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      Exploring the gap: attitudes, knowledge, and training needs in complementary and integrative medicine among healthcare professionals at German university hospitals

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          Abstract

          Introduction

          The use of Complementary and Integrative Medicine (CIM) is very popular among the general population in Germany. However, international studies show that nurses, physicians, and other health care professionals (HCPs) at hospitals often do not feel sufficiently informed about different CIM approaches. Moreover, they do not feel trained enough to counsel their patients appropriately. In the German-speaking context, particularly within university hospitals, research on this subject is scarce. Therefore, the aim of this explorative study was to evaluate attitudes, subjective knowledge, and needs regarding CIM among HCPs with direct patient interaction across all four university hospitals in the federal state of Baden-Württemberg, Germany (Tübingen, Ulm, Freiburg, Heidelberg).

          Methods

          The multicenter, cross-sectional, anonymous full survey was conducted online using a self-developed, semi-structured, web-based questionnaire. Recruitment took place via all-inclusive e-mail distribution lists of all four university hospitals.

          Results

          A total of n = 2,026 participants (response rate varied by location from about 5 to 14%) fully answered the questionnaire. Nurses constituted the largest professional group ( n = 1,196; 59%), followed by physicians ( n = 567; 28%), physiotherapists ( n = 54), psychologists ( n = 48), midwives ( n = 37), and other professions ( n = 124). More than two-thirds (71%, n = 1,437) of the participants were female and 14% ( n = 286) reported additional training in CIM. The overall attitude toward CIM (10-point Likert scale, 10 = “very favorable”) was clearly positive ( M ±  SD: 7.43 ± 2.33), with notable differences between professional groups: midwives (9.05 ± 1.18), physiotherapists (8.44 ± 1.74), and nurses (8.08 ± 1.95) expressed the highest support, whereas physicians (5.80 ± 2.39) the lowest. 42% of the participants incorporated CIM in patient care (from 33% of physicians to 86% of midwives). Overall, relaxation therapy ( n = 1,951; 96%), external applications ( n = 1,911; 94%), massage ( n = 1,836; 91%), and meditation/mindfulness ( n = 1,812; 89%) were rated as useful or rather useful for patients. The average self-assessed knowledge level about CIM was moderate (M ± SD: 5.83 ± 2.03). Most of the participants found CIM training at university hospitals important and saw research about CIM as one of the tasks of university hospitals. The participants expressed the highest interest in education for acupuncture/acupressure, relaxation therapies, and manual medicine.

          Discussion

          This comprehensive survey of health care professionals (HCPs) at university hospitals in Germany reveals a clearly positive disposition toward CIM, aligning with findings from other hospital-based surveys and highlighting differences among professional groups. While most therapies deemed beneficial for patient care are supported by positive evidence, further research is required for others. Given the average self-reported knowledge of CIM, targeted education is essential to meet the needs of both HCPs and patients and to ensure the provision of evidence-based information on the risks and benefits of CIM.

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          Most cited references55

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          Evidence based medicine: what it is and what it isn't

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            How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis.

            No comprehensive systematic review has been published since 1998 about the frequency with which cancer patients use complementary and alternative medicine (CAM). MEDLINE, AMED, and Embase databases were searched for surveys published until January 2009. Surveys conducted in Australia, Canada, Europe, New Zealand, and the United States with at least 100 adult cancer patients were included. Detailed information on methods and results was independently extracted by 2 reviewers. Methodological quality was assessed using a criteria list developed according to the STROBE guideline. Exploratory random effects metaanalysis and metaregression were applied. Studies from 18 countries (152; >65 000 cancer patients) were included. Heterogeneity of CAM use was high and to some extent explained by differences in survey methods. The combined prevalence for "current use" of CAM across all studies was 40%. The highest was in the United States and the lowest in Italy and the Netherlands. Metaanalysis suggested an increase in CAM use from an estimated 25% in the 1970s and 1980s to more than 32% in the 1990s and to 49% after 2000. The overall prevalence of CAM use found was lower than often claimed. However, there was some evidence that the use has increased considerably over the past years. Therefore, the health care systems ought to implement clear strategies of how to deal with this. To improve the validity and reporting of future surveys, the authors suggest criteria for methodological quality that should be fulfilled and reporting standards that should be required.
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              Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis

              Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for 4 chronic pain conditions. We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm. We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. Although factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain after acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominantly by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.
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                Author and article information

                Contributors
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                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                09 May 2024
                2024
                : 11
                : 1408653
                Affiliations
                [1] 1Institute of General Practice and Interprofessional Care, University Hospital and Faculty of Medicine , Tübingen, Germany
                [2] 2Center for Complementary Medicine, Department of Medicine II, Medical Center, Faculty of Medicine – University of Freiburg , Freiburg im Breisgau, Germany
                [3] 3Section of Molecular Immunology, Institute of Immunology, Heidelberg University Hospital , Heidelberg, Germany
                [4] 4Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products, Ulm University , Ulm, Germany
                Author notes

                Edited by: Christian S. Kessler, Immanuel Hospital Berlin, Germany

                Reviewed by: Jost Langhorst, Klinikum Bamberg, Germany

                Alfred Laengler, Gemeinschaftskrankenhaus Herdecke, Germany

                *Correspondence: Carina Klocke, carina.klocke@ 123456med.uni-tuebingen.de

                These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fmed.2024.1408653
                11111851
                38784234
                53bd5da2-470f-4200-859c-ae18cd29ea1f
                Copyright © 2024 Hesmert, Klocke, Stolz, Huber, Samstag, Hübner, Simmet, Syrovets, Joos and Valentini.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 28 March 2024
                : 23 April 2024
                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 60, Pages: 10, Words: 8335
                Funding
                The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The survey was conducted by AZKIM (Academic Center for Complementary and Integrative Medicine) and was funded by the Ministry of Science, Research, and the Arts in Baden-Württemberg.
                Categories
                Medicine
                Original Research
                Custom metadata
                Family Medicine and Primary Care

                complementary medicine,integrative medicine,healthcare professional,attitude,knowledge,needs,university hospital,germany

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