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Status of complementary and alternative medicine in the curricula of health colleges in Saudi Arabia
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
OP-171 Complementary treatments and holistic perspective: experience in a public Mental Health Service Betti Mario Azienda USL 2 Lucca, Italy For the past 16 years, at the Serchio Valley Adult Mental Health Functional Unit (part of the National Public Health System of Lucca), with the support of the Regional Administration of Tuscany, experimentation has been conducted to explore a new organisational, operational model centred on the holistic perspective. The basic assumptions on which this model is based can be traced to three main criteria: systematic interaction with the social network, modular residential facilities at rapid turnover and integration of treatment. With regard to the third criteria, alongside the more traditional therapies (pharmaceutical, clinical, house calls and social actions) are included the psycho-therapeutic and socio-rehabilitative treatments, such as the various complementary methods, Qi Gong, herbal medicine, meditation techniques, natural organic disciplines (particularly psycho-corporeal), the artistic mediation therapies (theatre, music, biodance, emotional painting and photography) and the biophysical therapies (light therapy and cyclotronic ion resonance therapy). These various therapies are applied following a synergetic criteria, on the basis of a therapeutically integrated project created by a working team. The therapeutic rehabilitative paths have been subjected to outcome assessments that have confirmed the validity of the model. In particular, there has been a dramatic reduction in hospitalisation, a significant decrease of psychopathological and behavioural symptoms and an improvement of the quality of life. Regional Administration of Tuscany, in collaboration with the ‘Cittadinanzattiva’ Association, has supported the creation of a graduate school, to promote the model among young operators. In 2009, ‘Schesis’ was thus founded. The present work shows the results of our assessments of clinical observations. http://dx.doi.org/10.1016/j.eujim.2012.07.666 EDUCATION AND CLINICAL PRACTICE OP-172 Reaching at consensus: developing and validating a prakriti analysis tool for Ayurvedic clinical practice Rastogi Sanjeev State Ayurvedic College, Hospital, Lucknow, India Prakriti has been one important and unique proposition of Ayurveda towards the idea of personalised medicine. Based absolutely on the primitive thoughts of genomics as were understood many thousand years ago, Ayurveda utilised its principles in a more pragmatic way to reach its goal of choosing the appropriate interventions on the basis of genomic differences. Considering the observation as the only tool available to generate evidence, Ayurveda had gone through a trail of
83
continuous observation through years to generate the idea of physical–physiological and psychological differences prevalent among a population and noted that these changes actually form a subgroup within a population, which may be called ‘prakriti’. It was observed that the people who share similar traits in one domain of characters also share the characters of the other domain, a fact that was realised only after centuries by the advent of Mendalian genetics. Unfortunately, for its being based solely upon the observations, Ayurvedic concept of prakriti suffered a setback for its inability to verify the observations through any objective method. It is only now, with the advent of thoughts of genomics, that Ayurvedic prakriti concepts have got a revival for their possible implications in personalised medicine. Despite its striking similarities to the idea of personalised medicine based upon genomics-like principles, examining prakriti in a clinical setting has been cumbersome. Due to difficulty in observing and interpreting the features, characterising certain traits and eventually the prakriti had been a difficult task for its subjectivity and ambiguity. Identifying the gap between principles and practice of prakriti analysis in Ayurvedic clinical practice, we designed, validated and evaluated a prakriti analysis tool for its possible use in Ayurvedic clinical settings. This tool, based upon observation of clinical features relevant to various dosha dominance in reference to a particular trait, had been validated by examining the same volunteers by different raters using the same set of tools. A strong correlation was observed among most observations when the same volunteers were observed by three independent raters. This tool therefore may be taken ahead for further testing to see its practical utility in prakriti analysis at Ayurvedic clinics. http://dx.doi.org/10.1016/j.eujim.2012.07.667 OP-173 Status of complementary and alternative medicine in the curricula of health colleges in Saudi Arabia Khalil Mohamed 1 , AlBedah 2 Mohamed , El-Olemy Ahmed 1
Abdullah 1 , AlRukban
1 Saudi
National Center for Complementary and Alternative Medicine, Riyadh 2 AlMajmaa Faculty of Medicine, Riyadh, Saudi Arabia Aim: To assess the status of complementary and alternative medicine (CAM) education in health colleges in Saudi Arabia. Methods: A cross-sectional descriptive study was conducted including all medical, dentistry, pharmacy, nursing, allied medical science and health colleges in Saudi Arabia. A semistructured questionnaire was designed to collect information covering CAM tracks, courses and contents in the college’s curricula, available postgraduates programmes, continuing medical education activities and number of colleges staff members specialised or interested in CAM. Results: Out of 110 health colleges in Saudi Arabia, 90 (81.1%) participated in the survey. There is no CAM-specialised track or postgraduate education in any college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in differ-
84
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
ent study subjects. Five (5.6%) colleges conducted continuing medical education activities related to CAM. Among faculty members, there are only 16 CAM specialists working in seven colleges and 84 interested staff members, working in 20 colleges. Colleges of pharmacy are more interested in CAM education compared to other colleges. Six out of 14 (42.9%) of them have CAM courses in their curricula (p = 0.006). In addition, they have more faculty CAM specialists (p = 0.026) compared to other colleges. Conclusion: There is a low and diverse attention given to CAM in medical education in Saudi Arabia. There is a need for a national plan to review health colleges’ curricula to prepare health-care providers for the integration of evidence-based CAM practices. http://dx.doi.org/10.1016/j.eujim.2012.07.668 OP-174 Inter-examiner reliability in low back column: pre- and posttraining of a specific protocol of palpation tests Arienti Chiara, Uberti Stefano, Daccò Silvia Istituto Superiore di Osteopatia, Milan, Italy Background: Evidence-based medicine requires that osteopaths use, in their clinical practice, only touching tests of proved reliability. Inter-operator reliability is considered by the scientific community to be the most relevant aspect to judge the validity of a manual test. In osteopathic clinical practice, palpation tests are widely used in the research of somatic dysfunction. Aim: The objective of this study was to verify if interexaminer reliability in the research of somatic dysfunction, in subjects not affected by low back pain in the L1–L4 region, is higher using a wider number of palpation tests against the use of single positional palpation tests. Methods: A total of 45 healthy subjects of both sexes were enrolled, at the Istituto Superiore di Osteopatia (ISO) of Milan. Three examiners, students of the 5th year of ISO, researched somatic dysfunctions in the low back region between L1 and L4 using only positional palpation tests (phase 1), unaware of the results obtained by the other examiners. Subsequently, the three operators have been trained to use a wider number of palpation tests (phase 2). The examiners have then used such number of palpation tests to search for somatic dysfunctions in the low back region from L1 to L4 in the same group of enrolled subjects and with the same methods. The data analysis has been carried out through an interclass correlation coefficient (ICC) to evaluate the inter-examiner agreement. Results: In the first evaluating method (phase 1), the interexaminer reliability showed a value defined as average, with an ICC of 0.44. On the contrary, in the second evaluating method (phase 2), the inter-examiner agreement showed a value defined as excellent, with an ICC of 0.79. Conclusions: The data obtained with the first evaluating method (phase 1) confirmed what has already been scientifically demonstrated by the literature: palpation tests alone cannot be considered as reliable. With respect to the literature, our data
have a value indicated as average and not poor, as the selected operators all belonged to the same course of study. On the other hand, the data of the second evaluating method (phase 2) obtained a value identified as excellent and this indicates that the three operators got a high level of agreement. These data were obtained thanks to a training period before the second evaluating method and the use of a digital algometer during phase 2 for pain stimulation. The literature confirms these data. http://dx.doi.org/10.1016/j.eujim.2012.07.669 OP-175 The AYUGRID project–Digital Ayurveda Kessler Christian 1 , Hellwig Oliver 2 , Oberlies Thomas 3 , Wischnewsky Manfred 2 , Michalsen Andreas 4 1 Immanuel
Hospital, Berlin of Bremen, Bremen 3 University of Göttingen, Göttingen 4 Immanuel Hospital, Charité, Berlin, Germany 2 University
Aims: The traditional Indian medicine Ayurveda is a mainstream system of medicine in South Asia and one of the fastest growing holistic medical systems worldwide. It offers one of the world’s largest written traditional medical records, composed in Sanskrit language. To date, Asian and Western practitioners of Ayurveda directly refer their practice to classical Ayurvedic Sanskrit texts. However, to this day no synoptic approach has been undertaken to intelligently extract medical information from Ayurvedic Sanskrit texts in order to generate systematic digital Ayurvedic treatment guidelines. The goal of the interdisciplinary AYUGRID project is the creation of a digital treatment-guideline database for Ayurveda and the setting up of a virtual Ayurveda grid community working environment. Methods: The modular AYUGRID project will use stateof-the-art e-Science/e-Research-, e-Service-, e-Infrastructure-, e-Learning- and e-Community-tools involving Indologists, computer linguists, IT experts, Ayurveda specialists and medical doctors in an interdisciplinary approach. Work packages will be (1) the (semi-)automatic digital extraction of medical knowledge from the three Ayurveda main texts with a focus on three test-domain indications of high clinical relevance (viz., cardiovascular diseases, chronic pain syndromes and diabetes mellitus), (2) the systematic generation of historic treatment guidelines (AYUGRID-SUTRA) based on the digital extraction results and (3) the diachronic integration of the historic treatment guideline results into modern evidence-based S1-Ayurveda-treatment guidelines for the chosen indications (AYUGRID-GUIDE). Project duration: 2012–2015. Conclusion: The AYUGRID project will be the initial point for the development of ‘Digital Ayurveda’ starting with the establishment of a proof-of-concept Ayurvedic guideline data bank. The community grid environment AYUGRID will (1) facilitate workflows in e-Science and e-Research on Ayurveda, (2) help to enhance e-Services and e-Infrastructure in this field, (3) provide a virtual e-Learning ambience and (4) will be conducive for networking, collaboration and cooperation in research
OP-171 Complementary treatments and holistic perspective: experience in a public Mental Health Service Betti Mario Azienda USL 2 Lucca, Italy For the past 16 years, at the Serchio Valley Adult Mental Health Functional Unit (part of the National Public Health System of Lucca), with the support of the Regional Administration of Tuscany, experimentation has been conducted to explore a new organisational, operational model centred on the holistic perspective. The basic assumptions on which this model is based can be traced to three main criteria: systematic interaction with the social network, modular residential facilities at rapid turnover and integration of treatment. With regard to the third criteria, alongside the more traditional therapies (pharmaceutical, clinical, house calls and social actions) are included the psycho-therapeutic and socio-rehabilitative treatments, such as the various complementary methods, Qi Gong, herbal medicine, meditation techniques, natural organic disciplines (particularly psycho-corporeal), the artistic mediation therapies (theatre, music, biodance, emotional painting and photography) and the biophysical therapies (light therapy and cyclotronic ion resonance therapy). These various therapies are applied following a synergetic criteria, on the basis of a therapeutically integrated project created by a working team. The therapeutic rehabilitative paths have been subjected to outcome assessments that have confirmed the validity of the model. In particular, there has been a dramatic reduction in hospitalisation, a significant decrease of psychopathological and behavioural symptoms and an improvement of the quality of life. Regional Administration of Tuscany, in collaboration with the ‘Cittadinanzattiva’ Association, has supported the creation of a graduate school, to promote the model among young operators. In 2009, ‘Schesis’ was thus founded. The present work shows the results of our assessments of clinical observations. http://dx.doi.org/10.1016/j.eujim.2012.07.666 EDUCATION AND CLINICAL PRACTICE OP-172 Reaching at consensus: developing and validating a prakriti analysis tool for Ayurvedic clinical practice Rastogi Sanjeev State Ayurvedic College, Hospital, Lucknow, India Prakriti has been one important and unique proposition of Ayurveda towards the idea of personalised medicine. Based absolutely on the primitive thoughts of genomics as were understood many thousand years ago, Ayurveda utilised its principles in a more pragmatic way to reach its goal of choosing the appropriate interventions on the basis of genomic differences. Considering the observation as the only tool available to generate evidence, Ayurveda had gone through a trail of
83
continuous observation through years to generate the idea of physical–physiological and psychological differences prevalent among a population and noted that these changes actually form a subgroup within a population, which may be called ‘prakriti’. It was observed that the people who share similar traits in one domain of characters also share the characters of the other domain, a fact that was realised only after centuries by the advent of Mendalian genetics. Unfortunately, for its being based solely upon the observations, Ayurvedic concept of prakriti suffered a setback for its inability to verify the observations through any objective method. It is only now, with the advent of thoughts of genomics, that Ayurvedic prakriti concepts have got a revival for their possible implications in personalised medicine. Despite its striking similarities to the idea of personalised medicine based upon genomics-like principles, examining prakriti in a clinical setting has been cumbersome. Due to difficulty in observing and interpreting the features, characterising certain traits and eventually the prakriti had been a difficult task for its subjectivity and ambiguity. Identifying the gap between principles and practice of prakriti analysis in Ayurvedic clinical practice, we designed, validated and evaluated a prakriti analysis tool for its possible use in Ayurvedic clinical settings. This tool, based upon observation of clinical features relevant to various dosha dominance in reference to a particular trait, had been validated by examining the same volunteers by different raters using the same set of tools. A strong correlation was observed among most observations when the same volunteers were observed by three independent raters. This tool therefore may be taken ahead for further testing to see its practical utility in prakriti analysis at Ayurvedic clinics. http://dx.doi.org/10.1016/j.eujim.2012.07.667 OP-173 Status of complementary and alternative medicine in the curricula of health colleges in Saudi Arabia Khalil Mohamed 1 , AlBedah 2 Mohamed , El-Olemy Ahmed 1
Abdullah 1 , AlRukban
1 Saudi
National Center for Complementary and Alternative Medicine, Riyadh 2 AlMajmaa Faculty of Medicine, Riyadh, Saudi Arabia Aim: To assess the status of complementary and alternative medicine (CAM) education in health colleges in Saudi Arabia. Methods: A cross-sectional descriptive study was conducted including all medical, dentistry, pharmacy, nursing, allied medical science and health colleges in Saudi Arabia. A semistructured questionnaire was designed to collect information covering CAM tracks, courses and contents in the college’s curricula, available postgraduates programmes, continuing medical education activities and number of colleges staff members specialised or interested in CAM. Results: Out of 110 health colleges in Saudi Arabia, 90 (81.1%) participated in the survey. There is no CAM-specialised track or postgraduate education in any college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in differ-
84
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
ent study subjects. Five (5.6%) colleges conducted continuing medical education activities related to CAM. Among faculty members, there are only 16 CAM specialists working in seven colleges and 84 interested staff members, working in 20 colleges. Colleges of pharmacy are more interested in CAM education compared to other colleges. Six out of 14 (42.9%) of them have CAM courses in their curricula (p = 0.006). In addition, they have more faculty CAM specialists (p = 0.026) compared to other colleges. Conclusion: There is a low and diverse attention given to CAM in medical education in Saudi Arabia. There is a need for a national plan to review health colleges’ curricula to prepare health-care providers for the integration of evidence-based CAM practices. http://dx.doi.org/10.1016/j.eujim.2012.07.668 OP-174 Inter-examiner reliability in low back column: pre- and posttraining of a specific protocol of palpation tests Arienti Chiara, Uberti Stefano, Daccò Silvia Istituto Superiore di Osteopatia, Milan, Italy Background: Evidence-based medicine requires that osteopaths use, in their clinical practice, only touching tests of proved reliability. Inter-operator reliability is considered by the scientific community to be the most relevant aspect to judge the validity of a manual test. In osteopathic clinical practice, palpation tests are widely used in the research of somatic dysfunction. Aim: The objective of this study was to verify if interexaminer reliability in the research of somatic dysfunction, in subjects not affected by low back pain in the L1–L4 region, is higher using a wider number of palpation tests against the use of single positional palpation tests. Methods: A total of 45 healthy subjects of both sexes were enrolled, at the Istituto Superiore di Osteopatia (ISO) of Milan. Three examiners, students of the 5th year of ISO, researched somatic dysfunctions in the low back region between L1 and L4 using only positional palpation tests (phase 1), unaware of the results obtained by the other examiners. Subsequently, the three operators have been trained to use a wider number of palpation tests (phase 2). The examiners have then used such number of palpation tests to search for somatic dysfunctions in the low back region from L1 to L4 in the same group of enrolled subjects and with the same methods. The data analysis has been carried out through an interclass correlation coefficient (ICC) to evaluate the inter-examiner agreement. Results: In the first evaluating method (phase 1), the interexaminer reliability showed a value defined as average, with an ICC of 0.44. On the contrary, in the second evaluating method (phase 2), the inter-examiner agreement showed a value defined as excellent, with an ICC of 0.79. Conclusions: The data obtained with the first evaluating method (phase 1) confirmed what has already been scientifically demonstrated by the literature: palpation tests alone cannot be considered as reliable. With respect to the literature, our data
have a value indicated as average and not poor, as the selected operators all belonged to the same course of study. On the other hand, the data of the second evaluating method (phase 2) obtained a value identified as excellent and this indicates that the three operators got a high level of agreement. These data were obtained thanks to a training period before the second evaluating method and the use of a digital algometer during phase 2 for pain stimulation. The literature confirms these data. http://dx.doi.org/10.1016/j.eujim.2012.07.669 OP-175 The AYUGRID project–Digital Ayurveda Kessler Christian 1 , Hellwig Oliver 2 , Oberlies Thomas 3 , Wischnewsky Manfred 2 , Michalsen Andreas 4 1 Immanuel
Hospital, Berlin of Bremen, Bremen 3 University of Göttingen, Göttingen 4 Immanuel Hospital, Charité, Berlin, Germany 2 University
Aims: The traditional Indian medicine Ayurveda is a mainstream system of medicine in South Asia and one of the fastest growing holistic medical systems worldwide. It offers one of the world’s largest written traditional medical records, composed in Sanskrit language. To date, Asian and Western practitioners of Ayurveda directly refer their practice to classical Ayurvedic Sanskrit texts. However, to this day no synoptic approach has been undertaken to intelligently extract medical information from Ayurvedic Sanskrit texts in order to generate systematic digital Ayurvedic treatment guidelines. The goal of the interdisciplinary AYUGRID project is the creation of a digital treatment-guideline database for Ayurveda and the setting up of a virtual Ayurveda grid community working environment. Methods: The modular AYUGRID project will use stateof-the-art e-Science/e-Research-, e-Service-, e-Infrastructure-, e-Learning- and e-Community-tools involving Indologists, computer linguists, IT experts, Ayurveda specialists and medical doctors in an interdisciplinary approach. Work packages will be (1) the (semi-)automatic digital extraction of medical knowledge from the three Ayurveda main texts with a focus on three test-domain indications of high clinical relevance (viz., cardiovascular diseases, chronic pain syndromes and diabetes mellitus), (2) the systematic generation of historic treatment guidelines (AYUGRID-SUTRA) based on the digital extraction results and (3) the diachronic integration of the historic treatment guideline results into modern evidence-based S1-Ayurveda-treatment guidelines for the chosen indications (AYUGRID-GUIDE). Project duration: 2012–2015. Conclusion: The AYUGRID project will be the initial point for the development of ‘Digital Ayurveda’ starting with the establishment of a proof-of-concept Ayurvedic guideline data bank. The community grid environment AYUGRID will (1) facilitate workflows in e-Science and e-Research on Ayurveda, (2) help to enhance e-Services and e-Infrastructure in this field, (3) provide a virtual e-Learning ambience and (4) will be conducive for networking, collaboration and cooperation in research