Biomedical subjects

Iris R Bell

Publications and source records attributed to Iris R Bell.

28 records · Page 2Linked to original sources

PubMed2004

One size does not fit all: aptitude chi treatment interaction (ATI) as a conceptual framework for complementary and alternative medicine outcome research. Part II--research designs and their applications.

When multiple treatment choices are available, the question is not just "which treatment is the best?" but more importantly "best or better for whom, when, and why?" Aptitude (or attribute) by treatment interaction (ATI) is a research paradigm that attempts to examine exactly that--how outcome depends on the match or mismatch between patients' specific characteristics and the treatments they receive. The purpose of this two-part paper is to introduce ATI methods as a conceptual framework into complementary and Alternative medicine/integrative medicine (CAM/IM) outcome research. Part I presented key concepts in ATI research. Part II presents ATI research designs and discusses their applications to the examination of the relationships between individuals and therapies, and the illumination of the mechanisms that make therapies differentially effective. Based on this examination, we conclude that ATI research offers invaluable insights into the multifaceted package of care typically delivered in contemporary medicine and therefore should be included in the portfolio of all CAM/IM outcome research.

Aptitude↗

PubMed2003

Development and validation of IMAQ: Integrative Medicine Attitude Questionnaire.

BACKGROUND: Complementary/alternative medicine and integrative medicine (CAM/IM) are increasingly used in the U.S. We set out to develop and validate a brief questionnaire measuring health care provider and medical student attitudes regarding these approaches to healthcare. METHODS: IMAQ is a 29-item, 7-point Likert scale rated instrument, developed from focus groups consisting of faculty, fellows, visiting residents, and medical students at a university based integrative medicine program. Respondents included 111 (of 574 contacted) internal medicine physicians on an academic medical center CME list and 85 healthcare providers (mostly physicians) attending an American Holistic Medical Association Annual Conference (296 attending). Cohorts were selected for expected differences in attitudes toward CAM/IM. RESULTS: Factor analysis demonstrated that a 2 factor solution best explained the variance in responses (38%). Factor 1 ("openness to new ideas and paradigms") explained 26% of variance with loadings ranging from 0.79 to 0.3, with factor 2 ("value of both introspection and relationship to patient") contributing an additional 12% of the explained variance with loadings ranging from 0.69 to 0.42. Both factors demonstrated adequate reliability. Factor 1 had a Cronbach's alpha of 0.91, while factor 2 was 0.72. As expected, AHMA conference attendees scored higher (F = 120.00, p < 0.001) than the internists on the IMAQ, supporting the construct validity. Although 63% of the AHMA subjects, and only 32% of the internists were female, analysis revealed that gender did not explain the score differences (F = 2.6, p > 0.05). CONCLUSIONS: Analysis of the IMAQ provided evidence of its reliability and validity in measuring attitudes toward CAM/IM, specifically openness to new ideas and paradigms, and the value of relationship to self and patient. Initial findings support use of the IMAQ in measuring attitudes of students and practitioners towards CAM/IM interventions as a first step in understanding willingness to use these approaches to healing. It is our desire that this preliminary instrument will continue to be refined as the field of CAM/IM matures.

Attitude of Health Personnel↗

PubMed2003

Gas discharge visualization evaluation of ultramolecular doses of homeopathic medicines under blinded, controlled conditions.

OBJECTIVES: To determine the feasibility of using a computerized biophysical method, gas discharge visualization (GDV), to differentiate ultramolecular doses of homeopathic remedies from solvent controls and from each other. DESIGN: Blinded, randomized assessment of four split samples each of 30c potencies of three homeopathic remedies from different kingdoms, for example, Natrum muriaticum (mineral), Pulsatilla (plant), and Lachesis (animal), dissolved in a 20% alcohol-water solvent versus two different control solutions (that is, solvent with untreated lactose/sucrose pellets and unsuccussed solvent alone). PROCEDURES: GDV measurements, involving application of a brief electrical impulse at four different voltage levels, were performed over 10 successive images on each of 10 drops from each bottle (total 400 images per test solution per voltage). The dependent variables were the quantified image characteristics of the liquid drops (form coefficient, area, and brightness) from the resultant burst of electron-ion emission and optical radiation in the visual and ultraviolet ranges. RESULTS: The procedure generated measurable images at the two highest voltage levels. At 17 kV, the remedies exhibited overall lower image parameter values compared with solvents (significant for Pulsatilla and Lachesis), as well as differences from solvents in fluctuations over repeated images (exposures to the same voltage). At 24 kV, other patterns emerged, with individual remedies showing higher or lower image parameters compared with other remedies and the solvent controls. CONCLUSIONS: GDV technology may provide an electromagnetic probe into the properties of homeopathic remedies as distinguished from solvent controls. However, the present findings also highlight the need for additional research to evaluate factors that may affect reproducibility of results.

Chromatography, Gas↗

PubMed2003

Homeopathic practitioner views of changes in patients undergoing constitutional treatment for chronic disease.

OBJECTIVES: To identify areas that classical homeopathic practitioners would want to see evaluated in a patient self-report questionnaire sensitive to change during constitutional treatment. DESIGN: Open-ended, written practitioner questionnaire, analyzed using inductive content analysis. SETTINGS/LOCATION: Two classical homeopathic meetings held in the western United States. SUBJECTS: Homeopathic practitioners attending the above professional meetings and volunteering to complete the questionnaire in response to announcements prior to sessions. DATA COLLECTION METHODS: Practitioners completed a demographic questionnaire and answered an open-ended question inquiring for changes about which to ask people undergoing classical homeopathic constitutional treatment. RESULTS: The categories that the 38 homeopaths identified included changes in: (1) emotions; (2) mentation; (3) specific physical functioning; (4) general physical changes; (5) perception of self; (6) relationships; (7) spirituality; (8) lifestyle; (9) energy; (10) dream content and tone; (11) well-being; (12) perceptions by others; (13) life relationships; (14) a sense of freedom or feeling less "stuck"; (15) sleep; (16) coping; (17) ability to adapt; (18) creativity; and (19) recall of past experiences. Sixteen percent (16%) of participants added more in-depth description of the nature of changes across categories (i.e., a rhythmical process of innovation and flux). CONCLUSIONS: The findings are consistent with the systemic orientation of classical homeopathic philosophy to evaluate and treat the patient as a whole. Taken together, the results support the need for development of new, multidimensional outcome measures for clinical research in homeopathy beyond the disease-specific and health-related quality-of-life scales available from conventional medical research.

Activities of Daily Living↗

PubMed2002

Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care.

Clinicians and researchers are increasingly using the term integrative medicine to refer to the merging of complementary and alternative medicine (CAM) with conventional biomedicine. However, combination medicine (CAM added to conventional) is not integrative. Integrative medicine represents a higher-order system of systems of care that emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship. Using the context of integrative medicine, this article outlines the relevance of complex systems theory as an approach to health outcomes research. In this view, health is an emergent property of the person as a complex living system. Within this conceptualization, the whole may exhibit properties that its separate parts do not possess. Thus, unlike biomedical research that typically examines parts of health care and parts of the individual, one at a time, but not the complete system, integrative outcomes research advocates the study of the whole. The whole system includes the patient-provider relationship, multiple conventional and CAM treatments, and the philosophical context of care as the intervention. The systemic outcomes encompass the simultaneous, interactive changes within the whole person.

Complementary Therapies↗

PubMed2002

Homeopathic constitutional type questionnaire correlates of conventional psychological and physical health scales: individual difference characteristics of young adults.

This study examined associations between scores for 19 different remedies on the constitutional type questionnaire (CTQ) and scores on standardized psychological and medical trait and state scales from health psychology research. Subjects were 104 young adult American college students (mean age 20 years; 67% female). Scales included the chemical intolerance index (CII) for environmental sensitivity, the NEO personality inventory, Marlowe-Crowne social desirability (MCSD) Scale for defensiveness, Harvard parental caring scale (HPCS) for perceived mother and father traits, Profile of Mood State (POMS) scale, Pennebaker symptom checklist (PSC), and a 3-item global health rating scale. The majority of CTQ constitutional type scores correlated significantly with greater NEO neuroticism, lower MCSD defensiveness, and greater psychological distress on the POMS subscales. NEO Extraversion and Openness subscales correlated with specific CTQ scores in directions consistent with clinical remedy pictures. CTQ Carcinosin differed from other remedies, showing no significant correlations with other scales. As hypothesized (a) persons high on CTQ scores for Carcinosin and low in parental caring (HPCS) had the highest symptom score; (b) those high on CTQ scores for Sulphur and low on HPCS had the poorest global health ratings; (c) individuals high on four different CTQ type scores (Carcinosin, Lachesis, Nux vomica, Sulphur) and high on environmental sensitivity (CII) exhibited the highest symptom scores. Taken together, the data offer additional validation of the CTQ and provide a foundation for studying interactions of constitutional type with both psychosocial and physicochemical environmental factors in homeopathic provers and patients.

Adult↗

PubMed2002

US military veterans' perceptions of the conventional medical care system and their use of complementary and alternative medicine.

BACKGROUND: Use of complementary and alternative medicine (CAM) is growing quickly in the USA, prompting hypotheses about why people turn to CAM. One reason for increasing use of CAM modalities may be dissatisfaction with the conventional care system. However, recent studies suggest that dissatisfaction is not a major factor. OBJECTIVES: This paper provides another perspective on the possible relationship between dissatisfaction with conventional care and the use of CAM. METHODS: Qualitative data collection, in the form of 12 focus groups with 100 CAM users, was used to inquire about issues surrounding the use of CAM. Focus group participants were military veterans enrolled in the Southern Arizona VA Health Care System, and their significant others. Qualitative analysis identified key themes emerging from the focus groups. RESULTS: Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population. CONCLUSIONS: Independent research and a sense of responsibility on the part of focus group participants for their own health seemed to be taking them outside the domain of the conventional health care system.

Adult↗

PubMedDate not supplied

A profile of military veterans in the southwestern United States who use complementary and alternative medicine: implications for integrated care.

BACKGROUND: Complementary and alternative medicine (CAM) use and expenditures are on the rise in the United States. Although civilian users of CAM have been well described, little is known about military veteran users of CAM. OBJECTIVE: To describe military veteran CAM users in the southwestern United States. METHODS: The study population comprised 508 military veterans randomly selected from Southern Arizona Veterans Administration Health Care System (Tucson) primary care patient lists, who had agreed to participate in a telephone interview. The chi(2) test was used to analyze CAM use by demographic characteristics, military service, military-related health outcomes, and physician-diagnosed health complaints. Logistic regression was used to determine predictor variables. RESULTS: Of the 508 subjects, 252 (49.6%) reported CAM use. Military veteran CAM users were significantly more likely to be non-Hispanic white, earn more than $50 000 per year (both P<.05), and have greater than 12 years of education (P<.01). Current high daily stress, perceived negative impact of military life on physical or mental health, and physician-diagnosed chronic illnesses (eg, gastrointestinal problems, insomnia, and asthma) were statistically associated with CAM use. Regression analysis provided adjusted odds ratios and indicated that ethnicity (non-Hispanic white), higher education, greater current daily stress, and overseas military experience were significant predictors of CAM use by these veterans (each P<.05). CONCLUSIONS: Ethnicity, education, income, and several chronic health complaints are consistent with civilian CAM use. Findings also suggest, however, that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.

Adult↗

PubMedDate not supplied

Translating a nonlinear systems theory model for homeopathy into empirical tests.

Various investigators have proposed that nonlinear systems theory, notably chaos and complexity theory, provides a heuristically useful modelfor conceptualizing the way in which complementary and alternative medicine therapies, which purport to modify subtle energies, effect change throughout the individual as a whole. In this paper we apply this theory to classical homeopathy and outline an empirical approach for testing the resultant hypotheses. Such research may advance understanding of the mechanisms of homeopathic remedy effects and provide a direction for homeopathic research that expands the previous emphasis on clinical trials and the remedies themselves. In refocusing attention on the dynamics of the patient as a nonlinear complex system, the proposed research program is consistent with the homeopathic emphasis on the individual rather than the disease. This approach may have additional applications that can elucidate similar effects of other energy medicine modalities (eg, acupuncture) on the healing process of the person as a unified whole.

Homeopathy↗

PubMedDate not supplied

On the definition of complementary, alternative, and integrative medicine: societal mega-stereotypes vs. the patients' perspectives.

Much confusion exists regarding the definitions of complementary, alternative, and integrative medicine. Whereas 'complementary and alternative medicine' (CAM) is used to describe a variable set of diagnostic and therapeutic modalities considered as non-conventional, 'integrative medicine' is commonly used to describe the combination of allopathy and CAM. CAM, however, is nothing more than a categorical label that subsumes numerous therapeutic modalities generally sharing few commonalities. Creating a unique category out of such diversity has lead to misunderstanding and skepticism. From the physician's stand-point, this can generate numerous stereotypes, prejudices, and misconceptions that may compromise the therapeutic relationship, impede compliance, and lead to treatment failure. To help avoid this dangerous pitfall, we propose a distinctly new operational definition for CAM; one that shifts the focus from the traditional, population-based approach to a definition that focuses on the individual. This paper outlines various definitions of CAM and discusses their relative strengths and weaknesses for the 21st century practice of medicine. It is our conclusion that individual patients, rather than society, should be the frame of reference and defining source for what constitutes integrative medicine and CAM.

Complementary Therapies↗