World Congress Integrative Medicine & Health 2017: Part one

Introduction

I1 World Congress for Integrative Medicine & Health 2017 - A global forum for exploring the future of comprehensive patient care

Benno Brinkhaus¹, Torkel Falkenberg^2,3, Aviad Haramati^4,5, and Stefan N. Willich¹

¹Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany; ²Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden; ³I C – The Integrative Care Science Center, Järna, Sweden; ⁴Department of Biochemistry, Molecular and Cellular Biology, Georgetown University, Medical Center, Washington, DC, USA; ⁵Department of Medicine, Georgetown University Medical Center, Washington, DC, USA

We are excited to present the abstracts of the keynote speakers, parallel sessions and oral and poster presentations of the World Congress on Integrative Medicine & Health (WCIMH 2017; http://www.ecim-iccmr.org/2017/) to be held in Berlin on May 3-5, 2017, which will be jointly convened by the European Society of Integrative Medicine (ESIM) and the International Society for Complementary Medicine Research (ISCMR). The Congress will take place in association with a number of national and international organizations from North America and other continents. Consequently, the congress will provide the most comprehensive global forum and perspective in the field of Complementary and Integrative Medicine in 2017.

The congress goal is reflected in its tag line: The Future of Comprehensive Patient Care - Strengthening the Alliance of Researchers, Educators and Providers. We believe that by bringing together researchers, educators and providers, who are addressing various aspects of Integrative Medicine and health, we can build on the evidence obtained through research to inform clinical education and practice and thereby create a better platform for comprehensive patient care.

The main themes of the Congress are:

• 1. Clinical care: The practice of Integrative Medicine should be based on distinct definitions, should be informed by evidence and evolve from guidelines that are developed by experts from conventional and complementary medicine.

• 2. Education: Academic leaders and health officials have called for future clinicians to possess the knowledge and skills to understand how Integrative Medicine can be incorporated into conventional care to improve the health of the public. Therefore, it is essential to share best practices in how to create robust curricular opportunities for medical students to experience systematic teaching of the principles, strengths and limitations of Integrative Medicine.

• 3. Research: Within this Congress scientists will showcase the highest quality research worldwide in this field and will provide the state-of-the-science evidence base through plenary lectures, symposia and abstract presentations.

• 4. Traditional healing systems (THS): Traditional healing practices and practitioners are an important and often underestimated part of health care. THS is found in almost every country in the world and the demand for its services is increasing. Research contributing to evidence informed decision making is imperative to develop a cohesive and integrative approach to health care that allows governments, health care practitioners and, most importantly, those who use health care services, to access THS in a safe, respectful, cost-efficient and effective manner.

• 5. Arts and medicine: For the first time at a research congress, this theme will explore the important contributions of the arts (music, visual arts, dancing, etc,) for integrative therapeutic interventions to achieve optimal health and healing.

Given the ambitious scope of this worldwide international congress, the four authors of the present editorial serve as co-presidents and they are guided by the International Organizing Committee consisting of many experts from around the world including Myeong S. Lee, Jianping Liu, Kenji Watanabe (from Far East Asia), Renee Street (Africa), Amie. Steel (Australia), Paulo Arturo Caceres Guido, Chin An Lin (South America), Heather Boon, Josephine Briggs, John Weeks (North America) and Abdullah Al-Bedah, Mohamed Khalil, Elad Schiff (Middle East and Israel).

The programming for each of the five themes is directed by WCIMH 2017 theme subcommittees involving some of the most highly regarded clinicians, educators and researchers in the world in this field (in alphabetic order): Linda Balneaves, Lesley Braun, Eva Bojner Horwitz, Gustav Dobos, Jeffery Dusik, David Eisenberg, Iva Fattorini, Eckhart G. Hahn, Suzanne B. Hanser, Frederick Hecht, George Lewith, Harald Matthes, Andreas Michalsen, Judy Rollins, Volker Scheid, Michael Teut, Robert Saper, Claudia M. Witt, Merlin Wilcox and Darong Wu. The Local Organizing Board is coordinated by M. Cree. We are very grateful to all organisations and individuals working diligently to making this first World Congress for Integrative Medicine & Health in 2017 a great success.

We are also pleased to announce that the opening welcome will include the Director General for the World Health Organization, Dr Margaret Chan (on video). All plenary speakers are internationally recognized experts in the field of Complementary and Integrative Medicine such as Josephine B Briggs (US) and Merlin Willcox (UK) as keynote speakers for the theme traditional healing systems; Klaus Linde (Ger) and Michael Moore (UK) for the research theme; Lisa M Wong (US) and Töres Theorell (Sweden) will address the theme of arts and medicine; Darong Wu (China) and Jeffery A Dusek (US) are presenting on the theme of clinical care; and Aviad Haramati and David Eisenberg (both US) will close the Congress with presentations on education.

In addition, more than 100 oral presentations in over 40 parallel sessions will be in the program to provide newly emerging data from recent research projects, experiences from new treatment aspects in clinical care, descriptions of new models of education in medicine, information about integration of traditional healing systems in health care systems and new aspects on the integration of arts in medicine. In addition, more than 400 posters will be presented in guided poster sessions during the three days of the Congress.

To translate the congress goals and objectives into a tangible action for the field, a Berlin Agreement is being developed. With the title ‘Social and Self-responsibility in practicing and fostering Integrate Health and Medicine Globally,’ this document is meant to help shape the future of comprehensive patient care in Integrative Medicine, and addresses the responsibilities of all participants, including patients and citizens, physicians and all colleagues working in the healthcare system. The Berlin Agreement has been developed by the WCIMH 2017 congress presidents and the International Organizing Committee to create a document for further distribution to the scientific and clinical community and to health care stakeholders, decision makers, and politicians. We anticipate having the final version of the Berlin Agreement endorsed by a number of organizations prior to the Congress and also soliciting the support of congress at the WCIMH 2017 in Berlin. Our hope is that this document will provide an important impetus for further engagement world-wide after the Congress has concluded.

Immediately before the start of WCIMH 2017 on Wednesday May 3rd 2017 there will be several high-quality pre-conference workshops covering all congress topics. Reflecting the political situation in recent years, especially in Europe, we have arranged for a unique half-day workshop on the topic: “Refugees with Chronic Diseases between the Middle-East and Europe: The Role of Traditional and Integrative Medicine in Bridging Gaps”, The speakers are all from the Middle East and Europe and will address how Integrative Medicine may serve as an important element to overcome the problematic health situation of refugees around the world.

We are convinced that the field of Complementary and Integrative Medicine, including traditional healing systems and medicine and the arts, will benefit from The 2017 World Congress on Integrative Medicine & Health—a preeminent scientific international forum that is focused on highlighting advances in these thematic areas. We invite all practitioners, educators and researchers in the field of Integrative Medicine to come together, participate and engage together to make this Congress an exciting meeting for the successful advancement of Integrative Medicine across the globe.

I2 The Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally

April 5, 2017

Introduction

Faced by multiple challenges, including the rise of chronic, lifestyle related diseases, and grossly inequitable access to healthcare, we are committed to achieving the Sustainable Development Goals 2030 to foster healthy lives and promote well-being for all ages. We are part of a global movement to orient care, and the education, research and policy that support it, toward a model that draws on biomedical, complementary and traditional medicine practices and respects multiple philosophies. This approach to medicine and healthcare:

“ … 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 and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.”¹

Our work stands on that advanced in 1978 at the Alma-Ata Conference that mobilized a movement for primary healthcare for all and officially declared the importance of integration of effective traditional practices to promote global health. Today, the World Health Organization (WHO) advocates universal health coverage and integration of safe and effective traditional providers and complementary services into health service delivery, as well as self- care practices. These are key objectives of the WHO’s traditional medicine strategy 2014-2023. We also affirm our alignment with the declarations from Beijing in 2008 and Stuttgart in 2016 and fully support calls on governments and non-governmental agencies to adopt, support, fund, research and promote activities that advance evidence informed integrative care models.

With this Berlin Agreement we call on ourselves as individuals to engage, to the best of our abilities, in the following:

Model Health

Recognizing that our ability to impart and enhance health and well-being is not only performed by a social and professional health practice, but is also informed by our own self-care and resilience, we strive to model personal engagement in health-creating practices.

Engage Patients

Knowing that the most important strategy for fostering health is to engage patients in better lifestyle choices, we seek to develop our skills to activate patients to be self-responsible, to strengthen their resilience, and become captains of their own healing processes.

In respect for the importance of natural processes as guides for enhancing well-being, we educate and stimulate patient understanding of, and participation in, efforts to protect and sustain the natural environment.

Promote Interprofessionalism and Team Care

Knowing that no single type of practitioner has all the answers that can be useful to a given patient, we individually seek to develop quality relationships with members of other disciplines and professions to guarantee that we can quickly connect patients to the right services from the right practitioners and right professions at the right time;

Aware that such care may be provided via knowledge or practitioners from multiple global healing traditions, we personally commit to continuously broadening our understanding, awareness and engagement with other fields and resources.

Recognise the importance of traditional medicine in global healthcare

Given that traditional medical products, practices and practitioners are the main access to healthcare in most regions of the world, we highlight the importance of global investment to systematically develop best practices in these diverse systems that supports their safe and effective use and integration with biomedical practices.

Commit to Evidence-Informed Dialogue and Practice

Aware that a substantial portion of what is done in medicine and healthcare lacks a quality evidence base, we personally seek ever more effective ways to end polarizing dialogue and to stimulate collaboration in our collective ability to research, create and operationalize optimal evidence informed integrative care.

Foster Whole Systems Research

Committed to practices that respect the whole human being through use of diverse modalities and often through teams of practitioners, we personally champion development of methods, funding, and dissemination of research that address chronic diseases from multiple etiologies and treatments that often are best resolved through whole person and whole systems approaches.

Aware that questions related to cost are often an obstacle to the system-wide implementation of these models and thus access to these services, we will personally endeavor to support heightened focus on research that includes the economic dimensions of integrative models of care.

Stimulate Collaboration

Given the limitations and harm that can emanate for professions and stakeholders operating in isolation, we challenge ourselves individually, and within our own professional organizations and institutions, to commit to programs and projects that stimulate increased respect, collaboration and understanding across disciplines, traditions, professions, and stakeholders.

Bridge Clinical Care with Prevention, Community and Public Health

Knowing that clinical medical interventions represent but 10%–20% of the factors that shape the health of a community, we actively engage in creative methods to deepen the preventive and lifestyle dimensions of our individual practices while also connecting our practices and patients to community and public health resources.

Engage as Change Agents

Recognizing that imbalances in social, environmental, economic and political structures are major influences in the health of citizens, we seek to foster more equitable communities and societies.

To better empower our own work, we seek to expand our abilities to work closer and more constructively with other professions, government agencies, non-governmental organizations, private and not for profit businesses, patients and other stakeholders in advancing integrative health and medicine.

Through engaging these personal and social responsibilities, we will improve individual patient care and positively influence the preconditions of healthcare systems, locally and globally, to achieve optimal health and healing in the individuals, communities and planet we serve.

¹Definition of Integrative Medicine and Health. Academic Consortium for Integrative Medicine and Health (www.imconsortium.org)

This agreement was developed by the Congress Presidents (B. Brinkhaus (Germany), A. Haramati (USA), T. Falkenberg (Sweden) and S.N. Willich (Germany) with J. Weeks (USA) and the other members of the International Organizing Committee (A.M.N. Al-Bedah (Saudi Arabia), H. Boon (Canada), P.A. Caceres Guido (Argentina), M. Khalil (Saudi Arabia), M.S. Lee, (Korea), C.A. Lin (Brazil), J. Liu (China), E. Schiff (Israel), A. Steel (Australia), R. Street (South Africa) and K. Watanabe (Japan) of the World Congress on Integrative Medicine and Health 2017 in Berlin and is supported by several societies such as the e.g.

European Society of Integrative Medicine (EU)

Academic Collaborative for Integrative Health (USA)

Integrative Health Policy Consortium (USA)

Academy of Integrative Health and Medicine (USA)

Umbrella Association of Austrian Doctors for Holistic Medicine (AUT)

Association of Anthroposophic Physicians in Germany (Germany)

Interprofessional Organization for Anthroposophic Medicine (Germany)

German Physicians Society of Osteopathy (Germany)

International Society for Chinese Medicine (Germany)

German Physicians' Association for Ayurvedic Medicine (Germany)

The Society of Complementary Medicine in Israel (Israel)

German Association of Homeopathic Physicians (Germany)

Latin American Society of Phytomedicine (Latin America)

Argentine Council of Osteopaths - Registry of Osteopaths (Argentina)

First Ayurveda Health Foundation (Argentina)

Spanish Federation of Integrative Medicine (Spain)

as well as individual clinicians, researchers, educators and policy-makers.

Plenaries

Plenary session I

S1 The lessons from integrative medicine: sometimes less really is more

Josephine P Briggs

NCCIH, NIH, Bethesda, MD, USA

It is widely recognized that our health care system does too much of some things, and too little of others. Learning what actually works and for whom – finding the true balance between benefit and harm - is the charge to the biomedical research enterprise. Negative findings are as important a product of evidence-based medicine as the positives. Three examples will be explored: cancer screening, pain management, and end-of life care. Critical examination of common health care practices in these areas is yielding surprises; careful examination of data from observational studies and large scale randomized trials is frequently finding less benefit than expected (or even harm) of some drugs, widely used screening strategies, and other health interventions; and in some cases a more favorable benefit to harm ratio of gentle ‘old-fashioned’ approaches that come from outside the mainstream.

Nevertheless, translation of evidence into good care remains problematic. Increasingly it is understood that the answers will lie in part with greater patient engagement and shared decision making. Integrative medicine practitioners are defining an innovative style of practice that provides a model for greater openness to the patient’s voice. Health care decision making needs to more effectively marry the insights that come from evidence-based medicine with the individual values of each patient. Integrative practitioners tap into an interest of patients in greater involvement and often in less use of technology. While the input and expertise of the health care practitioner is essential for good care, so is an active, partnership with the patient and the flexibility to adapt to the patient’s concerns.

S2 Traditional medicine and primary healthcare in Africa

Merlin Willcox (Merlin.willcox@phc.ox.ac.uk)

Department of Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Coxford Rd, Southampton 2016 5ST, UK

Background

It is often stated that 80% of the world’s population relies on traditional medicine for their primary health care [1]. However very few countries in Africa have attempted to integrate traditional and modern healing systems for the benefit of patients. On the contrary, traditional medicine has been widely discouraged and some practices even banned. We set out to investigate ways in which traditional and modern medical systems could better collaborate, for the benefit of patients.

Methods

Surveys were undertaken in Mali, Uganda and Ethiopia of treatments used by patients for febrile illnesses, and associated outcomes. In Mali, we selected the plant associated with the best outcomes for further clinical research using a “reverse pharmacology” approach [2], in order to develop an improved traditional medicine. In Mali and Uganda, the “confidential enquiry” methodology was used to investigate maternal, perinatal and child deaths in a total of 10 subdistricts over 3 years. Local panels analysed how deaths could have been avoided by improvements in both traditional and modern medical systems, and made recommendations to this effect.

Results

Prevalence of use of traditional medicine for febrile illnesses varied widely, from 0% in the Apac district of Uganda, to 60% in the Sikasso area of Mali [3]. Of 66 plants traditionally used in Mali, Argemone mexicana was the only one systematically associated with clinical recovery. This was further investigated in a dose-escalating trial [4], and then in a randomised controlled trial [5]. Its use has since increased. The confidential enquiry revealed that traditional healers and traditional birth attendants had been involved in the care of 15% of children who had died (ranging from 5% to 36% in different districts), whereas official health centres and hospitals had been involved in 58% of cases in Mali and 49% in Uganda. The majority of children who had consulted a traditional healer had not been referred in a timely manner. Training courses were organised to improve recognition and referral of severe illnesses.

Conclusions

In Africa, usage of traditional medicine in primary care is still prevalent, at least for febrile illness in children, including illnesses which are eventually fatal. The “reverse pharmacology” approach facilitated the development of an evidence-based improved traditional medicine in Mali, which became more widely used. The “confidential enquiry” approach engaged both traditional and modern practitioners together in a discussion of what could be done to reduce childhood deaths.

References

1. Bannerman R, Burton J, Wen-Chieh C. Traditional Medicine and Health Care Coverage. Geneva: World Health Organisation; 1983.

2. Willcox M, Graz B, Falquet J, Diakite C, Giani S, Diallo D. A "reverse pharmacology" approach for developing an anti-malarial phytomedicine. Malaria Journal. 2011;10(Suppl 1):S8.

3. Diallo D, Graz B, Falquet J, Traore AK, Giani S, Mounkoro PP, et al. Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome. Trans R Soc Trop Med Hyg. 2006;100(6):515-20.

4. Willcox ML, Graz B, Falquet J, Sidibe O, Forster M, Diallo D. Argemone mexicana decoction for the treatment of uncomplicated falciparum malaria. Trans R Soc Trop Med Hyg. 2007;101(12):1190-8.

5. Graz B, Willcox ML, Diakite C, Falquet J, Dackuo F, Sidibe O, et al. Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications. Trans R Soc Trop Med Hyg. 2010;104(1):33-41.

Plenary session II

S3 Evidence of effectiveness but not efficacy - why many complementary therapies are so hard to accept for biomedicine

Klaus Linde (klaus.linde@tum.de)

Institute of General Practice, Technical University Munich, Munich, Germany

While the integration of complementary therapies into health care practice continues to progress in many countries, the scientific and academic debate on many of these therapies seems to heat up again in the last decade after a period of relative openness. Interestingly, both those attacking and defending complementary medicine claim that their view is evidence-based. In my presentation I will try to analyze important reasons why there is so much, often fierce debate.

Using acupuncture and homeopathy as examples I will show how the same evidence is sometimes interpreted completely different. The more controversial the topic, the more interpretation is shaped by the influence of prior beliefs, personal preference of different types of evidences, previous knowledge and experience. The main problem for the acceptance of many complementary therapies is not the lack of evidence that patients benefit but weak theoretical foundations (leading again to stronger demand of proof of specificity). I will explain why “specificity” is such a crucial tool for demarcation of the unacceptable, both for science and the medical profession. At the same time, many of these “intellectual” problems do not seem to be relevant in the pragmatic reality of everyday practice.

In my view there are two important consequences of these considerations: 1) a public debate is needed whether “scientific nonsense” could be effective in practice – and if so, whether it should be reimbursed by public health insurance; 2) there is a strong need for more research on how complementary therapies work, but this research should not take the often naïve and mechanistic theoretical concepts of these therapies as granted.

Plenary session III

S4 Arts in health promotion

Töres Theorell^1,2

¹Department of Neuroscience, Karolinska Institute, Stockholm, Sweden; ²Stress Research Institute, Stockholm University, Stockholm, Sweden

Arts (music, writing, dance, visual arts and theatre) have a strong potential in health promotion. Health can be defined in many ways, ranging from strict absence of medical conditions to well-being in a wide social sense [1]. When we discuss musical experiences, flow is potentially a central concept in health promotion. The flow concept is particularly applicable to music performance. When a subject has practiced a difficult music piece and is finally able to perform it well, a high level of arousal and at the same time a high degree of elation arises. Our own experiments indicate that this state is associated with a concomitant activation of the sympathetic and parasympathetic systems. A subject who is allowed to have these rare experiences repeatedly collects flow experiences which add to a high quality of life. This would correspond to life-long flow capital. Flow experiences can arise in several domains, in sports, while performing theatre, while giving a lecture etc. According to our theory flow experiences add importantly to quality of life.

Alexithymia, inability to differentiate, describe and communicate feelings, is a central concept in psychosomatic medicine. Our research has shown that competence in arts is associated with a good ability to handle emotions. Each one of the artistic skills (see above) adds statistically to emotional ability and there are also additive effects. Since alexithymia has an established role in early stages of hypertension, burnout syndrome and abuse of alcohol these relationships are of importance to health promotion. However, our twin research has shown that a large part of the relationship between musical practice and alexithymia is genetically determined [2,3]. Therefore relatively large controlled intervention studies are required in order to establish health effects of musical experiences. An RCT study, the Culture Palette study, performed on health care centres in Stockholm, showed that cultural activities organized for women with burnout syndrome for three months twice a week were followed by improved burnout and alexithymia scores which were not seen in the control group [4]. The alexithymia changes were even more pronounced three months after the cultural intervention than immediately after the end, findings which may indicate that health promotion processes have started. Efforts to stimulate cultural activities should start in childhood [5].

References

1. Theorell T: Psychological Health Effects of Musical Experiences: Theories, Studies, and Reflections in Music Health Science Dordrecht, Netherlands: Springer, 2014

2. Theorell TP, Lennartsson AK, Mosing MA, Ullén F. Musical activity and emotional competence - a twin study. Front Psychol. 2014 Jul 16;5:774. doi: 10.3389/fpsyg.2014.00774.

3. Lennartsson AK, Bojner Horwitz E, Theorell T and Ullén F (2017) Lack of creative artistic achievement (writing, music, dance, theatre, visual arts) is related to alexithymia. Creativity Research Journal. In press 2017

4. Grape Viding C, Osika W, Theorell T, Kowalski J, Hallqvist J and Bojner Horwitz E (2015) ”The Culture Palette” a randomized intervention study for women with burnout symptoms in Sweden. Brit J Med Practitioners 2015; 8(2):a813

5. Theorell T, Lennartsson AK, Madison G, Mosing MA, Ullén F. Predictors of continued playing or singing--from childhood and adolescence to adult years. Acta Paediatr. 2015 Mar;104(3):274-84. doi: 10.1111/apa.12870

S5 Healing the community through the arts: framing and reflections

Lisa M. Wong (lisamwong@gmail.com)

Arts and Humanities Initiative, Harvard Medical School, Boston, MA 02115, USA

The arts are an essential element of human life that foster health, wellness and balance. Through the arts, the relationship between practitioner and patient can be affirmed and deepened. The arts in medicine focus on the whole person, making use of several therapeutic approaches: through dance, individuals living with movement disorders enhance their flexibility with grace and confidence; through mask-making, wounded veterans find a voice as they struggle with PTSD.

Integrating the arts into the practice of medicine presents an exciting new intersection of fields. Important new questions emerge. What is the role of the physician musician? How can the experience and knowledge of music therapist, neuroscientist and physician best be utilized to institute a personalized care plan for the patient? What does evidence-based practice look like through the lens of the artist in healthcare settings?

Caregivers and healthcare providers in training also benefit from the integration of the arts into their practice. Narrative medicine encourages healthcare providers to understand their own story, as well as the patient’s story, beyond the diagnosis. Looking deeply at art in the museum enhances observation skills, critical thinking, and communication. Analyzing, playing and listening to music invites deeper reflection and analysis of complex diagnoses.

Join the growing number of physicians, musicians, therapists, neuroscientists, and patients who are embracing the arts as a critical aspect of integrative medicine. Together we will pave the way forward, discover new parallels, learn from each other, and ultimately improve the way we care for our patients and each other.

Plenary session IV

S6 Integrating complementary and integrative health therapies into US hospitals – the role of practice based research in guiding the field

Jeffrey Dusek

Psychosomatic medicine, Neuropsychology, Allina Health, Minneapolis, MN, USA

Consumer demand for complementary and integrative health (CIH) therapies continues to grow in the United States (US). As a result, about 15 years ago, several US health systems were early adopters in the inclusion of CIH therapies into hospital settings. Several randomized controlled trials provided initial evidence that specific CIH therapies (e.g., acupuncture) were efficacious for relief of symptoms (e.g., pain) in certain hospitalized patient populations (e.g., post-surgery). Additional studies suggested that the CIH therapies were safe for these patients. While results of the randomized trials were important, translation of these results into clinical practice has been challenging due to the fact that neither health care administrators, nor clinical providers are aware of which CIH therapy would be most effective for specific condition relief in specific patient populations. An important question being asked is: can the right patient be provided the right CIH therapy for the right symptom relief outcome? This presentation will include a description of the development and evolution of one early adopter model for the integration of CIH therapies services into a US hospital setting. The presentation will also include results from a large National Institutes of Health practice based research evaluation in the early adopter model to explore the effectiveness of different CIH therapies on pain in varied clinical populations. The presentation will detail lessons learned from these experiences that will provide health care system administrators and clinical providers with guidance for efficient delivery of CIH therapies in US hospital settings and perhaps across the world.

S7 Integrating CAM into hospital care: prospectives from China (Abstract ID 220)

Darong Wu

2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

Objective

The integration of traditional Chinese medicine(TCM)and western medicine in China was initiated more than a century ago. Since early 1950s, TCM as one of the important component of complementary and alternative medicine (CAM), has been integrated into hospital care, including inpatients"medical services, due to several practical reasons, e.g. China"s health policy, Chinese traditions, patient"s promises and claims, etc.

Methods

There are mainly two types of model in terms of integration TCM into inpatient/hospital settings in China, (1) Disease-based model, which has been adopted in most of the western medicine hospitals, especially in the departments of cardiovascular disease, tumor disease, or other rehabilitation related diseases, or virus infection diseases; (2) Pattern diagnose-based model, usually is applied in the hospitals of integrative medicine or TCM medicine. Despite the types of model, more and more physicians and other health care professionals realize that it is important to help the patients to make informed health care decision during the integration procedure. And it shall combine the management methods which have been successfully applied in hospital operation, including clinical pathways and lean management.

Results

Clinical pathways has been adopted to efficient the progress of integrating TCM into inpatient services since 2002 in China. Researches found that it might help to reduce the length of stay, to maintain the cost within a reasonable range, and would still keep the quality of medical services in the same or even higher levels. The ideas of evidence-based practice, patient-informed decision,etc, have been embodied, while we would not ignore any "unexpected" outcomes from clinical practiceswhichmight be "new" ideas for further researches orfuture evidences.

Discussion

ntegrating TCM into inpatient services has six-decade history in China, any further development in this area may face both opportunities and challenges ahead.

Keywords: Integration, Complementary and Alternative Medicine (CAM), Traditional Chinese Medicine (TCM), Hospital Care, China

Plenary session V

S8 Nutrition and lifestyle education in an era of obesity and diabetes – might “Teaching Kitchens” serve as catalysts of personal and societal transformation?

David Eisenberg

Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, MA 02115, USA

To address dramatic global increases in obesity, diabetes and other lifestyle-related diseases, the medical establishment must invent and experiment with novel approaches whereby patients – and caregivers as role models – learn to eat, cook, move and think differently.

As a result of this presentation, participants will:

• Review trends in obesity, diabetes and other lifestyle-related chronic diseases in the US and globally

• Be introduced to the conceptual construct of a “Teaching Kitchen”. This includes educational approaches which combine: (1) nutrition education, (2) hands-on culinary instruction, (3) mindfulness training, (4) enhanced movement and exercise, and (5) optimal behavior change strategies including health coaching

• Appreciate the unique role played by mindfulness in these curricula

• Learn about Teaching Kitchen prototypes being developed and evaluated at universities, medical schools, hospitals, corporate workplaces, colleges, K-12 schools and community settings across the US, Europe and Asia

• Envision future models of medical education and healthcare delivery which focus on both: (a) “salutogenesis”, the creation and maintenance of health and wellness, in combination with (b) “pathogenesis”, which typically focuses on disease diagnosis and treatment, in an effort to enhance public health and reduce total healthcare related expenditures

• Be introduced to the recently established “Teaching Kitchen Collaborative” which includes more than 30 institutions with Teaching Kitchens, all of whom are committed to (a) establishing best practices; (b) developing shared research strategies; and (c) participating in multi-site studies to assess the clinical and financial impact of these emerging models

S9 Addressing chronic stress and burnout in health professionals: the educational imperative for incorporating mindfulness for self-care

Aviad Haramati

School of Medicine, Georgetown University, Washington D.C., United States

Recent reports suggest that chronic stress and burnout among physicians are pervasive problems and cause for concern. More than half of all physicians in the United States experience some element of burnout, and this can lead to changes in the patient-provider relationship and adversely impact on the quality of care. In some specialties, the rates are even higher. This trend may begin earlier with the observed decline in empathy during medical student training and the alarming rates of burnout in medical and other students in the health professions. In response, various groups are developing interventions with medical students, residents and faculty to address the rise in burnout and the decline in professional resiliency. Keys to this work are themes of self-awareness, mindfulness and exploring domains of control and meaning in the clinical encounter. In this plenary presentation, Dr. Haramati will review published outcomes on interventions using mindfulness approaches to reduce stress and burnout and improve wellbeing. A physiologic framework will be provided to explain why mindfulness appears to be effective. He will also share his perspective on why it is essential to incorporate mind-body techniques into the training curriculum for all health professionals—something that will require both skill and courage.

Pre-workshops

Research

A1 Qualitative research methods in complementary and integrative medicine

Bettina Berger (bettina.berger@uni-wh.de)

Department of Health, University of Witten/Herdecke, Witten/Herdecke, Germany

This workshop will give an insight in qualitative research methods for complementary and integrative medicine, teach how to reflect quality criteria of qualitative research methodology and try different ways to interpret data to know more about the diversity of qualitative methodologies.

A2 Getting your work published – tips from editors

Kathi Kemper (kathi.kemper.md@gmail.com)

OSU, Blacklick, OH, United States

This will be an interactive session led by three editors from prominent CAM journals – BMC CAM, Complementary Therapies in Medicine, and Journal of Alternative and Complementary Medicine. The pros and cons of submitting to different journals, the availability and recommended use of writing guidelines from the EQUATOR network will be reviewed and the participants will be offered a simple, hands on approach to writing a journal article without getting bogged down in writer’s block.

A3 Horizon 2020 – networking and creating working groups

Beate Stock-Schröer¹, Hedda Sützl-Klein²

¹Carstens-Foundation and FORUM, D-45276 Essen, Germany; ²ESIHR (European Society for Integrative Health Care), A-1070 Vienna, Austria

Correspondence: Hedda Sützl-Klein (hedda.suetzl-klein@aon.at)

During the preconference of 12th WCIMH (World Congress Integrative Medicine & Health 2017)/10th ECIM (European Congress of Integrative Medicine) a Horizon 2020-Networking Workshop will offer researchers and potential participants of Horizon 2020-projects the opportunity to network, share information and create working groups for research proposals involving integrative medicine and multimodal approaches. The workshop was initiated by DDr. Hedda Suetzl-Klein and Dr. Beate Stock-Schröer with support from researchers of the FORUM research network (Forum universitärer Arbeitsgruppen für Naturheilverfahren und Komplementärmedizin: http://www.uniforum-naturheilkunde.de).

Background and goals

Complementary and integrative medicine is supposed to provide opportunities for highly personalised medicine and other challenges of the specific programme „Health,

Demographic Change and Well-being” of Horizon 2020, the “EU Framework Programme for Research and Innovation” from 2014 – 2020. The goals of this pre-conference workshop are to analyse the current (and upcoming) work programme, to discuss potential topics of research and to build working groups for Horizon 2020 proposals. As well as defining topics, networking is a major aim, in order to form appropriate teams to formulate research proposals and increase the number of promising EU-projects (Horizon 2020-research projects) involving integrative medicine issues and multimodal approaches.

Speakers and working group leaders

Dr. Wolfgang Weidenhammer (KOKONAT-TU Munich, CAMbrella project coordinator) will analyse work programmes and current developments, Dr. Pierre Madl (University of Salzburg, participant in 3 FP7 research projects: CATO, Bridge, NanoValid) will share experience and lessons learned from former applications and successful EU-research projects.

To build working groups for Horizon 2020 applications, the researchers are supported by Prof. Dr. Jost Langhorst (University of Duisburg-Essen, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte), Dr. Wolfgang Weidenhammer (KOKONAT-TU Munich), Prof. Dr. Roman Huber (University of Freiburg, Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, focussing on: prevention and treatment of chronic diseases), PD Dr. Kristjan Plaetzer (University of Salzburg: AMR and antimicrobial strategies based on natural resources), Doz. Dr. Alexander Haslberger (University of Vienna: Epigenetically active nutrition in integrative medicine therapies and prevention) and Dr. Pierre Madl (University of Salzburg: Integrative medicine, health & biophysics).

Clinical care

A4 Integrated Cchronic Care Model and diabetes: the project as implemented within the Center of Integrated Medicine of the Hospital of Pitigliano

Rosaria Ferreri (tyvvf@tin.it)

Hospital Centre of Integrated Medicine, Hospital of Pitiglian,o ASL SudEst Toscana, Grosseto, Italy

The care of people with diabetes is, all over the developed world, and now, even in countries in the developing world, one of the main problems of organization of systems of health protection. This goes far beyond the meaning of the care of a single disease, but rather is almost a paradigm of the Chronic Care Model, which, in most companies in the world, it is epidemiologically prevalent today. The challenge of this project is to develop an integrated protocol including Homeopathy and Phytotherapy to evaluate how, where and when it is possible to introduce the integrated protocol in the course of the CCM Diabetes. Proposals has been accepted by the chief of Medicine Department of the Hospital of Pitigliano. We are going to study different categories of diabetic patients included in the project:

• 1) Patients that have high value of emoglobina glicata, despite their anti diabetic oral therapy;

• 2) Patients that suffer from comorbidities (that could have influenced their metabolic status and the course of their diabetes)

We have approached the patients, collecting their informed consent, and establishing the integrated protocol to be adopted in each of the two categories. The protocols include:

• an homeopathic remedy

• a phytotherapy compound, made of two plants extracts

A group of 20 diabetic patients have been enrolled, ten of them were affected by diabetes and other ten have comorbidities; for each of them, we have collected data related to: blood sugar level, glycated haemoglobin, renal and hepatic function, blood pressure, (other parameters that will be included in a second phase of the project). To each of them we have given: a Questionnary (as SF12) for the quality of life and ADL skills for daily ability; we have also used EDMONTON scales for the assessment of symptoms and a CARD for the consumption of conventional drugs, to monitoring the use of antidiabetic drugs.

Results and discussion

We describe:

• A new organisational model, which includes new roles and new functions.

• A new common pathway.

• How to identify proactive patient using risk stratification tools.

• How we have improved hospital infrastructure, which supports sharing information and patient monitoring.

A common set of shared objectives and indicators linked to health outcomes and process improvement have been adepte and we"ll show the results in terms of:

• Ameliorating QoL: from 68 to 85% of them declare improvements in the general health feelings

• Improving HB glycate value : in 12 weeks have been improved about - 10%-

• Reducing use of conventional drugs: preliminary data will be shown

A5 Phyto-nutrition and diabetes

Rosaria Ferreri (tyvvf@tin.it)

Hospital Centre of Integrated Medicine, Hospital of Pitigliano, ASL SudEst Toscana, Grosseto, Italy

Introduction

Managing blood glucose and preventing complications in diabetes care are important goals for anyone with this chronic disease. Nutrients present in various foods play an important role in maintaining the normal functions of the human body and some phytonutrients help to lower blood glucose. Others protect insulin-producing cells in the pancreas from oxidative damage. But where can we get these nutrients? The best challenge is to have them through a studied diet, not only based upon calories and nutrients, but also taking in account the so called phyto-nutrients. That also why, recently, vegeterian regimen has been proposed to be the best to cope with diabetes.

Materials and methods

Phytonutrients are the plant nutrients with specific biological activities that support human health. Due to the fact that some of these nutrients have a great and recognized role in the help of chronic conditions, as diabetes is, we have tried to include them in the composition of an ideal diet, not based upon the energetic values but on phytonutrients and their ORAC value.

Discussion

Well show the composition of an ideal diet for patients with diabetes, that could be more helpful in the control of hyper insulinism and also in the control of oxidation process. We propose our rationale for the choice of foods and their distribution during the day, based upon the best research in the field of plant-derived preparations, such as pomegranate seed oil[1], grape skin extract [2], blood orange extract [3] barley b-glucan [4], anthocyanins from cherries [5], and green tea (2)-epigallocatechin-3 [6]. We also show that this strategy is also comparatively cheap, easy to be used by aged people and could significantly reduce health care costs.

Bibliography

1. Vroegrijk, I.O et al. -2011- Pomegranate seed oil, a rich source of punicic acid, prevents dietinduced obesity and insulin resistance in mice. Food Chem. Toxicol. 49: 1426–1430

2. Hogan, S. et al - 2011-. Dietary supplementation of grape skin extract improves glycemia and inflammation in diet-induced obese mice fed a Western high fat diet. J. Agric. Food Chem. 59: 3035–3041

3. Titta, L., et al. -2010-. Blood orange juice inhibits fat accumulation in mice. Int. J. Obes. (Lond.) 34: 578–588

4. Choi, J.S et al – 2010- Consumption of barley beta-glucan ameliorates fatty liver and insulin resistance in mice fed a high-fat diet. Mol. Nutr. Food Res. 54: 1004–1013

5. Jayaprakasam, B. et al - 2006- Amelioration of obesity and glucose intolerance in highfat-fed C57BL/6 mice by anthocyanins and ursolic acid in Cornelian cherry (Cornus mas). J. Agric. Food Chem. 54: 243–248

6. Lee, M.S et al – 2009 - Green tea (-)-epigallocatechin- 3-gallate reduces body weight with regulation of multiple genes expression in adipose tissue of diet-induced obese mice. Ann. Nutr. Metab. 54: 151–157

A6 A comprehensive integrative approach to the management of chronic pain

Gary Kaplan

The Kaplan Center for Integrative Medicine, Georgetown University, McLean, VA, United States

“Chronic pain” and “depression” are not actionable diagnoses; they are, instead, symptoms of a neuroinflammatory disease of multiple and compounding aetiologies. Exploring the proposal that accepted medical practices often fail to help chronic pain sufferers because they have been based on a fundamental misunderstanding of the illness itself, the goal of this workshop is to understand the pathophysiology of chronic pain and depression according to a neuroinflammatory model as well as the multiple aetiologies of neuroinflammation.

The participants will learn how to take a comprehensive, chronic-pain history according to the neuroinflammatory model of chronic pain and, based on that, create an integrative treatment.

A7 Visit of Gemeinschaftskrankenhaus Havelhoehe: Anthroposophic medicine in workaday life for patient centred care in a capital town (8.30-12.00 a.m, half day)

Harald Matthes

Hospital Havelhöhe, Berlin, Germany

On this excursion the participants will experience the concept of the Anthroposophic Clinic “Havelhoehe” and get to know practical integrative concepts. The program includes a guided Visit in different (optional) fields: a) From the intracardiac catheter to the Heart school (life style modification) b) Integrative Oncology in a certified oncology centre (OnkoZert) c) Integrative Pain Unit d) Integrative Psychosomatic Medicine e) Integrative Concepts of functional diseases (IBS) f) The Self-Governing Concept of the Clinic.

Time: 8.30 am - 12.15 pm (including bus transfer)

A8 Introduction to osteopathic medicine – a hands-on workshop

Gabriele Rotter (gabriele.rotter@charite.de)

Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital, Berlin, Germany

This workshop offers an introduction to osteopathic medicine and is intended for medical students and medical doctors with few or no knowledge in osteopathic medicine. The participants should learn basic osteopathic principles, their indication and contraindication as well as the integration of osteopathy into the overall treatment strategy of a patient. During the hands-on part of the workshop participants are given a practical demonstration of basic examination procedure with special emphasis on palpation, as well as selected treatment techniques.

Education

A9 Implementing skills from hypnosis and touch therapies to improve doctor-patient communication

Elad Schiff¹, Zahi Arnon^2,3

¹Internal medicine and Complementary medicine service, Bnai Zion Medical Center, Haifa, Israel; ²Complementary-Integrative Surgery Service, Bnai Zion Medical Center, Haifa, Israel; ³The Emek Yezreel Academic College, Yezreel Valley, Israel

Correspondence: Elad Schiff

Currently, education toward optimal physician-patient communication does not take into account the impact of positive and negative suggestions on health and disease. Moreover, there is vast evidence in the medical literature that such suggestions can trigger placebo, or nocebo effects respectively. As an example, saying to a patient "here are your pain pills" implies that the patient owns the pain (nocebo), whereas "here are medications that will help you reduce pain, and increase your comfort" activate patient empowerment and control over pain (placebo). Implementing fundamentals of hypnosis to suggestions embedded in communication with patients can tremendously improve the outcomes of such encounters.

Hypnosis is a mind-body technique aimed to activate innate healing forces by using words with positive suggestions as well as non-verbal communication such as touch. The effect of hypnosis is thought to occur best in a "trance state" where the sub-conscious mind is more receptive to suggestions, which are conveyed to the nervous & immune systems. In contrast to the common belief that hypnosis requires patients to be calm and relaxed, hypnotic trance due to stressful health conditions is very common. Actually, patients are in spontaneous trance state during most encounters with physicians. Hypnotic trance places patients in a state-of-mind where they are highly influenced by suggestions- for the good (placebo), and for the bad (nocebo). Consequently, physicians could learn how to activate patient's healing forces by using the correct suggestions in verbal and non-verbal communication (i.e. touch and body gestures), based on fundamentals of hypnosis. The workshop will introduce health-providers and medical students to hypnotic based communication that potentiates the healing capacity of patients. Videos of real patient-physician encounters as well and vivid demonstrations, and hands on techniques to improve physical exam skills, are built in the workshop.

A10 Developing pre-residency core entrustable professional activities in integrative medicine: a skills-based workshop for medical educators and students

Eckhard Hahn (eckhart.hahn@uk-erlangen.de)

Medicine I, University Hospital Erlangen, Erlangen, 90154, Germany

The goal of this workshop is to provide the participants with a hands-on opportunity to create core Entrustable Professional Activities (EPAs) in integrative medicine for trainees entering residency and post-graduate training. EPAs are becoming an important part of outcomes based education and are increasingly looked at being essential in preparing students for graduate medical training. This workshop will build on precourse assignments, start with an interactive summary of this knowledge and will then shift to experiential as we create the opportunity for participants to work in groups and develop team-based core EPAs in integrative medicine that include interprofessional practice.

Outline of Workshop

• 1. Participants introduce themselves 5 min.

• 2. Workshop Activity: 20 min. Q&A 5 min

How to develop a team-based EPA – interactive summary of precourse assigment.

• 3. Work in small groups with facilitator: Creating a blueprint for team-based EPAs in Integrative Medicine. 30 min.

• 4. First patient encounter

• 5. Self-care

• 6. Treatment plan (a patient with breast cancer)

Coffee break 15 min.

• 4. Experiential learning of IM-EPAs: team-based practice. 30 min.

• 5. A simulated IM patient encounter

• 6. A simulated self-care session (patient with breast cancer)

• 7. A simulated assessment session of IM-EPA (treatment plan for patient with breast cancer).

• 8. Debriefing – later letters. 15 min

Total time 120 minutes

Precourse assignment:

• 1. Integrative Medicine in the Continuum of Medical Education;

• 2. Entrustable Professional Activities (EPAs) - especially core EPAs for entering residency;

• 3. Interprofessional aspects of Integrative Medicine (the team-based approach).

A11 Differentiating the psychological and physiological mechanisms of relaxation versus mindfulness: an experiential workshop and clinical implications

Christina M. Luberto (cluberto@mgh.harvard.edu)

Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA

Mind-body therapies, used to treat a variety of stress and pain-related conditions, often include the use of both relaxation techniques and mindfulness exercises. Relaxation techniques are interventions such as progressive muscle relaxation and diaphragmatic breathing that are intended to alter physiological and emotional states by eliciting the relaxation response. Mindfulness techniques, which can be taught using stand-alone exercises (e.g., mindful breathing, mindful sitting) or formal mindfulness-based interventions (e.g., Mindfulness-Based Stress Reduction), are intended to promote present moment awareness and acceptance as a way of enhancing self-regulation. Thus, there is a distinct difference in both the intention and, ultimately, the psychological and physiological mechanisms associated with these two approaches - which have important implications for informing clinical practice. Unfortunately, over time, the term “mind-body therapies” has become synonymous with both the use of relaxation therapies and mindfulness techniques, thereby obscuring these critical differences.

Therefore, the primary purpose of this workshop is to provide participants with a deeper understanding of the differences in the psychological and physiological mechanisms associated with relaxation versus mindfulness techniques, using a combination of experiential exercises and brief didactics. Four relaxation and mindfulness exercises (20-30 minutes each) will be used throughout the workshop to allow participants to experientially learn the difference between these two approaches. Each exercise will be followed by paired and/or group discussions to provide opportunities for processing and reflection. Three didactics will be interspersed throughout the workshop in order to supplement the experiential exercises: (1) theoretical/conceptual similarities and differences between relaxation and mindfulness approaches; (2) extant research documenting differences in psychological and physiological mechanisms and outcomes between these approaches; and (3) implications for clinical practice and research settings. Case examples will be used to exemplify when relaxation versus mindfulness training would be most clinically indicated based on evidence-based recommendations. This session deserves to be included in the program because it provides a depth of theoretical and practical knowledge that can help clinicians and researchers alike more accurately differentiate between types of mind-body practices to select interventions best suited to their clients’ needs. This level of nuance, comparing and contrasting specific mind-body approaches, is also an important next step for moving the field of mind-body medicine forward.

A13 Meditation and medicine – investigating the underlying laws and forces

David Martin, Silke Schwarz

Children’s Hospital, University of Tübingen, Tübingen, 72076, Germany

Correspondence: David Martin (david.martin@med.uni-tuebingen.de)

Meditation is increasingly becoming a relevant health factor: What do students and physicians need to know? What are the underlying factors and „natural laws“? What actually happens during meditation? This experiential workshop focuses on the different types of meditation and what they can do for students, physicians, medical personnel and patients.

A14 Developing clinical clerkships in Integrative medicine

Diethard Tauschel

Integrated Curriculum for Anthroposophic Medicine, Faculty of Health, University of Witten/Herdecke, Herdecke, Germany

In this workshop the participants will discover possibilities and problems in establishing, conducting and sustainably developing clinical clerkships in Integrative Medicine (IM). This will include aspects of curriculum development like needs assessment, finding and setting adequate goals, learning objectives and the use of feedback and evaluation.

Participants will be given an overview about the opportunities and challenges of IM clerkships, examples from 12 years of experiences of establishing and conducting IM Clerkships within the Integrated Curriculum for Anthroposophic Medicine.

Traditional healing systems

A15 Herbal medicine research: from margins to mainstream

Andrew Flower

University of Southampton, Southampton, SO16 5ST, United Kingdom

This pre-congress-workshop allows the participant to explore different research methods used to investigate herbal medicines as done at the University of Southampton.

The key domains of herbal medicine research such as quality control, batch consistency, the importance of stabilising levels of known active compounds, interactions with pharmaceuticals, model validity, and herbal pharmacokinetics will be considered.

Besides, the idea is to develop a model for future research into herbal medicines that can incorporate a properly phased, iterative programme of research that will optimise both pragmatic rigour and the clinical relevance of these investigations.

A16 Cost and health benefits from integrating new age Ayurveda into European health systems

Harsha Gramminger^1,2

¹Euroved GmbH, Bell, Germany; ²European Ayurveda Association, Bell, Germany

General Health Costs are spiraling in all developed and developing nations of the world. In 2013, Germany spent almost € 315 billion on health. This was an increase of about € 12,1 billion compared to 2012 : 3910,00 € in 2013 vs. 3770,00 € in 2012 per inhabitant.

Type 2 Diabetes, Obesity, Hyperlipidemia, Hypertension & Other “civilization” diseases are the main factors for these costs. With over 8 million sufferers (in 2009 and growing), Diabetes Mellitus is one of the most widespread diseases in Germany. Serious “secondary complications” and “associated diseases”/co-morbidities include heart attack, stroke, athlete’s foot etc. Total costs € 3.817.00 includes three components: Direct - disease (), Indirect () & associated complication () Obesity is another new global epidemic and set to become the “number one health problem globally” by the year 2025. In 2013 52% of all Germans were overweight, which is about 42.02 Million people! The associated conditions include: Type 2 Diabetes, Hypertension, Vascular diseases, Stroke, Coronary heart disease, Gall stones, Cancer, Sleep Apnea Syndrome, Diseases of the joints and of the skin and more. Clinical and practical experience is proven, that Ayurveda is able to improve the condition of both Type 2 diabetes and Obesity. Furthermore it is able by its lifestyle guidance and preventive holistic approach, to reduce and avoid follow – up diseases and costs. The presentation will show with facts and figures how the wisdom of Ayurveda can be followed for the New Age to prevent, manage and cure such diseases. Figures for savings to the European Health care costs will be presented and discussed. The presentation will show with facts and figures how the wisdom of Ayurveda can be followed for the New Age to prevent, manage and cure such diseases. Figures for savings to the European Health care costs will be presented and discussed.

A17 Ayurvedic herbs in modern times

Hedwig H Gupta (info@dr-gupta.de)

Private Medical Practice, Ludwigsburg, 71638, Germany

Ayurveda is an Asian Medical System with a history of more than three thousand years.

Through the centuries, as documented by ayurvedic texts, the materia medica kept changing slightly as new plants were described and added. But all in all the system stayed stable as the population using ayurvedic herbs grew only slowly and the usage of ayurvedic plants was confined mainly to southern Asia.

With the globalization of medical systems and the development of modern life Ayurveda faces tremendous changes which give rise to many questions that will be discussed in this presentation as: How can Ayurveda be practiced if more and more people use its herbs? Many classically described herbs are grown in the Himalayans or other areas of a very specific climate. Is it feasable and sensible for the whole world to use these plants? What effects do environmental changes, industrial agriculture of herbs and pollution have on the quality of herbs? How can locally grown plants be understood and integrated in a modern and ecologically correct ayurvedic therapy?

A18 West meets east - differences in general attitudes between European and Indian Ayurveda-patients

SN Gupta^1,2 (guptayurveda@yahoo.com)

¹Kayacikitsa (PG) Department, J. S. Ayurveda college & P.D. Patel Ayurveda Hospital, Nadiad (Gujarat), India; ²Academic advisory board, European Academy of Ayurveda, Birstein, Germany

Human behavior is always influenced by sociocultural environments. This is applicable also for patients, particularly regarding their attitude towards their disease, its treatment, their health service providers and co-patients. With a growing popularity of Ayurveda, contacts of European patients with Ayurvedic doctors are also growing. Socio-cultural differences may cause bilateral difficulties, often in the form of a cultural shock. To develop a physician-patient rapport, it is essential for the physician to understand these aspects, in which European patients differ from their Indian counterparts.

The article is not based on a scientific research, but on a 20 years’ observation in treating a great number of European patients in India and in Germany.

Faith and evidence

For Indians faith in the system is prime. For them the tradition of thousands of years is not challengeable. While in the West, an evidence based rational approach is the dominant factor. Decisions and actions are less emotionally driven as in Indians. Religious and spiritual beliefs play important roles in the context of healing for Indian patients, while Europeans expect scientifically evaluated therapies.

Individuality and relationship

Familial and social bonds in India are very strong therefore family members or close friends of a patient take care of the basic needs even a decision about treatment. While In the West, since the individuality is dominating, usually patient has to look after himself together with a decision about the treatment.

Disclosing ability

Western patients are very good in disclosing and explaining their problems, which is helpful for the physician. While in India, certain aspects of life, though very important e.g. sex, are still taboos.

Privacy

If European patients tend to respect other patients’ privacy and not embarras them by intervening while Indians, when upset, generally value people showing concern.

Accuracy

Europeans expect accuracy in everything. These features are seldom seen in Indian patients.

The mentioned differences still can be observed in most parts of India. But a few westernized islands already exist in India, too, mainly in urban Indian centers, where the differences are not as obvious.

A19 Home remedies from all over the world – evaluation and education

Annette Kerckhoff

Naturopathy, Charité University Hospital, Berlin, Germany

This workshop focuses on the evaluation of traditional folk remedies from all over the world. The top ten ingredients for home remedies will be examined closer; relevant data from food pharmacology and clinical trials will be presented to understand the active principle. Reliable and safe simple interventions are presented and advice for education is given.

These evaluated interventions using easy-to-get, worldwide spread and cheap ingredients can support health and self-efficacy.

A20 Ayurveda in Europe– what’s needed when healing tradition travels abroad?

Christian S Kessler^1,2, Andreas Michalsen^1,2

¹Institute of Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, Germany; ²Department for Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany

Correspondence: Christian S Kessler (c.kessler@immanuel.de)

Ayurveda is one of the oldest codified traditional systems of medicine worldwide. During the last decades an increasing usage and acceptance of Ayurveda in countries outside of its original context, particularly in European countries and North America, has been observed. Notably, Ayurveda has developed quite heterogeneously during this journey by interacting with other concepts of healing and philosophy. Depending on where and by whom it is being practiced and called upon, it has taken different shapes to different degrees depending on a significant number of cultural, political, economic, geographical and other factors. Due to this complexity, interdisciplinary Ayurveda research and networking is required in all related fields, e.g. medicine, anthropology, philosophy, Indology, religious sciences and health economics, in order to further clarify Ayurveda’s current statuses in Western countries and its health care potentials in countries outside of South Asia. This pre-conference workshop invites (1) leading scientists in the field to present their research work related to Ayurveda as practiced outside of South Asia, (2) senior clinicians with long standing expertise in treating patients with Ayurvedic medicine in Western contexts to share their experience, and (3) board members of the leading Western therapists’ associations for Ayurveda (DÄGAM,VEAT, AFGIM, EUAA, EURAMA, DGA and others) to highlight crucial aspects related to national/supranational health care economics and policy making. This session deserves to be included in the program because Ayurveda is one of the fastest growing traditional systems of medicine in Western countries, however, it is still lacking acceptance as a whole system of medicine in conventional mainstream medicine. This session aims to develop strategies for a long-term inclusion of evidence-based Ayurvedic therapies into reimbursable Western health care delivery and health education in countries outside of South Asia. 6 interconnected short presentations (10 + 3 min.) will be followed by a 40 min. round table discussion to conclude the 120 min. session.

A21 Clinical trials on Ayurveda in western countries: implications for future projects

Christian S Kessler^1,2 (c.kessler@immanuel.de)

¹Institute for Social Medicine, Epidemiology and Health Economics, Charité University, Berlin, Germany; ²Immanuel Hospital Berlin, Department for Complementary Medicine, Berlin, Germany

Clinical research on traditional systems of medicine like Ayurveda should not just be doing research on unconventional therapies by using conventional methodology. Several issues have to be taken into account in order to facilitate a successful implementation of clinical trials that should simultaneously fulfill quality criteria of modern research methodology and internal criteria of complex whole systems approaches like Ayurveda. Moreover, within international collaboration projects cultural-, context- and setting-aspects as well as clear research communication between partners have to be taken into account in order to guarantee fruitful research cooperation. Experiences from clinical trials on Ayurveda in Germany will be presented, outlining chances, challenges, obstacles and pitfalls.

A22 Integrative Korean medicine treatment for the management of pregnant women’s health: Korean medicine approach

Eun S. Kim¹, Eun H. Jang², Rana Kim³, Sae B. Jan¹

¹Gynecology in Korean Medicine, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea; ²Acupuncture, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea; ³Obstetrics and Gynecology, You and Green Korean Medical Clinic, Daejeon, 35262, South Korea

Correspondence: Eun S. Kim (greenmiz@naver.com)

During the process of treating diseases and enhancing the health of pregnant women, Korean Medical Treatment increases rate of success of other medical treatments, at the same time as reducing any complications to help maintain pregnancy and induce term delivery. Under the binary medical system, separated as western and Korean Medicine Systems, there are various treatment modules for the improvement of pregnant women and the management of diseases during pregnancy.

In this respect, we suggest Korean Medical Treatment including acupuncture, moxibustion, hip steam bath, and traditional medicine as an effective adjuvant tool, could help reduce any complication caused by other medical treatments and even help improve health of patients overall. As the title of this year’s conference means, for the comprehensive patient care, introduction of integrative Korean Medicine Treatment would give a safe and effective way to reduce complications and, later improve overall health of patients psychologically and physically.

On the whole, Korean gynecology, based on the theory of traditional Korean Medicine, encompasses the disciplines of physiology and pathology of pregnant women from conception till delivery. Emesis gravidarum or cold is a common complication that occurs during early pregnancy period. It is possible to treat common cold with proper management of symptom such as prevention of pathogenic factors. Abortions such as threatened abortion can be prevented with inducing hemostasis and speeding up the absorption of hematoma.

There might be preterm labor associated with development of the fetus during the mid-pregnancy because of plummeting bearing capacity of uterine lining. This can be improved by increasing blood flow to uttering lining. Even in case of placenta previa, increasing blood flow to placenta would prevent abruption of placenta and slow down placenta previa. Amniotic fluid is interrelated with nutrition supply to fetus, so oligohydramnios can be partially improved just by increasing blood flow to the fetus. Growth of the fetus gives strain on your waist and causes musculoskeletal pain. Once the blood flow to the fetus naturally increases, muscles and ligaments supporting musculoskeletal system weaken. Consequently, musculoskeletal pain occurs in spite of little movement. This can be improved by applying acupuncture, moxibustion, Korean physical therapy. Delivery can be completed by the contraction of uterus. In Korean medicine, natural delivery does not mean reducing the pain, but shortening the pain interval. Thus, maximizing blood flow to uterine lining would shorten pain interval to achieve natural delivery.

A23 Ayurveda and salutogenesis

Martin Mittwede (martin.mittwede@ayurveda-akademie.org)

Director, Faculty of Ayurvedic Medicine, European Academy of Ayurveda, Birstein, Germany

Since more than 2500 years Ayurveda is based on concepts that were developed from a combination of philosophy and clinical practice. From a modern perspective we have to ask whether Ayurveda is more than a philosophy of life or a knowledge system. Traditional systems of medicine have a strong focus on health, wellbeing and prevention.

Ayurveda does not only include medicine and therapy, but is also a teaching of balanced life. On the basis of knowing oneself and knowing what is really strengthening or weakening in life, right decisions can be made which are the basis of action in everyday life and lead to good habits.

In this sense, knowledge of life also includes profound self-knowledge and healthoriented action. Inner and outer reality are connected to one another and give an integrated feeling of life (sense of coherence in the sense of salutogenesis)

Through scientific research, not only the successes of Ayurvedic therapies can be examined, but also the beneficial effects of a balanced life. It is important that the research approaches reflect the complex nature of the ayurvedic system and the multifactorial genesis of health as well.

By comparing Ayurveda with concepts of Salutogenesis deeper insights in traditional medical systems can be reached; and these can inspire new lines of empirical research.

A24 Introducing Ayurveda in a GP practice

Wiebke Mohme (mohme@gmx.net)

Ayurveda and naturopathy, General Practice, Hamburg Eimsbüttel, Germany

A large percentage of patients asking for Ayurveda in my GP practice suffer from stress-related and psychosomatic diseases. Ayurvedic concepts of lifestyle changes, diet, physical therapies and phytotherapy tailored to the individual state and constitution offer a perspective towards healing. Due to limited resources in terms of time, finances and availability of remedies and therapies practical approaches have to be chosen to translate these concepts into practical steps that fit into patients’ everyday life. To talk with the patients and explaining everything in a way they can relate to becomes crucible. The inclusion of yoga practice, breathing techniques, relaxation and meditation have proven useful and effective. The focus is on supporting the patient's motivation to change their condition, and exploring the patient's resources, skills and potential. If a condition cannot be changed it is important to foster acceptance of what is. Since most of the success of a treatment depends on the patient's cooperation and homework, anything that is offered has to add a sense of joy and satisfaction to their life.

Various topics

A25 Refugees with chronic diseases between the Middle-East and Europe: the role of traditional and integrative medicine in bridging gaps

Eran Ben-Arye^1,2, Massimo Bonucci³, Bashar Saad⁴, Thomas Breitkreuz^5,6, Elio Rossi^7,8, Rejin Kebudi⁹, Michel Daher¹⁰, Samaher Razaq¹¹, Nahla Gafer¹², Omar Nimri¹³, Mohamed Hablas¹⁴, Gunver Sophia Kienle¹⁵, Noah Samuels¹⁶, Michael Silbermann¹⁷

¹Integrative Oncology Program, Lin Medical center, Clalit Health Services, Haifa, Israel; ²Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; ³The Association for Integrative Oncologic Therapies Research (A.R.T.O.I.), Rome, Italy; ⁴Al-Qasemi Academy, Baqa El-Gharbia, Israel; ⁵Die Filderklinik, Stuttgart, Germany; ⁶Paracelsus-Krankenhaus Unterlengenhardt, Bad Liebenzell, Germany; ⁷ASL Tuscany North West, Lucca, Italy; ⁸Tuscan Network for Integrative Oncology, Florence, Italy; ⁹Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey; ¹⁰St. George Hospital, Balamand University, Beirut, Lebanon; ¹¹Children’s Welfare Teaching Hospital, Baghdad, Iraq; ¹²Radiation & Isotope Centre, Khartoum, Sudan; ¹³Ministry of Health, Amman, Jordan; ¹⁴Palliative Care Services, Gharbiya Cancer Society, Al Gharbiya, Egypt; ¹⁵University of Witten/Herdecke, Freiburg, Germany; ¹⁶Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel; ¹⁷Middle East Cancer Consortium, Haifa, Israel

Correspondence: Eran Ben-Arye (eranben@netvision.net.il)

The recent wave of immigration from the Middle-East to Europe has intensified the need to find a model for supportive care which is tailored to the dominant paradigm of health belief among refugees, with its high affinity for complementary and traditional (CTM) medicine. The Middle-Eastern context of health care contrasts significantly from that of integrative medicine research and clinical practice which is prevalent in Europe and other developed nations, where complementary medicine is typically used by patients from the upper socio-economic and educational level of society. The goal of the workshop will be to address the cross-cultural health conflicts experienced by refugees from the Middle East who have fled to Europe. The workshop will be comprised of integrative physicians from Middle Eastern countries invited by the Middle-East Cancer Consortium, as well as leading European figures from the field of integrative medicine. This workshop reflects the commitment of clinicians and researchers from Europe and the Middle East to bridge cross-cultural gaps experienced by refugees and health care providers by the use of an integrative bio-psycho-social-spiritual approach.

Young people in integrative healthcare – workshops

Y1 Open dialogue with experts - Integrative Medicine: A Conversation with Experts

Lena Bandelin, Anna-Lena Lang

Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital, Berlin, Germany

This workshop will provide a space for conversation between students, young doctors, practitioners, and experts in the field of integrative medicine. This meeting will be casual in nature, where general questions that represent the diverse perspective may be asked to explore issues related to pursuing a career in integrative medicine. This session is for people who may ponder: What does integrative medicine mean to me? What does a holistic approach to patient care mean? Where do I see myself in the medical health system of the future? How will I get there? What integrative medicine resources are available to me to inform and improve medical practice? Hearing perspective from experts in various fields of integrative medicine whose work ranges from research to patient care, inpatient to outpatient practice, and public to private practice will help the attendee of this session have a better understanding of how to navigate their journey in integrative medicine. Possible experts that may serve on this panel include: Michalsen (Naturopathic medicine), Stange (Naturopathic medicine), Kessler (Ayurveda), Chris von Scheid (MBM), Haramati (Mindfulness), Brinkhaus (TCM), Girke (Anthroposophic Medicine)

Y2 Integrative medicine hands on workshop

Eva Wartner

Naturopathy, Immanuel Hospital Berlin-Wannsee, Berlin, Germany

90 minutes of Integrative Medicine/CAM practice! Discover elements of different IM disciplines through hands-on experience. Join us for cupping massage, sound therapy, phytotherapy, wet packs, yoga, dietary and mind body medicine. Leave with new knowledge and skills that you can immediately incorporate into your practice.

Y3 Integrative medicine online

Christoph Holtermann

Pediatrics, Filderklinik, Filderstadt, Germany

How does integrative medicine relate to the Internet? How do people interested in integrated medicine network and access information? This workshop will explore these questions using online networking and information tools like Facebook, mailing lists, and Wikipedia as case studies. The focus will be on how we are both affecting the medium and being shaped by the medium. How can we best utilize these resources to effectively communicate with one another? How can we further utilize these tools to address the questions and tasks necessary for integrative medicine’s development and success in the future?

Y4 Comparing medical student integrative medicine curricula from around the world

Maxwell Binstock

University of California, Berkeley, CA 94720-4206, USA

This event will explore the various integrative medicine curricula available to undergraduate medical students in different countries. Our panel will have medical student representatives from a diverse array of countries. They will share the student experience of integrative medicine education, including, but not limited to accessibility, topics, and curriculum design. We will compare and contrast programs from different countries and explore facilitators and barriers to undergraduate medical student learning and practice of integrative medicine. Ample time will be left for additional perspectives from other students in the audience as well as questions. The purpose of this session is to give students and educators additional insight, inspiration, and ideas of how to improve integrative medicine education for their country's undergraduate medical student. This workshop is meant for students, educators, practitioners, and researchers.

Y5 Composing the moment

Robert Riebau, Edin Mujkanovic

Institute for Music Scieneces and Music Pedagogy, University of Osnabrück, 49074 Osnabrück, Germany

Music may give one access to inspiring experiences of the moment. In our workshop we will explore unconventional techniques to get in touch with our creative energy. It is not about being "right" or "wrong," but rather learning how to have an open mind. We will have fun communicating and improvising through various instruments and sound making objects. Come on out and play!

Symposia

Research

X1 Yoga in therapy and prevention: the current state of the science on utilization, efficacy and safety

Holger Cramer¹, Romy Lauche², Andres Michalsen³, Lesley Ward⁴

¹University of Duisburg-Essen, Essen, Germany; ²University of Technology Sydney, Sydney, Australia; ³Charité – University Medical Centre, Berlin, Germany; ⁴Oxford University, Oxford, UK

Correspondence: Holger Cramer (h.cramer@kliniken-essen-mitte.de)

As yoga is gaining increased popularity as a therapeutic practice, it has become one of the therapies with the most rapid increase in prevalence. Accordingly, yoga’s potential as a preventive or therapeutic means has been explored in a growing number of clinical trials to date. The purpose of this symposium is to present a comprehensive overview on the state of the science on the application of yoga in therapy and prevention. Presenters will review scientific research on utilization, efficacy, and safety of yoga for the general population as well as for selected patient samples with specific mental or physical conditions. Dr. Lauche will present data on the association between yoga and weight control from clinical trials, systematic reviews and current cross-sectional analyses. Dr. Michalsen’s presentation will cover the current state of knowledge on yoga for stress reduction and include results of a new study on yoga for stress reduction in schools. Dr. Ward will present data on yoga for pregnancy, and for neurological conditions; and discuss the content of yoga interventions which have been developed for these conditions. Dr. Cramer’s presentation will cover the current state of knowledge on the safety of yoga both in clinical care and in everyday use. Presenters will also describe highlights of their own ongoing yoga research initiatives to further illustrate these concepts and approaches; and recent trends, developments and future directions for this field of research.

Given its relatively low costs, yoga could easily be implemented worldwide as a preventive or therapeutic means for a variety of important health conditions. As such, health-care providers are increasingly presented with patients using, or interested in trying, yoga for the management of their medical conditions. This increased use of yoga raises the issue of the efficacy and safety of yoga as a prevention strategy and therapy. The symposium will present up-to-date scientific evidence on the prevalence and patterns of yoga use as well as on the efficacy and safety of yoga for health conditions of global medical and socioeconomic importance. This information will promote evidence-based decision making on the clinical application of preventive or therapeutic yoga interventions. Gaps and open question in current research and implications for further studies will also be highlighted. The symposium thus aims to improve both clinical decision making and research quality on one of the most prevalent complementary therapies used for the prevention and therapy of chronic health conditions.

X2 The safety of yoga – a comprehensive review of clinical and epidemiological data

Holger Cramer

Department of Internal and Integrative Medicine, University of Duisburg-Essen, Essen, 45276, Germany

While yoga has long been viewed as a cure without harm, this view has been challenged in recent years. Mainly based on anecdotal evidence, the safety of yoga has been questioned in a number of lay-press articles. These publications seem to have led to a general uncertainty among yoga practitioners and those interested in starting practice.

To address this issue from a scientific perspective, the results of a systematic review of case reports on yoga-associated injuries and other adverse events are presented. Systematic reviews as well as own studies on epidemiological data will also be reported, assessing data from more than 10,000 yoga practitioners. Large population-based surveys on associations of yoga practice with falls, injuries, and joint problems will be covered. Further, clinical data will be presented in a meta-analysis on all available randomized trials on yoga reporting on safety-related data. In total, 94 trials with more than 8,400 participants were analyzed.

The available evidence shows that just as any other mental or physical practice, yoga is indeed associated with certain risks of injuries and other adverse events. However, yoga appears just as safe as other forms of exercise. Between one in four and one third of yoga practitioners have been injured or suffered another adverse event due to their yoga practice; however most were mild and transient. Given that yoga has been shown effective for a number of conditions and risk constellations, there no need to discourage yoga practice for healthy people or those with underlying physical or mental ailments.

X3 Effects of integrative medicine on purinergic signalling and on the autonomous nervous system - implications for the treatment of anxiety and pain

Dominik Irnich¹, Wolfram Stör², Geoffrey Burnstock³, Hans-Georg Schaible⁴, Thomas Ots⁵

¹Department of Anesthesiology, Multidisciplinary Pain Centre, University of Munich, Munich, Germany; ²German Medical Association for Acupuncture (DÄGfA), Munich, Germany; ³Autonomic Neuroscience Centre, University College Medical School, London, NW3 2PF, United Kingdom; ⁴Institute of Physiology, University of Jena, Jena, Germany; ⁵Private practice, Graz, Austria

Correspondence: Dominik Irnich (dominik.irnich@med.uni-muenchen.de)

This session presents the scientific underpinnings of the mind–body connection documenting the numerous interactions of the peripheral, autonomous and central nervous system. First, this session will provide important background information about how these systems profoundly impact human functioning, and how this can be modulated on different levels by techniques like acupuncture, neuraltherapy, meditation, relaxation techniques and movement therapies.

Second, it will be assessed how this knowledge can be translated into daily practice to achieve long term effects in chronic pain and anxiety disorders.

Strategies using a patient-centered approach will be presented for group treatment as well as in an individualized setting. Speakers will demonstrate that desensitization, somatic awareness, understanding, respect, discipline, empathy and patience are the basic principles of a successful treatment.

X4 Integrative gastroenterology

Jost Langhorst (j.langhorst@kliniken-essen-mitte.de)

Kliniken Essen-Mitte, University of Duisburg-Essen, Duisburg, Germany

Expertise

I have serious experiences regarding conference’ and session’ organizing and have chaired and held sessions at several conferences, in the field of complementary medicine as well as in gastroenterology and internal medicine. I have published numerous articles in the field of gastroenterology, conventional and complementary. Integrative gastroenterology can be considered my field of expertise, witnessed by several trials and publications. I am the director of the department for integrative gastroenterology with special focus on patient care and clinical as well as basic research. I am the expert in the field for complementary and alternative medicine (CAM) and psychosomatic medicine in Inflammatory bowel diseases for the German Society of Gastroenterology (DGVS). I am capable of organizing this session in an intelligent and forward fashion. The invited speakers demonstrate outstanding experience in high quality research in integrative gastroenterology on an international level. They have all been attending or organizing conferences in the past and are well recognized and leading experts in the field of integrative gastroenterology. We expect this session to be a success.

Synospis

There is a huge interest of the public in an integrative approach implementing complementary treatment approaches into gastroenterology; however evidence for the efficacy and safety of complementary therapies is still sparse or of lower quality in various fields leading to dissatisfaction among patients and practitioners. During the past years several trials and reviews have been conducted increasing the evidence base for integrative gastroenterology. Chinese Medicine has a long history in the treatment of digestive disease and with faecal microbiota transfer an old therapy strategy with a long history in medicine is gaining more and more attention at the moment. This is based on the enormous interest in the scientific field of the microbiome where fascinating interactions between the mind and the microbiome have been proposed.

The purpose of this symposium is to present recent clinical trials, systematic reviews and basic research on complementary and alternative therapies with the focus on Chinese Medicine, faecal microbial transfer and the mind-gut axis. The presenters, coming from three different continents, will not only provide the most recent developments in the field of integrative gastroenterology, but also point out blind spots of current research in order to direct future research for the best possible patient care. The presenters will further describe highlights of their own ongoing research initiatives in the field of integrative gastroenterology. The session will consist of three talks.

X5 Yoga for weight loss and weight control – a critical review of research findings

Romy Lauche

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, 2007, Australia

The rates of overweight and obesity have reached epidemic proportions worldwide, with nearly two in three people in Germany, Australia and the United States classified as overweight or obese. A large percentage of complementary medicine interventions specifically target overweight and obesity, and as such it is not surprising that weight loss is one of the most frequently stated reasons for many CM practices including yoga. Yoga is in fact regularly advertised as the magic remedy for weight management in public yet a lack of quality research has been identified to fully understand the role of yoga in weight management, from public health and clinical perspectives.

The aim of this presentation is to evaluate latest research on the associations of yoga with dietary patterns, body weight, body image and eating disorders, and methods to lose or control weight; to summarize findings from clinical trials and systematic reviews; and to discuss directions for future research needed to establish a scientific foundation for the use of yoga in overweight and obesity.

X6 Evidence-based assessment of integrated care for pain – how do we best integrate different outcomes, to understand the effects of integrated care?

Tobias Sundberg, Torkel Falkenberg

IC –The Integrative Care Science Center, Stockholm, Sweden

Correspondence: Tobias Sundberg (tobias.sundberg@integrativecare.se)

Brief summary

The overall aim of this session is to present and inform international stakeholder perspectives and expert opinions on integrating different outcomes in the evaluation of integrated care, i.e. the evidencebased assessment of integrated healthcare interventions for pain.

Timeline (90 minutes)

• 1) A panel of researchers and stakeholders will share their expert perspectives, experiences and opinions about the integration of outcomes in the assessment of integrated pain rehabilitation interventions. (45 min)

• 2) The audience is invited to contribute to the discussion sharing their views of integrated outcomes for integrated care via a panel dialogue, possibly complemented by means of small group participatory "think tanks". (30 min)

• 3) The session will finish by summarizing the proposed "best" outcomes to be integrated and used in the evaluation of integrated care for pain. (15 min)

Why this session deserves to be in the program

The impact of bringing together expert opinions from key stakeholders including research and industry leaders to summarize scientific outcomes for evidence-based assessment of integrated pain rehabilitation is anticipated to be of high importance contributing to improved understanding of the use of integrated outcomes in integrated care for pain in clinical practice and research. Additionally, it is the organizers' intention that this session will contribute with information and outcomes to inform a subsequent report. Importantly, together with data from a literature review, this session may contribute with information to a proposed "toolbox", i.e. a document that can be used by different stakeholders for informing relevant evidence-based assessments of healthcare interventions with a special emphasis on integrating multiple outcomes in the evaluation of integrated care for pain.

The audience will

• 1) Gain international stakeholder perspectives and expert opinions on the integration of outcomes in the evaluation of integrated care for pain.

• 2) Gain knowledge about clinical and research based outcomes for evidence-based assessment of integrated care for pain.

• 3) Take home ideas and hypothesis with relevance for clinical practice and future research in the area of integrated care for pain.

Clinical care

X7 Implementation of integrative medicine in a german pediatric hospital setting – clinical realization of complementary and alternative treatment approaches

Catherina Amarell

Kinderkrankenhaus St. Marien, Landshut, Germany

Complementary and alternative medicine (CAM) can support and amplify traditional therapies, especially in children. However, they are barely being used in in-patient treatment. The children’s hospital St. Marien initialized a responsible use of CAM as part of a model project.

Over the past years, CAM methods were integrated into routine pediatric care of the hospital in in-house and outpatient treatments. Complementary treatments are not only provided for acute illness like upper airway nfections, headache or abdominal pain but are also offered as a supportive treatment to children with chronic illnesses.

The clinical implementation of these treatments was undertaken in close collaboration of all healthcare professionals (nurses, physiotherapists, doctors, etc).

Different modalities were implemented, using methods of acupressure, relaxation techniques, herbal medicine, wraps and poultices and aromatherapy.

Regular in-house trainings led to broad knowledge and embedding of different techniques in all therapeutic areas.

One important pillar of implementation is the education of parents. Parents are regularly involved in the implementation process, receiving guidance on how to apply CAM and also receiving informational material informing them of possible complementary treatments as well as recommended life style changes for their children.

X8 Update on pediatric integrative medicine – three main topics – upper airway infections

Catherina Amarell

Kinderkrankenhaus St. Marien, Landshut, Germany

Upper respiratory tract infections (URI) are very common among children and account for a majority of visits to pediatric clinics. A small child suffers from about 6-10 URIs per year. They are usually mild, 90% viral and self-limiting, however the symptoms can cause irritability, fever and great discomfort- both for the child and the parents. Antibiotic treatment is not necessary in uncomplicated URI episodes. Over the counter medicines („conventional”and complementary products) are widely used, but many of them are not effective (or: evidenced based) and can even cause a variety of side effects, particularly in very young children.

In this part of the symposium an update will be given on integrative approaches of treatment strategies for URIs by taking into account not only current evidenced based treatments to shorten the duration and reduce symptoms, but also taking a closer look at home remedies, dietary changes, supplements and lifestyle changes.

X9 Update on pediatric integrative medicine – three main topics - chronic headaches

Melanie Anheyer

Elisabeth Krankenhaus Essen, Essen, Germany

Headaches are one of the most common pain conditions in children. The worldwide prevalence is estimated about 58.4%, with an increasing incidence during the last years. The classification of headache for children and adolescents as well as for adults is defined by the International headache Society and published in the International Classification of Headache Disorders III (ICHD-3). The most common headache types in childhood are migraine and tension-type headaches. Both types are generally associated with a reduction of overall quality of live and a high frequency of school absence.

This part of the session will give an overview of the current evidence for integrative treatment options of primary chronic headaches in children and adolescents. On this occasion especially mind body therapies, acupuncture, herbal medicine and nutritional supplements will be taken into account.

X10 Implementation of integrative medicine in a german pediatric hospital setting– development of a concept and steps towards realization

Marion Eckert (dr-eckert@t-online.de)

Kinderkrankenhaus St. Marien, Landshut, Germany

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in the pediatric care so far. Therefore it is often used without the knowledge of the attending pediatrician and compartmentalized mostly into the outpatient care.

For the responsible implementation and systematic evaluation of complementary medicine in pediatric care a model project “Integrative Pediatrics – implementation of naturopathic and complementary medicine in pediatrics” was initialized in 3 different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” Landshut. Within this project we started to implement CAM Methods in the pediatric routine care of the hospital and the outpatient setting. A concept of the implementation process has been developed based on clinical care, teaching and scientific evaluation. The concept and the main steps which lead to successful implementation will be presented and individual speakers will introduce the audience into selected treatment modalities implemented and scientifically evaluated over the period of one year.

X11 Update on pediatric integrative medicine - three main topics - functional abdominal pain

Marion Eckert¹, Mercedes Ogal²

¹Kinderkrankenhaus St. Marien, Landshut, Germany; ²Arztpraxis für Kinder und Jugendliche, Brunnen, Switzerland

Correspondence: Marion Eckert (dr-eckert@t-online.de)

Abdominal pain is a common complaint of many children. According to the KiGGS study up to 69% of all 3- to10-year old children and about 60% of all children age 11-17-years complain about abdominal pain over the period of 3 months. The entity of functional abdominal pain is considerd to make for about 8% percent of abdominal pain episodes in children. It is characterized and defined as ROME III criteria and many times difficult to diagnose and treat.

Many children undergo numerous diagnostic tests and sometimes painful procedures before the diagnosis functional abdominal pain is made. The ROME III criteria were developed to avoid unnecessary diagnostic tests and help facilitate the diagnosis.

It still is challenging to treat and give the children strategies to deal with their pain.

In this part of the symposium we will focus on giving an update on the current evidenced based treatment strategies in „conventional medicine“ and also focus on evidenced based integrative approaches for functionel abdominal pain in different treatment settings.

X12 Implementation of integrative medicine in a german pediatric hospital setting – concept and realization using the example of the Kinderkrankenhaus St. Marien, Landshut

Marion Eckert¹, Catherina Amarell¹, Annette Schönauer¹, Birgit Reisenberger¹, Bernhard Brand¹, Dennis Anheyer², Gustav Dobos²

¹ Kinderkrankenhaus St. Marien, Landshut, Germany; ²Klinik für Naturheilkunde und Integrative Medizin, Knappschafts-Krankenhaus, Kliniken Essen-Mitte, Essen, Germany

Correspondence: Marion Eckert (dr-eckert@t-online.de)

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in the pediatric care so far. Therefore it is often used without the knowledge of the attending pediatrician. The growing interest amongst users as well as therapists leads to an increasing need of information about safety and efficacy for the CAM methods used.

For the responsible implementation and systematic evaluation of complementary medicine in pediatric care a model project Integrative Pediatrics – implementation of naturopathic and complementary medicine in pediatrics was initialized in 3 different pediatric hospitals in Germany, one of them being the Kinderkrankenhaus St. Marien Landshut. Within this project we started to implement CAM Methods in the pediatric routine care of the hospital and the outpatient setting. A concept of the implementation process has been developed based on clinical care, teaching and scientific evaluation. The main steps which lead to successful implementation will be presented and individual speakers will introduce the audience into selected treatment modalities implemented over the period of one year. The modalities presented will be methods of TCM, relaxation techniques, foot reflexology, wraps and poultices, aromatherapy and homeopathy. Other modalities implemented are yoga and herbal medicine. To evaluate the implementation process a survey of expectations, knowledge and usage of CAM among patients and the medical staff was performed at the onset of this project. Also qualitative and quantitative data of this survey will be presented to the audience.

X13 The anthroposophic-medical approach to the treatment of insomnia, other stress-related complaints and ADHD

Matthias Kroez¹, David Martin², Harald Matthes³, Aldo Ammendola⁴

¹Interdisciplinary Oncology, Hospital Havelhöhe, Berlin, Germany; ²Pediatrics, University of Tübingen, Tübingen, Germany; ³Hospital Havelhöhe, Berlin, Germany; ⁴Weleda AG, Arlesheim/CH, Arlesheim, Switzerland

Anthroposophic medicine (AM) is an integrative multimodal treatment system based on a holistic understanding of disease and treatment. It is building on a concept of four levels of formative forces in nature and on the model of a three-fold human constitution. AM is practiced by conventionally-trained physicians, therapists and nurses who have undergone additional, specialized training, learning to apply a broad array of effective natural medicines. This whole-person approach also incorporates art, music, movement (eurythmy), and massage therapies as elements of a multidisciplinary health care.

More than forty percent of all adults suffer adverse health effects from perceived stress, e.g. insomnia; about seventy-five percent of all doctor's office visits are for stress-related complaints. Stress playing also a role in problems such as headaches, high blood pressure, diabetes, asthma, arthritis, depression and anxiety is mainly a hazard of the workplace which costs the industries worldwide several hundreds of billions Euro annually.

Attention deficit hyperactivity disorder (ADHD) is a mental disorder characterized by problems paying attention, excessive activity, or disruptive behavior. Despite being the most commonly studied mental disorder in children, the exact cause is unknown in the majority of cases. ADHD treatment varies by country and usually involves some combination of counseling or behavioral therapy, lifestyle changes, and medications.

The anthroposophic-medical approach to stress-related complaints, exemplified in this symposium by insomnia and other diseases, include counseling with regard to behavioral changes (daytime and sleep hygiene adapting to an individual circadian rhythm, inner spiritual sleep preparation e.g. with a review of the day, meditation or prayer), external applications (lower leg and foot embrocation) e.g. with lavender oil or cuprum ointment, and anthroposophic medications such as Bryophyllum pinnatum, potentized Phosphorus, Avena sativa combinations, or possibly also medications such as Neurodoron® or Cardiodoron® from Weleda AG. Similar approaches to the management of ADHD will also be presented and discussed.

X14 Advancing the science and care of integrative oncology around the world

Jun J Mao¹, Claudia Witt², Yufei Yang³, Gustav Dobos⁴

¹Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA; ²Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland; ³Clinical Cancer Center in Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; ⁴Complementary and Integrative Medicine, Clinic for Internal and Integrative Medicine, University of Duisburg-Essen, Essen, Germany

Correspondence: Jun J Mao

Advances have been made in research to develop evidence and improve clinical delivery of integrative onoclogy care. In this international symposium, the speakers will discuss the current status of clinical care delivery in North America, Europe, and Asia. In addition, this international group of physician scientists will discuss their own research in the areas of acupuncture, mind-body medicine, and herbal medicine for cancer care. Following their talks, they will engage the audience to discuss how to increase collaboration to advance the science and care of integrative oncology around the world.

X15 From communication to integration – consultations about complementary medicine in cancer care

Miriam Oritz¹, Markus Horneber², Petra Voiß³

¹Institute for Social Medicine, Epidemiology and Healthe Economics, Charité University, Berlin, Germany; ²Oncology, Klinikum Nürnberg, Nürnberg, Germany; ³Naturopathy and Integrative Medicine, University of Duisburg-Essen, Essen, Germany

Correspondence: Miriam Oritz (Miriam.oritz@charite.de)

This session will give an overview about how to effectively communicate with patients (and relatives) about complementary medicine in routine oncological care. Four talks will be provided on:

• Needs and expectations: a patient’s perspective

• Tasks and topics for the health professionals: case presentations

• Consultation service: results of a collaborative research project

• Implementation strategies: international perspective on consultation models

After the session the audience will

• Be able to understandthe oncological patients`perspective

• Know about special communication skills in integrative oncology

• Know about models for implementing integrative oncology in practice

X16 Implementation of integrative medicine in a german pediatric hospital setting– integration of foot reflexology as one pillar of an integrative treatment approach for hospitalized children

Birgit Reisenberger

Kinderkrankenhaus St. Marien, Landshut, Germany

Direct involvement of parents in the treatment of their sick child is very important for the wellbeing of the child, the parents, as well as for the staff involved in treating the child. Foot reflexology is a great means to accomplish this goal and an effective way to provide fast alleviation of symptoms in many cases. Out of the many indications for the application of foot reflexology we chose two common ailments in children for which we offer this additional treatment modality: abdominal pain and lung affections such as bronchitis.

The parents are given teachings by physiotherapists and nurses apply certain techniques whilst caring for the children. Additionally handouts explaining the technique are provided. The aim is to offer parents and caretakers of the children a practical and easy way to alleviate symptoms and activate self-regulating mechanisms in their children in the hospital and at home.

For scientific evaluation a study was initiated to investigate the effects of the treatment. Questionnaires were developped to be filled in by the parents before and 2 weeks after the initiation of the intervention. Certain aspects of the parent’s stress level resulting from their child’s illness, as well as practicability, comprehension and effectivity of the techniques used are assessed.

So far there has been a very positive feedback and openness to the study and foot reflexology. It is perceived as an efficient help for the children and also as an emotional relief for the parents by lowering their own stress levels.

X17 Up-date on integrative pediatrics

Alexandra von Rosenstiel¹, Marion Eckert², Mercedes Ogal³, Catharina Amarell², Melanie Anheyer⁴

¹Pediatrics, Rijnstate Hospital, Arnhem, the Netherlands; ²Pediatrics, Kinderkrankenhaus St. Marien, Landshut, Germany; ³Integrative pediatrics, medical office, Brunnen, Switzerland; ⁴Pediatrics, Elisabeth Krankenhaus, Essen, Germany

Correspondence: Alexandra von Rosenstiel (Ivonrosenstiel@rijnstate.nl)

The aim of this 90 minute symposium is to equip individual clinicians and multidisciplinary teams with up-to-date knowledge of an integrative approach to manage common problems in pediatrics.

For three pediatric key domains (1) chronic headache (2) functional abdominal pain and (3) upper airway infections the latest scientific research and clinical expertise on integrative therapies in various age groups will be discussed by pioneers from 3 European countries.

Culture-sensitive concepts and frameworks relevant for informed, shared decision making with families will be provided.

This session also highlights successful strategies for incorporating integrative pediatrics into conventional medicine set ups across Europe.

X18 Integrative oncology in anthroposophic medicine - concept, research and clinical practice

Friedemann Schad^1,3*, Marc Schläppi², Matthias Kröz^1,3,4, Arndt Büssing⁵, Gil Bar-Sela^6, Harald Matthes^1,3

¹Community Hospital Havelhöhe, 14089 Berlin, Germany; ²Center of Integrative Medicine, Hospital St. Gallen, 9000 St. Gallen, Switzerland; ³Research Institute Havelhöhe, 14089 Berlin, Germany; ⁴Institut for Social Medicine, Epidemiology and Health Economics, Charité University Medicine, 10117 Berlin, Germany; ⁵Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, 58313, Herdecke, Germany; ⁶Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technology Institute of Israel, 3525433 Haifa, Israel

Correspondence: Friedemann Schad

Background

For decades Anthroposophic Medicine (AM) has provided integrative concepts in cancer care. In hospitals as well as ambulant settings multimodal integrative oncology (IO) treatment options have been developed combining high quality provision of conventional cancer treatment with art therapies, movement therapies, eurythmy therapy and mind body interventions. In addition, therapeutic nursing interventions, rhythmical massage, psycho-oncology and mistletoe treatment complement daily care. Based on guideline orientated medicine, central aspects are the individualized approach, the relationship between professionals and patients, health related quality of life and patient orientation. Further development of academic structures and research and exchange with other integrative concepts are future challenges. The World Congress of Integrative Medicine and Health 2017 (WCIMH) in Berlin, Germany provides the necessary platform to address these aspects of IO.

Methods

Individual aspects, concepts and clinical practice of IO in Anthroposophic healthcare will be subsequently deepened in a first WCIMH discussion panel consisting of physicians from European healthcare institutions which have successfully implemented and exercised IO concepts.

Results

The panel provides recent data from various fields of IO and AM: clinical outcome of advanced and metastatic pancreatic cancer treated with standard and IO concepts in a certified cancer center, multimodal treatment concepts and perspectives of chronic fatigue in breast cancer patients, and spiritual needs of oncological patients. Furthermore, research and clinical approaches of IO through the example of Swiss, Israeli and German hospitals and the implementation in AM concepts will be introduced and discussed.

Conclusion

Addressing academization and implementation of IO concepts in Anthroposophic healthcare a discussion panel of the WCIMH world congress 2017 was set up to deepen and discuss results of actual studies, individual approaches, concepts and clinical practice in this field.

X19 An integrative approach to understanding & managing procedural anxiety - a 3600 perspective

Elad Schiff^1,2, Eran Ben-Arye^3,4, Zahi Arnon⁵, David Avshalomov⁶, Samuel Attias^2,7

¹Internal Medicine, Bnai Zion Medical Centre, Haifa, Israel; ²Complementary Medicine Service, Bnai Zion Medical Centre, Haifa, Israel; ³Integrative Oncology Program and Western Galilee Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel; ⁴Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; ⁵Psychology & Mind-Body therapies, Complementary Medicine Servive, Bnai Zion Medical Centre, Haifa, Israel; ⁶Chinese Medicine, Bnai Zion Medical Center, Haifa, Israel; ⁷School of Public Health, University of Haifa, Haifa, Israel

Correspondence: Elad Schiff (elad.schiff@b-zion.org.il)

Pre-Operative Anxiety (POA) is associated with a negative patient experience, increased morbidity, and even mortality. Conventional management of POA is suboptimal and relies on anxiolytics. Complementary and Integrative Medicine (CIM) therapies have been shown to reduce POA. In the session, we will present:

• 1) Patient’s and health care providers’ perceptions of POA and its impact on patient-provider communication. We will contemplate at anxiety within the broader bio-psycho-social-spiritual context of the patient’s health belief model.

• 2) We will also present a variety of CIM therapeutic perspectives on POA: Traditional Chinese Medicine (the "Shen" concept), Reflexology (4 elements theory), Hypnotherapy (fear of death, and nocebo effects). A hands-on experience will be given for each modality, so that participants will be able to apply simple techniques for relieving anxiety.

• 3) In addition, we will present findings from state-of-the-art research on CIM for POA related to obstetric, general surgery/anesthesia, and gastroenterology procedures.

• 4) Finally we will share our experience with thousands of patients at Bnai Zion Medical Center in preventing & treating POA.

• 5) Q&A

Session will be interactive with audience mainly during the segment on therapeutic approaches.

X20 Implementation of integrative medicine in a german pediatric hospital setting – homeopathy as one pillar of an integrative treatment approach for hospitalized children

Annette Schönauer

Kinderkrankenhaus St. Marien, Landshut, Germany

Over the course of many years, there has been an increasing interest in the homeopathic treatment of children suffering from various ailments. Not only cough and the common cold, but also acute diseases such as pneumonia or severe chronic illnesses like rheumatism, asthma, etc. have been targets for a homeopathic supportive therapy.

For more than 10 years we have been offering a consult service for the homeopathic complementary treatment for various different diseases in the „Kinderkrankenhaus St. Marien, Landshut“ with great success. The patients are treated with classical allopathic and evidence based treatment modalities and additionally a consult service conducted by a highly experienced homoepathic doctor is offered 24 hours a day. Inhouse teachings are given on a regular basis to the staff and treatment policies are provided on the intranet of the hospital.

Patients and families as well as the medical staff highly welcome this additional possibility of treatment for the children. In a study performed in 2016, 80% oft he parents who have been offered the additional homeopathic treatment for their child accepted this option readily. For the staff a more comprehensive treatment of the whole child is made possible this way.

An overview over the concept for the homepathic care, financing strategies and benefits for the treatment of hospitalized children will be given during this session.

Education

X21 Challenges, outcomes and lessons learned from implementing a mind-body,edicine program into the health professions curriculum

Aviad Haramati¹, Claudia Witt², Benno Brinkhaus³, Sian Cotton⁴, Miek Jong⁵, Mats Jong⁶

¹School of Medicine, Georgetown University, Washington, DC, United States; ²Institute for Complementary and Integrative Medicine, University and University Hospital Zurich, Zurich, Switzerland; ³Institute for Social Medicine, Epidemiology and Health Economics, Charité - University, Berlin, 10117, Germany; ⁴Centre for Integrative Health and Wellness, UC College of Medicine, Cincinnati, OH 45267, USA; ⁵Louis Bolk Institute, Driebergen, 3972LA, Netherlands; ⁶Department of Nursing, Mid Sweden University, Sundsvall, Sweden

Correspondence: Aviad Haramati (haramati@georgetown.edu)

Reports from many countries suggest that burnout among physicians and other health professionals is a pervasive problem and a cause for concern. More than half of all physicians in practice in the US, and residents in training in Canada, experience burnout, and this can lead to changes in the patient-provider relationship and can adversely impact on the quality of care. Some believe that this process begins with the decline in empathy and rise in cynicism seen during medical school and post-graduate training. In response, there is increased interest among faculty, adminstrators and policy makers to develop interventions with medical students, residents and faculty and provide them with tools to address the rise in chronic stress and burnout and the decline in resiliency. Keys to this work are themes of self-awareness and mindfulness and exploring domains of self-care and finding meaning in one’s work. At Georgetown University School of Medicine, a mind-body medicine skills course was developed to provide opportunities for students, residents and faculty to experience various mind-body techniques in a safe, confidential group setting. The program has now been adapted by a number of other institutions in the US and Europe.

In this 90-minute session, representatives from 6 institutions (Germany, Netherlands, Sweden, Switzerland and the US) who have implemented mind-body programs will share perspectives on the challenges they faced, the strategies they used to implement the program into the curriculum, the outcomes they obtained, and the lessons learned. The symposium will involve short (10) minute presentations, which will enable at least a 30 minute discussion with the audience participants.

By the end of the session, participants will be able to:

• 1. Describe of the challenges and barriers to implementation of a mind-body medicine program into the curriculum

• 2. Understand the strategies that facilitated the successful curricular implementation of mind body medicine programs

• 3. Delineate some of the outcomes that programs have reported in their students and faculty

X22 Promoting development in one self and others: educating for self-care and leadership in integrative health care

Christian Scheffer¹, Aviad Haramati², Diethard Tauschel^1,3, Friedrich Edelhäuser^1,3

¹Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke, Witten Herdecke, Germany; ²School of Medicine, Georgetown University, Washington, DC, United States; ³Faculty of Health, University of Witten/Herdecke, Witten, Germany

Correspondence: Christian Scheffer (Christian.scheffer@posteo.de)

Integrative Medicine and Health Care focuses on individual preferences, needs and values of patients. Fast changing health care systems with progressive economization, with a digital-technologic transformation and with global interdependencies ask for increased capabilities of health care professionals, especially leadership and self care. Based on educational research and educational experiences at Georgetown University in the US and at Witten/Herdecke University in Germany we will present contemporary learner centered educational tools to meet these challenges.

Adi Haramati will introduce the symposium by outlining the Principles of Mindful Leadership and then describing how the Mind-Body-Medicine program at Georgetown University School of Medicine has been effective to foster self-care, self awareness, and professional identity formation among faculty.

Diethard Tauschel will present successful tools of Self-Directed Learning to Promote Leadership in Self-Development. Friedrich Edelhäuser will address the topic: Becoming a Change Agent: Fostering Student Engagement and Transformational Learning. Christian Scheffer will give the final presentation on the topic: „Responsibility Drives Learning - Leadership and Self-Care during Active Participation in Patient Care. The latter three presenters will describe essentials of their educational experiences with the Integrated Curriculum for Anthroposphice Medicine at Witten Herdecke University. This 90 minute session will include 4 short (15 minute) presentations followed by 30 minutes of audience participation and discussion,

Participants will be able to:

• 1. Understand the basis for self-awareness and self-care as key elements that form the basis of mindful leadership and also of learner-centered education

• 2. Distinguish among various approaches that foster self-awareness

• 3. Describe different educational methods to foster leadership in integrative medical education.

Traditional healing systems

X23 Wet cupping: evidence, guidelines and policy

Abdullah AlBedah¹, Myeong Soo Lee², Mohamed Khalil¹

¹National Centre for Complementary and Alternative Medicine, MOH, Riyadh, Saudi Arabia; ²Korean Institute of Oriental Medicine, Daejeon, Korea

Correspondence: Abdullah AlBedah (aalbedah33@yahoo.com)

Wet cupping is a leading traditional therapy in Asia and Middle East as a part of traditional healing systems or as a complementary therapy. The session will give an overview of taking wet cupping therapy beyond research stages and discuss the experience of developing guidelines and policy in complementary and integrative medicine. During the session, Dr AlBedah will highlight the Saudi Governmental experience in regulating and integrating wet-cupping in the conventional health care. Dr Lee will give a talk on Cupping therapy in Korean medicine clinical practice guideline, then Dr Khalil will present a model for evaluating wet cupping evidence and the reality of policy makings.

Objectives

• Policy and regulation of wet cupping in Saudi Arabia, obstacles and opportunities

• Developing clinical guidelines in Korea

• The scientific evidence and reality of policy making: Model of using wet cupping in low back pain

X24 Kampo medicine (traditional Japanese medicine) for cancer care under integrated universal health care coverage in Japan

Keiko Ogawa¹, Yoshiharu Motoo¹, Junsuke Arimitsu², Masao Ogawa¹, Genki Shimizu³

¹Kanazawa University Hospital, Kanazawa, Japan; ²Clinical Immunology, Osaka University, Suita, Osaka, Japan; ³Departement of East Asian Traditional Medicine, Ehime Prefectural Central Hospital, Matsuyama, Japan

Correspondence: Keiko Ogawa (ikkandoo@gmail.com)

The effectiveness of traditional Japanese herbal (Kampo) medicine in cancer care is attracting more and more attention in medical system in Japan.

Kampo is the most frequently used alternative and complementary medicine in Japan. The aim of Kampo therapy is to improve patients condition whatever their diseases are. Kampo therapy is unique because its focus is patients condition not their disease. Therefore, Kampo Medicine plays more and more important roles in closing the gap between modern modern medicine and demand of patients. It can be also used easily for cancer patient because it is operated under integrated universal health care by Japanese government. Patients are diagnosed from both viewpoints of modern and Kampo medicine, and they are treated with the appropriate combination of both therapies. This characteristic suggests an ideal form of integrated medicine, where scientific and analytical approach of western medicine is integrated with holistic approach of Kampo Medicine. Though its origin was in ancient China, Kampo Medicine has been developed under the influence of Japanese nature and culture, and nowadays is working as an independent medical system significantly different from Traditional Chinese Medicine (TCM). We would like to discuss on the advantage and disadvantage of Kampo medicine for cancer patients through some clinical researches and reports.

According to four key objectives of WHO strategy, policy to integrate TM within national health care systems, establishment of the safety, efficacy and quality of TM, and preservation of the right of patients to access TM. Japanese medical system might be a good example for countries where traditional medicines are used.

• 1. Provide some information on Kampo medicine through some clinical researches and case reports.

• 2. Discuss on the efficacy of Kampo medicine, Japanese medical system, and usage of Kampo medicine in cancer care.

X25 Phytotherapy in therapy and prevention: current state of science and regulation and perspectives of future uses

Rainer Stange^1,2, Karin Kraft³, Kenny Kuchta⁴

¹Immanuel Krankenhaus, Berlin, Germany; ²Charité University Medical Centre, Berlin, Germany; ³University of Rostock, Rostock, Germany; ⁴National Institute of Health Sciences, Tokyo, Japan

Correspondence: Rainer Stange (r.stange@immanuel.de)

Phytotherapy has been the basis of almost any Traditional Medicine for ages. Appr. after 1850 and beginning in Europe, there has been increasing use of botanical, pharmaceutical and later pharmacological scientific efforts to guarantee delivery of phytotherapeutical products of highest quality and to evaluate their use in therapy as well as to a smaller part also in preventive medicine for a variety of medical conditions. Today, phytotherapy is well regulated in countries with Western standards of drug regulation. We overlook a number of clinical trials of any type as well as reviews and systematic reviews. Traditional use of phytotherapy esp. as teas or decocts, still is around.

The purpose of this symposium is to present different dimensions on the state of the science on the application of phytotherapy in therapy and prevention. Presenters will review scientific research on utilization, efficacy, and safety of phytotherapy for the general population as well as for selected patient samples with specific mental or physical conditions. One example will be the current state of knowledge on the use of phytotherapy for therapy and prevention of infectious diseases, esp. urinary tract in and airways infections.

Kampo medicine in Japan is a very good case to study its implementation into the Japanese public health system. Presently, freeze-dried granules of 148 traditional prescriptions are covered by public health insurance in Japan. One of these is Yokukansan, a novel phytotherapeutic preparation for the treatment of neuronal disorders on the basis of traditional Japanese Kampo medicine.

Given its relatively low costs, phytotherapy could easily be implemented worldwide as a preventive or therapeutic means for a variety of important health conditions. As such, health-care providers are increasingly presented with patients using, or interested in trying, phytotherapy for the management of their medical conditions. This increased use of phytotherapy raises the issue of the efficacy and safety of phytotherapy as a prevention strategy and therapy.

Gaps and open question in current research and implications for further studies will also be highlighted. The symposium thus aims to improve both clinical decision making and research quality on one of the most prevalent complementary therapies used for the prevention and therapy of chronic health conditions.

Given its relatively low costs and so far good safety records, phytotherapy should be implemented on a wider sale, as is also suggested by WHO with its quest for broader acceptance and understanding of Traditional Medicines.

X26 Globalization of traditional healing systems

Kenji Watanabe (watanabekenji@keio.jp)

Keio University, Tokyo, Japan

International classification of diseases (ICD) is an international platform for health statistics of mortality and morbidity since 1900. In 2018, ICD-11 will be launched and traditional healing system will be incorporated at the first time in the long history of ICD. First Traditional healing system features the Asian Traditional Medicine originating from ancitne China. Other modalities such as Ayurveda or Unani are expected to follow in future. This session will spotlight the meaning of the globalization of traditional healing system.

Medicine and arts

X27 Therapeutic recitation in anthroposophic therapeutic speech: physiological and psychological interactions of respiration, pulse and well-being

D Bonin

GTM, Anthroposophic Therapeutic Speech, Bern, Switzerland

Objectives

In two studies we investigated cardiorespiratory synchronization in healthy subjects during (simultaneous effects) and after (immediate effects) recitation of ancient verse (Hexameter, H/Alitteration A), controlled and spontaneous breathing (C and S) as well as random conversation (R). Cardiorespiratory synchronization was analyzed with respect to the oscillations in heart rate induced by respiration, i.e. respiratory sinus arrhythmia (RSA) and a respiratory trace. Ancient verse (e.g. Hexameter) is used frequently in Anthroposophic Speech Therapy ATS, and effects of stress reduction and improved breathing have been attributed to its therapeutic application.

Methods

Simultaneous effects study

20 healthy subjects were included in the study. Each subject had to perform three different exercises in the following sequence: 15 min. sitting - 20 min. walking and exercise - 15 min. sitting. The exercises were: Hexameter exercise (H), Controlled breathing (C), Spontaneous breathing (S).

Immediate effects study

7 healthy subjects were included in the study. Each subject had to perform three different exercises in the following sequence: 15 min. sitting (S1) - 30 min. walking and exercise - 15 min. sitting (S2). To ensure comparable levels of physical activity during the exercises, the subjects walked at a pace of 50 steps/min. The exercises performed were: Hexameter exercise (H), Alitterative verse (A), Random conversation (R). The participants were asked to comment on mood-changes in free text.

Results

Simultaneous efffects study [1]

In total 180 recordings were analysed. All exercises showed an increase in heart rate, whereas heart rate always decreased after exercise as compared to baseline. The hexameter exercise showed the highest heart rate (mean 82.9/min.). Cardiorespiratory synchronisation was high after hexameter recitation (γ = 0.70), less after controlled breathing (γ = 0.57) and desynchronized after spontaneous breathing (γ = 0.15).

Immediate effects study [2]

In total 105 recordings were analyzed. The overall binary pattern predominance (PP) as well as the frequency of predominant and cyclically recurrent cardiorespiratory phase locking patterns were calculated. Furthermore the changes of low and high frequency heart rate variability. ATS provoked alterations in heart rate dynamics which were different from those after control exercises and which persisted at least during 15 minutes following exercise.

References

1. Cysarz D, et al. Oscillations of heart rate and respiration synchronize during poetry recitation. Am J Physiol Heart Circ Physiol. 2004;287:H579 - H587

2. Bettermann H, et al. Effects of speech therapy with poetry on heart rate and cardiorespiratory coordination. International Journal of Cardiology. 2002;84/1:77-88

X28 Eurythmy therapy – effects observed in clinical studies

Arndt Büssing

Witten/Herdecke University, Witten/Herdecke, Germany

Eurythmy Therapy (EYT) is a non-pharmacological mindfulness-oriented movement therapy of Anthroposophic Medicine. It focuses on the relationship and regulation of spirit and soul with the physical body and life forces. EYT expresses sound and rhythm which are transformed in specific movements. It is used for several quite heterogeneous indications, which underlines the importance to examine more closely its effectiveness.

So far there are two systematic reviews on EYT effects in clinical settings. The 2008 review from Büssing et al., published in BMC Complementary and Alternative Medicine, referred to 8 citations which met the inclusion criteria and indicated that EYT is a “potentially relevant add-on in a therapeutical concept”. In 2015 Lötzke et al. published an updated systematic review in the Journal of Integrative Medicine and referred to 11 studies published since 2008. Most of these studies described positives treatment effects with effect sizes ranging from small to large. The studies were heterogeneous according to the indications, study design, methodological quality, and outcome measures.

A recent randomized clinical study by Büssing, Michalsen, Krötz et al., which was not included in the 2015 review, compared the efficacy of three active interventions, i.e., EYT, yoga and physiotherapeutic exercises (PhyE) in a group 270 persons suffering from chronic low back pain. The study had an eight week intervention and an eight week follow-up phase. All three interventions were similar effective to significantly decrease patients’ physical disability and pain perception, while SF-12’s mental health component increased. Here, EYT had a significant benefit compared to PhyE. Moreover, there were significant improvements of stress perception, life satisfaction and mood for yoga and EYT, which were not seen for patients receiving PhyE. Significant improvements of patients’ self-efficacy expectation were observed within the active intervention period only in the EYT group. Thus, with respect to the different ‘levels’ of the human being, all three interventions were effective on the physiological level (pain and associated disability), yoga and EYT on the emotional level (psychological quality of life components), and EYT on the level of the ‘inner self’ (self-efficacy). This larger study showed that EYT can be a therapeutic option for patients with chronic low back pain comparable to the ‘gold standard‘ PhyE - and similarly effective as Yoga which is already implemented in the US guidelines.

In summary, EYT is an important and promising intervention already established in Anthroposophic Medicine, and worth of further research in conventional settings.

X29 Arts therapies within anthroposophic medicine – one essential modul of holisitic medical approach

Harald Gruber (Harald.gruber@alanus.edu)

Alanus University of Arts and Social Sciences, Alfter, Germany

Anthroposophic medicine is based on science and includes the whole range of conventional therapies. It furthermore aims to strengthen the whole constitution of the patient by taking into account the vital, emotional, mental, spiritual and social dimension as seriously as the physical one. Arts Therapies as sculpture-, painting-, music-, speech-, and eurythmie therapy are well established and appreciated in Anthroposophic Medicine since decades. They can directly influence emotions and psychophysiological parameters one the one side and can help nonverbal selfexpression and self-realisation on the other side. Within Anthroposophic Medicine Arts Therapies are therefore more than only a “nice to have”. The different applied Arts Therapies are based on traditional approaches and modified by anthroposophically enhanced perspectives. Research results from speech therapy, music therapy, and eurythmie therapy give evidence for the effectiveness of these special therapeutic approaches in Anthroposophic Medicine. Basic research studies and randomised controlled trials are accumulating, documenting the effectiveness of Arts Therapies for various patient groups. More comprehensive research is necessary but the first findings are promising.

X30 Research in arts therapies

Sabine Koch¹, Harald Gruber¹, Urs Pohlmann¹, Christine Caldwell², Barbara Krantz³, Ria Kortum¹, Lily Martin¹

¹Research Institute for Creative Arts Therapy, Alanus University Alfter/Bonn, Alfter/Bonn, Germany; ²Naropa University, Boulder, CO; ³Hoogeschool Nijmegen, Nijmegen, Netherlands

Correspondence: Sabine Koch (sabine.koch@alanus.edu)

Art Therapy, Music Therapy, Dance Movement Therapy, Drama Therapy and Poetry Therapy together form the field of Creative Arts Therapies (CATs) and are mainly applied in mental health contexts. Recently they have also expanded into work and research on neurological and cardiovascular diseases as well as prevention, where they have been found to significantly reduce stress and to enhance the parent-infant relationship. In palliative care, art, music and dance movement therapy have been shown to reduce pain, anxiety and depression for cancer patients; for patients suffering from Parkinson’s disease they have been shown to increase quality of life. Yet in many areas, research needs to be expanded, enhanced and deepened as to what specifically works in arts therapies. How can we investigate active factors and mechanisms? How can we apply psychophysiological measures for the benefit of the field? This symposium provides an overview of existing empirical evidence, research findings, and directions in Creative Arts Therapies.

(4 presentations; 90 Minutes)

• 1. Arts Therapies: Dr. Christine Caldwell, Naropa University, Boulder, CO, USA: Measuring synchronization of physiological parameters in arts therapies – Ideas and first results

• 2. Art Therapy: Dr. Ria Kortum & Prof. Dr. Harald Gruber, Alanus University, Germany; Effects and Active Factors in Art Therapy: An overview for the field of palliative care

• 3. Music Therapy: Barbara Krantz, M.A., Nijmegen: Parent-infant Music Therapy: Effects, efficacy and practice - A research overview

• 4. Dance Movement Therapy: Prof. Dr. Sabine C. Koch/Lily Martin, Alanus University/SRH University, Heidelberg: Dance movement therapy research: Efficacy of DMT and therapeutic factors across the arts therapies

Workshops

Research

W1 The Cochrane risk of bias tool - how to use the updated tool for assessing clinical trial evidence

Lisa S Wieland¹, Ben Kligler², Susan Gould-Fogerite^3,4

¹Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; ²Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, Brooklyn, New York, NY, United States; ³ICAM, Rutgers School of Health Professions, Newark, New Jersey, USA; ⁴Clinical Laboratory Sciences and Primary Care, Rutgers School of Health Professions, Newark, New Jersey, USA

Correspondence: Lisa S Wieland (lswieland@gmail.com)

Cochrane systematic reviews are considered the gold standard for evaluating the clinical trials evidence for a given therapeutic approach. However many clinicians still find Cochrane reviews intimidating and difficult to translate into the setting of clinical decision-making. One reason for this gap is a lack of clear understanding among health care providers of the specific methodology and tools that Cochrane reviews rely on to arrive at their conclusions. In particular, the Cochrane tool for assessing risk of bias—which forms the core of the Cochrane strategy for assessing the methodological quality of clinical trials included in a review, and contributes to the overall assessment of the quality of the evidence stemming from the review —is not well understood by most clinicians, educators and even researchers. The Cochrane risk of bias tool has been updated by Cochrane methodologists and will be presented to the Cochrane community in late 2016. This workshop provides an opportunity to bring the latest methodological advances in this area to integrative medicine clinicians, educators, and researchers.

This hands-on workshop will provide an overview of the risk of bias tool, followed by a supervised practice session in which participants will work through the process of evaluating an article using the tool. This first-hand experience in utilizing the risk of bias tool will equip participants to feel more confident in understanding and using Cochrane reviews, and demonstrate how they themselves could participate as a Cochrane reviewer if they are interested.

The workshop will consist of two parts:

1) Presentation

We will introduce the participants to the Cochrane review process and how the risk of bias tool is used in Cochrane reviews. We will describe the components of the updated tool and how each domain of risk of bias is to be assessed.

2) Hands-on experience

We will supervise the participants in working through an article describing an integrative medicine clinical trial, and applying the risk of bias tool to the trial. At the end of the hands-on session, we will review the risk of bias assessments and answer any questions about the concepts or their application.

W2 How to develop clinical practice guidelines for integrative medicine part 1: assessing the quality of the evidence used to inform a recommendation

Yuqing Zhang^1,2,3, Lisa S Wieland⁴, John J Riva^5,6

¹Clinical Epidemiology and Biostatistics department, McMaster University, Hamilton, Canada; ²Michael G. DeGroote National Pain center, McMaster University, Hamilton, Canada; ³Quality, Methodology and Innovation (QMI), Doctor Evidence, Santa Monica, USA; ⁴Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; ⁵Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; ⁶Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

Correspondence: Yuqing Zhang (madisonz1220@gmail.com)

Clinical practice guidelines (CPG) have become increasingly important to guide optimal clinical practice. They play the crucial role of translating research findings into succinct clinically relevant recommendations to facilitate clinicians, patients and caregivers in making clinical decisions. When developing evidence-based CPGs, trials, systematic reviews and meta-analyses are some of the most common sources of evidence to inform evidence-based recommendations.

Clinicians want to get a sense of how much they should trust underlying evidence. However, the quality of the evidence depends upon many factors including the availability, biases, precision, and consistency of the underlying evidence. The quality of the evidence obtained influences the confidence in effect estimates for each outcome underpinning CPG recommendations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach is a systematic and transparent method for summarizing the quality of evidence for an outcome into simple phrasing for clinicians. The formulation of evidence-based CPGs relies upon GRADE assessments of the evidence, and it is therefore important for CPG developers to understand how to use this approach. GRADE also allows clinicians, policy makers, and consumers to use reviews’ results and recommendations efficiently and reliably.

This workshop will have two main components:

1) A learning component;

We will introduce the participants to the GRADE approach for quality appraisal developed by the GRADE working group in McMaster University, Hamilton, Canada. We will describe why it is important to evaluate the quality of the evidence in the context of integrative medicine Cochrane systematic reviews, the relevance of the GRADE approach to clinicians, researchers and policy makers, GRADE’s objectives, and the five domains that are used to assess the quality of the evidence.

2) A hands-on component

We will provide an example based on an evidence profile of a research question of interest in integrative medicine. The participants will work in small groups, applying the concepts presented in the learning section to this evidence.

Participants will obtain the introductory skills to assess the quality of evidence for estimates from integrative medicine Cochrane systematic reviews. This skill is important for understanding the conclusions of a Cochrane-style systematic review, and essential for those who may be considering carrying out a Cochrane-style systematic review. Participants will also master one of the crucial steps in developing evidence-based CPGs to make evidence-based integrative medicine related recommendations.

Education

W3 Understanding and learning the skills to manage stress in hospital residents and medical faculty

Michael Lumpkin¹, Emily Ratner²

¹Georgetown University School of Medicine, Washington DC, USA; ²Medstar Health, Columbia, Maryland, USA

Correspondence: Michael Lumpkin (mlumpk01@georgetown.edu)

Numerous studies show that hospital residents and medical/healthcare faculty suffer from excess stress, burnout, and loss of empathy. To address the challenge of healing these healers so that they may better serve their patients and themselves, we will briefly highlight the current knowledge about the physiology of the stress response in the context of the mind-body connection and describe the pathophysiological consequences of chronic stress on residents and faculty. Having defined the problem, participants will learn through experiential practice how to more effectively manage their own stress through the use of several mind-body medicine techniques including guided imagery, meditation, and autogenic biofeedback. To enhance the impact and meaning of the experiential activity, a real-time, non-invasive monitoring device will be provided to measure the result of mindfulness practice.

Timeline: Introduction and Goals-5 min; Physiology and Pathophysiology of Stress-20 min; Guided Imagery Experiential-15 min; Constructing a Program for Residents and Faculty to Adress Stress and Burnout-15 min; Experiential Session with Meditation and Biofeedback with Monitoring Device-25 min; Processing and Discussion-10 min.

The importance of such a session to the program is to promote the long-term health and well-being of healthcare providers so that they may more effectively and reliably provide comprehensive healthcare to patients into the future.

W4 Concepts of TCM education in China and Europe - what can we learn from each other

Liu Ping¹, Pei Jian¹, Gesa-Meyer Hamme², Xiaosong Mao², Han Chouping³, Sven Schröder²

¹Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China; ²HanseMerkur Center for TCM at the UKE, Hamburg-Eppendorf, Germany; ³International Education College, Shanghai University of TCM, Shanghai, China

Correspondence: Sven Schröder (schroeder@tcm-am-uke.de)

In China full academic education in TCM started 60 years ago is now available throughout the country at universities and colleges on all levels including bachelor, master and PHD programs. After receiving their bachelor degree, students usually choose a specialization, either acupuncture/tuina or internal (herbal) medicine for their further studies.

In Europe TCM is seen as an additive to Western medicine after graduation. Education programs started in the 1950th but are mainly non-academical and organized by societies of physicians and practitioners. In Germany medical doctors can reach a postgraduate specialization degree for acupuncture, education on Chinese herbal medicine is not regulated. Non-medical practitioners can receive a limited allowance for treatment. However, a few academical programs at non-medical universities have been introduced recently in Europe.

Based on 30 years of sistercityship the TCM University Shanghai and the HanseMerkur Center for TCM at the University Medical Center Hamburg Eppendorf cultivated an active exchange on all aspects of TCM with frequent reciprocal visits, cooperative research projects, co-organized symposiums and reciprocal training for many years.

Nowadays, many textbooks and classical texts are available in English language. Furthermore, chinese scientific articles increasingly provide an english abstract and more and more research on TCM is performed in western countries. Main differences in education can be found in didactic concepts. In China lectures are mainly teacher oriented with less interactive elements. In western countries, students demand modern teaching material, problem oriented learning and discussions. Chinese teachers expect exact repetition of textbook contents, while western didactics pronounce context oriented learning and transferal of information. However, transferal of information is only possible, if there is a basic understanding of facts and terms. One further difference is the evaluation of the PHD education. In China, PHD studies are seen as a combination of further qualification in the specific field and the scientific thesis. In western countries more impact is put on the experiments, thesis and the following scientific publication. For the internationalization of TCM education, both educational systems have to be taken into account. Furthermore, transfer of knowledge, exchange of teachers, harmonization of curricula and cooperative international projects are mandatory.

To approve an educational academic cooperation in practice, Shanghai and Hamburg are planing an academization of TCM education at a western medical university. The concept includes common teaching by chinese and german specialist in Hamburg as well as in Shanghai; and common research projects for master and PHD theses.

Traditional healing systems

W5 Treatment of allergic rhinitis and asthma with Chinese Medicine

Josef Hummelsberger¹, Michael Wullinger²

¹SMS, Munich, Germany; ²Medical Practice, Rosenheim, Germany

Correspondence: Josef Hummelsberger

According to actual trials Acupuncture and CHM seem to be a alternative method to help patients with Allergic rhiniits. Decicisve in TCM is a correct pattern differentiation. Aim of this workshop is to help the physican to give hi a clear and practical help and guideline to use TCM in this disease effectively.

Medicine and arts

W6 Performing arts medicine: preventing injuries and restoring resiliency in musicians

Marc Brodzky^1,2,3, Christoff Zalpour^3,4

¹Center for Integrative Medicine and Wellness, Stamford Hospital, Connecticut, USA; ²Columbia University, New York, USA; ³Performing Arts Medicine Association (PAMA), Englewood, USA; ⁴INAP/O, Institute of Applied Physiotherapy and Osteopathy, University of Osnabrück, Osnabrück, Germany

Correspondence: Marc Brodzky

INAP/O, Institut für angewandte Physiotherapie und Osteopathie; Hochschule Osnabrück, Osnabrück, Deutschland

Performing Arts Medicine (PAM) is the study of the prevalence, etiology and management of playing-related disorders. Similar to Integrative Medicine, PAM embodies relief of suffering from pain, nutrition and other lifestyle recommendations, and mind-body stress reduction strategies to help people overcome anxieties that may hinder performance during high pressure situations.

Musicians are predisposed to certain injuries such as musculoskeletal overuse, nerve entrapment conditions, and focal dystonia. They may also experience stress-related psychological conditions. Barriers to care include affordability, access, and attitudes.

This workshop/case conference session will introduce the audience to the unique health needs of performing artists. Thorough history taking and pertinent physical exam may identify potential or existing performing-related conditions. Preventing injury and restoring resiliency may optimize a sense of well-being and performance in musicians and other artists.

W7 Using art to enhance observation skills and improve patient care and provider communication

Julia Langley (Julia.langley@georgetown.edu)

Arts and Humanities Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., USA

Keen observation and communication skills are critical to patient care. The ways in which we see, understand and respond to patients, caregivers and colleagues are complex and often ineffective due to missed cues, distractions and time constraints. If each individual and every situation is unique, how can we be certain that we convey the nuances of each case with clarity and precision? Especially when time is of the essence? This workshop uses the analysis of artworks, active sketching and expressive writing to teach participants how to look carefully, describe precisely and communicate directly – skills which transfer directly from the classroom to the clinic.

References

1. Herman, Amy H. Visual Intelligence: Sharpen Your Perception, Change Your Life, Boston: Houghton Mifflin Harcort, 2016.

2. Wellbery C. The value of medical uncertainty, The Lancet. 2010; 375(9727):1686-1687.

Discussions

Research

D1 Planning for and successfully conducting pragmatic trials of complementary and integrative interventions

Wendy Weber¹, Lanay M Mudd¹, Peter Wayne², Clauda Witt^3,4

¹Division of Extramural Research, National Center of Complementary and Integrative Health, National Instititutes of Health, Bethesda, MD, USA; ²Osher Center for Integrative Medicine, Brigham and Womens Hospital, Boston, MA 02215, United States; ³Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine, Berlin, 10117, Germany; ⁴University of Zurich, Zurich, Switzerland

Correspondence: Wendy Weber

In the last few years there has been a growing interest by the public and the scientific community in pragmatic clinical trials that test research hypotheses, which will directly inform the health care system. This interest has been driven by a number of factors including the high cost of traditional efficacy studies and the exclusion of many individuals from efficacy trials resulting in results that do not generalize to many patients. The proposed discussion session will include presentations that will provide definitions of pragmatic trials; how feasibility studies can inform design of large scale pragmatic trials and how they differ from explanatory trial feasibility studies; and provide resources for planning and conducting pragmatic trials. Dr. Mudd will highlight an overview of pragmatic trials and how to plan feasibility studies to inform design of pragmatic trials. Dr. Wayne will present results of feasibility studies of a community delivered tai chi program in preparation for larger scale studies. Dr. Witt will provide an overview two full scale pragmatic trial she has recently published. Presenters will discuss an overview of the challenges encountered in conducting these studies and how they have overcome these challenges. Dr. Weber will provide highlights of a pragmatic trials that are ongoing in the field of complementary health and a final summary of resources developed by the NIH Health Care System Research Collaboratory for investigators who are planning and conducting pragmatic trials (www.nihcollaboratory.org). The session will close with a panel discussion with all presenters to answer questions from the audience.

This session will provide attendees with a strong overview of how to conduct pilot studies to plan for successful conduct of pragmatic trials. Attendees will also be informed of resources and tools available to help them better understand the complexity of pragmatic trials.

D2 The future of collaborative research on complementary medicine in Europe

Wolfgang Weidenhammer¹, Vinjar Fønnebø², Heather Boon³

¹Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der Isar, TU München, Munich, Germany; ²NAFKAM, Tromsø, Norway; ³University of Toronto, Toronto, Canada

Correspondence: Wolfgang Weidenhammer (Wolfgang.weidenhammer@tum.de)

Since finishing the EU-funded CAMbrella project – defined as a coordination action – no convincing organizational structure could be established yet to continue and further develop the network of European CAM/IM research groups. The discussion should disclose the reasons for this development and compile new ideas for a modified strategy taking into account the needs and specific conditions of the research groups. The discussion should be fuelled by 3 short inputs: i) history of ISCMR European chapter (Weidenhammer), ii) experiences from the Canadian chapter (Boon), iii) organizational framework for networking provided by ISCMR (Fønnebø).

This international meeting is an ideal platform to sort out the current situation, the need for networking and ideas for future strategies to facilitate international collaborative CAM/IM research.

Education

D3 Development of a framework to support critical enquiry in complementary and integrative medicine education programs: a collaborative discussion

Amie Steel^1,2, Andrea Bugarcic³, Melisa Rangitakatu¹

¹Endeavour College of Natural Health, Brisbane City, Australia; ²University of Technology Sydney, Ultimo, Australia; ³University of Queensland, Brisbane, Australia

Correspondence: Amie Steel (amie.steel@endeavour.edu.au)

Complementary and integrative medicine practitioners face unique challenges when drawing upon relevant information sources to inform clinical decision-making and as such require specific skills in critical enquiry to navigate the available evidence. This session will provide an overview of the current challenges facing educators within CIM practitioner education programs regarding the development of critical enquiry skills in their students and provide the foundation for future progress in this topic. The speakers will present current research, initiatives and insights from the context of CIM education which relates to critical enquiry. Dr Steel will present original research from CM education institutions exploring the challenges associated with the inclusion of both traditional knowledge and scientific research within the curriculum (Approx. 15 minutes). Dr Bugarcic will overview a novel approach to engendering skills in critical enquiry amongst students of CIM practitioner programs (Approx. 15 minutes). Dr Rangitakatu will discuss the role of reflectivity in critical enquiry and practitioner competence (Approx. 15 minutes). Attendees will then to contribute to a discussion about key elements which could be included in a critical enquiry framework for CIM practitioners (Approx. 30 minutes). The outcomes of this discussion will provide a platform to inform the advancement of meaningful and relevant critical enquiry in CIM education. The international audience of the conference will strengthen the diversity of the discussion, and ensure the outcomes are appropriate and relevant to the wider international CIM community.

D4 The Practitioner Research and Collaboration Initiative: establishment and baseline data for the world’s largest practice-based research network in complementary healthcare

Amie Steel¹, Jon Adams¹, David Sibbritt¹, Jon Wardle¹, Matthew Leach¹, Janet Schloss², Helene Dieze²

¹University of Technology Sydney, Ultimo, Australia; ²Office of Research, Endeavour College of Natural Health, Fortitude Valley, Brisbane City, 4006, Australia

Correspondence: Amie Steel

Purpose

Practice-based research networks (PBRNs) are an accepted infrastructure which supports pragmatic research drawn from real-life clinical environments. There has been a strong growth in PBRNs in recent years encompassing a wide range of health professions including integrative medicine. The Practitioner Research and Collaboration Initiative (PRACI) is the largest PBRN within complementary healthcare in that it encompasses fourteen (14) different complementary medicine health professions.

Methods

All CM practitioners with qualifications in the professional groups included in PRACI were invited to complete a workforce survey. Those interested in joining PRACI were asked to provide contact details to link their results to a PRACI ID number. This data was used to form the foundation of the PRACI membership database.

Results

764 CM practitioners joined PRACI with the highest number of practitioners reporting qualifications in massage therapy (n = 447; 58.5%), naturopathy (n = 202; 26.4%), nutrition (n = 110; 14.4%), and reflexology (n = 102; 13.4%). The largest number of PRACI members have a practice based in Victoria (34.7%), Queensland (24.6%) and New South Wales (22.8%) although members are also represented in all other States and Territories. The PRACI members reported diverse practice interest areas.

Conclusions

PRACI is a PBRN which affords the potential to support diverse research projects due to its innovative sub-study design. As a result, PRACI offers significant opportunity to facilitate economies of scale and growth in CM research across a broad range of research areas.

Traditional healing systems

D5 Statutory regulation of traditional and complementary medicine professionals: operationalizing the World Health Organization guidelines

Heather Boon, Nadine Ijaz

University of Toronto, Toronto, Canada

Correspondence: Heather Boon (Heather.boon@utoronto.ca)

The World Health Organization has called upon states to regulate practitioners of traditional and complementary medicine (TCAM) systems and therapies, and an increasing number of jurisdictions are taking steps to do so. However, to date, scholarship that addresses the distinct complexities of TCAM professional regulation has been scant. The objectives of this project were: 1) To explore the factors that distinguish TCAM professional regulation from that of biomedical health providers; and 2) to develop a public interest framework to guide TCAM professional regulation. Data collection included an extensive review of literatures reporting various jurisdictions" approaches to and experiences with regulating TCAM providers; and re-analysis of our research team"s fifteen-year study of TCAM professionalization in Ontario, Canada which has included a multiple sets of qualitative interviews with front line TCAM practitioners and leaders, as well as a survey of all Chinese medicine, naturopathy and homeopathy practitioners in the Province (n = 1047). We found several features that differentiate TCAM professional regulation from that of biomedical professionals, including: contrasting epistemic frameworks and conceptualizations of evidence; traditional medicine"s concurrent clinical and cultural importance; the internal diversity of traditional health care systems; and historically-situated, differential power relations between TCAM and biomedicine. Applying critical theories of the professions as well as post-coloniality, we propose a principle-based framework for guiding TCAM professional regulation across jurisdictions. Underpinned by the principle of regulatory equity, our framework prioritizes traditional knowledge protection alongside patient safety, quality of care, and accessibility. We discuss how these principles may be diversely interpreted and applied across contexts, with respect to such specific issues as: professional standards, linguistic regulatory requirements, and biomedical professionals" increasing adoption of TCAM practices.

D6 How to prioritise traditional treatments for further research, including clinical trials

Merlin Willcox, Michael Heinrich, George Lewith, Andrew Flower, Bertrand Graz

University of Southhampton, Southhampton, United Kingdom

Correspondence: Merlin Willcox (Merlin.willcox@phc.ox.ac.uk)

There are tens of thousands of traditional treatments used throughout the world, and limited resources for their evaluation, especially in clinical trials. To date, there have been no scientific guidelines on how to prioritise which treatments should be researched in depth, including for clinical trials. We propose to present several ideas from different viewpoints, and to engage the audience in discussing how these ideas could be developed into guidelines to improve the efficiency of research on traditional medicines.

Specifically we will have short presentations on the following approaches:

• 1. The need for consolidated standards on reporting ethnopharmacological research – Prof Michael Heinrich

• 2. Ethnopharmacological studies with diverging expections: why a consensus? – Dr Bertrand Graz

• 3. Novel methods for prioritising plants for further research – the “RITAM score”; and the “Retrospective Treatment Outcome study” – Dr Merlin Willcox

• 4. The “5-phase model” to define good practice – Dr Andrew Flower and Prof George Lewith

Orals

Research

O1 Impact of acupuncture on medication use in patients suffering seasonal allergic rhinitis – results of the ACUSAR trial

Daniela Adam, Linus Grabenhenrich, Miriam Ortiz, Sylvia Binting, Thomas Reinhold, Benno Brinkhaus

Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany

Correspondence: Daniela Adam (daniela.adam@charite.de)

Background

Seasonal allergic rhinitis (SAR) is a common disease with diminishing effects on quality of life (Qol). An estimated 18% of the patients try to alleviate their symptoms through acupuncture. The ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) study assessed the impact of acupuncture on SAR and showed significant improvements in rhinitis specific Qol (RQoL), SAR symptoms and the use of rescue medication (RM). We investigated patients use for antihistamines into more detail.

Methods

Patients were randomised into three study groups: acupuncture plus RM, sham acupuncture plus RM and RM alone. They documented their medication use before and during the intervention period (8 weeks). Main outcome were the days of antihistamine used. Statistical analyses were conducted using parametric and non-parametric tests. Robustness of the results was tested by sensitivity analyses.

Results

Data of 414 patients were analysed. Following results were determined for the intervention period: The acupuncture group used antihistamines on significantly fewer days than the other groups (acupuncture vs. sham acupuncture: mean difference = -4.49 days, p = 0.01; acupuncture vs. RM: mean difference = -9.15 days, p < 0.001). About 38% of the acupuncture group did not use any antihistamine compared to only 16% in the RM group. Acupuncture patients did not need to increase the days of antihistamine use to handle their symptoms in contrast to patients who used RM alone.

Conclusions

Besides improving RQoL and SAR symptoms, acupuncture significantly reduces the use of antihistamines and can therefore be considered as a valuable treatment option for SAR patients.

O2 Measuring existential qualities of patients' health and suffering – the first stages of instrument development

Susanne Andermo^1,2, Tobias Sundberg^1,2, Torkel Falkenberg^1,2, Johanna Hök Nordberg^1,2, Maria Arman^1,2

¹Division of nursing, Karolinska Institutet, Huddinge, 14183, Sweden; ²I C – The Integrative care science center, Järna, Sweden

Correspondence: Tobias Sundberg (tobias.sundberg@ki.se)

Purpose

Patients may appreciate integrative care by its whole person and existential approaches. However, such caring qualities can be difficult to measure. The aim of this Swedish study was to develop a first version of an instrument measuring patients’ experiences of health and suffering with an existential focus.

Methods

A methodological design with three phases for instrument development was used. First; an item pool was developed based on qualitative interviews (n = 64) from patients receiving integrative care. Subsequently the relevance of the items was explored in 2 iterative rounds of cognitive patient interviews (n = 5 and n = 3). Finally expert stakeholder consultations (n = 5), were used to further refine the instrument.

Results

The first phase development of the instrument resulted in two interrelated dimensions: existential qualities of "health" and "suffering", characterized by 5 domains; "Life passion and energy", "Personal freedom", "Present in life" "Relations" and "Meaning". Instrument items were formulated as word pairs on a semantic differential scale representing opposite ends of a continuum. The cognitive patient interviews and expert opinions helped to refine items and domains, but did not change the overall instrument construct.

Conclusions

The dimensions and domains of this first version of the instrument, developed from a contemporary use of language, resemble well with theories in caring science focusing on existential qualities of health and suffering as integral to human life. The instrument is anticipated to be of value for evaluations in research, development of integrative and conventional health care practice as well as for theory development in caring science.

O3 Epigenetics alterations associated with short-term relaxation response training in healthy subjects

Manoj Bhasin^1,2, Xueyi Fan², Towia Libermann^1,2, Gregory Fricchione^3,4, John Denninger^3,4, Herbert Benson^3,4

¹Benson-Henry Institute for Mind Body Medicine, BIDMC, Harvard Medical School, Medicine, Boston, MA, United States; ²Genomics, Proteomics, Bioinformatics and Systems Biology Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Interdisciplinary Medicine and Biotechnology, and Division of Interdisciplinary Medicine and Biotechnology, Boston, MA, United States; ³Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, United States; ⁴Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

Correspondence: Manoj Bhasin (mbhasin@bidmc.harvard.edu)

Background

The relaxation response (RR) is the physiological and psychological opposite of the fight-or-flight or stress response. The RR has been reported to be effective in a number of disorders that are believed to be caused or exacerbated by stress. We had performed multiple genomics and systems biology studies in healthy and disease conditions to understand the molecular mechanism of RR. Our studies provided compelling evidence that the RR elicits specific gene expression changes linked to upregulation of energy production and insulin secretion, and downregulation of NF-kB mediated inflammation.

Methods

To explore further whether the beneficial effects of RR are associated with upstream epigenetic modifications (specifically, changes in DNA methylation), we now report a pilot study on 6 healthy subjects before and after 8 weeks of RR training. To identify RR-associated epigenetic changes, we performed genome-wide bisulfite sequencing to measure methylation changes. We also carried out integrated analysis of methylation and transcriptome data to identify molecular alterations which affect both regulatory and transcriptional genomic spaces.

Results

Comparison of pre- and post- RR methylation data identified 18,979 significantly hypo- or hyper- methylated regions (Adjusted P value < .01), corresponding to hyper- and hypo- methylation of 1,033 and 1,587 genes, respectively. Pathway enrichment analysis revealed significant hypo-methylation of genes linked to: neuron and muscle cell differentiation and development; lipid metabolism; mRNA processing and MAPK signaling. A similar analysis revealed hyper-methylation of multiple pathways, including: interferon gamma response; cell cycle regulation; and systemic lupus erythematosus.

We also performed an integrated analysis of our epigenetic and gene expression data from a previous study of healthy subjects (n = 19). The comparison identified multiple pathways that significantly impacted both at the transcriptional and epigenetics levels: Electron transport chain signaling pathways had significant hypo-methylation and up-regulation at the gene expression levels, indicating a positive effect of RR on energy production, mRNA processing, GPCR ligand Binding and Epithelial Cell Differentiation pathways. Further regulatory analysis of epigenetics and transcriptional data showed activation of INSR, a key molecule in insulin signaling, indicating that RR may have a positive effect on glucose metabolism. Similarly, the analysis indicated inhibition of the expression of IL6, a key cytokine associated with chronic inflammation, supporting the role of RR in downregulating inflammation.

Conclusion

This pilot study provides a unique insight into how the RR effects DNA methylation and gene expression of energy production, glucose metabolism and immune response pathways.

O4 Prolonged fasting in T1DM – case study from patient perspective

Bettina Berger¹, Rainer Stange ², Andreas Michalsen ², David D Martin ^3,4

¹University Witten/Herdecke, Health, Herdecke, Germany; ²Immanuel Hospital, Berlin, Germany; ³Hospital of Children, University, Tuebingen, Germany; ⁴Hospital of Children, Filderstadt, Germany

Correspondence: Bettina Berger (bettina.berger@uni-wh.de)

Background

Fasting as a medical treatment has been proven to be a valuable therapeutic method for chronic diseases like rheumatoid arthritis, hypertension, and metabolic syndrome [1]. For patients with Type 1 Diabetes mellitus (T1DM), fasting therapies has neither been recommended nor excluded by fasting guidelines [2] and most fasting clinics do not accept people with T1DM for fear of ketoacidosis. The literature on fasting in T1DM is scarce and limited to fasting during Ramadan [3].

AIMS: Report on a single case study of prolonged fasting in a T1DM patient for about seven days.

Methods

A femal patient (age 49 y) suffering from T1DM for 39 years, decided to fast on her own. Fasting during 7 days scheduled a reduction of insulin dosage from around 36 units short acting insulin and 18 units basal insulin/d to basal insulin only (18 units/d). The faster took water, tea, and vegetable broth only. She measured blood sugar level daily 10-12 times and took carbohydrates in case of blood sugar level below 60 mg/dl. She decided to measure ketone body daily and to take carbohydrate in case of uncertanty.

Results

Fasting was performed during 7 days without any carbohydrate intake. Only two times a mild hypoglycemia (treated with two units of carbohydrates) and two times a mild hyperglycemia (treated with four units of short acting insulin) but no serious hypoglycemia or hyperglycemia, not ketoacidosis occurred. Glucose profil were balanced between 60 and 180 mg/dl, av. 150 mg/dl during the whole time. The patient felt very well.

Conclusion

To the best of our knowledge, this is the first case report on prolonged complete fasting in T1DM. It indicates that persons with Type 1 diabetes can participate safely in prolonged fasts provided they reduce their usual insulin dose and carefully supervise their blood sugar level. Interventional studies are needed on the effects of fasting on metabolism, quality of life and longevity.

Literatur

1. Michalsen A, Li C. Fasting therapy for treating and preventing disease - current state of evidence. Forsch Komplementmed. 2013;20(6):444-53.

2. Wilhelmi de Toledo F, Buchinger A, Burggrabe H, Holz G, Kuhn C, Lischka E, et al. Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch Komplementmed. 2013;20(6):434-43.

3. Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes & metabolic syndrome. 2016.#

O5 Hypnotherapy or transcendental meditation versus regular relaxation exercises in the treatment of children with primary headaches: a multi-centre, pragmatic, randomized clinical study

Inge Boers¹, Arine Vlieger², Miek Jong¹

¹Louis Bolk Institute, Driebergen, 3972LA, Netherlands; ²Antonius Hospital, Nieuwegein, Netherlands

Correspondence: Inge Boers (i.boers@louisbolk.nl)

Questions

To investigate the effectiveness of hypnotherapy or transcendental meditation (TM) versus regular relaxation exercises added to usual medical treatment of paediatric primary headaches.

Methods

A pragmatic, randomized controlled trial was carried out in six hospitals in de Netherlands. Children (age 9-18 years) with primary headache and headache attack frequency of ≥2 times per month were randomized to receive either hypnotherapy or TM or regular relaxation exercises (control group), in addition to usual medical treatment. Primary outcome were mean frequency of primary headache attacks and clinically relevant (>50%) reduction in headache frequency, after three months of intervention. Secondary outcome was subjective improvement in symptoms (adequate relief).

Results

112 children were included: hypnotherapy (N = 39), TM group (N = 36) and control group (N = 37). Mean age was 13.3 years and 77% was female. Preliminary analysis were performed and showed that headache frequency was significantly reduced after 3 months for all groups from 18 to 13 days with headache per month (p = 0.0001). No significant differences were found between the groups (p = 0.95). The percentage of children with clinically relevant reduction in headache attacks was 38% and did not significantly differ between the three groups. Subjective improvement after intervention (adequate relief) was reported