Integrative Medicine
اسلاید 1: www.tabaye.ir
اسلاید 2: Integrative MedicineCaroline Oczachowski, PGY 2Emory Family MedicineAdapted from Dr. J. Michelfelder at Loyola University in Chicago
اسلاید 3: 54 year-old female presents with peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for breast cancer. She is believed to be in complete remission currently. She states that she is exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians, but feels like she could be doing more for her issues.What more do you want to know?What options would come to mind for you?How would you find information about those options?
اسلاید 4: Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a 2007 nationwide government survey
اسلاید 5: Definitions“Complementary and Alternative Medicine is a Group of Diverse Medical and Health Care Systems, Practices, and Products That are Not Presently Considered Part of Conventional Medicine”NCCAM
اسلاید 6: Definitions“Complementary Medicine is Used Together With Conventional Medicine.”“Alternative Medicine is Used in Place of Conventional Medicine.”NCCAM
اسلاید 7: Definitions“Integrative Medicine Combines Mainstream Medical Therapies and CAM Therapies for Which There is Some High-Quality Scientific Evidence of Safety and Effectiveness.” “Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”http://www.integrativemedicine.arizona.edu/about2.htmlNCCAM
اسلاید 8: The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Governments lead agency for scientific research on CAM. They are 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services.
اسلاید 9: The mission of NCCAM is to:Explore complementary and alternative healing practices in the context of rigorous science.Train complementary and alternative medicine researchers.Disseminate authoritative information to the public and professionals.
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اسلاید 14: What are the conditions for which adult pts most frequently seek CAM????
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اسلاید 18: What are the conditions for which pediatric pts most frequently seek CAM????
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اسلاید 22: AlternativeMedicalSystemsAyurveda, Chinese, Native American, Aboriginal, African,Middle Eastern, Tibetan, Central and South American cultures,Homeopathy, Naturopathy Mind-BodyInterventionscognitive-behavioral approaches, meditation, hypnosis, dance,music, art therapy, prayer, mental healing, visual imagery BiologicalBased Therapiesdietary supplements, herbs, orthomolecular (varying concentrations of chemicals, such as, magnesium, melatonin, and mega-doses of vitamins), individual biological therapies (use of laetrile, shark cartilage, bee pollen). Manipulative And Body-Based Methodschiropractic, osteopathic manipulation, massage, reflexologyEnergy TherapiesBiofield therapies: Qi gong, Reiki, therapeutic touchBioelectromagnetic-based therapies: pulsed fields, magneticfields, or alternating current or direct current fields5 Domains of CAMAs defined by NCCAM
اسلاید 23: Other CAM therapiesAromatherapyColonic IrrigationTherapeutic TouchEDTA ChelationCuppingPrimordial Sound Meditation
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اسلاید 25: DefinitionsAyurveda - Indias traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Ayurvedic theory states that all disease begins with an imbalance or stress in the individuals consciousness. Lifestyle interventions are a major ayurvedic preventive and therapeutic approach. Ayurvedic practices is to cleanse the body of substances that can cause disease, and this is believed to help reestablish harmony and balance.
اسلاید 26: DefinitionsHomeopathy - a system of medical practices based on the theory that any substance that can produce symptoms of disease or illness in a healthy person can cure those symptoms in a sick person. For example, someone suffering from insomnia may be given a homeopathic dose of coffee. Administered in diluted form, homeopathic remedies are derived from many natural sources—including plants, metals, and minerals.
اسلاید 27: DefinitionsNaturopathy – an alternative medical system. Naturopathic medicine proposes that there is a healing power in the body that establishes, maintains, and restores health. Practitioners work with the patient with a goal of supporting this power through treatments such as nutrition and lifestyle counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese medicine.
اسلاید 28: DefinitionsQi gong - A component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function.
اسلاید 29: DefinitionsReiki - A Japanese word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a reiki practitioner, the patients spirit is healed, which in turn heals the physical body.
اسلاید 30: Why Should We Care?30,000 herbs on the market currentlyEstimates of $30-40 billion dollars spent annually Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575Sales of Metabolite 356 approached $1billion in 1999 Alternative Medicine Alert, January 2000Avlimil – est. $100 million in sales in 2003 Herbal entrepreneur proving that sex sells: Local business reaps millions from supplements The Cincinnati EnquirerRelacor $23 Million; 900,000 bottles by July 06Enzyte has 21,400 repeat customers at $99.95 a month for a whopping $2,138,930.00 a month in sales ($25,667,160.00 annually) USA today
اسلاید 31: Why Should We Care?600 Million Visits a year to CAM Providers – More Than to Primary Care ProvidersAn estimated 15 million adults took prescription medications concurrently with herbal remedies and/or high-dose vitaminsEisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575
اسلاید 32: Why? What is Mainstream Medicine Not Offering to Our Patients?
اسلاید 33: Have We Missed the Boat? Dissatisfaction with health care providers and medical outcomesSide effects of drugs and treatmentsHigh health costsTechnologyLack of control in their own health care practicesTime spent with practitionerStephen Strauss, M.D., NCCAM Director
اسلاید 34: Have We Missed the Boat?Looking for “cures”Want to use “natural” products Patient feels empoweredFocus on spirituality and emotional well-beingHealth Care Provider provides the 3 T’s: touch, talk, timeStephen Strauss, M.D., NCCAM Director
اسلاید 35: What about communication?Between 40 and 70% of CAM users do not disclose their use to their physician.Eisenberg 2001
اسلاید 36: Why do patients not tell their physician about their CAM use?60% - “My doctor never asked.” 60% - “It wasn’t important for my doctor to know.”20% - “My doctor wouldn’t understand.”14% - “My doctor would disapprove.” Eisenberg DM. Ann Int Med 2001;135(5):344-51
اسلاید 37: What are our patients reading???
اسلاید 38: PRESS RELEASE:Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says. - IOM July 2006
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اسلاید 41: Evidence Based MedicineDifficulties With CAM ResearchSham AcupunctureNon Standardized Herbal FormulationsDifficult to Blind Patients and PractitionersTreatments Very Individualized – Difficult to Formulate ProtocolsDrug companies have to do studies to go on the market—supplement companies do not, so clinical trials sponsored by supplement companies are rare
اسلاید 42: ComparisonMainstream MedicineLarge Double Blind Placebo Controlled TrialsMany Exclusions Such As Multiple Medicines, Other Illnesses, Female, Pregnant, Children, Race“Placebo Effect” DiscountedApply These Narrow Results to The IndividualIntegrative MedicineVery Individualized“Placebo Effect” Not Discounted
اسلاید 43: Patients are choosing integrative and alternative medicine, but what about physicians?
اسلاید 44: Physician’s AttitudesSurvey sent to 660 physicians at the Mayo Clinic (233 responded)Three areas: utilization, familiarity and attitudesUtilization:75% had never referred to CAM practitioner44% said they would consider if available at Mayo (<46 years or female more likely)Less than 25% discussed benefits or risks with CAM57% thought incorporation of CAM would have a positive impact on pt satisfaction
اسلاید 45: Physician’s Attitudes Familiarity:Biofeedback, massage, chiropractic and relaxation therapies were the most familiar59% were unfamiliar with energy healing, 53% with naturopathic medicineOf the 13 herbs listed, only 3 were commonly listed as familiar66% were not familiar with feverfew and 52% were not familiar with Kava49% of the physicians felt it was difficult or very difficult to find reliable information about herbs
اسلاید 46: Physician’s Attitudes41% of the physicians neither agreed or disagreed that physician knowledge had an impact on patient’s health52% felt physicians’ spiritual beliefs were important and 87% felt patients’ spiritual beliefs and practices were important67% agreed some CAM therapies hold promise but 70% felt current practices of CAM was a “threat” to the public healthMost important factors in changing physicianss attitudes were RCT’s and evidence demonstrating mechanism70% of the physicians felt Mayo clinic should provide proven CAM therapieseCAM 2006;3(4) 495-501
اسلاید 47: Where Are We Today?Clinical Fellowships:University of Arizona (Founding Program)University of MichiganUniversity of MarylandUniversity of WisconsinMaine Medical CenterCooper Health System (NJ)Lawrence MABeth Israel Medical CenterUCLAAcademic Fellowships (Research)Harvard UniversityTuftsBoston UniversityStanfordDukeResidencies in Integrative MedicineOregon Health Sciences UniversityMontefiore Medical Center (NY)
اسلاید 48: Where Are We Today?
اسلاید 49: CAHCIM MembersAlbert Einstein/Beth IsraelColumbia UniversityDuke UniversityGeorge WashingtonGeorgetownHarvardLaval UniversityMayo ClinicOHSUStanford UniversityYale UniversityWake Forest UniversityUniversity of AlbertaUniversity of CA/IrvineThomas Jefferson UMDNJUniversity of ArizonaUniversity of CalgaryUniversity of HawaiiUniversity of WashingtonUniversity of California/LAUniversity of California/SFUniversity of ColoradoUniversity of ConnecticutUniversity of KansasUniversity of MarylandUniversity of MassachusettsUniversity of New JerseyUniversity of New MexicoUniversity of North Carolina-Chapel HillUniversity of MichiganUniversity of MinnesotaUniversity of PennsylvaniaUniversity of PittsburghUniversity of Texas-GalvestonUniversity of VermontUniversity of Wisconsin
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اسلاید 51: The Future of Integrative MedicineDefinition of Integrative Medicine From the CAHCIM“Integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.”
اسلاید 52: The Future of Integrative MedicineThe Term “Integrative Medicine” Will DieOur Patients Will Demand Integrative Medicine From All of UsTraining Will Be Demanded by Medical StudentsTraining Will Be Demanded by Residents
اسلاید 53: The Future of Integrative MedicineIntegrative Medicine Will Be A Skill Set Added on Just Like:Electronic Health RecordsNew MedicationsNew Procedures
اسلاید 54: Real Patient54 year-old female presents with peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for breast cancer. She is believed to be in complete remission currently. She states that she is exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians, but feels like she could be doing more for her issues.What more do you want to know?What options would come to mind for you?How would you find information about those options?
اسلاید 55: Integrative Medicine requires a paradigm shift from the disease-centered approach of conventional biomedicine to an approach in which patient values and participation of patients are central. Maizes 1999
اسلاید 56: Integrative MedicineIntegrative Medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.www.integrativemedicine.ariazona.eduPIM – U of Arizona
اسلاید 57: The Future of Integrative MedicineEpocrates Rx ProMicromedexCommission EPlus Many Other Databases
اسلاید 58: ResourcesCommission EGermanyRanks Quality of EvidenceEvaluates Benefits and Risks
اسلاید 59: http://nccam.nih.gov/
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اسلاید 61: Integrative MedicineDonald Novey, M.D. – Lutheran General HospitalEvidence Based Review of Each Modality
اسلاید 62: Integrative MedicineDavid Rakel, M.D., University of WisconsinInstructions on how to put CAM into your own medical practice
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اسلاید 64: ResourcesNational Center for Complementary and Alternative Medicinehttp://nccam.nih.gov/Agency for Healthcare Research and Qualityhttp://www.ahrq.gov/clinic/epcindex.htm
اسلاید 65: ResourcesAmerican Academy of Medical Acupuncturewww.medicalacupuncture.orgOnline Resourcehttp://www.altmedicine.com
اسلاید 66: Where Should We Go for Information?Product claimswww.quackwatch.comwww.snopes.comProduct quality assurancewww.consumerlab.comProduct ingredientsNatural Medicines Database www.naturaldatabase.com Product safety and efficacywww.cfsan.fda.gov/~dms/ds-ind.htmlwww.naturaldatabase.comThe Natural Pharmacist www.iherb.com or www.consumerlab.com
اسلاید 67: Dr. Ou completed an Internal Medicine Residency at Emory. He was the first doctor in the world to be certified in Field Control Therapy by its creator, Savely Yurkovsky, M.D. Dr. Ou was one of the first medical doctors to become certified in NES Health and Matrix Energetics.
اسلاید 68: 2502 Macy Drive Roswell, Georgia 30076
اسلاید 69: Dr. Clairborne began her journey at Emory University completing her BA in Psychology then went on to complete her medical degree at Morehouse School of Medicine. Finishing her Family Medicine Residency at Florida Hospital in Orlando, FL., she ventured on to complete pose graduate trainings in acupuncture with The Academy of Pain Research Acupuncture and the International Academy of Medical Acupuncture.
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اسلاید 72: Thank You!
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