Pittsburgh, PA, United States
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Heinz J.,Center for Integrative Medicine | Fiori W.,University of Munster | Heusser P.,Witten/Herdecke University | Ostermann T.,Witten/Herdecke University
Evidence-based Complementary and Alternative Medicine | Year: 2013

Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. © 2013 Jürgen Heinz et al.


Andreescu C.,University of Pittsburgh | Glick R.M.,University of Pittsburgh | Glick R.M.,Center for Integrative Medicine | Emeremni C.A.,University of Pittsburgh | And 4 more authors.
Journal of Clinical Psychiatry | Year: 2011

Background: Over 50% of patients with major depressive disorder (MDD) either do not tolerate or do not respond to antidepressant medications. Several preliminary studies have shown the benefits of acupuncture in the treatment of depression. We sought to determine whether a 2-point electroacupuncture protocol (verum acupuncture) would be beneficial for MDD, in comparison to needling at nonchannel scalp points with sham electrostimulation (control acupuncture). Method: Fifty-three subjects aged 18-80 years, recruited via advertisement or referral, were included in the primary analysis of our randomized controlled trial, which was conducted from March 2004 through May 2007 at UPMC Shadyside, Center for Complementary Medicine, in Pittsburgh, Pennsylvania. Inclusion criteria were mild or moderate MDD (according to the Structured Clinical Interview for DSM-IV Axis I Disorders) and a score of 14 or higher on the Hamilton Depression Rating Scale (HDRS). Exclusion criteria included severe MDD, seizure disorder or risk for seizure disorder, psychosis, bipolar disorder, chronic MDD, treatment-resistent MDD, and history of substance abuse in the prior 6 months. Patients were randomized to receive twelve 30-minute sessions of verum versus control acupuncture over 6 to 8 weeks. The HDRS was the primary outcome measure. The UKU Side Effect Rating Scale was used to assess for adverse effects. Results: Twenty-eight subjects were randomized to verum electroacupuncture and 25 to control acupuncture. The 2 groups did not differ with regard to gender, age, or baseline severity of depression. Both groups improved, with mean (SD) absolute HDRS score decreases of -6.6 (5.9) in the verum group and -7.6 (6.6) in the control group, corresponding to 37.5% and 41.3% relative decreases from baseline. There were no serious adverse events associated with either intervention, and endorsement of adverse effects was similar in the 2 groups. Conclusions: We were unable to demonstrate a specific effect of electroacupuncture. Electroacupuncture and control acupuncture were equally well tolerated, and both resulted in similar absolute and relative improvement in depressive symptoms as measured by the HDRS. Trial Registration: clinicaltrials.gov Identifier: NCT00071110. © Copyright 2011 Physicians Postgraduate Press, Inc.


Juknis N.,Washington University in St. Louis | Cooper J.M.,Center for Integrative Medicine | Volshteyn O.,Washington University in St. Louis
Handbook of Clinical Neurology | Year: 2012

In the past quarter century, spinal cord injury medicine has welcomed the proliferation of new medications and technologies that improve the survival and quality of life for people with spinal cord injury, but also endured the failure of strategies we hoped would salvage the cord in the acute phase. Surgical decompression and spinal stabilization should be pursued whenever indicated and feasible; however, there is no compelling evidence that early decompression facilitates neurological improvement. Methylprednisolone, the subject of over two decades of trials, has proven to be of marginal benefit in improving functional outcome.Recent advances in the management of the respiratory, cardiovascular, autonomic, endocrine, skeletal and integumentary systems have not only changed morbidity and survival of spinal cord injury patients but also improved quality of life.Progress has been made in the early diagnosis and effective treatment of cardiac arrhythmias, neurogenic shock, autonomic dysreflexia and orthostatic hypotension. Aggressive respiratory care for high cervical level of injury patients should include an option for phrenic nerve pacing as it is a viable rehabilitative strategy for appropriately selected patients. Pressure ulcers remain a significant psychological, financial, and functional burden for many people with SCI and for healthcare providers. This area will continue to require further work on early prevention and education. Despite extensive scientific and clinical data on neurogenic osteoporosis, there is no consensus regarding the best pharmacotherapeutic agents, dosing regimens, or rehabilitative strategies for prevention and treatment of bone loss. This chapter will focus on the advances. © 2012 Elsevier B.V.


Shaltout H.A.,Center for Integrative Medicine | Shaltout H.A.,Wake forest University | Tooze J.A.,Wake forest University | Rosenberger E.,Wake forest University | And 2 more authors.
Explore: The Journal of Science and Healing | Year: 2012

Objective: Compassion is critical for complementary and conventional care, but little is known about its direct physiologic effects. This study tested the feasibility of delivering two lengths of time (10 and 20 minutes) and two strategies (tactile and nontactile) for a practitioner to nonverbally communicate compassion to subjects who were blind to the interventions. Methods: Healthy volunteers were informed that we were testing the effects of time and touch on the autonomic nervous system. Each subject underwent five sequential study periods in one study session: (1) warm-up; (2) control - with the practitioner while both read neutral material; (3) rest; (4) intervention - with practitioner meditating on loving-kindness toward the subject; and (5) rest. Subjects were randomized to receive one of four interventions: (1) 10 minutes tactile; (2) 20 minutes tactile; (3) 10 minutes nontactile; or (4) 20 minutes nontactile. During all interventions, the practitioner meditated on loving-kindness toward the subject. For tactile interventions, the practitioner touched subjects on arms, legs, and hands; for nontactile interventions, the practitioner pretended to read. Subjects' autonomic activity, including heart rate, was measured continuously. Subjects completed visual analog scales for well-being, including relaxation and peacefulness, at warm-up; postcontrol; immediately postintervention; and after the postintervention rest and were asked about what they and the practitioner had done during each study period. Results: The 20 subjects' mean age was 24.3 ± 4 years; 16 were women. The practitioner maintained a meditative state during all interventions as reflected in lower respiratory rate, and subjects remained blind to the practitioner's meditative activity. Overall, interventions significantly decreased heart rate (P <.01), and although other changes did not reach statistical significance, they were in the expected direction, with generally greater effects for the tactile than nontactile strategies and for 20-minute than 10-minute doses. Conclusions: Two strategies are feasible for blinding subjects to nonverbal communication of compassion; even with blinding, nonverbal communication of compassion affects subjects' autonomic nervous system. These results should be replicated in larger samples, including patient populations, and mechanisms sought to explain observed effects. Compassion is not only good care; it may also be good medicine. © 2012 Elsevier Inc.


Kameda G.,Gemeinschaftskrankenhaus | Kempf W.,University of Zürich | Oschlies I.,University of Kiel | Michael K.,Gemeinschaftskrankenhaus | And 3 more authors.
Klinische Padiatrie | Year: 2011

A 12-year old girl presented with general weakness and weight loss, a localised cervical lymph node enlargement and cutaneous lesions compatible with lymphomatoid papulosis (LyP). Biopsies from lymph node and skin revealed a histological diagnosis of nodal large cell ALK-1 anaplastic lymphoma (ALCL) with a synchronous CD30+ cutaneous lymphoproliferation consistent with lymphomatoid papulosis (LyP). The girl was treated with mistletoe (MT) as monotherapy. Within 1 week after initiation of MT-treatment the skin lesions and lymph node enlargement improved. Under continuing MT-therapy 30 months after diagnosis the patient is still in complete remission. It is not possible to know whether this was a rare case of spontaneous remission of the nodal and skin-manifestations of this CD30+ T-cell lymphoproliferation or whether the observed effect was a specific therapeutic response to MT-treatment. © Georg Thieme Verlag KG Stuttgart · New York.


PubMed | British Columbia Cancer Agency, University of Ottawa, University of British Columbia, University of Alberta and 3 more.
Type: Journal Article | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2016

For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors CT and general information and decision-making needs related to menopausal symptoms.The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n=22) and interviews with conventional (n=12) and CT (n=5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data.Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70% of the sample were currently using CTs, including mind-body therapies (45.5%), natural health products (NHPs) and dietary therapies (31.8%), and lifestyle interventions (36.4%). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management.High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.


PubMed | Center for Integrative Medicine
Type: Journal Article | Journal: Biomarkers in medicine | Year: 2014

To examine the relationship between inflammatory and coagulation biomarkers and cardiac autonomic function (CAF) as measured by heart rate variability in persons with HIV.This analysis included 4073 HIV-infected persons from the Strategies for Management of Antiretroviral Therapy study. We examined the association between IL-6, high-sensitivity C-reactive protein (hsCRP) and D-dimer with heart rate variability measures (SDNN and rMSSD), both cross-sectionally and longitudinally.Cross-sectional analysis revealed significant inverse associations between IL-6, hsCRP and d-dimer with SDNN and rMSSD (p < 0.01 for all comparisons). However, longitudinal analysis failed to show a significant association between baseline IL-6, hsCRP and d-dimer with change in CAF over time.Cross-sectionally, higher levels of inflammatory and coagulation biomarkers were associated with lower levels of CAF in the Strategies for Management of Antiretroviral Therapy trial. Although deterioration in CAF was observed during followup, baseline levels of inflammatory and coagulation markers were not predictive of the decline in CAF over time.


PubMed | Center for Integrative Medicine
Type: | Journal: Evidence-based complementary and alternative medicine : eCAM | Year: 2013

Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually.


PubMed | Center for Integrative Medicine
Type: Journal Article | Journal: Journal of alternative and complementary medicine (New York, N.Y.) | Year: 2013

Although pediatric patients with chronic pain often turn to complementary therapies, little is known about patients who seek academic integrative pediatric care.The study design comprised abstraction of intake forms and physician records from new patients whose primary concern was pain.The study setting was an academic pediatric clinic between January 2010 and December 2011.Of the 110 new patients, 49 (45%) had a primary concern about headache (20), abdominal pain (18), or musculoskeletal pain (11).The average age was 134 years, and 37% were male. Patients reported an average pain level of 63 on a 10-point scale, and most reported more than one kind of pain; parents had an average of 73 health concerns per child, including fatigue (47%), mood or anxiety (45%), constipation/diarrhea (41%), and/or sleep problems (35%). Most patients (57%) were referred by specialists; 71% were taking prescription medications; and 53% were taking one or more dietary supplements at intake. Of those tested, most (61%) had suboptimal vitamin D levels. All families wanted additional counseling about diet (76%), exercise (66%), sleep (58%), and/or stress management (81%). In addition to encouraging continued medical care (100%) and referral to other medical specialists (16%), frequent advice included continuing or initiating dietary supplements such as vitamins/minerals (80%), omega-3 fatty acids (67%), and probiotics (31%). Stress-reducing recommendations included biofeedback (33%), gratitude journals (16%), and yoga/tai chi (8%). Other referrals included acupuncture (24%) and massage (20%).Patients who have chronic pain and who present to an integrative clinic frequently have complex conditions and care. They are interested in promoting a healthy lifestyle, reducing stress, and using selected complementary therapies.Patients with chronic pain who seek integrative care may benefit from the kind of coordinated, integrated, comprehensive care provided in a medical home.


News Article | February 20, 2017
Site: globenewswire.com

BOISE, Idaho, Feb. 20, 2017 (GLOBE NEWSWIRE) -- The Idaho Center for Integrative Medicine (ICIM) (http://idahointegrativemedicine.com/), a leader in functional and holistic healthcare, is hosting a Customer Appreciation Day on February 21, 2017, from 4 p.m. to 7 p.m. The clinic is located at 3271 N. Milwaukee Street. In addition to complimentary refreshments and supplement samples, the staff will be available for free therapy, chair massages, office tours, and answer questions for participants. "We are excited to host this event as it gives us an opportunity to thank our patients for their support and let them know how important they are to us," said Dr. Noah Edvalson, Founder of ICIM. "This event will also allow us to introduce therapies to our customers that they may be unaware we have. Patients are our top priority and we look forward to providing them with the best care possible." In addition to celebrating customer appreciation, ICIM will present new members of the team, including Greg Howard and Randi Roark. Greg Howard, Nurse Practitioner, comes with a broad background working in both Family Medicine and Urgent Care settings. While most of his background and training is in traditional medicine, he has always been open minded about alternative medicine, and recognizes the need to support the body through nutrition and lifestyle modifications. Randi Roark, a nationally certified massage therapist and Bodyworker, practices a variety of massage techniques including Swedish, Deep Tissue, NMT/Trigger Point, Shiatsu, Cranial-Sacral Fascial Release, Tai/Yoga, and Integrative/Mindful Expression. Randi believes that every body is different and there is no one massage that suits all; therefore, her approach is tailored to each individual. She loves helping others and is enthusiastic about health and overall well-being. ICIM strives to use a functional and holistic approach to provide competent and progressive health care encompassing physical, nutritional, emotional, and energetic vitality in a compassionate and collaborative environment. The clinic treats the cause of disease using safe, natural, and effective therapies, while enriching the community with education, self-reliance, and self-empowerment. About The Idaho Center for Integrative Medicine The Idaho Center for Integrative Medicine effectively helps their clientele find the healthcare they need. Dr. Edvalson, founder and owner of ICIM, is trained in Chiropractic (a Certified Chiropractic Sports Physician and has received the Distinguished Service Award by the American Chiropractic Association Council on Sports Injuries and Physical Fitness), Naturopathy, Functional Medicine, Acupuncture, Ultraviolet Blood Irradiation, and much more.  He is a Fellow of the American Academy of Ozone therapies, with the distinguished honor of being certified as an Advanced Prolozone Therapist. It is his passion and ICIM's goal to help offer a new hope to those suffering unnecessarily with chronic diseases.

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