Melinda Ring

Developing and implementing core competencies for integrative medicine fellowships

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as “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, health care professionals, and disciplines to achieve optimal health and healing.” Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force’s process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Yoga Versus Resistance Training in Mild to Moderate Severity Parkinson’s Disease: A 12-Week Pilot Study

Background: Yoga is a mind-body intervention which may address the motor and non-motor needs of patients with Parkinson’s disease (PD). Objective: Explore the safety and feasibility of a 12-week biweekly course of Iyengar yoga in patients with PD, and collect pilot data on efficacy compared to resistance exercise. Method: Prospective randomized controlled single blinded study in patients with mild to moderate PD. Participants selected an urban or suburban site, and was randomized 1:1 to yoga or resistance classes. Results: 17 participants were enrolled. Mean age 67.3 (SD 9.8) years, and mean UPDRS III score was 24.2 (SD 7.0). There were 3 withdrawals unrelated to the intervention. There were no major adverse events. 16% of yoga classes were missed compared to 8% of resistance classes (p=0.04). Significantly more classes were missed at the urban site (14.8% vs. 7.5%). Both groups improved on mean TUG time, UPDRS score, and PDQ-39 score compared to baseline, although the between-group differences were not statistically significant. Conclusion: Attendance for yoga classes was inferior to resistance classes. Improvements in both motor and non-motor outcome measures need to be replicated with a larger study. Feasibility data will need to be taken into account in designing such a study.

Women's Health: Polycystic Ovarian Syndrome, Menopause, and Osteoporosis.

Surveys consistently show that a significantly higher percentage of women with chronic medical conditions report use of complementary and integrative medicine (CIM) approaches compared with men. A total of 54.5% of women report use of at least one CIM approach specifically for obstetric or gynecologic problems. However, primary care providers remain an underutilized resource by patients for guidance in the safe and appropriate use of integrative therapies. This article provides a practical overview of the most appropriate integrative therapies to consider in the management of commonly seen womens health conditions: polycystic ovarian syndrome, menopause, and osteoporosis.

Acupuncture as Adjuvant Therapy for the Management of Cervical Dystonia

Objectives: There are no curative treatments for cervical dystonia (CD), therefore conventional management is aimed at pain relief and muscle relaxation. Many patients with CD use complementary and integrative medicine interventions to manage symptoms, yet there are limited data on the use of acupuncture for CD. The aim of the current study was to determine the feasibility, safety, and efficacy of adjuvant acupuncture. Materials and Methods: A pilot open-label study was conducted on acupuncture treatments as add-on therapy to botulinum-toxin injection sessions (3 months apart) in 5 subjects with chronic idiopathic CD. Six 1-hour acupuncture sessions were administered every other week over the 3-month period between consecutive botulinum-toxin sessions. Data from exploratory efficacy endpoints-including a visual analogue scale for pain, the Clinician Global Impression of Change, the Patient Global Impression of Change, the Toronto Western Spasmodic Torticollis Rating Scale, and the Short Form-36) Health Survey-were collected. Results: Five subjects completed the study with only 1 acupuncture session missed by 1 subject, thereby meeting the studys predetermined adherence goal. All participants reported improvement from acupuncture. Only minor adverse events were reported, with self-resolved discomfort in 1 subject and self-resolved minor bruising in 2 subjects. Conclusions: Acupuncture is feasible and safe as an adjunct treatment for chronic CD, and might be associated with subjective symptomatic benefits.

Integrative Women’s Health

This article addresses the common womens health concerns of menopause-related symptoms, premenstrual syndrome, and chronic pelvic pain. Each can be effectively addressed with an integrative approach that incorporates interventions such as pharmaceuticals, nutraceuticals, mind-body approaches, acupuncture, and lifestyle modification.

Dietary Supplements for Insomnia

Purpose of ReviewThis article provides an overview of the evidence of commonly used dietary supplements for insomnia.Recent FindingsMany bioactive phytochemicals and other components have been identified in dietary supplements that could provide therapeutic effects in patients with insomnia. There is a paucity of high-quality clinical research on most supplements, though some have promising findings.SummaryWhile additional research is warranted to establish safety and efficacy, in the interim, health professionals are encouraged to explore existing resources and partner with patients to understand their goals and advise on safe and effective use of dietary supplements.