Agishi, Tetsuzo. Incentive for a Shift from Modern Scientific Medicine to Integrative Medicine. J Artif Organs 2006, 9, 123–129.
Abstract Medicine has been evaluated in recent years both quantitatively and qualitatively. Contemporary medicine has been assumed to be conceptually based on modern science. However, there is a problem that quantity and quality are hard to evaluate using only scientific parameters. It is, therefore, the aim of this article to emphasize that the quantity and quality of medicine need to be evaluated not only from the standpoint of modern scientific medicine but also in terms of integrative medicine. Integrative medicine is postulated to be comprehensive in its fundamental doctrine, emphasizing a holistic approach including technical, artistic, social, religious, philosophical, and ethical elements.
However, in evaluating carefully and seriously actual performance, it was noted that contemporary medicine has been giving greater emphasis to aspects of integrative medicine where increasing concern is paid to patients’ personal preferences, as indicated by their quality of life. An incentive for a shift from exclusively scientific to integrative medicine, which started as early as the 1970s, is revival emotion toward a prime modality of medicine.

Burke, Adam/ Peper, Erik/ Burrows, Kenn/ Kline, Barry. Developing the Complementary and Alternative Medicine Education Infrastructure: Baccalaureate Programs in the United States. The Journal of Alternative and Complementary Medicine 2004, 10(6), 1115–1121.
Abstract
Objectives: Efforts to build a complementary and alternative medicine (CAM) education and research infrastructure have been productive. Development has focused largely on graduate, postgraduate, and professional level training. This paper examines baccalaureate programs, looking at the prevalence and characteristics of CAM and holistic health training in the United States.
Design: A comprehensive literature and web site search was conducted to find educational institutions offering baccalaureate programs in CAM or holistic health. Search criteria included accredited undergraduate programs terminating in a minor, an AA, or a BA/BS degree.
Results: A search of health and education databases produced marginal results. Internet searches, by contrast, were very productive in locating CAM or holistic health-related programs generally and baccalaureate programs specifically. The most effective search strings included terms such as ‘holistic health,’ ‘minor,’ ‘certificate,’ and ‘undergraduate.’ Using these terms, 5 programs were found in the United States that met the inclusion Criteria: Arizona State University East, Bastyr University, San Francisco State University, Metropolitan State College of Denver, and Georgian Court College.
Conclusions: Preparing tomorrow’s scholars and clinicians to contribute meaningfully to this emerging healthcare paradigm will require a plan that integrates all elements of higher education. The creation of a truly effective workforce of CAM-competent M.D.s, nurses, health educators, pharmacists, and other allied health professionals will increasingly necessitate baccalaureate preparation. Curriculum discussions at the campus, state, and national levels are needed.

Donnelly, Gloria F. The Transformation of Healthcare: A Wicked Problem. Holistic Nursing Practice September/October 2006, 215-216.

Hewson, Mariana G./ Copeland, H. Liesel/ Mascha, Edward/ Arrigain, Susana/ Topol, Eric/ Fox, Joan E.B. Integrative Medicine: Implementation and Evaluation of a Professional Development Program Using Experiential Learning and Conceptual Change Teaching Approaches. Patient Education and Counseling 2006, 62, 5-12.
Abstract
Objective: To meet the increasing patient interest in complementary and alternative medicine (CAM), conventional physicians need to understand CAM, be willing to talk with their patients about CAM, and be open to recommending selected patients to appropriate CAM modalities. We aimed to raise physicians’ awareness of, and initiate attitudinal changes towards CAM in the context of integrative medical practice. We developed and implemented a professional development program involving experiential learning and conceptual change
teaching approaches.
Methods: A randomized controlled study with a pre-post design in a large academic medical center. The 8-hour intervention used experiential and conceptual change educational approaches. Forty-eight cardiologists were randomized to participant and control groups. A questionnaire measured physicians’ conceptions of, and attitudes to CAM, the likelihood of changing practice patterns, and the factors most important in influencing such changes. The questionnaire included an embedded control question on a topic that was not the focus of this program. We administered the questionnaire before (pretest) and after (posttest) the intervention. We compared differences in pre- and post-intervention scores between the participant (N = 20) and control (N = 16) groups. We used both groups to identify factors that influenced their practice patterns. The study was NIH-funded and IRB-exempt.
Results: Both groups initially had little knowledge about, and negative attitudes to CAM. The participant group had significant positive changes in their conceptions about, and attitudes to CAM after the program, and significant improvements when compared with the control group. Participant physicians significantly increased in their willingness to integrate CAM in their practices. Physicians (combined groups) rated research evidence as the most important factor influencing their willingness to integrate CAM. They requested more research evidence for CAM efficacy, and more information on non-conventional pharmacology. Participants reflected enthusiasm for the experiential program.
Conclusions: The participants were able to experience the positive effects of selected CAM modalities. It is possible to increase physician knowledge and change attitudes towards integrative medicine with an eight-hour intervention using experiential and conceptual change teaching approaches.
Practice implications: Professional development on integrative medicine can be offered to medical practitioners using experiential learning and conceptual change teaching approaches, with the help of local CAM practitioners.

Keller, Jill S. Implementation of a Prechemotherapy Educational Intervention for Women Newly Diagnosed with Breast Cancer. Clinical Journal of Oncology Nursing 10(1), 57-60.
Women newly diagnosed with breast cancer often are misled by false information regarding treatments and side effects. Web sites can be filled with graphic stories and false information about chemotherapy. Research has examined how patients handle the side effects of chemotherapy physically and emotionally during treatment. No standardized prechemotherapy intervention has been developed to assist patients with breast cancer preparing for chemotherapy. A 30-minute educational intervention provided by nurses before the start of chemotherapy may assist women in increasing their knowledge of chemotherapy treatment, enhancing their ability to manage side effects and improving their coping strategies.

Kemper, Kathi J./ Wornham, Wendy. Consultations for Holistic Pediatric Services for Inpatients and Outpatient Oncology Patients at a Children's Hospital. Arch Pediatr Adolesc Med. 2001, 155, 449-454.
Abstract
Background: As demand increases for complementary and alternative medical care, pediatric institutions face the need to answer patients' and clinicians' questions about integrating these therapies in hospital settings.
Objective: To describe the first year of experience in providing holistic medicine consultations in an urban tertiary care teaching hospital.
Design: Prospective cohort.
Subjects: Patients seeking consultation from the Center for Holistic Pediatric Education and Research, Boston, Mass, from July 16, 1999, to July 15, 2000.
Methods: Review of consultation notes and medical records.
Results: Of the 70 physician consultations, most (n = 43) were for oncology patients. Most consultations (n = 44) were accomplished with a single visit. The most common goal for consultation was to obtain help in managing symptoms such as nausea, pain, insomnia, or agitation (n = 50). The most common questions about specific therapies had to do with herbs (n = 41) or dietary supplements (n = 42), but there were also frequent questions about diet and nutrition (n = 33) and mind-body therapies such as guided imagery and biofeedback (n = 28) and massage (n = 25). Approximately 0.3 full-time equivalents of physician time was required to provide clinical consultations, and $7315 was collected of the $26 638 billed for these services.
Conclusions: The complementary medicine consultation service was primarily consulted by oncology patients requesting assistance with pain and symptom management. Patients had questions about various therapies, particularly herbs and dietary supplements. Additional research is necessary to determine the cost-effectiveness of an integrated approach to care, particularly for institutions without access to reliable community resources for complementary and alternative medical therapies. 

Kennealy, Philippa. Have Dream…Will Prevail. The Physician Executive Nov/Dec 2006, 62-64.

Nurse’s Alter Ego Touches Audiences With Insights Into Life and Death. Journal of Hospice and Palliative Nursing July/Aug 2006, 8(4), 190-197.

Palinkas, Lawrence A./ Kabongo, Martin L./ et al. The Use of Complementary and Alternative Medicine by Primary Care Patients. The Journal of Family Practice Dec 2000, 49(12) 1121-1130.
Background Despite the increased use and acceptance of complementary and alternative medicine (CAM) practices and practitioners by patients and health care providers, there is relatively little information available concerning the reasons for use or its effect on patient health status and well-being.
Methods We conducted a survey of 542 patients attending 16 family practice clinics that belong to a community-based research network in San Diego, California, to determine patients’ reasons for using CAM therapies in conjunction with a visit to a family physician and the impact of these therapies on their health and well-being.
Results Approximately 21% of the patients reported using one or more forms of CAM therapy in conjunction with the most important health problem underlying their visit to the physician. The most common forms of therapy were visiting chiropractors (34.5% of CAM users), herbal remedies and supplements (26.7%) and massage therapy (17.2%). Recommendations from friends or coworkers, a desire to avoid the side effects of conventional treatments, or failure of conventional treatments to cure a problem were the most frequently cited reasons for using these therapies. Using of practitioner-based therapies was significantly and independently associated with poor perceived health status, poor emotional functioning, and a musculoskeletal disorder, usually low back pain. Use of self-care-based therapies was associated with high education and poor perceived general health compared with a year ago. Use of traditional folk remedies was associated with Hispanic ethnicity.
Conclusions Sociodemographic characteristics and clinical conditions that predict use of CAM therapies by primary care patients in conjunction with a current health problem vary with the type of therapy used.

Patterson, Charlotte. Complementary Practitioners as Part of the Primary Health Care Team: Consulting Patterns, Patient Characteristics and Patient Outcomes. Family Practice 1997, 14(5), 347-354.
Background Complementary medicine is increasingly popular with patients and with GPs, although it still remains mainly in the private sector. Few data are available from the private sector about patient-consulting patterns and outcome.
Objectives We aimed to describe detailed consulting patterns, help-seeking behaviour and outcome of care for patients attending a group of private complementary practitioners in a single general practice surgery.
Method Prospective data on consulting patterns were collected from all 147 new patients attending complementary practitioners over a 12-month period. For the first 30 weeks of this period, additional information on help-seeking behaviour and outcome, as measured by the SF-36 health survey and Measure Yourself Medical Outcome Profile (MYMOP), was collected by questionnaires from 46 out of the 68 new patients. The same information was collected from a systematic one-in-seven sample of GP patients.
Results Patients seen by complementary practitioners did not vary significantly in sex and age from GP patients, except in the low numbers of children. Almost half the patients had been symptomatic for over a year and muscoloskeletal disorders accounted for 66% of problems; but there was much variation between the therapies. The average number of visits per patient was three for osteopathy and homeopathy but eight for acupuncture and reflexology. The change in MYMOP scores after four weeks showed a statistically significant improvement in both complementary and GP patients, which was to similar degrees except that the mean change in well-being was significantly greater for complementary patients.
Conclusion Prospective data collection in single settings adds valuable information to a little researched area. This study illustrates how individual each complementary therapy is in its patient characteristics, problem category and length of treatment. The particular improvement in well-being with complementary therapy requires confirmation in other studies.

Scherwitz, Larry/ Stewart, William/ McHenry, Pamela/ Wood, Claudia/ Robertson, Lailah/ Cantwell, Michael. An Integrative Medicine Clinic in a Community Hospital. American Journal of Public Health Apr 2003, 93(4), 549-554.

Scherwitz, Larry W./ Cantwell, Michael/ McHenry, Panela/ Wood, Claudia/ Stewart, William. A Descriptive Analysis of an Integrative Medicine Clinic. The Journal of Alternative and Complementary Medicine 2004, 10(4), 651–659.
Abstract
Objective: To evaluate and describe an integrative medicine clinic including its patients; their presenting problems, medical objectives, treatment recommendations; whether recommendations were recalled and adhered to; and patients’ self-reported health outcomes.
Design: A prospective cohort study of 160 new clinic patients were treated using a wide range of integrative medicine therapies. Patients were interviewed at intervals of 1, 3, and 6 months after their initial visit.
Setting: The study was conducted at the Institute for Health and Healing clinic, at California Pacific Medical Center located in San Francisco, CA.
Subjects: The subjects were new clinic patients seeking care for a variety of symptoms and diagnoses.
Intervention: Patients presented with an average of 4.0 symptoms and 2.9 diagnoses; physicians recommended 9.5 “treatments” per patient.
Results: At 6-month follow-up, symptom intensity decreased from 6.5 to 4.2 (on a 10-point scale; p < 0.005); and 57% of the patients had made “substantial” progress or had completely achieved their health objectives (p < 0.005). The Short Form 12 (SF-12) measure of mental and physical functioning improved significantly from baseline to one month (p = 0.05; p = 0.001, respectively) and maintained this improvement at 3 (p = 0.01; p = 0.01) and 6 months (p = 0.001; p = .001). At 1-month follow-up, patients recalled 57% of the actionable statements from the physician without a prompt and they followed 55% of all recommendations well (90% or above). Over the follow-up period, patients increasingly attributed the reductions in symptoms (p = 0.01) and achieving their health objectives (p = 0.01) to the treatment plan. Self-reported measures of days ill and days missed at work/school did not differ significantly from the year before coming to the clinic.
Conclusion: The results indicate that patients can recall and follow a complex treatment regimen. Subjective and objective measures of patients’ health status improved after one month and this effect was sustained or improved further at 6 months follow-up. Further study is needed to determine whether patients’ improvement was the result of the treatment regimen.

Stein, Howard F. A Window to the Interior of Experience. Families, Systems & Health 2004, 22(2), 178-179.
Physicians’ access to the inner, experiential worlds of others (patients, families) is medicated and facilitated by physicians’ access to their own. One method is the cultivation of physicians’ own imaginations. By writing poetry and stories about sickness and healing, physicians can become better attuned to the lived worlds of patients and their families. The journey inward is undertaken in service of the journey outward toward improved relationships with patients, families, and colleagues.

Tarantino, David P. Making Smart Mistakes. The Physician Executive Sept/Oct 2006, 66-67.

The Place of Complementary Medicine in Modern Medical Education. Education for Primary Care 2006, 17, 206-212.

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