Regardless of specific national drug regulations there is an international consensus that all TCM drugs must meet stipulated high quality standards focusing on authentication, identification and chemical composition. In addition, safety of all TCM drugs prescribed by physicians has to be guaranteed. During the 25 years history of the TCM hospital Bad Kötzting, 171 TCM drugs underwent an analytical quality proof including thin layer as well as high pressure liquid chromatography. As from now mass spectroscopy will also be available as analytical tool. The findings are compiled and already published in three volumes of analytical monographs. One more volume will be published shortly, and a fifth volume is in preparation. The main issues of the analytical procedure in TCM drugs like authenticity, botanical nomenclature, variability of plant species and parts as well as processing are pointed out and possible ways to overcome them are sketched.
Background: Prevalence rates of complementary and alternative medicine (CAM) use are still missing for some European countries, especially in the East. Thus, we measured patterns and determinants of CAM use among a representative sample of the general population in the Czech Republic. Methods: A cross-sectional survey was conducted. A sex-, age- and region-stratified sample of citizens aged 15 and older were randomly selected from voter registration lists (n = 8,639,375). Results: Overall, 76.0% (n = 1,365) of the respondents reported use of one or more CAM modalities during the past 30 days. The top five CAM modalities used were vitamins/minerals (54.6%), herbal remedies (47.8%), massage (19.9%), relaxation techniques (9.5%), and dietary supplements excluding vitamins/minerals (9.2%). Prevention (82.0%) was the primary reason for CAM use. Only 15.9% of CAM users employed it for therapeutic purposes. The most commonly treated ailments were respiratory (35.0%) and musculoskeletal (33.6%) disorders. Conclusion: The prevalence of CAM use in the Czech Republic is high, especially among people who apply CAM for self-treatment prior to seeing a doctor. Half of the study population combined CAM with conventional medical treatment, which may result in potential harm to the patient. Healthcare providers as well as the public should be educated about effective and safe use of CAM.
Background: Neck reflex points (NRP) are tender soft tissue areas of the cervical region that display reflectory changes in response to chronic inflammations of correlated regions in the visceral cranium. Six bilateral areas, NRP C0, C1, C2, C3, C4 and C7, are detectable by palpating the lateral neck. We investigated the inter-rater reliability of NRP to assess their potential clinical relevance. Methods: 32 consecutive patients with chronic neck pain were examined for NRP tenderness by an experienced physician and an inexperienced medical student in a blinded design. A detailed description of the palpation technique is included in this section. Absence of pain was defined as pain index (PI) = 0, slight tenderness = 1, and marked pain = 2. Findings were evaluated either by pair-wise Cohen's kappa (ĸ) or by percentage of agreement (PA). Results: Examiners identified 40% and 41% of positive NRP, respectively (PI > 0, physician: 155, student: 157) with a slight preference for the left side (1.2:1). The number of patients identified with >6 positive NRP by the examiners was similar (13 vs. 12 patients). ĸ values ranged from 0.52 to 0.95. The overall kappa was ĸ = 0.80 for the left and ĸ = 0.74 for the right side. PA varied from 78.1% to 96.9% with strongest agreement at NRP C0, NRP C2, and NRP C7. Inter-rater agreement was independent of patients' age, gender, body mass index and examiner's experience. Conclusion: The high reproducibility suggests the clinical relevance of NRP in women.
Background: Pediatric use of complementary and alternative medicine (CAM) is popular in Europe, and utilization may be even more prevalent in chronically ill children/adolescents. This study's aim is to assess CAM use among adolescents with chronic conditions. Methods: Data on drug utilization (past 4 weeks) and consultation with CAM providers (past year) were collected using a self-administered questionnaire from 4,677 adolescents from the German GINIplus/LISAplus birth cohorts. All reported drugs were classified into therapeutic categories (conventional drugs, homeopathy, herbal drugs, etc.). Additionally, participants were asked to list any chronic diseases (that were parent-reported, physician-verified diagnoses such as allergies, atopic dermatitis, asthma, or other chronic diseases) that they had had over the previous 5 years. Results: Compared with the total sample, drug utilization in general (60.1% vs. 41.1%), homeopathy use (11.1% vs. 8.1%), and consultation with CAM providers (16.9% vs. 10.9%) was significantly more prevalent among chronically ill adolescents. However, chronically ill adolescents used relatively (proportion of the defined therapeutic category among all drugs used) more conventional drugs than healthy adolescents. Conclusion: Compared with healthy adolescents, CAM use is more prevalent among adolescents with chronic conditions. Nevertheless, CAM may predominantly be used as a complementary treatment option rather than substituting conventional drugs.
Die Sackett’sche Idee der evidenzbasierten Medizin (EBM) hat zu forschungsbasierten Therapieentscheidungen gefuhrt, Lehrmeinungen und Postulate infrage gestellt und den Wissenstransfer beschleunigt. Ein neues Zeitalter der Aufklarung in der Medizin wurde eingelautet. Man konnte sagen: Alte Zopfe wurden und werden im Licht aktueller wissenschaftlicher Erkenntnisse abgeschnitten, die Meinung von Opinion Leaders und Experten muss sich hinten anstellen. Auch Naturheilverfahren (NHV) wurden davon erfasst. Dann bewegte sich die EBM in eine problematische Richtung: Ihre Auslegung ging zunehmend mit starrem Blick auf Meta-Analysen und Reviews einher. Beschrieben hat David Sackett die Anwendung der EBM jedoch so: «...in making decisions about the care of individual patients, the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research» [1]. Die Ergebnisse von Meta-Analysen und Reviews bestimmen heute die Kernaussagen von Leitlinien, die wiederum in Lehrbuchern und vor Gerichten zu Richtlinien avancieren. Dabei sollten Leitlinien Wissenskorridore bilden, erfullt von den besten wissenschaftlichen Erkenntnissen, von der Expertise der arztlichen Anwender und den Bedurfnissen der Patienten. Die Sackett’sche EBM sieht diese Trias vor! Und NHV sowie die Komplementarund Alternativmedizin (CAM) in Leitlinien funktionieren aus meiner Sicht genau so am allerbesten: als evidenzgestutzte Wissenskorridore, angewendet von geschulten und kundigen Arzten, in gutem Austausch mit den Patienten und zu deren Wohl. Im Betrieb der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., der Dachorganisation fur das Regelwerk der Leitlinienerstellung, gilt naturgemas das geschriebene Wort – der Austausch mit den Patienten und ihre Behandlung finden in Kliniken und Praxen statt. Die arztlichen Autoren und Vertreter von NHV und CAM konnen sich trotzdem glucklich schatzen, am Leitlinienschaffen teilzuhaben: Durch die geforderten Evidenzbeweise geben sie Impulse an das Forschungsgeschehen, frischen damit und durch umfangliche Literaturrecherchen die Kenntnisse uber die tradierten Lehren auf und stellen NHV und CAM im besten Fall gleichberechtigt in einer Leitlinie dar, direkt neben den Methoden der Mainstream-Medizin. Jedenfalls hat der «body of evidence», der weltweite Wissensschatz von NHV und CAM, in erfreulichem Umfang zugenommen. Im ungunstigen Fall mussen die Vertreter von NHV und CAM gegen Vorurteile von Mitautoren kampfen. Zwar mag formal eine Untersuchung uber Blutegel dem hohen Evidenzlevel 1b (z.B. fur die Linderung von Kniearthrose-Schmerzen) entsprechen. Auch mag der Blutegel als Medizinprodukt apothekengangig und verordnungsfahig, sogar abrechenbar nach der Gebuhrenordnung fur Arzte sein. Doch warum erhalt er in der Leitlinie nur die schwachste Empfehlungsstarke C? Published online: June 23, 2016
a Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany; b Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden; c I C – The Integrative Care Science Center, Järna, Sweden; d Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, USA; e Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
Background: Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. Methods: We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. Results: The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. Conclusion: Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.
