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Globally, women are the highest users of complementary therapies, often during the perinatal period [pregnancy, childbirth, and postnatal time]. Midwives who provide care to women throughout the perinatal period need to have evidence-based knowledge of complementary therapies. There is a lack of research on why midwives are interested in learning about complementary therapies. The purpose of this research is to explore the experiences of Japanese midwives in undertaking professional development in complementary therapies. The study explored what the midwives learnt, how they used these therapies in their practice, and what strategies can help midwives implement these complementary therapies. A qualitative study was undertaken using semi-structured interviews with 15 Japanese midwives who had completed a certificate in complementary therapy. Content analysis was used to analyse the data. Two themes were identified as reasons midwives undertook professional development in complementary therapies: supporting women during the perinatal period with complementary therapies, and factors that influence midwives to learn complementary therapies as a new skill. Strategies to address challenges in implementing complementary therapy into practice were identified as follows: Needing a supportive working environment and encouraging midwives to increase their knowledge and skills about complementary therapies. Midwives in Japan undertook professional development in complementary therapy training as a new skill to support women in the perinatal period. Further research is warranted to assist midwives in implementing complementary therapies in practice by raising awareness of its evidence-based values among medical colleagues.
Complementary health approaches (CHAs) encompass a diverse range of practices used both independently and alongside conventional medical treatments. Understanding how graduate students across disciplines perceive CHAs is important because these trainees will occupy roles as clinical practitioners, medical researchers, healthcare policy makers, and consumers. The purpose of this research was to (a) explore differences in perceptions of CHAs across disciplines, (b) examine differences between medical versus mental health trainees' willingness to recommend CHAs, and (c) determine whether an association exists between descriptive terminology and willingness to recommend CHAs. Ratings of familiarity, perceptions of legitimacy, and willingness to recommend CHAs were examined among graduate trainees (N = 416). Responses from (a) clinical practice versus (b) research only trainees; and, within clinical fields, (c) medical versus (d) mental health trainees were compared via sequential rank agreement. Clinical practice trainees were more familiar with CHAs than research only trainees. Mental health trainees were most familiar with CHAs and perceived them as more legitimate than medical trainees. Perceptions of CHA legitimacy positively correlated with willingness to recommend across disciplines. Medical trainees associated CHAs with the term "alternative; " mental health trainees characterized them as "complementary." Association with "complementary" correlated with increased willingness to recommend. Mental health trainees characterize CHAs as "complementary; " they are also most likely to perceive CHAs as legitimate and to recommend them in practice. Clinical trainees and providers might be more likely to integrate CHAs into practice if characterized as "legitimate" and "complementary."
Post-stroke anxiety and depression symptoms are common after stroke and can persist long-term. Despite this, there is a lack of long-term psychological support for post-stroke anxiety and depression. Mindfulness-based interventions are emerging as feasible, acceptable and potentially effective interventions for post-stroke anxiety and depression. Sustained use of mindfulness practice can help stroke survivors to self-manage their anxiety and depression in the long-term. However, stroke survivors' experiences of continued practice following a mindfulness-based intervention have yet to be explored. This study aims to identify mechanisms underpinning sustained mindfulness practice by stroke survivors following completion of an adapted, stroke-specific mindfulness-based intervention called HEADS: UP (Helping Ease Anxiety and Depression After Stroke). A secondary analysis of 6-month follow-up qualitative data from course participants (n = 12) in the HEADS: UP randomised controlled trial was analysed using critical realist thematic analysis. Seven mechanisms were identified as determining sustained mindfulness practice: 1) Believing continued practice brings benefits, 2) Personal preferences and accessibility, 3) Continued learning, 4) Attitudes of others and society, 5) Togetherness and connection, 6) Structuring and scaffolding practice, and 7) Competing priorities. The mechanisms provide explanations behind stroke survivors' experiences of sustained mindfulness practice following HEADS: UP. The findings highlighted the potential benefit of providing support following a mindfulness-based intervention to facilitate sustained practice. Awareness of the mechanisms could aid future intervention design and help clinical practitioners and stroke support professionals support continued mindfulness practice.
Chronic back pain conditions are highly prevalent worldwide. Osteopathic treatment seems to improve pain and function in this population. However, the mechanisms underlying osteopathic diagnosis and treatment of the spine are mainly unknown. Arguably, both inflammatory and autonomic processes may be involved, which should entail changes in skin temperature. Primarily, the feasibility of the study protocol was evaluated by assessing the retention, adherence, acceptability, safety, and blinding concealment rates and carrying out a power analysis. Secondarily, we investigated diagnostic correlations between pain ratings, palpatory findings, and skin temperature in spinal segments and therapeutic effects of osteopathic and sham spine manipulations. In this single-blinded, randomized, and sham-controlled pilot and feasibility study, participants with chronic back pain were randomly allocated (1:1 ratio) to receive a single session of osteopathic or sham spine manipulations. Manual diagnosis, pain assessment, and infrared imaging were performed before treatment (baseline) and one week after treatment (follow-up), whereas infrared imaging was additionally conducted shortly after treatment (post-intervention). Seventeen participants completed the trial with 89.5 % retention, 100 % adherence, 100 % acceptability, 6 % adverse events, 22 % (osteopathic) and 50 % (sham) blinding concealment. A power analysis estimated a sample of 40 subjects for future randomized controlled trials. At baseline, no significant correlations were detected between palpatory findings, pain ratings, and skin temperature. There were no significant between-group differences in palpatory findings at single time points and pain ratings across time points (p < 0.05), whereas skin temperature showed significant between-group differences across all time points (p < 0.01). At post-intervention, osteopathic spine manipulations increased the skin temperature with a medium effect (Cohen's d = 0.66). The study was feasible. Osteopathic diagnosis does not seem to correlate with pain ratings and skin temperature. However, the increase in skin temperature shortly after osteopathic treatment suggests an autonomic (hyper-parasympathetic) effect.
Although mindfulness is widely acknowledged to foster resilience, limited research has examined how palliative care providers sustain this practice and how it shapes their resilience. This study explores how providers with sustained mindfulness practice, understand, and embody the cultivation of resilience across personal and professional domains. Fifteen palliative care providers (three physicians, eight nurses, three psychologists, and a spiritual care provider) who providing end-of-life care in hospitals across Taiwan were recruited. All practiced mindfulness regularly after completing a mindfulness-based stress reduction program, integrating techniques such as breath awareness, body scan meditation, or mindful walking into their daily and professional lives. Data from individual semi-structured interviews were analyzed using Smith and Nizza's interpretative phenomenological approach. Three group experiential themes were derived: discovering inner resilience through mindfulness, living mindfully as a way of life, and staying resilient in challenging environments. They illustrate how mindfulness fosters resilience by integrating emotional, mental, and existential dimensions. Mindfulness served as both an internal regulatory mechanism and a stabilizing force against external uncertainties, thereby fostering adaptability in challenging environments. These findings deepen our understanding of mindfulness as long-term resilience-building practice in palliative care. This study addresses the psychological challenges of palliative care providers in high-stress settings. The findings highlight how mindfulness fosters resilience by integrating self-awareness, emotional stability, and a reflective perspective into professional experiences. These insights extend beyond short-term stress relief, informing research and policies on healthcare provider well-being and sustaining palliative care practice.
Low back pain (LBP) is becoming increasingly common and has a significant negative impact on the physical and mental health of patients. A certain number of studies have been conducted on traditional Chinese exercises (TCEs) to treat LBP. However, the optimal treatment remains uncertain. The aim of this study was to systematically review the literature and perform a network meta-analysis (NMA) to compare the efficacy of different TCE and combination therapies for clinical practice. We systematically searched 8 databases from inception to February 2025 for randomised controlled trials (RCTs) of TCE for LBP. The risk of bias was evaluated using the RoB 2.0 tool, and the overall quality of evidence was assessed using the GRADE approach. NMA was conducted using Bayesian theory-based R 4.5.1 and STATA 16.0 software, focusing on pain and dysfunction. In addition, we critically reviewed the methodological limitations and potential bias of the included studies. This NMA included 38 eligible studies involving 2944 patients and 10 interventions: four standalone TCEs, four TCE combined with conventional treatment (CT), CT alone, and no intervention. Key findings indicated that: (a) wuqinxi was most effective for pain reduction [Visual Analogue Scale (VAS)]; (b) yijinjing + CT, taiji + CT, and yijinjing alone showed superior improvement in dysfunction [Oswestry Disability Index (ODI)/Japanese Orthopaedic Association (JOA)/Roland-Morris Disability Questionnaire (RMDQ)]; (c) yijinjing optimized lumbar flexion and extension range of motion (ROM), while baduanjin + CT enhanced lateral flexion ROM; and (d) taiji + CT achieved the highest total effective rate. TCEs and their combinations with CT may effectively improve pain, dysfunction, joint movement and overall efficacy in LBP. Wuqinxi, yijinjing + CT, taiji + CT, baduanjin + CT and yijinjing appear to be the most beneficial interventions. However, this study has limitations including notable heterogeneity and potential publication bias across some included studies. High-quality RCTs with standardized protocols and long-term follow-up are needed to validate these results and address clinical uncertainty.
Alzheimer's disease (AD) is a major global health challenge. While various traditional Chinese medicine (TCM) therapies are widely used as adjuncts to conventional Western medicine, their relative efficacy and safety remain unclear due to the lack of direct comparisons. This network meta-analysis aimed to compare and rank different TCM adjuvant therapies for AD, to inform evidence-based clinical decision-making. Randomized controlled trials (RCTs) evaluating TCM therapies as adjuncts to conventional Western medicine (CWM) for AD were searched in eight databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, and Web of Science, from inception to January 1, 2025. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0). Network meta-analysis was conducted using RevMan 5.4 and Stata 16.0. Thirty-one RCTs involving 3221 patients with AD were included, comprising seven interventions: CWM plus Chinese herbal medicine (CHM), CWM plus acupuncture (Acup), CWM plus Chinese patent medicine (CPM), CWM plus Acup and acupoint application (AA), CWM plus Acup and CPM, CWM plus Acup and CHM, and CWM alone. For clinical total effective rate, CWM + Acup + AA ranked first [odds ratio (OR) = 10.71; 95% confidence interval (CI), 3.44-33.33; surface under the cumulative ranking curve (SUCRA), 94.5%]. For Mini-Mental State Examination (MMSE) score, CWM + CHM + Acup ranked first [standardized mean difference (SMD) = 3.01; 95% CI, 1.65-4.37; SUCRA, 97.2%]. For Activities of Daily Living (ADL) score, CWM + Acup + AA ranked first (SMD = 4.10; 95% CI, 1.18-7.02; SUCRA, 99.2%). For Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) score, CWM + CHM + Acup ranked first (SMD = 2.43; 95% CI, 0.43-4.43; SUCRA, 89.3%). CWM + CPM ranked first for interleukin (IL)-1β (SMD = 1.73; 95% CI, 0.82-2.65; SUCRA, 83.8%), IL-6 (SMD = 3.47; 95% CI, 2.29-4.65; SUCRA, 96.3%), and tumor necrosis factor-alpha (TNF-α) (SMD = 3.71; 95% CI, 2.86-4.56; SUCRA, 100%). For serum superoxide dismutase (SOD), CWM + (CHM + Acup) ranked first (SMD = 2.78; 95% CI, 0.87-4.69; SUCRA, 94.1%). Available evidence suggests that CPM added to CWM may offer advantages for inflammatory biomarkers, while acupuncture-based combinations may be advantageous for selected clinical and functional outcomes. Treatment choice should therefore be guided by the therapeutic target and the certainty of the supporting evidence. Because several comparisons were supported by few studies and overall certainty was low to very low for major outcomes, these findings require confirmation in rigorously designed trials.
The Practitioner Research and Collaboration Initiative (PRACI), established in 2014, recruited the largest range of complementary medicine (CM) professions in a practice-based research network (PBRN) worldwide. The ongoing success of PRACI and its ability to accurately reflect current CM practice and use requires an updated practitioner membership. This paper aims to report the demographic and practice characteristics of the recently refreshed PRACI membership. A cross-sectional survey was administered to those currently in clinical practice within one of nine CM professions: acupuncture, Bowen therapy, Chinese herbal medicine, kinesiology, massage therapy, myotherapy, naturopathy, nutrition, and Western herbal medicine. Responders provided consent to join membership of the PRACI PBRN. The survey covered practitioner demographics, clinical identity and qualifications, clinical career and practice, and practice characteristics. A total of 922 practitioners across all nine targeted CM professions were recruited with the majority identifying as female and reported practicing in an urban locality. Most common areas of clinical interest were general health and wellbeing, musculoskeletal health, pain management, and women's health. The refreshed PRACI membership provides world-leading infrastructure to facilitate urgently needed research activity and capacity-building focused upon issues and challenges grounded in CM clinical practice. Such value will build upon and extend the numerous PRACI sub-studies successfully completed, and collaborations successfully undertaken to date.
In Mexico, traditional practices like herbal remedies, spiritual rituals, and energy-based therapies remain integral to mental health care. These are deeply rooted in cultural beliefs and often coexist with modern treatments. This study explores mental health professionals' perspectives on the prevalence, factors influencing, and integration of traditional practices into modern psychiatric care. This qualitative phenomenological study is part of a broader investigation into sociocultural factors in Mexican mental health care. Participants were selected through convenience and snowball sampling. Data were gathered through 1-hour semi-structured interviews, covering various aspects of mental health care. This analysis specifically focused on participants' discussions about traditional treatments, which were identified and extracted from the transcripts for thematic analysis. The study highlighted a wide range of traditional practices used by patients, including spiritual healing, energy therapies, medicinal plants, psychedelics, and complementary therapies. Factors influencing the use of these practices included cultural beliefs, emotional motivations, and issues within the healthcare system. Mental health professionals had varied attitudes toward these practices: most were respectful but did not integrate them into treatment, some were skeptical of their safety, and a few adopted an integrative approach, incorporating traditional practices into care. The study emphasizes the widespread use of traditional therapies in Mexico, influenced by cultural beliefs and gaps in access to modern care. While most professionals respect these practices, integrating them with evidence-based approaches requires a balance between cultural sensitivity and scientific validation, which is essential for providing comprehensive, culturally appropriate care.
Siguan points, comprising bilateral Hegu (LI4) and Taichong (LR3), have shown good therapeutic potential in migraine management. We aimed to systematically evaluate the clinical efficacy and neurovascular regulatory mechanisms of Siguan points-based acupuncture treatment (SPBAT) for migraine. A comprehensive literature search was conducted across 15 databases through January 1st, 2025. Randomized controlled trials (RCTs) comparing SPBAT with conventional pharmacotherapy or sham acupuncture were included. Primary outcomes encompassed the clinical effective rate and the headache intensity measured by the visual analogue scale (VAS). Secondary outcomes included attack frequency, migraine days, doses of analgesics, adverse events (AEs), and other relevant measures. Dichotomous variables were reported as risk ratios (RR) or risk differences (RD), and continuous variables as mean differences (MD) or standardized mean differences (SMD); all estimates were presented with 95 % confidence intervals (CIs). Trial sequential analysis (TSA) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. The neurovascular regulatory mechanisms of Siguan points for migraine were systematically reviewed. Analysis of 19 RCTs (1312 participants) demonstrated significant improvements with SPBAT in clinical effective rate (RR 1.22 [1.14, 1.31]), VAS for headache intensity (MD -1.11 [-1.50, -0.73]), attack frequency (SMD -0.81 [-1.49, -0.14]), and other outcomes. TSA confirmed the robustness of primary outcome findings. GRADE assessment indicated moderate to low evidence certainty across outcomes. No significant differences in AEs were observed between groups (RD -0.04 [-0.11, 0.04]). Mechanistic investigations revealed that Siguan points exerted therapeutic effects through integrated modulation of central pain processing networks and peripheral neurovascular pathways. SPBAT demonstrates significant efficacy in reducing migraine severity, duration, and frequency while maintaining a safety profile comparable to standard treatments. Its neurovascular regulatory effects and clinical benefits position SPBAT as a viable alternative for migraine management, though further high-quality research is warranted to strengthen the evidence base.
This study investigates the impact of a 3-month Pilates training program on lower limb joint muscle strength in unilateral transtibial amputees (TTA), focusing on enhancing muscle function in both the intact and residual limbs. This is a single-cohort pre-post-intervention study without a control group. Ten TTA participants, actively using prostheses for at least six months, completed a Pilates intervention with 36 sessions online, involving progressively increasing exercise intensities. Measurements of joint muscle strength in the intact limb and residual limb hip were taken at baseline, pre- and post-intervention, and at a three-month follow-up using an isokinetic dynamometer. Repeated measures ANOVA determined statistical significance (alpha level, p < 0.05); and effect size (ES) differences were determined to highlight clinical meaningfulness. Significant muscle strength increases were observed in the intact limb ankle (45.6 % plantarflexors, 11.9 % dorsiflexors), knee (25.9 % extensors, 28.7 % flexors), hip (22.9 % flexors, 42.2 % extensors) and hip of the residual limb (23.1 % flexors, 52.1 % extensors) - all increases represented a large effect size (ES > 3.0). These improvements persisted at follow-up. This pilot study demonstrated that Pilates training significantly improved joint muscle strength in the intact and residual limbs of the TTA participant group. These preliminary findings support Pilates as a beneficial and accessible modality for enhancing strength and mobility in lower limb amputees. However, further randomised controlled studies are required to fully determine the effects of Pilates training on functional outcomes and mobility in lower limb amputees.
and Purpose: Postoperative gastrointestinal dysfunction (POGD) is a significant complication following abdominal surgery and is characterized by delayed flatus and stool passage, postponed oral feeding, and dyspeptic symptoms. The study aimed to evaluate whether transcutaneous electrical acupoint stimulation (TEAS) accelerates gastrointestinal function recovery and reduces POGD-related complications after elective laparoscopic non-gastrointestinal surgery. Patients scheduled for selective non-gastrointestinal laparoscopic surgery were randomized into the TEAS or sham-TEAS group. TEAS group patients were administered electrical stimulation at acupoints Zusanli (ST36), Neiguan (PC6), and Hegu (LI4) starting 30 min prior to anesthesia induction and continuing until surgery completion. Patients in the sham-TEAS group received a sham stimulus at the same acupoints, and no output current was delivered by disconnecting the device's output line. Our primary endpoint included the time to first flatus, whereas the secondary endpoints were the time to first defecation, postoperative nausea and vomiting (PONV) rate, length of hospital stay, hospital expenses, numeric rating scale (NRS) pain score, and incidence of postoperative complications. A total of 587 patients were enrolled and assigned to the TEAS (n = 294) or sham-TEAS (n = 293) group between May 15, 2019, and October 18, 2021. Compared with the sham-TEAS group, the TEAS group had a significantly shorter time to first flatus (median [interquartile range (IQR)], 21.50 h [19.0-23.5 h] vs. 23.5 h [21.0-26.0 h]; p < 0.001) and time to first defecation (41.2 h [38.5-45.0 h] vs. 46.0 h [42.0-52.0 h]; p < 0.001). Additionally, the TEAS group showed lower rates of PONV (15% vs. 22.9%; p = 0.015) and abdominal distention (21.1% vs. 29.7%; p = 0.017), as well as lower NRS pain scores (median [IQR], 3 [2-3] vs. 3 [2-3.5]; p = 0.026). There were no significant differences in hospital stay length and hospitalization expenses. TEAS accelerates gastrointestinal function recovery in patients undergoing laparoscopic non-gastrointestinal surgery, reducing PONV, abdominal distention and postoperative pain without increasing hospital stay or costs.
Opioid misuse and dependence remain critical public health issues in the U.S., contributing significantly to reduced life expectancy. Emergency departments (EDs) are key settings for implementing opioid reduction strategies when treating acute pain, such as nonpharmacologic treatment options like acupuncture. This study explored clinician-related factors influencing the integration of the Pain Elimination through Acupuncture Research and Learning (PEARL) program for pain reduction within a high-volume urban ED. This study employed a sequential mixed methods design, involving surveys and interviews with ED clinicians. An 11-item electronic survey was administered annually to assess clinician attitudes related to appropriateness and effectiveness of integrating acupuncture into the ED's comprehensive care plan for treatment of pain. Near the end of the 3rd year of the PEARL program, semi-structured interviews were conducted to gather in-depth insights into clinician knowledge and perceptions of the program. Quantitative survey data from 99 eligible ED clinicians indicated positive perceptions of the program's appropriateness and effectiveness, and improved understanding of acupuncture referral procedures. Analysis of qualitative interviews conducted with 16 ED clinicians revealed five key themes: acupuncture as an acceptable analgesic strategy to reduce the use of opioids, patient benefits, program presence in the ED, integration challenges, and the need for continued education. Strong acceptance of acupuncture as a feasible nonpharmacologic addition to the comprehensive pain care plan used in the ED was observed. Dedicated space, expanded acupuncture staff and hours, and ongoing training of ED staff will require institutional support to sustain acupuncture as a nonpharmacologic treatment option for ED patients.
This qualitative study explores perspectives and experiences of users of Traditional, Complementary, and Integrative Medicine (TCIM) in university outpatient departments in Berlin, Germany. While TCIM use is widespread, little is known about user perceptions and interaction patterns. The study aims to deepen understanding of the socio-medical context of TCIM use in Germany, focusing on user characteristics and identities. Twenty semi-structured interviews were conducted in 2023 with patients from TCIM outpatient departments at Charité Berlin. Using an interview guide, participants reflected on experiences, perceptions, and biographical backgrounds related to TCIM. Interviews were recorded, transcribed, anonymized, and analyzed using MAXQDA following Kuckartz's content analysis. Key themes included motivations, health conceptions, and roles within the social context. Participants (17 women, 3 men; mean age 62) associated TCIM with holistic care addressing physical, psychological, and spiritual aspects. Acupuncture, homeopathy, and dietary therapies were commonly used. Motivations included especially dissatisfaction with conventional care, personal beliefs, and social influence. Participants actively engaged in their treatment choices, often maintaining good relationships with general practitioners, while criticizing specialist disregard of TCIM. TCIM acceptance reflected broader concepts of health, including personal responsibility and non-material aspects. Study results suggest that patient narratives and experiences play a central role in TCIM use. Participants called for integrative care models that value psychological and spiritual aspects alongside somatic treatment. Findings underscore a shift towards active patient roles. Given TCIM's continued relevance in Germany, integrating evidence-based TCIM into health systems may enhance patient engagement and outcomes.
Chronic non-cancer pain (CNCP) imposes a substantial burden on individuals and healthcare systems worldwide. Limitations and risks of long-term pharmacological treatment have increased interest in complementary therapies; however, the lack of direct comparisons limits evidence-based decision-making. Therefore, this study aimed to compare complementary therapies for pain and disability using a network meta-analysis. A network meta-analysis of randomized controlled trials was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA) guidelines. Four databases were searched from inception to December 2024, with an update in May 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A Bayesian random-effects network meta-analysis was performed. Treatment rankings were evaluated using the surface under the cumulative ranking curve (SUCRA), and inconsistency and publication bias were assessed. Thirty-three randomized controlled trials involving 6196 participants were included. Dry needling ranked highest for pain and disability, but the evidence quality was very low because of substantial heterogeneity. Cognitive behavioral therapy and acupuncture showed moderate-quality evidence and consistent improvements in both outcomes versus wait control. Safety reporting was inconsistent, and reported adverse events were mostly mild and transient. Cognitive behavioral therapy and acupuncture appear to be reliable options for improving pain and disability in chronic non-cancer pain, supported by moderate-quality evidence. Dry needling may provide short-term benefits but should be interpreted cautiously because of low certainty.
Effective management of glycolipid metabolism is key to reducing the risk of cardiovascular disease in patients with metabolic syndrome (MetS). Chinese patent medicines (CPMs), a type of standardized herbal formulation, are widely used in China. This study compared the efficacy, safety, and cost-effectiveness of CPMs as adjunctive therapies for glycolipid regulation in MetS via network meta-analysis (NMA), providing a reference for clinical decision-making. By October 2024, we searched eight databases for randomized controlled trials (RCTs) investigating the use of CPMs in the treatment of MetS. The impact of CPMs on lipid profiles, blood glucose levels, and insulin resistance indicators was evaluated using methods including surface under the cumulative ranking curve (SUCRA). The cost-effectiveness analysis was conducted on the basis of the market price in China and SUCRA rankings. A total of 25 RCTs involving 17 CPMs were included. The results revealed that combining specific CPMs with conventional treatment had significant beneficial effects on lipid and glucose metabolism. Hedan tablet was revealed to be the most effective at regulating the levels of lipids, when both efficacy and cost were considered. Shenqi Jiangtang granule and Jiangzhi Jianfei capsule had the greatest beneficial effects on glucose metabolism and insulin resistance. CPMs have the potential to serve as effective adjunctive therapies for glycolipid regulation in patients with MetS. However, given the limited number and quality of studies included in this NMA, these conclusions should be interpreted with caution. Further high-quality RCTs are warranted to validate and update the current evidence.
Although numerous pairwise meta-analyses have demonstrated the benefits of exercise on inflammation in hemodialysis patients, the comparative effectiveness of different exercise types on inflammation in this population remains unclear. This study aims to compare the effectiveness of intradialytic aerobic exercise (IAE), non-intradialytic aerobic exercise (NAE), intradialytic combined aerobic and resistance exercise (ICE), intradialytic resistance exercise (IRE), non-intradialytic aerobic exercise + intradialytic resistance exercise (NAE + IRE), and non-intradialytic resistance exercise (NRE) on inflammatory marker levels of hemodialysis patients using network meta-analysis (NMA) and to rank them subsequently. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), and China Biomedical Literature Database (CBM) from inception to August 13, 2025. We conducted an NMA using Stata 18.0. The interventions were ranked according to their effectiveness in reducing inflammation in hemodialysis patients using the surface under the cumulative ranking curve (SUCRA). Finally, the grading of recommendations, assessment, development, and evaluation (GRADE) framework was utilized to evaluate the reliability of evidence. This study included 46 studies across 9 countries involving 3073 hemodialysis patients. For the reduction of C-reactive protein, NAE + IRE (SUCRA = 85.3) and IRE (SUCRA = 59.6) were ranked first and second. For the reduction of interleukin-6, NAE + IRE (SUCRA = 93.0) and NRE (SUCRA = 66.5) were ranked first and second. For the reduction of tumor necrosis factor-α, NAE (SUCRA = 99.9) and NAE + IRE (SUCRA = 66.1) were ranked first and second. The GRADE evidence levels for the three outcome measures ranged from very low to low. NAE + IRE consistently ranked among the top two interventions across all inflammatory markers, making it the optimal exercise strategy to reduce inflammation in hemodialysis patients.
and Purpose: Depression and anxiety are common among women cancer survivors and negatively affect quality of life and recovery. While yoga is recommended as a supportive intervention, evidence for online yoga (particularly comparing group and individual delivery formats and targeting clinically elevated distress) is limited. This study evaluated the feasibility, acceptability, and exploratory changes in outcomes of a 6-week online yoga intervention comparing group-based and individualized yoga for women with breast or gynecological cancers experiencing elevated depression and/or anxiety symptoms. Thirty participants were randomized to group or individual sessions delivered via Zoom by a yoga therapist. The intervention consisted of weekly 60-min live sessions and supplementary pre-recorded practices. Feasibility metrics included recruitment rates (≥50% consent), session adherence (≥60% attending half the yoga sessions), and follow-up completion (≥60%). Depression, anxiety, overall health, stress, fatigue and quality of life were assessed at baseline, 4 weeks, and 6 weeks, complemented by post-intervention qualitative interviews analyzed via reflexive thematic analysis. The intervention met all feasibility thresholds in the overall sample. Depression and anxiety scores, measured using the Hospital Anxiety and Depression Scale (HADS), showed significant improvements over the intervention period in the overall sample for depression (difference -0.4; 95% confidence interval -0.2 to -0.6; p = 0.002) and anxiety (difference -0.7; 95% confidence interval -0.4 to -1.0; p < 0.001). There were no significant differences between the group and individual formats for these outcomes. Additionally, significant improvements were observed across all secondary outcomes in the total sample. Qualitative themes highlighted participants' positive experiences, noting the intervention's accessibility, perceived benefits, and overall acceptability. In this preliminary feasibility study, online yoga (whether in group or individual format) was feasible, well-accepted, and showed potential for improving mental health outcomes. Future randomized controlled trials are warranted to confirm online efficacy and optimized implementation in supportive care.
Postpartum urinary retention (PUR) is a frequent complication following epidural anesthesia in primiparous women, elevating the risk of urinary tract infections and long-term bladder dysfunction. This study aimed to investigate the efficacy of a self-heating traditional Chinese medicine (TCM) hot pack in preventing PUR and enhancing postpartum maternal comfort. Eighty primigravid women receiving epidural anesthesia were randomly assigned to a control group receiving standard postpartum care, or a test group receiving standard care plus application of a self-heating TCM hot pack for 4 h. Key measures included time to first urination, voiding volume, residual urine volume, incidence of PUR, and maternal comfort assessed using Kolcaba's comfort scale 6-8 h after delivery. The incidence of PUR was significantly lower in the test group (2.56 %) compared to the control group (12.5 %). Participants using the TCM hot pack exhibited a markedly shorter time to first void, increased voiding volume, and significantly higher overall and dimensional comfort scores (all P < 0.05). No significant differences were found in 24-h vaginal bleeding or rates of postpartum hemorrhage. The use of a self-heating TCM hot pack was associated with a reduced incidence of PUR and increased maternal comfort in this study, suggesting it may be a beneficial intervention for postpartum care. However, the specific contributions of thermal versus herbal components remain unclear. These findings indicate a simple and safe approach that warrants further investigation to confirm its efficacy and potential cost-effectiveness.
To examine obstetricians' and gynecologists' knowledge, attitudes, and practices regarding antenatal yoga and to explore the factors contributing to their hesitancy in recommending it. A cross-sectional survey was conducted among 71 obstetricians and gynecologists in Bangladesh using online and offline modes. Demographic data, professionals' knowledge, attitudes, practices, and perceived barriers to antenatal yoga were collected. Descriptive statistics and correlation matrix analyses were performed. 83.1 % of respondents recognised the benefits of antenatal yoga; however, only 50 % routinely recommended it to pregnant women. Key barriers identified included a lack of standardised training, insufficient knowledge of antenatal yoga practices, and cultural resistance. Despite these challenges, all participants (100 %) expressed interest in attending antenatal yoga-related workshops and training. While obstetricians and gynecologists in Bangladesh were optimistic about the benefits of antenatal yoga (AY), a lack of standardised guidelines and training, insufficient family support, and cultural factors hinder its widespread recommendation. To enhance the integration of AY into maternal care, this study recommends developing a standardised protocol for AY practices and incorporating specialised training for obstetricians and gynecologists to improve awareness and competency.