OBJECTIVEPatients with diabetes commonly use complementary and alternative medicine (CAM). Little is known about types and factors related to CAM use in patients with diabetes in Thailand. This study aimed to examine types and factors that were associated with CAM use in Thai diabetic patients.

METHODSA cross-sectional study of diabetic patients being treated in four primary healthcare units and two secondary hospitals in the north of Thailand was conducted. A questionnaire was used to collect data. Frequency, percentage, and Chi-square test were used to describe or analyze data.

RESULTSThe three most common types of CAM used by samples were Daode Xinxi (a modified version of Taichi), prayer and meditation. Women were more likely to use CAM than men (χ(2)=5.038, P=0.018). Patients aged between 40 and 69 years were more likely to use CAM than those aged younger than 40 or older than 69 years (χ(2)=11.041, P=0.026). Farmers were more likely to use CAM than those with other careers (χ(2)=19.248, P=0.007). Diabetes patients whose time since diagnosis was between 1 and 10 years were more likely to use CAM than those with a longer elapsed time since diagnosis (χ(2) = 8.407, P = 0.038). Marital status, religion, education, health insurance type and conventional treatment approaches were not associated with CAM use in diabetic patients.

CONCLUSIONThe most common type of CAM used by Thai patients with diabetes was mind and body practice. CAM use was significantly associated with gender, age, career and duration of diabetes. However, marital status, religion, education, health insurance types and conventional regimen for diabetics were not associated with CAM use.

OBJECTIVETo analyze and compare the curriculum and delivery of a Chinese and Australian university-level Chinese medicine program.

METHODSA review of PubMed and the Chinese National Knowledge Infrastructure for relevant educational papers was undertaken. Online and paper documents available at the University of Technology Sydney (UTS) and the Chengdu University of Traditional Chinese Medicine (CDUTCM) were read and analyzed. In addition, in-depth interviews with academics from the two universities were conducted during 2014 to 2015.

RESULTSThe two Chinese medicine programs share the common goal of providing health services to the local community, but differ in some aspects when the curricula are compared. Areas such as student profile, curriculum structure, teaching approaches and education quality assurance were found to be different. The UTS program adopts a "flipped learning" approach with the use of educational technology aiming at improving learning outcomes. On the other hand, the CDUTCM has better clinical facilities and specialist physician resources.

CONCLUSIONA better understanding of the different curricula and approaches to Chinese medicine education will facilitate student learning and educational outcomes.

The success of acupuncture anesthesia (AA) for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-level national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.

Apocynaceae is a large family of tropical trees, shrubs and vines with most species producing white latex. Major metabolites of species are triterpenoids, iridoids, alkaloids and cardenolides, which are known for a wide range of biological and pharmacological activities such as cardioprotective, hepatoprotective, neuroprotective, anti-inflammatory, anticancer and antimalarial properties. Prompted by their anticancer and antimalarial properties, the current knowledge on ten genera (Allamanda, Alstonia, Calotropis, Catharanthus, Cerbera, Dyera, Kopsia, Nerium, Plumeria and Vallaris) is updated. Major classes of metabolites are described using some species as examples. Species with antiproliferative (APF) and/or antiplasmodial (APM) properties have been identified. With the exception of the genus Dyera, nine genera of 22 species possess APF activity. Seven genera (Alstonia, Calotropis, Catharanthus, Dyera, Kopsia, Plumeria and Vallaris) of 13 species have APM properties. Among these species, Alstonia angustiloba, Alstonia macrophylla, Calotropis gigantea, Calotropis procera, Catharanthus roseus, Plumeria alba and Vallaris glabra displayed both APF and APM properties. The chemical constituents of these seven species are compiled for assessment and further research.

From a perspective of Chinese medicine (CM), persons with unregulated "unhealthy" body constitution (BC) will further develop chronic diseases, such as diabetes mellitus (DM). Conventional dietary therapy with nutrition component has its limitations in the regulation of "unhealthy" BC. However, empirical evidence supports that "unhealthy" BC can be regulated with food natures and flavors from a perspective of CM. Presentations of "unhealthy" BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency were found in persons with DM. It would be necessary to regulate the "unhealthy" BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

Scholars have argued that theoretical insights of critical medical anthropology should be applied to the analysis of complementary and alternative medicine in order to develop more critically engaged integrative medicine. In this essay we focus on nature cure in the context of India's contemporary epidemiological transition as an example of why engaged integrative medicine is important for public health, and how the institutionalization of nature cure treatment in India provides a critical framework for the development of programs focused on holistic treatment and prevention. After providing an overview of the epidemiological transition in contemporary India, we develop this argument through an examination of illustrative cases in a clinic that operates within the structure of India's Central Council for Research on Yoga and Naturopathy. Based on a review of recent history and contemporary practice we describe how a system of medicine that makes use exclusively of air, earth, sunlight, water and food has been institutionalized and professionalized in India. Whereas biomedical treatment for chronic non-communicable diseases is focused on the problem of curing individual diseases, nature cure establishes a regimen of personalized public healthcare for the integrated management of symptoms. We argue that nature cure is based on an ecological understanding of health, thus providing treatment that reflects a broad appreciation for the risk factors that characterize India's current crises of public health.

Adequate daily water consumption is an important factor of keeping regular homeostasis. However, the best quantity of daily water consumption for a healthy individual is not virtually stated in the literature. Despite the dearth of evidence-based recommendations, it is commonly thought that ingesting eight glasses of water a day is good for a healthy person. Avicenna had a unique viewpoint. He believed that daily water intake depended on numerous elements together with age, intercourse, body temperament, season, occupation and various internal and external elements. He also cited a few essential and useful measures regarding proper water consumption, which have additionally been emphasized in Islamic hadiths.

BACKGROUNDEffective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials (RCTs) support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown.

METHODS/DESIGNIn partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco's Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to: (1) assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and (2) evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a two-month pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders.

DISCUSSIONEffectiveness research in "real-world" practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide clinical acupuncture services and maintain a rigorous research design, practice-based trials of acupuncture require careful planning and attention to setting-specific, contextual factors.

TRIAL REGISTRATIONThis trial has been registered in ClinicalTrials.gov. The identifier is NCT01988194, registered on November 5, 2013.

Acupuncture Therapy ; Clinical Protocols ; Humans ; Inpatients ; Pain Management ; Pilot Projects

BACKGROUNDRheumatoid arthritis (RA) is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine (TCM) diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.

METHODS/DESIGNWe are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.

DISCUSSIONThe findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.

TRIAL REGISTRATION NUMBERClinicalTrials.gov Identifier NCT02553005.

Acupuncture Therapy ; Arthritis, Rheumatoid ; psychology ; therapy ; Clinical Protocols ; Double-Blind Method ; Hand ; physiopathology ; Humans ; Medicine, Chinese Traditional ; Pilot Projects ; Quality of Life