Referrals for alternative therapies

BACKGROUND: The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. METHODS: A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. RESULTS: More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. CONCLUSIONS: Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.     

Resources for alternative and complementary cancer therapies

Seventeen patients with persistent chronic hand eczema were treated with topical 0.1% 8-methoxypsoralen and UVA (PUVA) for 8 weeks. Significant improvement was achieved in 5 cases (29%), moderate improvement in 9 (53%), and little improvement in 3 (18%). The mean number of PUVA treatments was 22.2, and the mean total UVA dose was 63.5 J/cm2. There was no association between clinical response and duration of hand eczema, positive patch test reaction, or atopic status. Since topical PUVA has no risk of systemic side effects, it should be considered as an alternative treatment for patients with chronic hand eczema who are resistant to other topical medications.     

A case history in scientific method.

The case history in scientific method cited is autobiographical; Skinner relates certain relevant experiences in the development of some of his scientific contributions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternative therapies: abuses of scientific method and challenges to dental research

Research with the mismatch negativity component of event-related potentials has uncovered a system that detects change in the acoustic environment on an automatic basis. The system is considered to compare incoming stimuli to representations of the past and to emit an MMN if change is detected. Previous investigations have shown that the relevant memory of the past can become dormant and then be reactivated by a reminder stimulus. It is unclear, however, whether what is reactivated is an holistic representation of stimuli or separate representations of features of stimuli. The present study provides data that supports the latter possibility but leaves open the former one.     

Complementary and alternative therapies for our aging society

Gerontological nurses are dynamic individuals who recognize the necessary changes needed to reform a biotechnology-driven health care system to become a relationship-centered, care-driven healing system with elders. They must continue to take action to enhance caring and healing at personal levels and in various professional levels of clinical practice and health care reform. As gerontological nurses pursue personal, clinical, educational, and research approaches to holistic nursing and caring-healing modalities, they increase their knowledge and skills of holism and the complex body-mind-spirit interconnections, and provide relationship-centered care (Tresolini, 1994). Gerontological nurses then truly blend the art and science of caring with elders, and lead to a deeper understanding of healing as a lifelong journey into wholeness (Achterberg, Dossey & Kolkmeier, 1994).     

An alternative restorative method for regional odontodysplasia: case report

A 5-year-old Caucasian male presented with early loss of multiple deciduous teeth. All the characteristics were consistent with the diagnosis of regional odontodysplasia (ROD). Significant initial findings included premature loss of multiple primary mandibular teeth and some malformed permanent teeth. The affected teeth showed hypoplastic enamel and dentin, short roots, and wide pulp chambers, and were localized in the mandibular dentition. Treatment objectives for this patient were to provide improved esthetics, restored chewing function, and space maintenance by the construction of a temporary prosthetic restoration. However, with limited tooth support and an unusual occlusal pattern, it is difficult to obtain satisfactory retention and esthetics with traditional prosthetic techniques. In this article we introduce an alternative method for fabricating a custom removable denture and discuss the prognosis of the malformed permanent dentition and further treatment plan.     

Loxapine as an alternative to phenothiazines in a case of oculocutaneous skin pigmentation

The authors describe a patient with changes in oculocutaneous pigmentation that cleared after chlorpromazine was discontinued. They suggest that loxapine may be a suitable alternative to phenothiazines when skin pigmentation and ocular involvement occur, although the patient must be carefully monitored for ocular problems.     

Information exchange as empowerment: a case study

In July 1994 a newspaper was created to share information in and among the community of people with disabilities in Palmerston North, New Zealand. The project became, in only a few months, not only economically viable, but extremely successful as a social and community experiment, and an endeavour by people with disabilities to inform each other and the larger community. This article describes the origin, design and development, and the current status of the newspaper, and advances the recommendation that people with disability elsewhere, and those professionally employed in the rehabilitation field, consider similar initiatives to inform, and thereby empower, people with disabilities.     

Genocide as a scientific project.

Comments on the work of E. Staub (see record 83-27014) on the cultural-societal roots of violence. A. S. Winston contends that Staub neglected the role of mainstream academic science in providing the foundations, rationalization, and encouragement for the Nazi Holocaust. To race hygienists, Winston argues, Jews were a problem of biology that required the full cooperation of science and the state for a solution. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment acceptability of alternative therapies for depression: A comparative analysis.

174 college students were presented with the case scenarios of a 19-yr-old college student with either major depression or dysthymia. The treatment used in these case scenarios was described as consisting of behavioral, cognitive, interpersonal, or pharmacotherapy techniques. Ss were then administered a treatment evaluation inventory, the Semantic Differential, and a credibility rating scale to determine which treatment they thought was most acceptable. Interpersonal therapy was repeatedly rated as the most acceptable, followed by behavioral therapy, cognitive therapy, and pharmacotherapy. Ss viewed behavioral and cognitive approaches as equally acceptable across measures, but pharmacotherapy was consistently rated as least acceptable. Ss with evidence of depressive symptoms consistently rated psychotherapies as more acceptable than pharmacotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Montignac method: scientific foundation debatable

Obesity is a major health issue in Western society. In the Netherlands every fifth person suffers from obesity and every third person is on a weight-reducing diet. The Montignac method is a very popular diet. The diet is claimed to be a nutritional science. The method is based on several hypotheses about the metabolism of carbohydrates and fatty acids: carbohydrates with a low glycaemic index are preferred, carbohydrates are not to be eaten in combination with fatty acids, fruit is propagated but must not be combined with other components. The scientific literature refutes the hypotheses of Montignac regarding the metabolic effects of carbohydrates and fatty acids. As a method to lose weight, the conventional recommendations of caloric restriction, less intake of saturated fatty acids and more physical activity should be preferred to the Montignac diet.     

Conversational discourse analysis as a method for evaluating progress in aphasia: a case report

The gains made by a woman with Broca's aphasia as documented by traditional measures were paralleled by changes in conversation, including increased verbal output and efficiency, and changes in conversation repair patterns. Her conversational partner decreased her verbal output, as predicted. The progress documented with conversational discourse analysis was not observable from other test measures. Clinical and theoretical implications are discussed.     

Three-dimensional spiral computed tomography angiography as an alternative imaging modality for a silent dissecting aortic aneurysm--a case report

The authors report a patient with silent dissecting aortic aneurysm in whom three-dimensional spiral computed tomography (CT) angiography (3D-CTA) provided important imaging data. Images obtained by 3D-CTA were compared with the results of both conventional angiography and CT. They conclude that 3D-CTA was a powerful diagnostic modality for this patient, in addition to conventional CT and angiography.     

The study of individual differences as a method for dividing into stages the acquisition of a complex reflex

Cultured hepatic stellate cells (HSCs), the cell type primarily involved in the progression of liver fibrosis, secrete insulin-like growth factor-I (IGF-I) and IGF binding protein (IGFBP) activity. IGF-I exerts a mitogenic effect on HSCs, thus potentially contributing to the fibrogenic process in an autocrine fashion. However, IGF-I action is modulated by the presence of specific IGFBPs that may inhibit and/or enhance its biologic effects. Therefore, we examined IGFBP-1 through IGFBP-6 mRNA and protein expression in HSCs isolated from human liver and activated in culture. Regulation of IGFBPs in response to IGF-I and other polypeptide growth factors involved in the hepatic fibrogenic process was also assessed. RNase protection assays and ligand blot analysis demonstrated that HSCs express IGFBP-2 through IGFBP-6 mRNAs and release detectable levels of IGFBP-2 through IGFBP-5. Because IGF-I, platelet-derived growth factor-BB (PDGF-BB), and transforming growth factor-beta (TGF-beta) stimulate HSC proliferation and/or matrix production, we tested their effect on IGFBPs released by HSCs. IGF-I induced IGFBP-3 and IGFBP-5 proteins in a time-dependent manner without an increase in the corresponding mRNAs. IGFBP-4 protein levels decreased in response to IGF-I. TGF-beta stimulated IGFBP-3 mRNA and protein but decreased IGFBP-5 mRNA and protein. In contrast, PDGF-BB failed to regulate IGFBPs compared with controls. Recombinant human IGFBP-3 (rhIGFBP-3) was then tested for its effect on IGF-I-induced mitogenesis in HSCs. rhIGFBP-3 inhibited IGF-I-stimulated DNA synthesis in a dose-dependent manner, with a peak effect observed at 25 nM IGFBP-3. Because TGF-beta is highly expressed in cirrhotic liver tissue, we determined whether IGFBP-3 mRNA expression is increased in liver biopsies obtained from patients with an active fibroproliferative response due to viral-induced chronic active hepatitis. In the majority of these samples, IGFBP-3 mRNA was increased compared with normal controls. These findings indicate that human HSCs, in their activated phenotype, constitutively produce IGFBPs. IGF-I and TGF-beta differentially regulate IGFBP-3, IGFBP-4, and IGFBP-5 expression, which, in turn, may modulate the in vitro and in vivo action of IGF-I.     

Pericellular pO2 as an alternative method to test cytotoxicity

In 971 patients with squamous cell carcinoma of supraglottic larynx several clinical and physical prognostic factors were evaluated. There were 55% of patients with advanced primary tumours and 71% of patients with no regional neck metastases. All patients were irradiated radically using external megavoltage beam. The total dose was in range 60-70 Gy for 95% of patients. The 3-year local control rate and 3-year overall in whole group were 41% and 50% respectively. Clinical stage, haemoglobin level at the end of treatment, overall treatment time, sex and total dose were estimated as an independent and important prognostic factors for the outcome in radiotherapy of supraglottic larynx cancer.     

Development of a densitometric method for the determination of cephalexin as an alternative to the standard HPLC procedure

A HPTLC-densitometric method was developed in order to obtain a reliable procedure for routine analysis of cephalexin in pharmaceutical formulations. Optimization of TLC conditions for the densitometric scanning was reached by eluting HPTLC silica gel plates in an horizontal developing chamber. Quantitation of cephalexin was performed in single beam reflectance mode by using a computer-controlled densitometric scanner and applying a five-point calibration. A linear regression has been found in the 200-1000 ng range. The setup method is precise, reproducible and accurate. Recovery was also assessed by comparison with the HPLC USP XXIII alternate method. In this case HPTLC-densitometry appears worth of consideration as being relatively inexpensive and time-saving (up to 12 samples can be determined simultaneously in less than 15 min with a solvent consumption of about 15 ml). The results suggest that the proposed method may be used in place of HPLC for the routine quantitation of cephalexin in both pure and dosage forms.