World Congress Integrative Medicine & Health 2017: part three

P245 Complementary and Integrative Medicine in nursing homes – effects on caregivers in a prospective, exploratory, comparative, two-armed cohort study Miriam Ortiz, Katharina Schnabel, Michael Teut, Gabriele Rotter, Sylvia Binting, Margit Cree, Fabian Lotz, Ralf Suhr, Benno Brinkhaus Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital, Berlin, Germany Correspondence: Miriam Ortiz (miriam.ortiz@charite.de) BMC Complementary and Alternative Medicine 2017, 17(Suppl 1):P245


Background
The use of dietary supplements (DS) is common among patients with dementia. Direct risks associated with DS use are for instance adverse events and DS-drug interactions. However, the impaired cognitive functioning of persons with dementia can be associated with indirect risk. The aim of this study was to describe the extent and risk structure of DS use of persons with dementia in ambulatory care.

Methods
We conducted a survey among 151 patients with dementia attending an outpatient memory clinic in Northern Norway. Study measurements included patient characteristics, cognitive-and ADL-functioning (activities of daily living), and use of DS and prescription drugs (PD). We assessed direct risks by evaluating potential DS-drug interactions and indirect risks by evaluating conditions of use.

Results
Forty-six percent (n = 70) of the patients used DS. Ninety-seven percent (n = 147) used PD. Eight potentially clinically-relevant DSdrug interactions were identified. While only 36% (n = 26) of the patients received assistance with their DS, 73% (n = 106) received assistance with their PD. Patients living alone were at risk of not receiving assistance, while patients who scored worse on cognitive and ADL-functioning tests generally received more assistance with both DS and PD. Only one-third of the patients and half of the caregivers were aware of the risks of side effects and interactions concerning DS use.

Conclusions
Patients with dementia use DS frequently. DS use may be associated with direct and indirect risks to patient safety as potentially clinically relevant interactions were discovered and DS intake was often unsupervised. Camerata-Florence; Careggi-Florence and Pisa. Preliminary data show that 78% of the patients were female and 22% male; mean age 56 years (35 -88) years.

Conclusions
A clinic of integrative oncology seems to give the possibility to reduce adverse effects of anticancer therapy and ameliorate the quality of life of cancer patients

Introduction
In 2003, the Homeopathic Clinic for Women at Campo di Marte Hospital (now Cittadella della salute) was opened in Lucca, Italy. Over a 13-year period women mostly with gynaecological diseases were followed up. Purpose This paper explores the socio-demographic characteristics, main complaints, most commonly used integrative therapies, and the clinical results of women presenting over this period. Methods An observational, longitudinal study was conducted on 1516 women consecutively examined from 2003 to 2015. The ORIDL (Outcome in Relation to Impact on Daily Living) was used to assess outcome. All patients were treated with individualized homeopathic treatment (single remedy), without excluding other integrative treatments when necessary.

Results
Patients mean age was 42 years, most were office workers (23.9%); 33.4% had already used conventional therapies and 38% homeopathic remedies. The most frequently observed gynaecological diseases for 54%of the cases were: menopausal disorders (21.6%) and menstrual irregularities (11.9%), and among non gynaecological diseases, psychological disorders (12.9%). A homeopathic prescription was followed by herbal therapy for 42.2% of the patients with menopausal disturbances; 53.6% women with gynaecological problems, received follow-up and 38.1% were women with menopausal disorders. An improvement was obtained in 74.1% of the patients; major improvement or resolution (ORIDL = 2, 3, 4) was seen in 61.2% of the women, 66.9% of these with menopausal disorders. Conclusion Homeopathic treatment was sometimes integrated with diet, botanicals, and psychological counselling, and support in psychopathological conditions, and demonstrated positive therapeutic effects, particularly for women with menopausal disorders.

Methods
FMEA is a proactive risk management tool organized into seven steps: selection of the clinical process to be analysed: organization of a multidisciplinary group of experts; description of the process; identification of Failure Modes (FMs) for each step; estimate of the frequency, severity and detectability of the FMs; calculation of the Risk Priority Number (RPN); prioritize the improvement actions to prevent the FMs. Moreover, a clinical audit must be performed at least for the most complex cases.

Results
In homeopathic clinics, the highest RPN focused on the decision to switch from an allopathic to a homeopathic therapy, possible solutions required coordination with other specialists involved in the care process for complex cases. In agopuncture major problems could arise from the modalities of needle insertion.

Conclusions
Our experience demonstrates that an in-deep analysis can reveal potential risks for the patients as well as the priorities for improvement actions to be taken in order to guarantee a safe and reliable service in homeopathic medicine. Besides, this technique proved to be sustainable in terms of time and use of resources. According to our experience, the application of FMEA is recommended in CM after a basic patient safety training program.

P254
Establishing a concept of integrative care in a pediatric oncology unit of University hospitalchallenges and changes Britta Rutert 1,2 , Angelika Eggert 1 , Georg Seifert 1 , Wiebke Stritter 1 , Christine Holmberg 2 , Alfred Längler 3 1 Pediatric Oncology, Charité University Hospital, Berlin, 10117, Germany; 2 Institute of Public Health, Charité University Hospital, Berlin, 13353, Germany; 3  The treatment of cancer in children has shown to have high success rates, but is often accompanied by physical and emotional episodes of pain and suffering. Biomedical medication may be able to release the pain but does have little positive effect on the suffering. Suffering may rather be relieved by more integrative methods of treatment. Anthroposophic treatment has proven to be helpful in the reduction of pain, sleeplessness or nausea. By applying these methods touch and affection will be re-integrated into care and may thus reduce feelings of fear in children and provide contentment in nurses. The aim of a project at a German university hospital is to implement anthroposophic care into standard care in pediatric oncology by developing and implementing an integrative care concept. The leading question is here: what are the challenges, and chances, of implementing an integrative concept of care in a pediatric oncology hospital? Method By using ethnographic research and qualitative as well as quantitative data, the study first analyzed the status quo of care at a pediatric oncology unit. Based on this mixed-method approach, a concept was developed to implement anthroposophic care into the care unit at a pediatric care hospital.

Results
First results have shown that nurses, patients and parents feel constraint by the tightly structure care, which hardly allows for the engagement with the patients beyond the necessary. Anthroposophic treatment may re-instigate touch and affection without making demands on additional time in care.

Conclusion
Integrative care may be regarded as beneficial by nurses, patients and parents. The implementation of integrative care, however, is not easy in a setting, which is dominated by time pressure, economic budgeting and lack of nurses. The widespread and continuing use of CAM among Western patients will affect public healthcare delivery and doctor-patient communication for the foreseeable future. Studies have shown that doctor-CAM user communication often is challenging for both doctors and patients. We hypothesized that differing risk understandings may represent an important factor in this picture, and conducted a study on lay and medical risk perceptions and their possible implications. "Perceived risk" was here understood from a social science perspective, as based on a variety of factors involving individual experience, cultural beliefs, social practices, attitudes, and values. Methods Twenty-five Norwegian CAM-users diagnosed with cancer or multiple sclerosis and 12 of their doctors (five general practitioners, four oncologists and three neurologists) participated in qualitative, individual in-depth interviews.

Results
Most of the CAM users perceived CAM as "natural", "green"and "not involving risk". The doctors found such risk understandings difficult to discuss,because they differed fundamentallyfrom medical risk understandings based on science and clinical experience. From the CAM users' perspective, the doctors often acted arrogantly and not patient-centered. In the research interviews, however, the doctors expressed many "patient-centered" concerns for patients who choose to use CAM, such as delay of importantconventional treatment, quality of life for cancer patients hunting for a cure, and possible economic burdens for patients and their families. Their concerns were most often not discussed with the patients, mainly because the doctors were unsure whether they as doctors in the public healthcare services should engage in these issues.

Conclusions
Currently, gaps in lay and medical risk perceptions seem to represent barriers to well-functioning doctor-CAM user communication. Recent white papers describe "the patients' healthcare services", which for many patients includes CAM use. This study suggests that doctors have many concerns for patients who use CAM, and that the health authorities should clarify whether or not doctors shall actively relate to patients' CAM use in clinical encounters. If doctor-CAM-user communication includes both lay and medical views on risk and CAM, the goal of comprehensive patient care is within reach also in a patient safety perspective. Question Non-pharmacological interventions (NPI) have known benefit for physical and psychological health and quality of life (HRQL) in breast cancer patients. The aim of this pivotal study was to explore the association of breast cancer and the application of NPI in a multimodal integrative oncology setting.

Methods
Clinical and demographic data from the Network Oncology registry were analysed for 5.046 patients with breast cancer versus 11.469 patients with other cancer entities. The free statistical software R was utilized for logistic regression investigations.

Results
The median age of breast cancer patients was 54 years. Adjusted multivariate regression analysis revealed that breast cancer patients twice more likely choose educational programs (OR 2.09, 95%CI: 1.72-2.54, p < 0.00001) and less likely choose breathing (OR 0.33, 95% CI 0.26-0.42, p < 0.00001), nursing (OR 0.50, 95% CI: 0.42-0.60, p < 0.00001) and art therapies (OR 0.81, 95% CI: 0.68 -0.97, p = 0.022) compared to other cancer patients. The likeliness of choosing Viscum album L. (VA) was higher in breast cancer patients compared to patients with other cancer entities (OR 1.23, 95% CI: 1.11 -1.36, p < 0.00001). Enhanced application of massage and psychotherapy and less utilization of movement therapies was not dependent on whether patients had breast or other cancer.

Conclusions
Our results show that breast cancer patients are substantially interested in educational integrative programs. Further, the utilization of psychooncological supportive programs and massage is equal in patients with breast cancer or other cancer entities. Physicians knowledge on entityspecific application patterns of NPI might be a key to improve HRQL in cancer patients.

P257
Identifying the homeopathic simillimum: rubrics and the inner knowledge of the patient Irene Schlingensiepen Institut für wissenschaftliche Homoeopathie, Berlin, 13505, Germany With the concept of the simillimum, homeopathy has been advocating a highly individualized medicine from its beginnings. Allopathic medicine has built much of its reputation on its success in the treatment of acute, life threatening diseases with antibiotics and surgery as prominent examples. Similarly homeopathy had many of its early great successes with the treatment of acute infections and epidemics. Today, with higher life expectancy medicine faces the challenge of an increasing number of chronic diseases, which call for more and better individualization of therapeutic approaches. Objective In the case of homeopathy this translates into the challenge to be ever more precise and patient-specific in finding the optimal simillimum which mirrors the totality of the patient's physical, mental and emotional uniqueness. Such an all-encompassing similliumum should ideally fit in all rubrics of a remedyif it is well proven. Method In our practice we systematically tracked and compared different methods of identifying a patient's simillimum with patient outcomes over 20 years.

Conclusions
Our findings show that lasting therapeutic results using a single remedy can be regularly achieved with a true simillimum remedy. Patients for whom a truly perfect simillimum according to rubrics could be identified and who did not know, which remedy they were taking, could consistently identify the source of their remedy using associative interviewing techniques. This led to the unexpected discovery that the potential knowledge about the source of each patient's simillimum lies within the patient and can be brought to light using adapted interviewing techniques. For the pilot phase of an integrative pediatric program, we defined inpatient treatment algorithms for bronchiolitis, asthma and pneumonia, using medications and nursing techniques from anthroposophic medicine (AM). Parents could choose AM treatment as add-on to conventional care. We aimed to evaluate the 18-month pilot phase.

Methods
Parents of AM users were asked at discharge to complete the Client Satisfaction Questionnaire (CSQ-8) and a questionnaire on experience with the AM treatment; patient charts were analyzed; and economic data for staff training, medications and insurance reimbursements were collected.

Results
A total of 351 children with bronchiolitis, asthma and pneumonia were hospitalized. Of these, 137 children (39%) received AM treatment, with use increasing over time. 52 parents completed the questionnaire, 27 (54%) had never used complementary medicine for their child. Mean CSQ-8 score was 29.77 (95% CI 29.04 to 30.5) which is high in literature comparison. 96% of parents were mostly or very satisfied with AM; 96% considered AM as somewhat or very helpful for their child; 94% considered they learnt AM care skills to better care for their child in the future; 87% thought they received sufficient information about AM. Cost for staff training and medications was nearly covered by AM related insurance reimbursements; no additional staff positions were created.

Conclusions
Introduction of complementary treatments as part of an integrative concept in a Swiss pediatric hospital department was well accepted and led to high parent satisfaction. Cost was compensated by additional insurance reimbursements. Question A mental pandemy of psychosomatic disorders (PD) is consistently developing and requires new effective approaches to prophylaxis, early diagnosis, treatment and care.

Method/theory
We have developed a synergetic bio-psycho-socio-spiritual concept of PD that is represented by a four-dimensional model consisting of vectors of somato-and psycho-, socio-and animogenesis. Animogenesis is a term that integrates understanding of soul and spirit and represents the central fourth part of the proposed ontogenetic model. The vectors are interrelated and determine transit zones with a central part containing conscience.

Results
We propose a synergetic concept for PD development with identified there prenosological stages: predisposition -a psychosomatogenic family, latent -psychovegetative diathesis, initial -a functional disorder and three nosological stages: full-scale clinical picture, chronic phase and outcomes. Based on the concept we have developed a multidisciplinary program of care for patients with PD, which includes four sections: medical, psychological, spiritual-moral and social. Preventive measures are implemented in the first three prenosological stages, treatment and rehabilitation -in the three nosological stages. The protocol is realized by a team composed of a general practitioner, psychotherapist, clinical psychologist, social worker and bioethics specialist. The model presupposes a multidisciplinary and integral approach to complex psychosomatic cause-effect relationships in the course of the disease. The proposed methodology makes it possible to formulate clinical, psychological, social and moral diagnoses resulting in a synergetic functional diagnosis.
Since pre-term contractions are highly correlated with preterm delivery, the most common cause of neonatal mortality and morbidity, their inhibition by tocolysis is crucial. Several experimental data and a matched-pairs retrospective study revealed the potential of Bryophyllum pinnatum (BP), a herbal medication used as a tocolytic agent in anthroposophic medicine. Colorectal cancer has been recognized as a tumor of high incidence worldwide, radical resection in combination with radiotherapy or chemotherapy is commonly used in clinical treatment, while postoperative metastasis and relapse are the leading causes of death after radical resection, especially hepatic metastases. The key and difficult points of prevention and treatment are still the postoperative metastasis and relapse. Traditional Chinese medicine (TCM) plays a very important role in prevention and treatment of colorectal cancer. Preliminary studies found that TCM and western medicine combination was of high clinical value in reducing the postoperative metastasis and relapse of stage II and III colorectal cancer. The protocol established in this paper aims to further evaluate the effect of Chinese medicine in prevention and treatment of colorectal cancer after radical resection, and analyze the demographics of the patients who can benefit from the treatment and those who can't, as well as discuss the possible mechanism of action. This study adopts the method of multi center prospective cohort study,We enrolled patients with stage II or III colorectal cancer, and screened 200 patients within 6 months after resection, and they were, according to their own will, given or not given TCM decoction (once daily) based on routine western medicine treatment . Then we followed up these   patients up to 3 years, we are going to have a qualitative study of  the subjects with relapse and metastasis after surgery for stage II and  III colorectal

Methods/Design
This trial is designed as a multi-center, randomized, double-blind, placebo-controlled trial. 100 Korean nulliparous women aged from 16 to 40 years with primary dysmenorrhea and regular menstruation will be recruited, and randomly allocated into true or sham acupuncture group. Acupoints used in both groups are Zulinqi (GB41), Houxi (SI3), Zutonggu (BL66), and Qiangu (SI2) on right side using "small intestine excess method". Both groups will receive treatment twice a week for 3 menstrual cycles and have additional 3 cycles without treatment for follow-up. The primary outcome is subjective pain severity measured by Visual Analogue Scale. The secondary outcomes are pain characteristics, quality of life measured by Short Form McGill Pain Questionnaire, Retrospective Symptom Scales, Short-form 36 health survey, and serum prostaglandin level. The safety of acupuncture will be assessed at every visit.

Discussion
We expect that Sa-am acupuncture could help patients who are unsatisfied and have side effects with conventional medications. This trial will assess the efficacy and safety of Sa-am acupuncture on primary dysmenorrhea and aims to provide reliable clinical evidence in treating primary dysmenorrhea.

P263
The effects of pre-period acupuncture with heat-tonifying manipulation in dysmenorrhea patient Yuhao Wu 1 , Yumin Endometriosis and adenomyosis are mainly characterized by progressively aggravated dysmeorrhea. In addition, adenomyosis is often accompanied by delayed period and menorrhagia. From the perspective of traditional Chinese medicine, secondary dysmenorrhea is attributed to stasis in thoroughfare (Chong Mai) and conception (Ren Mai) vessels. Heat-tonifying manipulation is a method to remove the stasis by producing the warmth in local area and promoting the needling sensation travelling along channels or spreading to nearby area. The purpose of the present study is to observe the effects of pre-period acupuncture with heat-tonifying manipulation on CV4, SP6, BL17, BL 32, and Ashi acupoints in dysmenorrhea patient. Three patients aged 29, 34 and 35, have been diagnosed as dysmenorrhea for more than 5 years with endometriosis and/or adenomyosis. All the patients had been treated by acupuncture with heat-tonifying manipulation and needles should be retained for 20 minutes for 4-7 times, 3 times a week, before each period for three menstrual cycles. As the results, after the pre-period acupuncture with heat-tonifying manipulation, all the patients have remarkably relived pain in pelvis and lower back during the menstrual period. One patient shows less menstrual blood volume and another one shows the menstruation that is more regular. In conclusion, puncturing CV4, SP6, BL17, BL32 and Ashi acupoints with heat-tonifying manipulation can remarkably alleviate pain and simultaneously relieve menorrhagia. The frequent treatment just before each period is more effective and the treatment requires retaining the needles for longer time.

P264
Development of a mobile application in conjunction with a web service for personal health records regarding atopic Purpose Although a myriad of mobile applications that provide health or medical information have been developed for various diseases including atopic dermatitis (AD), most of them are not used by physicians in clinics. Usually they are used by patients themselves only to record their symptoms or get information about diseases. The purpose of this study was to develop a smart system which can record and retrieve medical symptoms and clinical information generated in daily life in order to connect physicians and patients and to enhance the quality and the efficiency of medical care.

Methods
Task force team consisting of three physicians and two developers has developed the system. Patient centered informatics tool for AD was developed by implementing a mobile application to collect daily information related to AD from patients and a web service to assist physicians for retrieving and integrating symptom information. User interface of mobile application was designed under consideration of convenient daily input. On web service for physicians, visualization and tabulation of the time-series recorded symptoms were designed based on the practical need of physicians. The developed system has been evaluated from July 2015 to August in clinical situation.

Results
The smart phone application, Atopy Mobile Note, has been registered in Google Play Store from March 2016. Patients can record AD score, episodic events of their illness, food diary, treatment and management diary using their mobile devices. Recorded information is saved in database of central server immediately. Physicians can retrieve a sequence of records in the clinic using web service program.

Conclusion
We have developed an mPHR application for patients and corresponding web service for physicians. To take advantage of this system in health care will require more research to find out how much it actually more beneficial to patients and/or physicians.

Methods
There are three phases in this mixed method study. Firstly, a usability study of the synopsis will be conducted using iterative cycles of testing with CMPs. The System Usability Scale (SUS) will be used for usability testing of synopses. This helps refine the writing format of synopses which will be uploaded on the open access website. Secondly, a randomized controlled trial of education on EBM and related methodology to CMPs will be conducted. Lastly, targeted messaging of clinical evidence synopses with quality of evidence grading to CMPs will be performed over 10 weeks. A mixed model analysis of outcomes will be performed based on the intention-to-treat principle in this study.

Expected results
This will be the first study establishing bilingual website dedicated clinical evidence on Chinese and Integrative medicine; investigating the effectiveness of EBM education and target messaging of clinical evidence synopses among CMPs. Chronic pain is increasingly recognized as a public health problem. This is especially so in the rural Appalachian region of the United States. An interdisciplinary approach to provider education is needed to empower medical professionals to make deliberative changes, especially in opioid prescribing practices.

Methods
Enduring webcasts, regional inter-professional roundtable events, and state-level conference presentations addressed behavioral factors in pain, use of alternative treatments and new treatment guidelines. Effectiveness of these activities was based on pre-and post-measures, as well as comparison to a control population, on: provider's intentions to change their care of chronic pain patients, confidence in meeting chronic pain patient's needs, and knowledge of pain management guidelines.

Results
Over 1,000 participants accessed the educational activities. For live events, the largest groups reached included nurses (38.1%), nurse practitioners (31.2%) and physicians (22.1%). A majority of conference (58%) and roundtable (69%) participants stated that they intend to make a change in practice in one or more areas related to chronic pain patients and opioid use. Participants were more confident postactivity intheir ability to change practice and.there were significant changes in knowledge from live event as well as webcasts.

Conclusions
The approach and methodology to interdisciplinary professional chronic pain education was shown to impact learner's knowledge and confidence, and holds potential for creating change in how opioid prescribing is managed.

P271
The Simonton- Dr. O. Carl Simonton, an internationally acclaimed oncologist pioneered the field of psychosocial oncology and is well known for the first systematic emotional intervention used in the treatment of cancera model of emotional support for the treatment of cancer patients which is considered to complement the medical treatment. As a psycho-oncologist, Simonton Counsellor, Supervisor and Trainer I was one of Carl Simonton`s closest team members and got his authorization to continue his training concept in Germany, Switzerland, Italy, Belgium and the Netherlands. I would like to provide deeper insight into this unique therapeutic approach, which may be described as a cognitive-behavioral self-help therapy for cancer patients and their support persons. The therapy directly addresses all spheres of human existenceemotional, cognitive, behavioral, social and spiritualintegrated in an internally consistent program, based on modern learning theory as well as ancient teachings. Our strategies include individual, group, family and social counseling as well as education in self-help skills. We focus on individual resources to support patients and their support team in gaining joy, increasing hope, trust and peace of mind with uncertainties in life. We work with guided imagination, meditation and mental tools for changing unhealthy beliefs. The clients are invited to reflect about the things that are helpful for them and to give priorities to their health. They learn how to increase awareness for their feelings and needs and get support to follow their own inner wisdom and realize changes in their life to live according to their own nature.

P272
Training in anthroposophical medicine at the University of To learn how to accompany heavy treatments whenever necessary (supportive treatments).
These courses aim to respond to a need for a deeper qualitative professional approach for the benefit of patients. This approach is complementary to all conventional therapies. , a nonprofit legal entity of private law, considered as Federal Public Interest, located in the city of São Paulo, Brazil, has a health department that has been developing an education program concerning the practice of spirituality for health professionals. So far, it has provided knowledge to more than 500 people. Despite the relative success of this action, it was concentrated and limited to a specific audience: professionals with higher education, graduated in several fields of health. In order to meet the interests of a wider audience with no specific training, the health department has developed and implemented in early 2014, a space of spiritualty practice learning in order to promote quality of life and integral health entitled "Dialogue about spirituality and health". This transdisciplinary educational activity takes place on a monthly basis at the headquarters of MOF. With a two-hour duration, the "Dialogue" comprises two stages: the first, lasting thirty minutes, consists of a theoretical explanation based on scientific literature searched in database such as PubMed, SCIELO or WEB OF SCIENCE. During the second step, a dialogue among participants is conducted and encouraged, in order to facilitate knowledge and experience exchange. Until October 2016, 24 events have been held with an attendance of about over 1,000 people. Since the october of year 2015, events have also been broadcast through the Internet, in real time, reaching viewers in several Brazilian states and even those from other countries like USA, Canada, Japan and Germany.

Conclusions
With an audience of different age ranges and backgrounds, from different cultures and religious rites, the "Dialogue about Spirituality and Health" has strengthened itself as a democratic experience of teaching and discussion on the practice of spirituality in order to promote quality of life and integral health.

P275
The In the municipality of San Carlos, the domain is also fairly fragmented, with an important area is located on the campus of the Federal University of São Carlos (UFSCar). Because of the heterogeneity and the specific morphological features, the Cerrado flora presents great medicinal potential, widely disseminated in popular culture.

Methods
In order to get to know medicinal plants of the Cerrado of UFSCar on the optics of the popular healers knowledge in the region, a tour guided in the area and a semi-structured interview (discussing, among other issues, aspects of culture and conservation) in order to contribute to the enhancement of knowledge and local vegetation at a time where the National Integrative Practices Policy and the movement of Popular Education (intensely connected to the traditions and herbs) gain space in the city.

Results
The healers easily identified a significant number of medicinal plants at the place of study, even without prior knowledge of the area. This reveals a precious wisdom about herbs, which extrapolates the herbal issues itself and expands cultural and environmental aspects.

Conclusions
The results obtained revealed the deep knowledge of the healers and the importance of conserving the Cerrado area of UFSCar as a source of studies on medicinal plants in the State and in the Country. The appreciation of the popular regional knowledge and local flora are aspects essential to the strengthening of Popular Education in Health and Integrative Medicine movements. Explaining the priorities of the field of Integrative medicine could be thoroughly enriched through the updated understanding of classical theories in textbooks of Traditional Chinese Medicine (TCM). There are strengths and weaknesses in the methods that could provide a vehicle for the transfer of ancient expert knowledge to the modern research, which is essential for the benefit and quality improvement of the integration process. Scientific studies of TCM are sustaining such evidence through the follow up of neurotransmitters secretion in central and autonomous nervous system (ANS). Maintenance of the body posture is very useful clinical approach in various kinds of patients, resulting in removal of blood and extracellular fluid congestion and improved feed-back loop of autonomic nerves signaling. Application of electrical stimuli and cupping therapy on viscerotomes shows ample clinical improvement of well being among cancer patients. Viscerotomes are important feed -back loop regions to observe, follow and restore functioning of their pertaining organs. ANS signaling, through the paravertebral ganglia and periaqueductal grey matter reflects congestions of extracellular fluids as well as various visceral disturbances. Those changes are common cause of increased tonus in paravertebral muscles, which impedes stagnation of extracellular fluid.Main purpose of poster presentation is to explain the correlation between Extraordinary, Small Intestine and Urinary Bladder vessels, body posture, body fluids and diet for the restoration of ANS disturbances. Degeneration of vertebral cartilage, fascia or accompanied adjacent connective tissue can slowly compress the vegetative nerves (which is, contrary to compression of sensory nerves, painless), and finally disturb the autonomous regulation of visceral signaling to the brain stem nuclei, especially solitary tract nuclei. Lifestyle changes, exercises and individualized dietary recommendations are to be explained in addition to ongoing treatment strategies.
Balancing ANS is feasible approach as a support for various health disturbances, many health and disease conditions.Ample clinical evidence shows that we should pay more attention and higher priority to this aspect of TCM in described clinical treatment. In order to recognize, treat and improve methodology of clinical follow up or in prospective studies in the field of Integrative Medicine. to be sufficiently exposed and appropriately trained in their use.

Methods/Results
The integration of the use of PROMs into a student clinic within a CM educational institution has been undertaken through a process designed to ensure students, supervisors, researchers and the institution gain maximum value from their inclusion. The outline of the process undertaken to implement PROMs within six different clinical sites and four clinical disciplines across Australia for the Endeavour College of Natural Health will be explained. The pros and cons of the implementation and lessons learnt will be examined.

Conclusion
PROMs are a valuable tool which can be implemented into student clinics in a CM education institution. By utilising these tools, students and supervisors can gather important information pertaining to the outcome of the health intervention used for patients. Moreover, as PROMs are validated instruments they afford the student the ability to publish case studies or case series in peer reviewed journals, thereby supporting research evidence and research capacity within CM. Certain PROMs, such as the Euroqol5D, can also assist in economic cost-benefit analysis. PROMs are important clinical tools for health practitioners and exposing student to PROMs during their clinical training assists them in understanding how to use these tools, why they are important, and how to incorporate them in their clinical setting post-graduation.

P278
The To present the importance of developing consciousness about "health and integrative medicine" in education process of professional massotherapists in Porto Alegre City, Brazil. Method Case report.

Results
Rio Grande do Sul is one of the 27 states of Brazil. Located in the south of the country, it has an area of over 280,000 km2 and a population of over 11 million residents, and the city of Porto Alegre is its capital. In this context was raised the "Sistema Educacional Gaucho" (SEG), with the proposed construction of a solid education system, with a standard of quality focused on education, which calls for educational work structure facing a commitment to awaken the student the sense of collective, social, preparing man for the "think -act -be" inserting and engaging in turn, interact actively in society. Encourages students to live effectively in society, not being mere spectators, but talented actors and excellence in the performance of their actions, leadership, decision making in collective processes. Its courses are organized considering the competences required by the labor market, social, economic and political, so that the student at the end of their qualification and training has a systemic and integrative view. Among the courses offered by SEG is technical in massage therapy, which aims to train professionals for the development of massage techniques that can work with esthetic, therapeutic, manual lymphatic drainage, shiatsu and sports massage recovery, and other integrative techniques like argil therapy and auriculoacupuncture. In its formation there are disciplines that directly address the issue of health and integrative medicine as a discipline " Complementary Therapies " and " Personal relationships ", discussing the importance of the development of this way of thinking as a new care paradigm to the human being in his various dimensions and transdisciplinary way. Complementing the theory, students undertake consultations at public events with several other integrative therapies in addition to massage, such as reflexology, moxibustion, shiatsu therapy and aromatherapy. In the past two years (2015 and 2016) were met over a thousand people with these techniques.

Conclusions
From theory to practice, which is the service to the population, students have the chance to experience the importance of integrative medicine in the development of whole health; the experience of direct assistance to human underscores the consciousness that the therapeutic of integrative medicine go far beyond the technical skills, particularly understanding the essential humanity of the true care. Question Prostate cancer is the most common male cancer in the UK. There is presently no national screening programme for prostate cancer in the UK although asymptomatic patients are increasingly being diagnosed earlier following Prostate Specific Antigen (PSA) testing. Recent developments in the management of localised prostate cancer include the increasing use of active surveillance (AS). With both PSA testing and AS being increasingly managed by General Practitioners (GPs), prostate cancer is an important health problem in primary care. The aim of this study was to 1) better understand GPs views on PSA screening and to establish what additional support could be given to GPs in order to help manage asymptomatic men requesting PSA tests and 2) to investigate GPs understanding of the use of AS in the management of localised prostate cancer and to establish any additional resources that could be provided to better manage these patients.

Methods
Twenty telephone interviews were conducted with practising GPs recruited from the primary care research network in the UK. Interviews were semi-structured but an iterative approach was taken, allowing emerging areas to be explored. Interviews were digitally recorded and transcribed verbatim, after which transcripts were analysed using a thematic approach.

Results
There were two overarching themes -1) PSA testing in asymptomatic men and 2) the management of localised prostate cancer with AS. PSA screening in asymptomatic men was not advised by GPs with many giving the potential need for further invasive investigations as a main disadvantage. Main areas of interest for AS were the need for clear guidelines on the management of AS in primary care, confusion over responsibility for different aspects of AS and the importance of communication between primary and secondary care.

Conclusion
With the increasing incidence of prostate cancer it is important to appreciate the role of primary care in managing these patients and to understand any areas that could be improved.

P282
Social network and healthcare seeking behavior in urban communities: A pilot study on using Traditional Chinese It is widely documented that health care usage is associated with the characteristics of social networks involvement. However, the theoretical hypothesis had seldom been empirically confirmed in epidemiology studies. This study was designed to identify individual social network types among residents of urban communities of Beijing, and examine the relationship between social network type and health seeking behaviors, mainly focused on the usage of Traditional Chinese Medicine (TCM).

Methods
Our study was approved by the ethics committee of Beijing University of Chinese Medicine before initiation. Therefore, A pilot study was carried out from June to August in 2016. Samples were selected from Changying neighborhood committee in Chaoyang district of Beijing, China. Data capture in questionnaire included demographic information, social and economic status, healthcare seeking behaviors, and characteristics of individual social networks. According to the theory of Blau and Duncan, we classified social networks into two types: inborn and afterwards networks. Influenced by the strongweak tie theory of Granovetter, we also explored the effects of strong and weak ties on health seeking behaviors.

Results
Totally, 38 participants completed the questionnaire. 22 of them are male. The average age was 42 ± 5. The average size of social networks which had been considered to be related to healthcare behaviors was 6. Social network type was significantly associated with several health seeking behaviors, after controlling for background characteristics. We also found that elder residents would more likely to use inborn social networks when seeding healthcare than younger people. But, they were more likely to believe the advices from weak ties when making decisions on medical affairs.

Conclusions
This pilot study highlights the importance of social networks on healthcare seeking procedure. Family and peer education based on communities were still needed to promote individuals knowledge, attitudes and behaviors on TCM.

P283
The analysis of communicate apprehension in students of TCM speciality and affecting factors Nanqi Zhao 1  Although Avicennas explanation of each step is based on the theories and principles of his time (humors, elements, and temperaments), but his logic holds still true today in light of our modern explanatory models of health and disease and scientific discoveries. In the present day protecting child from endless germs and viruses is the need of hour. Some pediatricians consider in a year six to seven bouts of flu or ear infections in children are normal. But there are healthy habits by which the childs immunity can be boosted and reduction in episodes of illness can be achieved. Adequate sleep, nutrition, regular exercise, hygiene maintenance, being away from allergens and germs are the good practices which can reduce the morbidity and boost the immune system. One such practice is Swarna Prashana explained in ancient literatures of Ayurveda which enhances the healthy status of child. Hiranya PraashTM is a patented, research product designed and developed by Dr. Krishna Life Science Ltd., Manipal. It is safe, natural rejuvenative with the power of gold. Pure gold is processed with selected organic, bio-active herbs by using patented techniques. Material and Methods: 1. An assessment of Cell mediated immune function by delayed type hypersensitivity (DTH) test. 2. Survey was carried out in various centres related the institution and hospital. 104 children randomly assessed for clinical study. 2 drops of Hiranyaprash™ administered to the children below the age group of 5 years and 4 drops administered above the age group of 5 years. The survey and clinical assessment was done and data obtained was analyzed statistically.

Conclusion:
1. Study has proved immune stimulant activity of Hiranyapraash. 2. It is found to be Hiranyaprash™is beneficial in preventing the respiratory manifestations and beneficial in increasing the appetite of children. Analysis of data on behavioural assessments shows high statistical significance in parameter school work performance and subject understanding ability.

P288
Al-Zahrawi, the first physician who described dysmenorrhea Embase were searched to use the experiences of other researchers and find published articles in this regard. The results were categorized under 12 categories. Generally, although there are considerable similarities between theory and functions of Arkan in TPM and theory of five elements in TCM. There are differences between the basic principles and the outcomes of both theories. Comparison between these theories shows that the source of both in philosophy are the same. TPM arises from a monotheistic (not necessarily Islamic) viewpoint while TCM comes mostly from a metaphysical point of view. Furthermore, there are four principles in TPM but five in TCM. In addition, principles in TCM and TPM differ as follows: while in the former, the principles (having interactions in a dynamic process) are assumed to be directly related to phenomena, in the latter, they are explained with the mediated concept of Mizaj.

Introduction
Menstrual pain or dysmenorrhea is the most common cause of pelvic pain that followed by many consequences and it has remained as a health problem. This study compared menstrual pain in Traditional Persian Medicine (TPM) vs currentmedicine.

Methods
This study investigate definitions, etiologies, manifestations and prognosis of menstrual pain in TPM references, Gynecological textbooks and databases through multiple and associated keywords. Then the findings were compared.

Result
Menstrual pain is called "usr o tams" in TPM. Usr o tams is divided into primary and dependent based on the delay or no delay in puberty. On the other hand, Dysmenorrhea is divided into primary and secondary based on the presence or absence of pelvic pathology. Risk factors of both points are similar, but "mizaj" in TPM view of point is important, too. Etiology in both views is reduction of uterine blood flow due to uterine vessel stenosis, while TPM's references has explained blood viscosity due to phlegm ("Balgham") and black bile ("Sauda") as another cause of reduction in uterine blood flow. In TPM, manifestation is divided into first and second degree that they are in accordance with the main symptoms of dysmenorrhea and premenstrual syndrome, respectively. Conclusion Separation of primary and dependent usr o tams with history is the first step of managing the menstrual pain. The second step is separation of primary and secondary dysmenorrhea by history and ultrasonography. The cause of primary dysmenorrhea should be investigated that uterine vessel stenosis or blood viscosity. Blood viscosity explains unknown reasons and lack response to treatment of dysmenorrhea. Human body is an extremely complex system and it is so simplistic to think that an active agent working on a single receptor is enough for an optimal clinical response. There is a growing body of evidence shows the necessity for shifting to a multitarget approach in the field of drug discovery. Traditional medicines which have holistic viewpoints in maintaining the overall balance of the body usually put forward such approach in their drug formulations as suggested in systems biology. It may be the reason of recent more interest of pharmaceutical companies for research in traditional medicines. Nonetheless, it has its own troubles; multicomponent formulations, possible toxicities, and lack of our knowledge regarding their mechanism of action are some of the obstacles. Understanding the concept of ameliorations -which means modulation of the effects and/or counteracting the side effects of ingredients of a compound formulation by one of its constituentsmentioned as Musleh in Traditional Persian Medicine and jun-chen-zuoshi in Traditional Chinese Medicine, could pave the way for further researches in this field. Question Fracture repair is a complex process. An inappropriate diet is a contributing risk factor in the non-union of a fracture. The aim of this study was to extract dietary recommendations for fracture healing from literature on traditional Persian medicine (TPM).

Methods
The content relevant to diet in fracture healing was selected from the main textbooks in TPM, like Al Qanon fi Al-teb (The Canon). Other reference textbooks in traditional medicine were used to achieve a comprehensive study in this respect. Finally, content analysis was used to summarize and describe the results.

Results
Foodstuffs are classified in TPM according to their nutritive value, their assimilability, and the quality of achieved chyme. Some light meals like chicken soup are recommended for the early days of fracture, while high-nutrient and dense foods such as goats or sheeps head and nuts are advised on the following days for acceleration of fracture healing and callus formation. Several recommendations are also provided for pacing the healing process.
Conclusions A comparison of the regimens recommended by Avicenna and other Persian sages with recent evidence revealed the potential positive effects of their regimen for acceleration of bone healing. This study can shed light on a part of the history of orthopaedics, and add to current knowledge about bone fracture and its management.

P294
Shuxuetong injection for ischemic stroke: An overview of systematic This overview is to summarize the systematic reviews (SRs) of Shuxuetong injection for ischemic stroke (IS), and to evaluate the methodological quality and the current evidence of these SRs.

Methods
We searched six databases (including CNKI, Wan Fang, VIP, SinoMed, Cochrane Library and PubMed) until October 2016, and included the SRs of RCTs concerning Shuxuetong injection for IS. AMSTAR scale was used to evaluate the methodological quality.

Conclusion
Maybe there have marked advantages about Shuxuetong injection for IS, but we should more high quality studies to make a judge. We can report reviews according to AMSTAR scale for a standardization report.
And the experts of evidence-based medicine should carry out more training courses about the methods of clinical research and SRs.

P295
Xingnaojing injection for ischemic stroke: An overview of systematic

Conclusion
Xingnaojing Injections for IS may have marked advantages; however the methodological quality of the reviews was awful and there need more high quality studies to make a judge. Whats more, researchers should report more outcomes about the endpoint indicators (e.g. the cure rate, response rate and disabled rate, recurrence rate) and the outcomes closed to the patients (e.g. the quality of life scores and the economic burden).

Background
The Sami today are closely connected to the traditional folk medicine. Religious prayers of healing (reading) and the laying on of hands are examples of the methods that they employ. In this study we will examine the knowledge and attitudes among health personnel regarding traditional healing in areas where this is used, and how this knowledge affects their clinical practice.

Method
Semi-structured individual interviews (n = 32) and focus group interviews (n = 2) were conducted among health personnel in two Sami communities in Norway. The text data was transcribed verbatim and analyzed based on the criteria for content analysis. The codes were defined prior to and during the data analysis (mixed type). Six themes were identified.

Result
The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They were all positive to the patients' use of traditional healing. They justified their attitudes stating there are more things in heaven and earth, and they had faith in placebo effects of the treatment. The health personnel respected their patients' faith and facilitated the use of traditional healing. In some cases they also conducted rituals on patients who wanted this. In this way they changed their clinical practice.

Conclusion
The health personnel were positive and open-minded towards traditional healing. According to the informants reading was a tool that helped patients to handle illness in a good way. The health personnel changed their clinical practice to meet the needs of their patients. In this manner they could offer their patients integrated health services which were tailored to the patients' culture. . We manually searched the books that could not be found in the electronic system. All the items about childhood diarrhea were put into an excel for data extraction. We included the items that were associated with pediatric massage acupoints, manipulation and treatment prescription, and excluded those belonged to the etiology and pathogenesis, syndromedifferentiation or other treatments of pediatric diarrhea.

Result
Among all the 150 professionals who received the questionnaires, forty eight (32%) of them responded. Twelve ancient books were recommended by more than half of the respondents. With the electronic and manual search of theses twelve books, we detected 3,001 items, among which only 30 items were eligible for inclusion. All together, 29 acupoints or manipulations were mentioned, among which Dachang and Sanguan were addressed for ten times respectively. Several other acupoints, e.g. Guiwei (DU1), Qi (RN8), Shouyinyang, Pi, were mentioned from five to nine times.

Conclusion
The information we found from ancient Chinese books in this study may provide valuable references in helping the researchers or practitioners to decide which acupoints they shall put into consideration in regards of the pediatric massage therapy for children with diarrhea. The thermoregulatory control of skin blood flow is vital for maintenance of core body temperatures. Complete and proper functioning of the body is dependent on maintaining a body core temperature between 36.5 to 38.5°C. Thyroid hormones contribute an important role in control of the body temperature. The action of thyroid hormones, secretion of norepinephrine and the presence of free fatty acids activate uncoupling proteins in the skeletal muscles, that play role in the skeletal muscle heat production. The diagnostic approach and medical interventions in Traditional Persian medicine is very different with conventional medicine because of different basics.

Objective
We aimed to compare the concept of heat and its effects on health between conventional and traditional Persian medicine.

Results
According to literature, maintenance of the internal heat increases longevity in animals but human studies are scarce in this issue. Traditional Persian medicine sources, however, confirms the role of innate heat preservation on longevity and health. Despite the differences between traditional and conventional approach to the subject of heat and health, there are common views about the importance of maintaining the internal body temperature on homeostasis and health in human being.

Conclusion
We are about to open a new window to issue of body homeostasis according to traditional medicine resources hoping to provide a context for interested researchers in this field to put enormous potential of traditional medicine into practice by well-designed clinical trials.

Methods
We considered TPM texts like "Makhzan-al-Advyeh", "Tohfeh", "Exir-e-aazam" and, "teb-e-Akbari" searching for therapeutic effects of fennel and its derivative formulas. Then, we look for English and Persian databases including pubmed, web of science, scopous, google scholar, chocrain library, SID, Iran medex and, Magiran in order to find new published surveys in this field.

Results
The use of medicinal plants in the treatment of many diseases is in rise nowadays. Although therapeutic effects of plants have not been proven completely, patients' tendency toward the use of medicinal plants is remarkable. There is a long list of therapeutic actions in TPM books including pain killer, dieresis, anti-diarrhea, menstruation initiator and mothers' milk stimulating agent (  Starting from the premise that science has for too long been bound by disciplinary boundaries, this contribution outlines the conceptual similarities between integrative medicine and sustainable development (SD). It argues for taking advantage of this concurrence by suggesting a structured approach to understanding traditional healing systems (THS) through the lens of SD in the sense of a more holistic practice of medicine. Examining THS against the backdrop of SD shows that most bioscientific studies on THS restrict themselves to largely functional aims by scrutinizing isolated knowledge items to determine their applicability for allopathic medicine whereas comparatively few studies research THS in their own right.

Methods
Methodologically, an extended literature analysis determined the central contributions by anthropology, philosophy and sociology regarding understanding traditional knowledge. Subsequently, suitable generic dimensions were distilled and aggregated in a conceptual-analytical framework following Jabareen [1], Dowdig [2] and Stanley [3] and considering the normative principles of SD.

Results
The result consists in a generic framework on THS based on theories from philosophy, sociology and anthropology, consistent with SD and intended to facilitate access to principally any given traditional knowledge form by providing a set of leading dimensions and questions. Next to covering knowledge content and processes/skills, the framework also includes central complementing dimensions such as the knowledges social organization, its socially legitimized sources or the general life-world context.

Conclusions
A structured and social sciences-based approach to THS supports researchers and professionals from all disciplinary backgrounds in gaining a comprehensive understanding of a given THS with the aim of making the insights viable for advancing holistic approaches to medicine in the West. Purpose Jamu, a Javanese traditional medicinal drink consisting of local plant ingredients, is produced and consumed in Indonesia, both in the rural and urban areas, to treat a variety of diseases, including diabetes, cold, stomach ache, and a number of womens reproductive health issues. Jamu is mainly prepared and sold by local women. The study analyzes how jamu sellers perceive their role in the healing process of customers and their perceptions about jamu efficacy.

Methods
This study is based on an ethnographic study conducted in the city of Yogyakarta, Indonesia, where individual in-depth interviews were conducted with a group of 91 jamu sellers.

Results
According to jamu sellers, the healing process depends on the active ingredients of the drink itself and the capacity of the jamu seller to select and mix them. Interviewees emphasized how the reputation of the jamu seller plays a central role in determining the perceived efficacy of jamu by the customers. Jamu sellers recognize that they must appear physically healthy, which is attributed to an effective jamu recipe. The reputation of jamu is also linked to specific behavioural traits of the jamu seller, including smiling, appearing friendly, and being generous.

Conclusion
The concept of efficacy of traditional medicine is socially constructed, depending on the reputation of the jamu sellers, and inscribed into the existing gender roles of Javanese society, which places particular importance on specific physical and behavioural traits of women. Persian medicine (TPM). Many therapeutic effects were listed in TPM manuscript for marshmallow. Not only many of these effects were proved in classic medicine but also no significant side effect already were reaported. Some of proved effects of marshmallow were mentioned in TPM books and a lot of them are yet unproved Methods At the beginning of the study, TPM pharmacopeia references like Makhza-al-advyeh" and "tohfeh" and books of treatment like "Teb e akbari" and "ExireAazam"were searched for determination of marshmallow benefits. Then English and Persian databases including PubMed, web of science, Scopus, google scholar, cochrain library, SID, Iran medex, Magiran for effects of marshmallow and the results were compared.

Conclusion
Using of marshmallow as an effective and useful drug can be considered also further research for other therapeutic effects of it can be useful.

Introduction
Chronic tinnitus is a world-wide problem of high prevalence (5% and 15%) and socio-economic relevance that considerably impaired quality of life. While many different treatments are used in clinical practice, the evidence for their efficacy is low and the variance of treatment response between individuals is high. So there are other treatments required. This disease has been mentioned in ear diseases section of Traditional Persian Medicine (TPM) manuscripts and for it is considered causes, clinical symptoms and treatments according to principles of this doctrine of medicine. The aim of this study is to introduce the viewpoint of TPM scholars for the treatments of tinnitus. Methods TPM manuscripts like Canon were investigated for tinnitus and its treatments.

Results
Tanin is defined as the hearing of sound in the absence of a external acoustic stimulus. It is classified into two subgroup. 1-Voices that generated in the body and not heard in healthy people be heard to form of Tanin. 2-There is a stimulant factor inside the head and brain or ear that cause Tanin. Subgroup 2 is sever and louder than subgroup 1. Tanin with this definition and classification is similar to tinnitus in modern medicine. Causes, symptoms and treatments of Tanin (chronic tinnitus): 1-If cause of tinnitus is severe weight loss or lack of food intake for long time or severe illness that weakens the powers of the body, including hearing, treatments included Increase the volume and number of servings of food, eating of foods with quick digestion and cold nature and soft like water of meat and reinforcement brain and ear with rose oil drop or violet oil or violet almond oil. In all type of tinnitus the patient should be avoided from sitting in the sun, near the fire, very hot bath, strenuous physical activity, loud voice, too much talking, frequent Sexual intercourse, overeating, consumption of Garlic (Allium Sativum) or Onion (Allium cepa L) or Chives (Allium schoenoprasu) or wine, long time Starvation, sleeping with full stomach and constipation.

Conclusions
To prove these practices of TPM sages for chronic tinnitus more researches are necessary to be performed. Keywords: Tinnitus, Traditional Persian Medicine, Treatment Purpose Jamu is an Indonesian traditional herbal medicine, based on plants and roots, which has been used for many centuries in the Indonesian community to maintain good health and to treat diseases. Although biomedicine is becoming increasingly important in Indonesia, jamu is still very popular in rural as well as in urban areas. This paper presents findings on knowledge, attitudes, and practices regarding jamu for maternal and child health care among both consumers and jamu small producers in Indonesia.

Methods
In-depth interviews were carried out with 35 women and 91 jamu producers in Yogyakarta, Java. The interviews consisted of semi-structured questions (duration 45 minutes to 1 hour) in which general information was gathered about the different uses and perceptions of jamu and traditional medicine, as well as their reputed therapeutic effects and socio-cultural values.

Results
Results show that different types of jamu are used for different purposes in various stages of a woman's life including for conditions associated with menstruation, puberty, pregnancy, abortion, birth, postnatal health and breastfeeding. Our study reveals that due to their educational and social background, the women have divergent ideas about the use of jamu. Attitudes towards the use of jamu are also influenced by generational factors.

Conclusion
The patterns of taking jamu deserve attention, since many are consumed regularly as preventive medicine. Study of womens' practices related to maternal and child health care is crucial to the design and implementation of effective health programmes in urban areas. phenomenological study was conducted in order to better understand how the process works, as the explanatory framework of Khalifa himself is not adequate.

Methods
The author underwent a treatment himself as a self-experience and immediately afterwards produced a rich qualitative experiential narrative. In addition he queried Khalifa about his own theories regarding his technique and read through materials that journalists had produced after interviewing Khalifa.

Results
RegentK is a technique where the therapist uses very low frequency pressures of an intense kind on fascial spots and trigger points distal to an injury and works his way upwards. In his own terminology these are "zero-points", where the tissue answers to his probing pushes and grips, responding, as it were, to a stimulation for growth. In first-person experiential terms these points are extremely painful and it feels as if the therapist were actually becoming one with the tissue. The time experience is extremely distorted during this 45 minute treatment. After feeding back the experience to the therapist, he actually agreed. He said that indeed he was "changing time" in his own experience.

Conclusions
The interpretative framework and the phenomenology of firstperson-experience of RegentK therapy seems to suggest that during this treatment the therapist somehow, in addition to all traditional efforts at stimulation, such as introducing potentially piezo-electric effects, changes the joint experienced time frame and enters the boundaries of another body in order to stimulate self healing. This can be conceptualised within the framework of a non-local theory. Participants, recruited via social media, were screened via inclusion and exclusion criteria. Suitable participants (n = 25) were asked to complete both tools. Appropriate demographic and inferential statistics were used to analyse the data. Ethical approval was granted by Middlesex University.

Results
Findings from the study and statistical non-parametric analysis suggest a perceptible relationship between traditional Ayurvedic body-constitution and food-taste preference. It was found that those of kapha, pitta-kapha and tridoshic constitution had a tendency to prefer sweet and pungent while pitta types were found to have a strong distaste for salt, pungent and bitter. Vata types had preferences for sour and bitter, compared to the other constitutions.

Discussion & Conclusions
Findings from the study suggest that the constitution may play a vital role in taste preference and food selection with potential positive and negative implications on health. Further investigation in this area is warranted and would contribute to an evidence-basis for Ayurvedic dietetic principles and a framework with which to practice personalised nutrition based on constitution. Purpose Anthroposophic art therapy (AAT) is facing problems due to a lack of evidence and the lack of generally accepted concepts of the working mechanisms. Case reports can provide insight in working mechanisms and allow for describing the unique interaction between therapist and patient. Multiple case reports of academic quality will also allow for the identification of best practices, which may serve as a starting point for efficacy studies. The CARE (CAse REport) guideline was developed in 2013 to improve the quality of medical case reports. The guideline was subsequently adjusted into a specific guideline for AAT. The academic, nonchronical order of this CARE-AAT guideline (2016) appeared to limit use of the guideline in daily practice by art therapists. It was envisioned that a documentation method could support therapists in the systematic gathering of all information necessary for a complete, transparent and comprehensible case report. Methods A documentation method was developed by means of expert knowledge and literature. The face validity and usability of the concept method was determined through a survey. In a field test, dossiers were collected and subsequently analyzed for completeness and quality with the CARE-AAT guideline as a reference.

Results
The survey provedthat the face validity of the documentation method was good. The completeness and quality of the provided dossiers differed considerably. Some dossiers lacked crucial information, obstructing academic case reporting.

Conclusions
These findings have led to the further improvement of the documentation method. The guideline and the improved documentation method will be presented. Purpose Theatricality methodology is proposed as a novel approach to explore gaps and enhance the research design and reporting in Complementary and Alternative Medicine (CAM). Use of a theatre concept provides a unique potential, as both CAM and Theatre represent global worlds where everything inside is a vital part of the whole event and, as a framework for researchers, this approach offers the potential to engage creatively and holistically with the whole complexity of CAM practice, it's characters and setting.

Methods
The approach was trialled in a study of 5 clinics across 4 European countries, with 31 practitioners and 47 patients actively taking part. Theatricality Framework Method (TFM) captured the scenography of each setting, while participant observations reported the actions and in-depth interviews created the dialogue. The researcher's responses completed the data set, which was viewed and analysed via 'performative criticism' with embodied reflexivity.

Results
This approach created a holistic 'space' where CAM practices could be perceived, engaged and reported as complex, therapeutic, healing events. Findings from this suggested that primary targets of therapy were often people, not problems, and that quality of outcomescould be determined by the whole contextual blend of practitioners, interventions and place. The research processwas similarly affected, finding it easier to engage holistically where participants acted holistically, and more difficult where they did not.

Conclusion
Theatricality proved effective and innovative for engaging 'the whole and the parts' of therapy together and extracting complex meanings. This suggests a potential new quality for research in CAM. The evidence base for music therapy interventions is growing as this service evolves into a more accepted form of integrative medicine and health. This investigator has developed such music therapy protocols for medical patients, and tested their effectiveness in randomized controlled trials, 3 of which are presented here. The music therapy protocol for a family medicine unit involved an assessment of musical preferences and background, as patients sampled receptive and active musical experiences. The music therapist prepared individual music playlists, and met individually at bedside to demonstrate music-facilitated guided imagery, meditation, relaxation and breathing techniques. More active interventions included songwriting, improvisation, singing/chanting, playing instruments, lyric substitution, and lyric analysis. Results no significant differences between treatment and usual care groups, but post-treatment interviews revealed positive outcomes in relaxation and the patient experience overall. Research with women who had metastatic breast cancer engaged these women during their chemotherapy treatment in the infusion unit of a major cancer center. They participated in relaxation exercises facilitated by live music, active improvisation on percussion instruments, and songwriting. Outcomes revealed post-session decreases in heart rate and positive changes in reported levels of anxiety, pain, and contentment. A set of eight music-facilitated stress management strategies were tested with depressed older adults. These included music listening techniques designed to relax the body and mind. Results included clinically significant changes in depression, anxiety, mood and distress, and statistically significant differences on multiple measures between music therapy participants and a no-contact wait list control group.

Introduction
Music therapeutic interventions are used to positively change patients' emotions and mood, which influence related physiological parameters. During therapeutic receptive lyre interventions in conjunction with singing, alterations in respiration and mood perception have been observed in oncological patients [1]. We determined changes of respiration rate (RR), heart rate variability (HRV) and mood during the same therapeutic intervention as used for oncologic patients, in six healthy volunteers.

Methods
Quantitative and qualitative evaluation with mood questionnaire [2] and semi structured interviews based on method of Qualitative Contents Analysis and Grounded Theory before and after each session. HRV and RR measurement was performed during pre-rest period, intervention [3] and post-rest period, using an ECG recorder with respiration sensor (MK3, TOM Medical). SimpleView© (Version 2.2, Release 15, TOM Medical) and MatLab© programming was used for analysis of HRV.

Results
After intervention: reduced heart rate, increased HRV, more regularly respiration, higher cardiorespiratory coordination and a shift towards higher vagal activity were found. Those changes remain during postrest. Physiological results are accompanied by improvements of inner balance and vitality. We evaluated efficacy and safety of Galgeun-tang (Gegen-decotion) versus western medicine for treating cervical spondylosis in the randomized controlled studies RCTs.

Methods
We systematically searched 10 databases including PubMed; Cochrane Library; EMBASE; two Chinese medical databases (China National Knowledge, Airiti Library); one Japanese medical database (CiNii); and four Korean medical databases (OASIS, KoreaMed, KMBASE, NDSL) until January 2017. There were not any language restrictions for randomized controlled trials (RCTs) comparing Galgeun-tang with western medicine (Celecoxib, Brufen, Ibuprofen, Mecobalamin). Data extraction and risk of bias assessments performed by two independent reviewers. Response rate was evaluated by 'Criteria of diagnosis and therapeutic effects of diseases and syndromes in traditional Chinese medicine'. The quality of the RCTs was assessed using the Cochrane risk of bias tool.

Results
Finally, four RCTs with a total of 552 participants were included in the analysis. The methodological qualities of the RCTs were low in the performance bias domain. The Galgeun-tang group had superiority in the response rate compared with Celecoxib group in two RCTs eligible for the meta-analysis (n = 338, RR:1.17, 95%CI : 1.09-1.25, P < 0.0001, I 2 = 3%). The other two RCT also showed a favorable effect of Galgeun-tang on response rate compared with western medicine.

Conclusion
Galgeun-tang may have potential effects on cervical spondylosis compared with western medicine. However, these RCTs have moderate and low quality of evidence. Therefore, the results need to be confirm in rigorous and large RCTs. The current work aims to present the results of research made on the influence of the performance of clowns from the NGO Doutores da Alegria (professional artists working in pediatric hospitals in Brazil since 1991) on the hospitalized children, parents, caregivers and health professionals. The study had the following methodology: 1. Qualitative phase: 12 focus groups with health professionals carried out every 6 months for 3 years at 2 hospitals in order to map performance indicators of the clowns acting over this period. 2. Quantitative phase: Implementation of structured questionnaires answered by 567 health professionals in 13 hospitals where Doutores da Alegria act.
Some results about the clowns effects that stand out in this study: In the perception of most health professionals, children became more comfortable with the hospital environment, more active and collaborative with the team. Children accept better medical examinations and procedures after the clowns visit. Professionals develop new ways to approach the children and started to talk more with them. They say that the families started to play more with the children and become more collaborative with the heath professional team. Most professionals agree that they feel calmer with the work and perform the work routines with better quality. The results show that the performance of clowns with the hospitalized children develops a better quality in relations between health professionals, patients and families.

P321
…To take medicine into the picture … art therapy and well-beinga pilot study in prevention and health Purpose This pilot study examined the effectiveness of an art therapy intervention concept on current and habitual well-being of stressed Waldorf School teachers. Furthermore, we identified potential work factors of art therapy that could be connected with the positive outcome.

Methods
The specialised concept of four art therapy interventions was applied in a single day project with 18 teachers (15 f, 3 m; mean age: 48). The evaluation was conducted using quantitative and qualitative methods. In the quantitative analysis, the change of habitual wellbeing was assessed with the SF-36 Health Survey, the change of current well-being with the Complaint List (B-L) and the Scale of Current Mood (ASTS). The qualitative analysis aimed to generate art therapeutic work factors. It was carried out by the structured content analysis of Mayring. These data were obtained on the basis of two interviews, conducted about two and five weeks after the project day, with selected subjects.

Results
The quantitative analysis concerning current well-being indicated a significant increase of positive mood and a significant reduction of complaints. In examining the habitual well-being, a short-term improvement could be observed. In the qualitative analysis three common and seven specific art therapy factors could be identified and be related to the positive outcome, namely the common factor Advancement of Cognitive Processes/Support of Development of Coping Strategies and the specific art therapy work factor Stimulation of Symbolization and Imagination.

Conclusions
Resource-oriented, art therapy interventions may be effective in stress prevention and health-promotion in teachers with stress.

Methods & Results
Using nonlinear algorithms, dynamics were detailed in RB, and elaborated manual techniques (e.g. vault hold) utilizing anatomical mechanical receptors to palpate CRI by 0 M practitioners. Either technique exhibited period lengths of 7-11 oscillations/minute as one of the most essential features of either of these rhythms. Another feature is spread of the RB with arterial systemic blood pressure across the entire organism as a correlate of the CRI. Due to differences of dynamics of sympathetic and parasympathetic nervous traffic, disruptions of rhythmic manifestations may become palpable as somatic dysfunctions, while rhythmic transfer from therapist to patient may yield correction thereof.

Conclusions
Using objective and individual (= subjective) levels of observation suggests put forth a robust hypothesis on essentials of RB or CRI which can be utilized as therapy regimes. Purpose It is envisioned that case reporting is a good way of providing insight in the working mechanisms underlying art therapy, as it leaves the uniqueness of the interaction between therapist, medium and patient intact.

Methods
In a field test ten dossiers were prospectively collected employing the CARE-AAT documentation method. One dossier was selected based on completeness and used as the starting point for writing a case report in which the working mechanism of art therapy was explored. The problems met in the process of clarifying the working mechanism were discussed in a team of art therapists with a research background.

Results
The most complete dossier was used as the starting point of academic case report writing. Dossier information was successfully sorted into the categories of the CARE-AAT guideline. Then it was decided which message to bring across by case reporting. This led to a clear focus during additional data collection (from literature) and data exclusion (from the dossier). Several ways to enhance the academic quality of clarifying the working mechanism of art therapy like predictability, causality and validity, were addressed.

Conclusion
The CARE-AAT documentation method was successfully used in prospective dossier formation. Several ways of demonstrating the working mechanism of art therapy in case report writing based on the dossier were identified and led to some changes in the documentation method.

Introduction
Tai Chi (TC) is normally practised standing, and can be practised seated, alone, or with friends/family. People with cystic fibrosis (CF) are often confined to home or hospital, and their daily exercise, which is an essential component of treatment, is often comprised due to ill health. TC, a gentle, more manageable exercise, may offer a solution to people with CF.

Methods
Children and adults attending CF clinics were invited to participate in a randomised trial offering eight TC lessons either face to face (group 1) or over the internet (group 2). Recruitment data was collected about why people did not wish to join the study. Participants were asked about their regular TC practice after lessons and 20 participants were asked in interviews 2 months after the end of lessons.

Results
Of 116 outpatients approached, 65 people declined, 51 accepted and 40 completed all lessons. 43% of those who refused did not like the idea of TC, 36% were too busy. Of those who participated, all practiced between lessons on average 3 times weekly for 13 minutes. At follow up 84% interviewed, still practised an average 2/3 times/week (group 1 = 62.5% vs group 2 = 37.5%). 79% of respondents said they intended to continue TC, (group 1 = 53% vs group 2 = 47%). Some participants asked about local classes. 32%, all children, included others in lessons. Two participants reported using TC whilst hospitalised.
Conclusions TC could prove to be an alternative exercise for people with CF that could be integrated into a weekly exercise regime.

Introduction
A strict regime of physiotherapy and regular exercise is an important part of daily regime to maintain the health of people with cystic fibrosis (CF). A mixed methods approach was utilised to collect data in a randomised feasibility study to explore the physical and psychological benefits of including Tai chi (TC) alongside normal exercise.

Methods
Validated questionnaires, objective clinical data, qualitative interviewing and self-reported measures were employed to gather data on a range of potential outcomes, including breathing, gastric pain, sleep, anxiety, posture and fitness. Learning TC face to face was compared with no TC and learning TC over an internet connection.

Results
Forty participants were recruited: 23 had face-to-face TC lessons (group1), whilst 17 had no TC lessons for 3 months, and then had TC lessons delivered over the internet (group2). Quantitative data showed trends in improvements, but no statistical significance. In qualitative interviews and questionnaires, 58%of participants reported improvements in breathing (group 1 = 70%, group 2 = 30%), including being able to take larger breaths, breathe better at night, and improved expectoration (45%). Improved posture (45%), and feeling calmer and less stressed (90%) were also reported.

Conclusions
People with CF may find TC helpful to reduce stress, improve breathing, posture and other issues associated with CF. However, findings are not supported by the recognised objective data collection tools. Such tools may not be sensitive to minor changes in a relatively well population. Further research is required to ascertain whether such improvements occur and how to improve outcomes using internet delivery.

Results
This methodology comprises a therapeutic process where the patientthrough art -expresses a temporal condition of your consciousness, feelings and body. From the diagnosis and performing art, with an orientation based on the fundamental principles of the methodology that the principles work of "Light, Color and Darkness", the patient begins to dissolve their standards, composing an ideal paint, a picture of a healthy composition related to him. It is understood that the human being is a microcosm of the macrocosm, a reflection of the outside world. From this concept, the principle of light is related to the upper pole, the neurosensory system; the principle of darkness is the lower pole, the metabolic system; the meeting of the two forces takes place in the middle area, it happens on the rhythmic system, which hosts the circulation and breathing processes. The treatment happens in the meeting between light and darkness, when the colors are brought in their own movements, environments, reaching space, artistic and vital elements (moisture, warm, surfaces and substance, freshness) and creating an image of nature. In humans, treatment refers to the achievement of a rhythm; creating space in the rhythmic system so that breathing and circulation happen harmonically, and others vital processes are stimulated and enhanced. This process allows the patient to achieve greater self-awareness, re-establish better social relationships, rekindle their life processes. This methodology has been recognized worldwide, from doctors and patient reports whom recognized that reached a better quality of life in their thinking aspects, feelings and their work. Evidence suggests that this treatment can lead to decreased pain, improved vitality, restoring senses, in addition to improvement in mood and wellbeing. There are reports of improvement of physical symptoms and decreased use of medications.

Conclusions
The Medical Painting Therapy in Liane Collot d'Herbois methodology demonstrates how therapeutic intervention with low cost, enjoyable and non-invasive aspect, can help. It brings together great potential as a resource of integrative medicine for achieving better quality of life in its integrality, working in the biological, psychological and social dimensions.

Introduction
Medicinal plants are used popularly in traditional systems of medicine. In Traditional Persian Medicine (TPM) pharmacopeia, beside therapeutic effects of herbs, their adverse effects on different body organs and the way of minimizing these side effects, are discussed from a traditional perspective. The aim of this study was to review herbal drugs with cardiac side effect from the viewpoint of TPM.

Methods
The most comprehensive TPM pharmacopeia "Makhzan-al-Advyeh" were searched for herbal drugs with cardiac adverse effects. The characteristics of these herbs were reviewed and compared to find a common mechanism to rationalize their adverse effect on the cardiac system. The way for minimizing these side effects was also classified.

Results
From 700 medicinal plants mentioned in Makhzan-al-Aladvyeh, 6 herbs are considered to have an adverse effect on the heart. Most of these herbs (85%) were classified as hot and dry temperament. Adding Gum Arabic and lemon juice to the formulations with these herbs was the most popular way of decreasing the side effects. Six popular herbs with cardiac side effect from TPM perspective and their characteristics are summarized in the table below.

Conclusion
The survey introduced medicinal plants with potential cardiac side effects in TPM which can be more investigated in modern studies. Keywords: Adverse effect, cardiac side effect, heart, Traditional Persian Medicine

Conclusions
The phase of application of the National Agreement is still ongoing and the commitment of CM professionals and patients will facilitate its complete application.

P329
Recent advances in the integration of CM in public healthcare system of the region of To describe new advances of the process of integration of complementary medicine (CM) in the Public Healthcare System of the Region of Tuscany in tune with the reorganization of the Regional Health System in place from 2015.

Methods
The integrated complementary medicine activities will be developed according to the following criteria: 1) optimization of the CM offer ensuring equitable geographical distribution and coverage of the priority areas of intervention among the various MC activities operating within the same Local Health Unit (USL); 2) development of the interaction between hospitals and universities within the same USL and at the regional level; 3) improvement and reorganization, within the healthcare pathways of the network nodes of CM, to ensure the realization of the essential regional priority goals;

Results
The priority and common objectives of integration of all the CM services of the region are: fight against pain; integrative oncology; promotion of physiological birth in low-risk pregnancies; gender medicine (menopause and gender oriented metabolic disorders); prevention and treatment of respiratory diseases and childhood and adulthood atopic diseases. Moreover specific projects will be developed in relation to an integrated management of chronic diseases and patients with multiple chemical sensitivity or drug hypersensitivity. The Local Health Units will also have to find their own Coordination Centre of CM, with the function to guarantee the best offer of MC services on the territory.

Conclusions
The  and motor impairments and psychological sequalae. The current approach to stroke rehabilitation in the UK involves a multidisciplinary team approach focusing on minimizing disability and handicap, encouraging a return to independence and activities of daily living and increasing life satisfaction. Rarely are complementary therapies involved. This study considers the ways in which Eurythmy therapy can contribute to a stroke patient's rehabilitation in the context of an inpatient neurorehabilitation hospital. Such a study is the first of its kind. Methods A case study research approach was adopted and the findings are based on three stroke patients. The research included both qualitative and quantitative data.

Results
The findings from this research provide evidence that Eurythmy therapy can address and bring improvement to a broad range of problems including increased strength, flexibility, co-ordination, control, body awareness, uprightness and balance. In addition, it can support improvements in the patient's psychological wellbeing.

Conclusions
The conclusion of the study noted that Eurythmy therapy has a unique potential to meet a patient's physical, emotional and spiritual needs as a whole and can therefore, make an important contribution to a patient's rehabilitation.

Methods
Curriculum drafts were presented to community members with a career-long commitment to addressing the social determinants of health in Hawai'i. Focus groups were held with environmental policy advocates at the Office of Hawaiian Affairs and NLOL-identified content experts were invited to participate in interviews. Participants were asked to provide candid feedback based on their professional experience on draft content. All focus groups and interviews were audio-recorded and scribed. Data from the focus groups and interviews was used to edit the first round of drafts which were then revised and returned to the experts for further review. (University of Hawai'i Human Subjects Protection review approved CHS# 30433) Results Two, 2-hour focus groups with 9 environmental policy advocates and 6 2-hour interviews with content experts were conducted. Participants shared feedback that was formative in adapting the curriculum. The process ensured that existing curricula were integrated with integrity and benefited from the practical knowledge of the participants in selecting the most effective elements for inclusion.

Conclusions
The iterative, interconnected methodology of this curriculum adaptation process is an effective way to maximize community scholarship to promote health equity and social justice in Hawai'i.

Conclusions
The IMG of Garrahan Hospital is the first official reported group working in pediatric integrative medicine at a public hospital in Latin America. These first ten years have shown that it is possible to work with integrative medicine at a pediatric tertiary referral hospital with satisfactory results in the clinical setting, teaching and research.

P335
The Purpose The purpose of this study is to support the strategy of the transformation process in Complementary and Alternative Medicine (CAM) in regards of the scientific and technology achievements.

Method
Base on the characters and tendency of CAM, we reviewed the successful model and mechanism of technology transfer in the developed countries and districts, and provided some promoting strategies which might be applied in China.

Result
We suggested some advices to promote the technology transfer of CAM, including (1) formulate sound legal system for technology transfer of CAM, strengthen the guiding and service function of government, and clearly define the right and obligation of stakeholders; (2) Increase the science and technology investment and keep rising stably and continually; (3) Develop more incentive mechanism and talent cultivation policy of technology transfer, improve the operability of property rights of technology; (4) Establish professional and diversity science-technology agency service system, integrating more transfer channels to digest the technology stock; (5) Carry out the pertinence and targeted work basis on the precise classification of CAM researches and national circumstance; (6) Encourage the scientific researchers turn to follow the guide of practical technology and products, and face the demands of markets and people; (7) Improve the monitoring and evaluation methods of technology transfer, and enhance the right of public access to the research information. Breast augmentation surgery and autologous fat grafting are frequently performed to improve the quality of life and self-esteem of patients. However, there is a risk of complications with these procedures; therefore, alternative treatments are needed. The aim of this study was to introduce integrative therapy involving traditional Chinese medicine (TCM) and conventional medical material (polydioxanone threads) embedding for improving breast size and elasticity.

Methods
Three patients were treated with TCM, such as acupuncture and herbal medicine, and polydioxanone (PDO) thread embedding therapy. Treatment efficacy was assessed based on the breast cup size, which was defined as the difference between the circumferences of the bust and under bust, and a self-evaluated questionnaire score on enhancement of breast size and elasticity. The side effects of treatment were also monitored.

Results
The breast cup sizes of three patients increased after treatment and considerable improvements in patient satisfaction were observed with respect to breast size and elasticity. There were no severe adverse events.

Conclusions
The results suggest that integrative therapy using TCM and PDO thread embedding could be a complementary and alternative option for enhancing breast size, elasticity, andsatisfactory on self-evaluation. Long-term follow-up and further studies are needed.

Consent
Written informed consent for the publication of this case study was provided by each patient,and the principles of the 1964 Declaration of Helsinki were followed in this study. In recent year, the integration of traditional medicine in to main stream medical practices and public health program has gained momentum.However, there are major challenges and discrepancies in the pace of adoption and implementation of traditional medicine in the name of evidence based practices. The main reason does not only lie in the scientific explanation but also the in efficient community mobilization and poor understanding of potential of that traditional medicine offer to combat emerging non communicable diseases. Hence, we present and critically discussed the example of the success implementation of traditional medicine to combat non communicable disease in low resources setting country like Nepal. We focus the fully community participation, mobilization of traditional healers along with Ayurveda female community health volunteers through establishment of weekly outreach clinic at village level. We tried to use traditional approach for health promotion activities and improvement of quality of life. The management and operation of that outreach clinic fully governed by the outreach clinic management committee that is formed in inclusively at local level. The Technical support provided by the concern authority in that district. This activities not only focus the utilization, enrichment of traditional knowledge but also the conservation of traditional knowledge and ethno medical prospects. People are not only treated but treated with happiness and full deserve of their belief. We belief that as healthy community initiative mature,many of them are offer their work in building community consensus for improved health care,often quality of life issue can be transferred in to public policy. Whereas 40-60% of the German population wish to use complementary or alternative therapies, the German health system and health legislation are reluctant to accept such approaches. Integrative medicine (IM) with its patient-centered and evidence-based approach has been shown to have the potential to overcome such reservations.

Objective
To describe the organizational and economic aspects of the implementation of an academic CIMH at a German teaching hospital in Bamberg, Bavaria. Methods A national and regional needs analysis for inpatients and outpatients was performed. In-and outpatient spaces, academic leadership, specialized health professionals and reimbursement strategies were analyzed and implemented..

Results
Major efforts were necessary to explain the concept and practice of IM to all stakeholders. Oncology, pediatrics, gynecology, psychosocial disciplines and chronic pain programs were most responsive. A lack of specialized health professionals had to be overcome by appropriate training programs.

Results
Main noticed disadvantages of academic medicine were lack of interest in a patient, being profit oriented, non willing to know alternative approach. Alternative medicine was seen as not always equally effective, hostile to academic treatments. The need of the patient was to use both medicines for the best health result. The lack of knowledge in alternative medicine of academic health professionals was seen as the main source of confrontation between the two medical directions. Ideal integrative medicine was imagined as patient oriented and free of relation to profit, ecological and environment friendly.

Conclusion
Obligatory informing of medical students about basic concepts of alternative medicine would be favorable to development of integrative medicine.

Results
Chocolate consumption was associated with reduction in cardiometabolic risk factors such as blood pressure, cholesterol, platelet function, atherosclerosis, and insulin resistance. The mechanisms included antioxidant, anti-inflammatory, anti-atherogenic, reduced low-density lipoprotein (LDL) oxidation, antiplatelet, anti-thrombotic, peripheral vasodilation, and antihypertensive effects as well as influencing insulin sensitivity and vascular endothelial function. The consumption of wine was associated with the reduction of several cardiometabolic risk factors, such as blood pressure, LDL and highdensity lipoprotein (HDL) levels, inflammation, serum glucose, as well as improvement in endothelial function. The mechanisms included antioxidant, anti-inflammatory, inhibition of inflammatory cytokines, reduction of reactive oxygen species (ROS), signal transduction, and inhibition of platelet aggregation.

Conclusions
Chocolate and red wine have numerous cardiometabolic health benefits, including antioxidant, anti-inflammatory, anti-atherogenic, antihypertensive, and cholesterol modifying properties.

P344
The interested in integrative medical approach in treating these kinds of disorders. The users are forced to search individually for these kinds of institutions and often specialists of different profiles that work with persons diagnosed within ASD have different methodologies and offer differing treatments. The purpose of this paper is to present the unique organization of BDORT Centeras the first center in Serbia and in the region which joins integrative medical approach together with behavioural therapy. This way of work allows a prompt diagnosis using noninvasive BDORT method, identification of adequate supplementation with the program of behavioural therapy unique to every user, and a systematic monitoring by the team of specialists (doctors, SLP and psychologist). This integrative approach supports early intervention and induction of necessary changes during the process of treatment which are of crucial importance for its success. Further, the BDORT Center is organising workshops for parents with ASD children to support them through education about the relevant themes related to the nature of ASD as well as through mutual exchange of experiences. The goal is to develop recognizable, integrated and coordinated system of early intervention which will be sustainable in spite of inconsistency in current practices.

P347
The role of speech and language pathologist in the treatment of autism The purpose of this paper is to present the role of speechlanguage pathologist in the treatment of children diagnosed within ASD implemented in BDORT Center. Since children within this spectrum are very different regarding their communicative, cognitive, motoric and adaptive skills, the focus is on making individual plan of treatment. The program of treatment and the development of the child is evaluated periodically, by psychological testing, so the correction and needed adjustments to the program could be conducted. The method of work is heavily related to the core principles of behavioural therapy, which we adapt to the local conditions of users. After the initial evaluation in BDORT Center, we suggest intensive treatment, between 15 and 18 hours per week. During the process of treatment great attention is dedicated to the education of parents about the way their children learn and about their role in helping their children learn. This is because we consider parents as co-therapists whose role in helping their children to generalize and apply learned kills in everyday life is of crucial importance. This is also due to the fact that many children upon entering primary school are not able to continue with an intensive treatment which further underline the role of a parent for continuing the work with a child. The goal of this practice is to develop a maximum of childs biological potential in the critical period of its development and to enable the child to be as an independent as it can. Purpose Symptoms are used as an important basis for diagnosis in Korean medicine. However, in the process of diagnosis, it is not easy to accurately identify the symptoms of daily life. Also, patients often fail to answer correctly because they rely on uncertain memories. Therefore, recording the symptoms of daily life can be helpful for diagnosis and prognosis. The purpose of this study is to derive the daily symptom obtainment techniques and processes in Korean medicine personal health record platform that records symptoms easily and conveniently, records and manages its own health information, and owns health information.

Methods
In order to provide personalized health care services based on Korean medicine, significant symptom collection items were derived. Significant symptom means a symptom which is useful for the patient to record among the symptoms used for the diagnosis of the Korean medicine. To do this, we examined the classical literature and previous research analysis items of Korean medicine, and then selected symptom items to be collected considering the ease of symptom recording.

Results
The selected significant symptoms are divided into original symptoms (素證) and daily symptoms. The original symptoms are usual physiological symptoms. The original symptom items were selected such as complexion, cold (warm) hands and feet, urine color, feces pattern, chills, amount of water to drink, urinary frequency, digestive status, frequent symptom groups, and etc. Daily symptoms are symptoms that are perceived in everyday life. They are divided into daily emotion, stool/urine/sleep, and subjective symptoms. Because of the nature of the symptoms, it is difficult to collect them automatically. Therefore, the survey type, daily emotion, human body, symptom classification, and natural language collection technique are derived as a method for user to collect symptoms. The user can enter the region and intensity on the human body for symptoms such as pain, pulling, and itching in the skin.

Conclusion
In this study, we selected significant symptoms that are meaningful when recorded by users in the symptoms required for diagnosis in Korean medicine. The symptoms are used as individual health care indexes through classification and scoring. We have configured the Korean Medicine Personal Health Record (KM PHR) platform to record significant symptoms. And we developed it to record the symptoms with a simple operation on the platform to increase the rate of symptom obtainment. Patients can share their symptoms with their doctor and can be connected to a diagnosis. Doctors can refer to shared symptoms to help with diagnosis and prognosis. In the future, we plan to use PHR health records as health information for EMR, EHR, CDSS and so on.

P351
Organic food consumption during pregnancy and consumer profiles, food patterns and intake: The KOALA birth cohort study Ana P Possible associations between consumption of organic foods and demographic characteristics, lifestyle, dietary patterns and macro-and micronutrient intakes during pregnancy have been investigated. Women participating in the Dutch KOALA Study filled in questionnaires on lifestyle and food frequency (n = 2786). Based on the origin of various food groups, organic participant groups were defined, which were then compared with the group of participants consuming conventional food only (reference). Consumers of organic food exhibit sociodemographic characteristics and lifestyle characteristics that differ from people consuming conventional foods: e.g. more often adhered to specific living rules, such as vegetarianism or anthroposophy. Consumption of organic food was associated with food patterns comprising more products of vegetable originsoy/vegetarian products, vegetables, cereal and cereal products, bread, fruits, legumesand fewer animal productsmilk and milk products, meat and meat productsthan conventional diets. In addition, the consumption of sugar, sweets and sweet sauces as well as of potatoes was lower among the participants with an at least partially organic diet. These differences reflected those in the intake of macroand micronutrients, including vitamin D and B12 intake that was only partially compensated by vitamin supplementation. Organic food users showed differences in the origin of proteins, iron and trans fatty acids compared with conventional food users.
Our results show that a wide variety of characteristicsincluding specific dietary patterns and food intakeare associated with the consumption of organic food. These aspects should be taken into consideration when studying possible effects of organic food consumption on health-related characteristics.

P352
The The study examines a complex, naturopathic health program. The patients who regularly visited phytoterapist for herbal medicine, vitamins, minerals, herbs had the opportunity to participate in Transcendental Meditation (TM) courses. The aim was to offer selfcare technique to improve physical health. TM is seemed to be new and unique for the patients. As we offered it reduces stress and supports healing process. Motivation and attitudes of practicing TM for self-healing were measured in a period of twelve months. The survey was self-reporting, used anonym questionnaires of TM practices with opened and multiple choices. The population was relatively small, but covered everybody who was trained by TM exercise. The results were processed on a statistical method. The results showed that the patients were not really motivated to practice TM. Comparing to their continuous consumption of vitamins probable it was the only belief to heal psychical health. The place of the survey was in a small town where people are unfamiliar with meditation practices. Most of the people refer the lack of time if they practice TM more often it would influence positively their health. Nonetheless, everybody would offer TM as stress-management technique to others. The strong personality of the TM trainer was determinative. It needs further researches, how people could be interested promoting their health with TM. The conclusion is that patients believe more in biologically based herbal products than in meditation, which they could do themselves. Question Chinese Herbal Medicine (CHM) is an increasing popular remedy, and more and more randomized controlled trials (RCTs) are being carried out to confirm the efficacy and safety of CHM. Due to the complex formula, prescriptions of CHM usually contain more than one single herbs, which may affects different Zang, and then, improve several symptoms which related to the disease. Many investigators hope to set more than one endpoint in a RCT. Three or more arms may be necessary for dose exploring. Multiple time points often were planned to long duration trials. All of above scenarios should consider the problem of multiple testing.

Methods
Our simulations and discussions were based on a RCT with total of 120 diabetes patients. They were randomly allocated to receive either Gegen Qinlian Decoction (GQD) or placebo for 12 weeks. Study outcomes include HbA1c, FPG, 2hPG, blood lipids, HOMA insulin resistance (HOMA-IR) and β cell function (HOMA-β).

Results
Various approaches for correcting the alpha error were used, including Bonferroni, Tukey, Hochberg and Holm's step-down methods. Bonferroni was too far conservative. With the increasing of post hoc testing, the false significant results were more likely.

Conclusions
Limiting comparisons between groups is necessary to control false discovery rate. In addition, to identify a single primary endpoint or use a composite endpoint is an acceptable alternative to multiple endpoints.

P354
The role of machine learning in the diagnosis of diabetic nephropathy and prescriptions of Chinese Herbal Question Diabetic nephropathy (DN) is the leading cause of end-stage kidney disease. The pathogenesis of DN is diverse and yet to be fully clarified. Chinse Herbal Medicine (CHM) has particular advantages to reach well prognostic outcomes in blood pressure, glucose and lipid level. Despite the popularity of CHM in China, the diagnosis and prescriptions are still complex, and will depend on the specific Zheng, laboratory examinations, physical profile and patient self-reported outcomes etc. Our study aimed to construct a classifier based on machine learning method to optimize the procedure of diagnosis and prescription. Methods A consecutive data recording was carried out on a phase III DN case from 2010 till now. This case was male, aged 45. He used simplex TCM for more than six years, and completed 60 return visits. The creatinine (Cr) was 132 umol/L in 2010. At the last visit in 2016, the CR was 122.7 umol/L. No disease progress happened in the six years. Many symptoms were improved.

Results
Several machining learning methods were used to classify the Zheng of TCM and formula. For each visits, the collected information included height, weight, BMI, blood pressure, HbA1c, 24 h urine protein, 24 h urine volumn, GLU, BUN, CR, ALT, AST, TBIL, DBIL, UA, CHO, TG, LDL, HDL etc. Patients self-reported symptoms, pulse and tongue picture were also captured. More than 20 herbal medicines were combined as a prescription in different visits.

Conclusions
Machining learning covers a various techniques including Bayesian classification, decision trees, regression and neural network etc. It is very helpful to explore the different stages for a certain disease and prescribe the targeted TCM formula.
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About this supplement
These abstracts have been published as part of BMC Complementary and Alternative Medicine Volume 17 Supplement 1, 2017. The full contents of the supplement are available online at https://bmccomplementalternmed.biomedcentral.com/articles/supplements/volume-17-supplement-1. Please note that this is part 3 of 3.
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