The journal of alternative and complementary medicine : research on paradigm, practice, and policy
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J Altern Complement Med · Jan 2005
ReviewPatients, doctors, and videotape: a prescription for creating optimal healing environments?
Despite repeated calls for greater patient autonomy, shared decision making, and exploration of patient preferences, relatively little is known about how patients actually experience care as a face-to-face interactional process. A selected review of the literature in this area suggests that important asymmetries exist. Key among them is the tendency to report experiences from the point of view of only one member of the doctor-patient dyad. ⋯ This finding flies in the face of traditional sociological thought, which holds that the greater the social distance between actors (doctors and patients), the more difficult it should be to communicate. With respect to being stratified by historical satisfaction scores, doctors with high historical satisfaction were found to comment more often, make fewer assumptions, take longer with their patients, and be more vigilant than doctors with historically low satisfaction scores. We conclude that videotape review is a parsimonious way of integrating face-to-face communication with the participants' lived experience of the care process, a necessary ingredient in creating optimal healing environments.
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J Altern Complement Med · Jan 2005
ReviewThe future of patient-centered care: scenarios, visions, and audacious goals.
The U. S. health care system is transforming. It must. ⋯ Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers.
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J Altern Complement Med · Oct 2004
Randomized Controlled Trial Clinical TrialA pilot study to examine the effects of a mindfulness-based stress-reduction and relaxation program on levels of stress hormones, physical functioning, and submaximal exercise responses.
Stress has been cited as a causal factor in heart disease. The objective of this study was to examine the effects of an 8-week mindfulness-based stress-reduction program on the resting levels of stress hormones, physical functioning, and submaximal exercise responses in women with heart disease. ⋯ While the 8-week stress reduction program for women with heart disease did not show significant interactions between groups for resting levels of stress hormones, physical functioning, or submaximal exercise responses, there was a significant difference in breathing patterns between the 2 groups during exercise following the mindfulness-based stress-reduction program. There was also a trend for change in the intervention group in the resting levels of cortisol and physical function scores that was not seen in the control group. Future studies could use the effect size generated from this pilot study to calculate the number of subjects needed for adequate power to detect significant differences between groups.
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J Altern Complement Med · Aug 2004
Effectiveness gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine.
An effectiveness gap (EG) is an area of clinical practice in which available treatments are not fully effective. EGs have not been previously researched. Complementary and alternative medicine (CAM) interventions, by definition, are not generally available through normal health care channels. Therefore, if effective, they have the potential to increase achieved community effectiveness. ⋯ EGs, mapped against evidence, have the potential to inform service development and research policy. Further study should be undertaken: it should incorporate improved sampling and data collection methodology. Specifically, where effective CAM interventions exist but are not being applied, EGs form part of the "avoidable burden of illness" identified by early work on evidence-based medicine. Practice guidelines should incorporate CAM interventions where there is evidence. The CAM research agenda should focus on areas affected by EGs.