial infections. Current scientific research suggests that the unique phytochemical composition of the botanical is largely responsible for the range of biological activities demonstrated by the different components of P. granatum L. The objective of this study was to evaluate the effects of the fruit extract of P. granatum L. on the following parameters of skin health: facial wrinkle severity, sebum production, transepidermal water loss, melanin index, and erythema index. The hypothesis was that oral pomegranate supplementation improves the facial appearance of wrinkles and the biophysical properties of the skin because of the well-studied antioxidant and anti-inflammatory properties of the phytochemicals in the fruit extract. A prospective, double-blind, placebo-controlled study was conducted in which subjects were supplemented daily with a punicalagin-enriched oral pomegranate extract for four weeks. The study was performed at Integrative Skin Science and Research (Sacramento, California, USA) and included 18 healthy males and females, aged 25–55 years, who were asked to restrict the intake of other polyphenolic-rich foods. A facial image collection and analysis system was used to assess the facial appearance of wrinkle severity, and standardized, noninvasive tools were used to collect information on facial sebum production, transepidermal water loss, melanin index, and erythema index. In addition, self-reports of quality of life and digestive health were collected from the subjects. These parameters were assessed at pretreatment baseline and after four weeks of oral supplementation. The results showed statistically significant reductions in the melanin index of the cheeks (p < 0.01), transepidermal water loss from the stratum corneum of the cheeks (p < 0.01), and facial appearance of average wrinkle severity (p < 0.01). Furthermore, a significant reduction was found in facial transepidermal water loss among females of the intervention group (p < 0.01). No adverse effects were reported over the four weeks of the study. In conclusion, this study demonstrated an improvement in several biophysical properties of the skin with oral pomegranate extract supplementation. As a result, oral pomegranate extract could be used as an effective agent for the maintenance of skin appearance and skin health.

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