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Volume 2, Issue 2 of Topics in Integrative Health Care is Now Available

Published on July 14, 2011

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Volume 2, Issue 2 of Topics in Integrative Health Care is Now Available.

Topics in Integrative Health Care (TIHC) is a peer-reviewed, open-access quarterly online journal. TIHC can be located on the web at http://www.tihcij.com.

TIHC is dedicated to advancing the integration of multiple disciplines, both complementary and mainstream, into diverse health care settings in order to provide optimal patient care. It presents themed issues on topics of current relevance to health care providers interested in integrative, conservative care, health promotion and disease prevention. It includes international, interdisciplinary Grand Rounds in order to facilitate communication and patient comanagement among various health professions, for the good of patients everywhere.

The current issue’s table of contents:

Editorial

Topics in Integrative Health Care
Cheryl Hawk, DC, PhD, CHES
Topics in Integrative Health Care 2011,Vol. 2(2) ID: 2.2001

Each issue of TIHC focuses on a particular theme. Although many of the articles are invited, we also welcome unsolicited manuscripts with original research, clinical briefs and “fast facts” collections. All submissions are peer-reviewed.
The following themes are tentatively scheduled:

· Fall 2011: Integrative Care Settings

· Winter 2011: Integrative Approaches to Chronic Disease Prevention and Management

Research

Chaplaincy and Spiritual Care Services: The Case for Muslim Patients

Wahiba Abu-Ras, Ph.D.
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2002

Religion and spirituality are the first, and sometimes the only available sources of comfort for many hospital patients facing difficult and stressful times. Since chaplaincy is typically practiced along Judeo-Christian lines, other spiritual perspectives receive less attention. This study assesses the existing chaplaincy care services available for Muslim patients as perceived by two different groups, 33 Muslim and non-Muslim chaplains and by 56 directors of chaplaincy departments at New York City hospitals. A mixed-methods approach was used, including a cross-sectional survey and in-depth interviews. The results indicate that Muslim patients’ religious needs may be underserved, and that they may not receive appropriate chaplaincy care. These results may provide a better understanding of the challenges that other immigrants and minority groups face when receiving medical care, and of the need for quality spiritual care for these communities.

Patients’ Perception of Care: Comparing Placebo and Manual Therapy Within a Pilot Study

Jerrilyn A. Cambron, LMT, DC, MPH, PhD ; James Jedlicka, DC ; Grant C. Iannelli, DC ; Jennifer Dexheimer, LMT, BS ; Gregory D. Cramer, DC, PhD
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2003

Introduction: Several previous placebo ‘treatments’ have been developed for chiropractic clinical trials. However, all of the placebos included some form of touch, such as sham massage or manipulation. The objective of this study was to develop and test a placebo treatment that included minimal contact with subjects.

Methods: Subjects were randomized to one of four groups; three groups receiving flexion distraction care (8, 12, or 18 visits) and one receiving placebo care (8 visits) over six weeks. Subjects were asked about their perception of care at the end of the first week of care and at the care completion visit.

Results: By the end of the study, approximately 23% of the subjects in the placebo group believed that the treatment was certainly placebo and another 39% believed that the treatment was possibly placebo. On the other hand, the majority of subjects in the active care groups believed they were receiving active care. Interestingly, more treatments led to a higher percent of subjects who believed that they were in the active treatment group.

Conclusion: Based on these results, it does not appear that our placebo was a successful comparison to the active treatment groups.

The Relationship of Heart Rate Variability to Health Status and Health Behavior

Cheryl Hawk, DC, PhD, CHES ; John Zhang, MD, PhD
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2004

Objective: to describe the characteristics and health habits of individuals with varying levels of HRV in order to observe possible correlations between HRV and various demographics, characteristics, and self-reported health behaviors.

Methods: This was an observational cross-sectional study. Data were collected by self-report and investigator measurement. Total HRV was the variable of interest in the analysis. Total HRV was categorized into tertiles (high, medium, and low) and variables were compared using these categories. Chi square tests were done for categorical variables and a one-way ANOVA for continuous variables, comparing variables to Total HRV categories.

Results: There were 78 participants, predominantly young adults with generally good health habits. Thirteen percent of participants had elevated blood pressure; 47% were overweight or obese and 28% had an unhealthy waist circumference. The only statistically significant relationship to total HRV level was heart rate, with lower heart rate in the higher category of total power (p=.002). Age approached a statistically significant difference in terms of total power level (p=.06); younger age was associated with higher total power. Although only 6 participants reported tobacco use, there appeared to be a trend toward significance (p=.10), with the proportion of tobacco users higher in the lower levels of total power.

Conclusions: Although the measurements themselves served as a useful screening tool to identify health risks such as hypertension and obesity in apparently healthy volunteers, the sample size and lack of diversity in our sample may have precluded the possibility of identifying lifestyle factors which might affect HRV.

Chiropractic Manipulation, Functional Neurologic and Nutritional Management for the Reduction for Tourette Syndrome Symptoms in a 27 Year Old Woman.

Daniel A. Martinez, MA, DC, Research Scientist ; Adam Marashi, BSN, DC
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2005

Objective: to report the treatment of a patient with Tourette syndrome (TS) utilizing nutritional supplements and dietary change along with chiropractic manipulative therapy (CMT), saccadic eye exercises, and audio therapy.

Case presentation: The patient is a 27-year-old female diagnosed with TS at age 23. Motor complaints centered on an eye blink. Vocal tics include throat clearing and sniffing. Obsessive compulsive components were described as touch-based and/or number-based.

Intervention and Outcome: Primary measures included the Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive Compulsive Scale (Y-BCOS), and the Health Status Questionairre-12 (HSQ-12). Secondary measures included documentation of appendicular coordination, balance, gait, and saccadic eye movements. Treatment consisted of vertebral and extremity adjusting, saccadic eye exercises, audio therapy, and supplementation of magnesium, vitamin B6, and omega 3 fatty acid for 4 weeks. At baseline the YGTSS score was 52, Y-BOCS was 22 and the HSQ-12 was 53. At two weeks, the YGTSS: 22 and the Y-BOCS: 17. At completion the YGTSS: 14, the Y-BOCS: 12, and the HSQ-12: 82.1.

Conclusion: The patient’s clinical picture indicated marked improvement in her symptoms. Although natural history cannot be disregarded, the clinical results documented suggest that a multimodal approach of diet, manipulation, and functional neurologic exercises may help in the management of Tourette syndrome symptoms. A controlled study is warranted.

Hypercholesterolemia and Ayurvedic Medicine: A Case Report

Anupama Kizhakkeveettil, BAMS (Ayurveda), MAOM, L. Ac. ; Parla S. Jayagopal, BAMS, MD (Ayurveda) ; Kevin Rose, DC, MPH
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2006

Background: Over the last two decades there has been an increasing emphasis placed on screening for high cholesterol and adopting interventions to reduce cholesterol levels in order to reduce the risk of heart disease. The high costs and side effects of hypercholesterolemia medications have led many people to search for alternate treatments. Only a few studies have been conducted to evaluate the effect of Ayurvedic herbal medicine formulae on hypercholesterolemia.

Objective: The objective of this article is to describe a case where Ayurvedic herbs appeared to have been helpful in the management of hypercholesterolemia.

Clinical Features: This patient was a 46-year-old woman who had been diagnosed with hypercholesterolemia two years prior to presentation. She had not responded to conventional treatment.

Intervention and Outcome: She was treated for eight months with the Ayurvedic formulae Kaishora Guggulu, Triphala and a custom made herbal tea mix. Her total cholesterol dropped from 270 to 208 mg/dl, her LDL dropped from 191 to 146 mg/dl, and her HDL rose from 57 to 63 mg/dl. There were no side effects reported.

Conclusions: This case demonstrates the use of Ayurvedic herbs in the management of hypercholesterolemia. Further high quality studies with randomized clinical trials should be conducted to better understand the effectiveness of Ayurvedic treatment for hypercholesterolemia.

Clinical Brief: Recognition of Abdominal Aortic Aneurysm

Dwain M. Daniel, D.C.
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2007

Abdominal aortic aneurysm is one of the most commonly missed diagnoses in all healthcare professions. The condition usually occurs in individuals over the age of 50. Spontaneous rupture is not uncommon and when this occurs the results are deadly in a large majority of cases. This brief review will discuss high risk groups, value of screening, clinical examination and contraindications to manual therapies.

Clinical Brief: Depression Screening and Treatment

Cheryl Hawk, DC, PhD, CHES
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2008

Depression is a condition seen frequently in primary care practice as well as by practitioners who treat patients with chronic pain. The U.S. Preventive Services Task Force recommends that all adults be screened for depression and those who screen positive for depression be appropriately referred for additional assessment and management. Cognitive behavioral therapy, pharmacotherapy, physical activity and mindful exercise are all accepted approaches to treatment of depression.

Fast Facts

Cheryl Hawk, DC, PhD, CHES
Topics in Integrative Health Care 2011, Vol. 2(2) ID: 2.2009

Readers are welcome to contribute to Fast Facts. Please include the original abstract (with citation) that is the source of your contribution. Contributors’ names will be included along with the item.

The following is an excerpt:

A 12-week yoga intervention demonstrated greater improvements in mood and anxiety than a metabolically matched walking exercise. This study also indicated that increased thalamic GABA levels are associated with improved mood and decreased anxiety.
Streeter CC, Whitfield TH, Owen L, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med 2010;16(11):1145-1152.

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