Publications by authors named "Anna Paul"

42 Publications

The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment.

BMC Cancer 2021 Jun 23;21(1):724. Epub 2021 Jun 23.

Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany.

Background: Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life.

Methods: INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events.

Discussion: This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer.

Trial Registration: German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.
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http://dx.doi.org/10.1186/s12885-021-08468-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220783PMC
June 2021

Nursing Procedures for the Prevention and Treatment of Mucositis Induced by Cancer Therapies: Clinical Practice Guideline Based on an Interdisciplinary Consensus Process and a Systematic Literature Search.

Integr Cancer Ther 2021 Jan-Dec;20:1534735420940412

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

Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis.

Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis.

Methods: The study design was an interdisciplinary consensus process based on a systematic literature search.

Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy.

Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.
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http://dx.doi.org/10.1177/1534735420940412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960907PMC
January 2021

Switching anti-VEGF agent for wet AMD: evaluation of impact on visual acuity, treatment frequency and retinal morphology in a real-world clinical setting.

Graefes Arch Clin Exp Ophthalmol 2021 Jan 7. Epub 2021 Jan 7.

Department of Ophthalmology, Region Västmanland, S-721 89, Västerås, Sweden.

Purpose: The aim of the present cross-sectional real-world study is to evaluate the impact of switch of anti-VEGF agent from ranibizumab to aflibercept on visual acuity, treatment frequency and retinal morphology after 12 months in eyes with ongoing chronic treatment for wet age-related macular degeneration (AMD) compared to eyes not subjected to switch of anti-VEGF agent.

Methods: Data was obtained retrospectively from the Swedish Macular Register, spectral-domain optical coherence tomography (OCT) images and electronic patient charts. All eyes included were treated in the same clinical setting at the Department of Ophthalmology at the county hospital of Västmanland in Västerås, Sweden.

Results: In total, 282 and 359 eyes were included in the non-switch and switch cohorts, respectively. The cohorts were well balanced. Visual acuity remained stable during the observation period in both cohorts of eyes. The number of anti-VEGF treatments slowly declined over time in both cohorts of eyes and, consequently, the treatment intervals increased during the observation period. In eyes subjected to switch of anti-VEGF agent, planned treatment interval at 12 months was 7.6 (mean; SD 2.9) weeks compared to 6.8 (mean; SD 2.7) in the non-switch cohort (P = 0.001). OCT images demonstrated lower prevalence of intraretinal and subretinal fluid as well as pigment epithelial detachment at 12 months in eyes subjected to switch of anti-VEGF agent compared to non-switch eyes.

Conclusion: Switch of anti-VEGF agent from ranibizumab to aflibercept did not affect visual function whereas improvement in retinal morphology was observed. These findings suggest a beneficial effect of switching from ranibizumab to aflibercept in eyes with ongoing chronic anti-VEGF treatment irrespective of previous response to ranibizumab. Longer follow-up is required to further evaluate the potential clinical significance of this finding.
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http://dx.doi.org/10.1007/s00417-020-05059-yDOI Listing
January 2021

The Relevance of Complementary and Integrative Medicine in the COVID-19 Pandemic: A Qualitative Review of the Literature.

Front Med (Lausanne) 2020 11;7:587749. Epub 2020 Dec 11.

Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany.

During the COVID-19 pandemic people are facing risks of adverse health effects due to the restrictions implemented such as quarantine measures, reduced social contact, and self-isolation. In this qualitative review, we collected data on potential preventive and therapeutic health benefits of Complementary and Integrative Medicine (CIM) that might be useful during the COVID-19 pandemic. We have reviewed the scientific literature to summarize CIM practices that could be beneficial for improving physical and mental health and well-being of the population under the current pandemic circumstances. It must be noted that this review is not SARS-CoV-2 specific and we explicitly do not intend to make any SARS-CoV-2 specific health claims in this article. A qualitative, non-systematic literature review was conducted in Medline to identify literature describing preventive and therapeutic CIM approaches for strengthening mental and physical health. For a variety of CIM approaches clinical evidence was identified, indicating beneficial effects. CIM approaches include specific dietary measures and selected micronutrients, physical activity, techniques from Mind-Body Medicine, single botanicals or botanical compounds, and spending time in nature among others. The effects of CIM measures on conditions like obesity and hypertension are of special relevance here, as these conditions are considered as risk factors for a severe course of COVID-19. Moreover, a possibly direct effect of CIM approaches on immune functions and clinical parameters in respiratory tract infections, such as influenza, were identified. The findings of this review could be helpful for clinicians, patients, and the general population during the current pandemic when discussing and/or considering CIM options. CIM offers a variety of preventive and therapeutic options for strengthening physical and mental resilience, which could also be useful in the current COVID-19 pandemic. The evidence of CIM approaches with a potential benefit in the COVID-19 pandemic in different areas is worth to be analyzed. While this qualitative review has several obvious limitations, it might serve as useful starting point for further research on this topic.
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http://dx.doi.org/10.3389/fmed.2020.587749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761649PMC
December 2020

Effects of an Integrative Mind-Body-Medicine Group Program on Breast Cancer Patients During Chemotherapy: An Observational Study.

Curr Pharm Des 2021 ;27(8):1112-1120

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Breast cancer is one of the leading cancers in women in the Western world. Cancer treatment, especially chemotherapy, is often associated with physical and psychosocial side effects.

Objective: To improve the quality of life and manage side effects, a new integrative mind-body-medicine group concept for breast cancer patients receiving chemotherapy was developed and pilot tested.

Methods: Breast cancer patients participated in a 66 hours mind-body-medicine group program tailored to the needs of cancer patients during chemotherapy. The program was integrated into standard care encompassing mindfulness training, yoga, moderate exercise, nutrition, complementary self-help strategies, cognitive restructuring, and acupuncture. Quality of life (EORTC QLQ-C30), depression and anxiety (HADS), stress (PSS-10), and fatigue (BFI) were assessed before and after the program, as well as satisfaction and safety. Analyses were carried out on exploratory basis with paired samples t-tests.

Results: Fifty-seven female patients, aged 51.3±10.5 years, with breast cancer diagnoses were enrolled. After completing the program, global EORTC quality of life was improved (D=9.5; 95%-CI=[2.9|16.1]; p=.005), although the EORTC-symptom scales assessing fatigue (D=9.9; 95%-CI=[1|18.8]; p=.030), nausea (D=7.1; 95%- CI=[0.6|13.6]; p=.031), and dyspnea (D=12.5; 95%-CI=[2.9|22.1]; p=.011) were found to be increased. Stress (D=-3.5; 95%-CI=[-5|-2.1]; p=.000), anxiety (D=-3.8; 95%-CI=[-4.9|-2.7]; p=.000) and depression (D=-3.9; 95%-CI=[-4.9|-2.8]; p=.000) were also found to be significantly reduced. Regarding the severity of (D=0.2; 95%- CI=[-0.8|0.5]; p=.644) and the impairment due to fatigue (D=0.1; 95%-CI=[-0.8|0.6]; p=.696), no significant worsening was observed. Patients were satisfied with the program. No serious adverse events were reported.

Conclusion: Breast cancer patients benefit from an integrative mind-body-medicine group program during chemotherapy regarding the quality of life and psychological symptoms. Randomized controlled trials are warranted.
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http://dx.doi.org/10.2174/1381612826666201211111122DOI Listing
May 2021

Effects of genetic variability of CYP2D6 on neural substrates of sustained attention during on-task activity.

Transl Psychiatry 2020 10 6;10(1):338. Epub 2020 Oct 6.

Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany.

The polymorphic drug-metabolizing enzyme CYP2D6, which is responsible for the metabolism of most psychoactive compounds, is expressed not only in the liver, but also in the brain. The effects of its marked genetic polymorphism on the individual capacity to metabolize drugs are well known, but its role in metabolism of neural substrates affecting behavior personality or cognition, suggested by its CNS expression, is a long-standing unresolved issue. To verify earlier findings suggesting a potential effect on attentional processes, we collected functional imaging data, while N = 415 participants performed a simple task in which the reward for correct responses varied. CYP2D6 allelic variants predicting higher levels of enzymatic activity level were positively associated with cortical activity in occipito-parietal areas as well as in a right lateralized network known to be activated by spatial attentional tasks. Reward-related modulation of activity in cortical areas was more pronounced in poor metabolizers. In conjunction with effects on reaction times, our findings provide evidence for reduced cognitive efficiency in rapid metabolizers compared to poor metabolizers in on-task attentional processes manifested through differential recruitment of a specific neural substrate.
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http://dx.doi.org/10.1038/s41398-020-01020-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539151PMC
October 2020

Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis-A Randomized Controlled Trial.

J Clin Med 2020 Sep 24;9(10). Epub 2020 Sep 24.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany.

Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM; = 47; 50.28 ± 11.90 years) or control ( = 50; 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire; IBDQ) at week 12. Secondary outcomes included IBDQ subscales; generic HrQoL; disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference ( = 0.251). If patients attended more than 50% of the training sessions, a significant group effect ( = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary ( = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subsample of patients who attended ≥ 50% of sessions.
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http://dx.doi.org/10.3390/jcm9103087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599849PMC
September 2020

Signals of anticipation of reward and of mean reward rates in the human brain.

Sci Rep 2020 03 9;10(1):4287. Epub 2020 Mar 9.

Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, 89075, Ulm, Germany.

Theoretical models of dopamine function stemming from reinforcement learning theory have emphasized the importance of prediction errors, which signal changes in the expectation of impending rewards. Much less is known about the effects of mean reward rates, which may be of motivational significance due to their role in computing the optimal effort put into exploiting reward opportunities. Here, we used a reinforcement learning model to design three functional neuroimaging studies and disentangle the effects of changes in reward expectations and mean reward rates, showing recruitment of specific regions in the brainstem regardless of prediction errors. While changes in reward expectations activated ventral striatal areas as in previous studies, mean reward rates preferentially modulated the substantia nigra/ventral tegmental area, deep layers of the superior colliculi, and a posterior pontomesencephalic region. These brainstem structures may work together to set motivation and attentional efforts levels according to perceived reward opportunities.
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http://dx.doi.org/10.1038/s41598-020-61257-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062891PMC
March 2020

Frequency and clinical features of treatment-refractory myasthenia gravis.

J Neurol 2020 Apr 11;267(4):1004-1011. Epub 2019 Dec 11.

Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Background: To investigate the frequency and characterize the clinical features of treatment-refractory myasthenia gravis in an Austrian cohort.

Methods: Patient charts of 126 patients with generalized myasthenia gravis and onset between 2000 and 2016 were analyzed retrospectively. Patients were classified as treatment-refractory according to strict, predefined criteria. These mandated patients being at least moderately symptomatic (i.e., MGFA class III) or needing either maintenance immunoglobulins or plasma exchange therapy for at least 1 year in spite of two adequately dosed immunosuppressive drugs. Clinical features and outcome at last follow-up were compared to treatment-responsive patients.

Results: 14 out of 126 patients (11.1%) met these criteria of treatment-refractory myasthenia gravis. Treatment-refractory patients had more frequent clinical exacerbations and more often received rescue treatments or a further escalation of immunosuppressive therapies. They also remained more severely affected at last follow-up. An early onset of myasthenia gravis was associated with a higher risk for a refractory course.

Conclusion: A small subgroup of patients with generalized myasthenia gravis do not respond sufficiently to standard therapies. Refractory disease has considerable implications for both patients and health care providers and highlights an unmet need for new treatment options.
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http://dx.doi.org/10.1007/s00415-019-09667-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109164PMC
April 2020

Milk Analog: Plant based alternatives to conventional milk, production, potential and health concerns.

Crit Rev Food Sci Nutr 2020 16;60(18):3005-3023. Epub 2019 Oct 16.

Department of Food Science and Technology, Dr. Y. S. Parmar University of Horticulture and Forestry, Nauni, Himachal Pradesh, India.

Nutraceutical and functional food market are one of the fastest-growing food segments in the newer food product development category. In the recent past, focus of beverage industry has shifted towards making food more nutritious and functionally enriched. To load the food with nutraceutical functionality, herbal sources having target functional compounds are either directly used as food or for separation of target compounds. Among beverages, milk is considered as a wholesome complete food providing macro (fat, proteins, and carbohydrates) and micronutrients (calcium, selenium, riboflavin, vitamin B, and pantothenic acid vitamin B) in balanced proportions. However, limited access to milk in some regions of globe, low availability of certain minerals (iron), vitamins (folate), and other biomolecules (amino acids) compounded with issues like milk allergy, lactose intolerance, and hypercholesterolemia have forced some specific population groups to search for better milk alternatives which are more or at least equi-nutritional to conventional milk. Plant-based wholesome or blended milk analogs are better studied as inexpensive alternates to conventional milk for people who are in search of better alternates for one or other reason. The market of milk analogs is currently dominated by soya bean milk, oat milk, coconut milk, hemp milk, cocoa milk, multigrain milk etc. most of which are produced by controlled fermentation which owes to their functional bioactive composition. Such analogs are appreciated for their functionally active components which are often correlated to their health-promoting and disease-preventing properties. One major advantage of analogs over conventional milk is that the energy input per unit of milk produced is much less compared to animal milk while there is always an opportunity to manipulate their composition based on demand. However, the major limiting factor in the acceptance of such non-conventional beverages is their challenging production technology and poor sensory profile which is true particularly for beverages derived from legumes. These challenges provide an opportunity for both industries and research personals to put in major concerted efforts in the field of functional bioactive food segment to produce tailor-made novel beverages which are nutritional, economic and have improved functionality. Keeping in view the potential of plant-based milk alternates and associated challenges the aim of the present review is to give a scientifically comparative and conclusive overview of the present status, market potential, and health concerns of plant-based nondairy milk beverages.
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http://dx.doi.org/10.1080/10408398.2019.1674243DOI Listing
November 2020

Integrated care for migraine and chronic tension-type headaches: A prospective observational study.

Complement Ther Clin Pract 2019 Aug 16;36:1-6. Epub 2019 Apr 16.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background And Purpose: This prospective observational study aimed to investigate the effects of an interdisciplinary multimodal integrated care program in patients with chronic migraine and/or tension-type headache.

Materials And Methods: Patients (n = 158) underwent inpatient, outpatient and/or semi-stationary treatment including conventional as well as complementary headache treatment. Headache frequency was defined as the primary outcome; secondary outcomes included pain (VAS, PPS), medication use, quality of life (SF-36), function (HDI, PSFS), depression and anxiety (HADS), and pain self-efficacy (PSEQ).

Results: Headache frequency decreased from 17.0 ± 8.8 days/month at treatment start to 11.4 ± 9.2 at treatment end and to 10.6 ± 9.3 at 6-month follow-up (p < 0.001). All other outcome measures also improved across the course of the study (all p < 0.001).

Conclusions: An integrated care approach based on integrative medicine improved headache symptoms and functioning in patients with chronic migraine and/or tension-type headache. Interdisciplinary multimodal treatment approaches seem to adequately address the specific treatment needs of headache patients.
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http://dx.doi.org/10.1016/j.ctcp.2019.04.001DOI Listing
August 2019

Hypoglossal acupuncture for acute chemotherapy-induced dysgeusia in patients with breast cancer: study protocol of a randomized, sham-controlled trial.

Trials 2019 Jul 4;20(1):398. Epub 2019 Jul 4.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.

Background: Distortion of taste sensations is a common chemotherapy-induced side effect; however, treatment evidence is limited. Pilot data indicated that acupuncture might be able to improve symptoms of dysgeusia. Thus, the aim of this study is to investigate the effects and side effects of hypoglossal acupuncture in the treatment of dysgeusia in patients with breast cancer undergoing chemotherapy.

Methods/design: The study is a randomized controlled trial comparing a single verum acupuncture treatment with two active comparators: sham acupuncture and dietary recommendations. Sample size calculation revealed a total of 75 patients pending an alpha of 0.05, a power of 0.8, and an estimated effect size of 0.80. Patients with breast cancer undergoing platinum- or taxane-based chemotherapy will be included if they present with phantogeusia (abnormal taste sensations without an external oral stimulus) with an intensity of 4 points or above on an 11-point numeric rating scale (NRS). The primary outcome is phantogeusia; secondary outcomes include parageusia (abnormal taste of food), hypogeusia (reduced taste sensations), hypergeusia (increased taste sensations), xerostomia (dry mouth), stomatitis, appetite, and functional impairment. All outcomes will be assessed at baseline and prior to the next chemotherapy administration using an 11-point NRS for each. All adverse events will be recorded.

Discussion: The results of this study will demonstrate the extent to which hypoglossal acupuncture may influence the intensity of and functional impairment due to chemotherapy-induced dysgeusia.

Trial Registration: Clinical Trials.gov, NCT02304913 . Registered on 19 November 2014.
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http://dx.doi.org/10.1186/s13063-019-3525-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610893PMC
July 2019

Better visual outcome at 1 year with antivascular endothelial growth factor treatment according to treat-and-extend compared with pro re nata in eyes with neovascular age-related macular degeneration.

Acta Ophthalmol 2019 Aug 3;97(5):519-524. Epub 2018 Dec 3.

Department of Ophthalmology, Hospital of Vastmanland, Vasteras, Sweden.

Purpose: To evaluate treatment outcome at 12 months in eyes with neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (anti-VEGF) injections according to either pro re nata (PRN)- or treat-and-extend (TE)-regimen in one clinical setting in Sweden.

Methods: Data were obtained retrospectively from the Swedish Macula Register, optical coherence tomography-database and electronic patient charts. The study included 443 eyes; 223 PRN- and 220 TE-treated eyes. Baseline (BL) characteristics and follow-up data at 6 and 12 months were collected. Statistical regression analysis was performed to evaluate association between treatment strategy and visual outcome at 12 months.

Results: Baseline (BL) characteristics were well balanced between cohorts. Visual acuity at 12 months was higher in TE-cohort 66.5 (13.1) compared to PRN-cohort 60.1 (17.6) (p = 0.000). Visual improvement at 12 months was +5.2 (11.8) and +1.2 (12.7) letters Early Treatment Diabetic Retinopathy Study (ETDRS) in TE- and PRN-cohorts, respectively (p = 0.002). Number of administered injections at 12 months was 10.2 (2.1) and 6.3 (2.1) in the two cohorts (p = 0.000). Statistical analysis demonstrated a strong association between TE treatment strategy and improvement in visual acuity at 12 months.

Conclusion: Eyes treated according to TE had better visual outcome at 12 months. The results indicate that treatment according to proactive TE-regimen is superior to treatment according to PRN-regimen in clinical routine care of nAMD.
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http://dx.doi.org/10.1111/aos.13989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767032PMC
August 2019

Central origin of pinprick hyperalgesia adjacent to an UV-B induced inflammatory skin pain model in healthy volunteers.

Scand J Pain 2013 Jan 1;4(1):40-45. Epub 2013 Jan 1.

Vienna Human Pain Research Group, Department of Anaesthesia, General Intensive Care Medicine and Pain Control, Medical University of Vienna, Vienna Austria.

Background and purpose The UV-B model is an established pain model of different types of hyperalgesia in animal and human pain research. Beside the skin region of the sunburn in human volunteers pinprick hyperalgesia has been described in a large zone of non-inflamed skin adjacent to the sunburn. However, there are opposing results on the existence of pinprick hyperalgesia and most notably a controversial discussion is still on-going whether this mechanical hyperalgesia in the undamaged tissue adjacent to and at some distance from the site of inflammation is of peripheral or central origin. We therefore addressed this in our study by hypothesising that pinprick hyperalgesia around a circular spot of UV-B inflamed skin is not reduced by a superficial local anaesthetic block and therefore underlies centrally mediated mechanisms. Methods This exploratory study was conducted in a prospective, controlled, randomised, single-blinded fashion in relation to the study hypothesis in 12 healthy volunteers. Before circular irradiation with UV-B light (3-times the individual minimal erythema dose at both thighs), a strip of continuous intradermal local anaesthetic block with lidocaine 2% was established via two single plasmaphoresis hollow fibres. These were positioned perpendicular to one thigh overlapping on the midline of the leg at the distal part of the planned irradiation site, and compared with the contralateral control side without anaesthetic block. The local anaesthetic block was established and then maintained via a syringe pump. The area of pinprick hyperalgesia was measured by pricking on a large skin surface including 360° around the circular irradiation site. This was done with a slightly painful pin (256 mN) until 8h after irradiation. Primary outcome was the area of pinprick hyperalgesia in the skin adjacent to the sunburn at 8h. Results Large areas of mechanical hyperalgesia to pinprick surrounding the adjacent skin of the sunburn developed on both sides after 8h without any significant difference between the side of the anaesthetic strip showing an area of 72.6±39.7 cm2 (mean±SD) and the control side (59.1±20.1 cm2); p = 0.24. Moreover, mechanical hyperalgesia to various pin stimuli of different strength was unchanged by the anaesthetic block. Conclusion This trial provides evidence that the development of mechanical hyperalgesia surrounding an experimental sunburn was not influenced by continuous peripheral afferent blockade with local anaesthetic at 8h after UV-B irradiation. Our data support the hypothesis that in the UV-B model peripheral nociceptive afferent input of inflamed skin may enhance central hypersensitivity of mechanosensitive nociceptors in a larger receptive field far beyond the inflamed skin. Furthermore, these findings are in line with other pain models demonstrating comparable central hypersensitivity around the site of injury. Implications As for other pain models this finding provides further evidence that the UV-B model offers secondary mechanical hyperalgesia in addition to its known primary hyperalgesia. Consequently, this is a further validation for the utilisation of the UV-B model in human pain research.
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http://dx.doi.org/10.1016/j.sjpain.2012.09.001DOI Listing
January 2013

Mind-Body Medicine in the Secondary Prevention of Coronary Heart Disease.

Dtsch Arztebl Int 2015 Nov;112(45):759-67

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Department of Internal and Complementary Medicine, Immanuel Hospital, Berlin, Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin, Berlin.

Background: In mind-body medicine (MBM), conventional lifestyle modification measures such as dietary counseling and exercise are supplemented with relaxation techniques and psychological motivational elements. This review studied the effect of MBM on cardiac events and mortality in patients with coronary heart disease (CHD).

Methods: This review is based on publications up to and including January 2015 that were retrieved by a systematic search in PubMed, the Cochrane Library, and Scopus. Randomized controlled trials of the effect of MBM programs (versus standard treatment) on cardiac events, overall mortality, and/or cardiac mortality were analyzed. Atherosclerosis, blood pressure, LDL cholesterol, and the body mass index (BMI) were chosen as secondary outcomes. Random-effects meta-analyses were performed. The risk of bias was assessed with the Cochrane tool.

Results: Twelve trials, performed on a total of 1085 patients, were included in the analysis. Significant differences between groups were found with respect to cardiac events (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.23-0.61; p<0.01; heterogeneity [I2]: 0%), but not overall mortality (OR: 0.82; 95% CI: 0.46-1.45; p = 0.49; I2: 0%) or cardiac mortality (OR: 0.98; 95% CI: 0.43-2.25; p = 0.97; I2: 0%). Significant differences between groups were also found with respect to atherosclerosis (mean difference [MD] = -7.86% diameter stenosis; 95% CI: -15.06-[-0.65]; p = 0.03; I2: 0%) and systolic blood pressure (MD = -3.33 mm Hg; 95% CI: -5.76-[-0.91]; p<0.01; I2: 0%), but not with respect to diastolic blood pressure, LDL cholesterol, or BMI.

Conclusion: In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.
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http://dx.doi.org/10.3238/arztebl.2015.0759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660854PMC
November 2015

CHL1, ITGB3 and SLC6A4 gene expression and antidepressant drug response: results from the Munich Antidepressant Response Signature (MARS) study.

Pharmacogenomics 2015 6;16(7):689-701. Epub 2015 May 6.

3Medical Faculty, Faculty Centre for Translational Medicine, University Bonn, Bonn, Germany.

Aim: The identification of antidepressant drugs (ADs) response biomarkers in depression is of high clinical importance. We explored CHL1 and ITGB3 expression as tentative response biomarkers.

Materials & Methods: In vitro sensitivity to ADs, as well as gene expression and genetic variants of the candidate genes CHL1, ITGB3 and SLC6A4 were measured in lymphoblastoid cell lines (LCLs) of 58 depressed patients.

Results: An association between the clinical remission of depression and the basal expression of CHL1 and ITGB3 was discovered. Individuals whose LCLs expressed higher levels of CHL1 or ITGB3 showed a significantly better remission upon AD treatment. In addition individuals with the CHL1 rs1516338 TT genotype showed a significantly better remission after 5 weeks AD treatment than those carrying a CC genotype. No association between the in vitro sensitivity of LCLs toward AD and the clinical remission could be detected.

Conclusion: CHL1 expression in patient-derived LCLs correlated with the clinical outcome. Thus, it could be a valid biomarker to predict the success of an antidepressant therapy. Original submitted 8 December 2014; Revision submitted 2 March 2015.
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http://dx.doi.org/10.2217/pgs.15.31DOI Listing
March 2016

Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors.

Support Care Cancer 2015 Oct 26;23(10):2945-55. Epub 2015 Feb 26.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.

Purpose: The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables.

Methods: One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention.

Results: Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R (2) = 7.3-43.6 %).

Conclusion: Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors' physical and mental health. Functional improvements are associated with improved satisfaction and coping styles.
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http://dx.doi.org/10.1007/s00520-015-2660-6DOI Listing
October 2015

Predictors of health behavior change after an integrative medicine inpatient program.

Int J Behav Med 2014 ;21(5):775-83

Background: Health behavior change can improve physical and psychosocial outcomes in internal medicine patients.Purpose This study aims to identify predictors for health behavior change after an integrative medicine inpatient program.

Method: German internal medicine patients' (N =2,486; 80 %female; 53.9±14.3 years) practice frequency for aerobic exercise(e.g., walking, running, cycling, swimming), meditative movement therapies (e.g., yoga, tai ji, qigong), and relaxation techniques(e.g., progressive relaxation, mindfulness meditation,breathing exercises, guided imagery) was assessed at admission to a 14-day integrative medicine inpatient program, and 3, 6, and 12 months after discharge. Health behavior change was regressed to exercise self-efficacy, stage of change, and health locus of control (internal, external-social, external-fatalistic).

Results: Short-term increases in practice frequency were found for aerobic exercise: short- and long-term increases for meditative movement therapies and relaxation techniques (all p <0.01). After controlling for sociodemographic characteristics,clinical characteristics, and health status, exercise self-efficacy or interactions of exercise self-efficacy with stage of change predicted increased practice frequency of aerobic exercise at 6 months; of meditative movement therapies at 3 and 6 months; and of relaxation techniques at 3, 6, and 12 months (all p <0.05). Health locus of control predicted increased practice frequency of aerobic exercise at 3 months and of relaxation techniques at 3, 6, and 12 months (all p <0.05).

Conclusion: Health behavior change after an integrative medicine inpatient program was predicted by self-efficacy,stage of change, and health locus of control.Considering these aspects might improve adherence to health-promoting behavior after lifestyle modification programs.
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http://dx.doi.org/10.1007/s12529-013-9354-6DOI Listing
June 2015

Hypnosis in breast cancer care: a systematic review of randomized controlled trials.

Integr Cancer Ther 2015 Jan 18;14(1):5-15. Epub 2014 Sep 18.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Introduction: Many breast cancer patients and survivors experience pain and emotional stress related to their disease, its diagnostic procedures, or treatment. Hypnosis has long been used for the treatment of such symptoms. The aim of this review was to systematically assess the effectiveness of hypnosis in women with breast cancer, breast cancer survivors, and in women undergoing diagnostic breast biopsy.

Methods: PubMed, Scopus, the Cochrane Library, PsycINFO, and CAMBASE were screened through February 2014 for randomized controlled trials (RCTs) of hypnosis in women with breast cancer or undergoing diagnostic breast biopsy. RCTs on postmenopausal women without a history of breast cancer were also eligible. Primary outcomes were pain, distress, fatigue, nausea/vomiting, and hot flashes. Safety was defined as secondary outcome measure. Risk of bias was assessed by 2 reviewers independently using the Cochrane Risk of Bias Tool.

Results: Thirteen RCTs with 1357 patients were included. In women undergoing diagnostic breast biopsy (3 RCTs), hypnosis positively influenced pain and distress; 1 RCT on breast cancer surgery found effects of hypnosis on pain, distress, fatigue, and nausea. For women undergoing radiotherapy (3 RCTs), hypnosis combined with cognitive-behavioral therapy improved distress and fatigue. In 3 RCTs on women with and without a history of breast cancer experiencing hot flashes, hypnosis improved hot flashes and distress. Three RCTs on women with metastatic breast cancer found effects on pain and distress.

Conclusions: This systematic review found sparse but promising evidence for the effectiveness of hypnosis in breast cancer care. While more research is needed to underpin these results, hypnosis can be considered as an ancillary intervention in the management of breast cancer-related symptoms.
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http://dx.doi.org/10.1177/1534735414550035DOI Listing
January 2015

Self-reported health and satisfaction of patients with chronic diseases who meditate: a case-control study.

Qual Life Res 2014 Nov 16;23(9):2639-44. Epub 2014 May 16.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany,

Purpose: While many clinical trials suggest that meditation is effective in reducing disease-related symptoms and increasing quality of life in diseased samples, subjective health benefits associated with the use of meditation under naturalistic conditions have not yet been investigated. The aim of this study was to investigate the differences in quality of life, mental health, and satisfaction in patients with chronic diseases who regularly use meditation versus those who do not.

Methods: The study applied a case-control design. Patients with chronic diseases who regularly used meditation were selected from a larger observational trial and compared to matched control patients who did not meditate regularly. They were compared in terms of their reported quality of life (SF-36 questionnaire), mental health (Hospital Anxiety and Depression Scale), life and health satisfaction (Questionnaire for Life Satisfaction), and medication usage as well as health locus of control (German version of the Multidimensional Health Locus of Control Scale).

Results: A total of 115 meditators and 115 controls were compared. Cases showed higher quality of life on the bodily pain subscale, higher internal and less external health locus of control, and higher life satisfaction than controls. No group differences were found for general health perception, most other aspects of quality of life, anxiety, depression, and medication use and health satisfaction.

Conclusions: Regular practice of meditation was not clearly associated with better health perception in chronically diseased patients. However, those who regularly used meditation reported better pain-related quality of life and are more satisfied with their life.
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http://dx.doi.org/10.1007/s11136-014-0714-8DOI Listing
November 2014

Effectiveness of additional self-care acupressure for women with menstrual pain compared to usual care alone: using stakeholder engagement to design a pragmatic randomized trial and study protocol.

Trials 2013 Apr 11;14:99. Epub 2013 Apr 11.

Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin - Berlin, Luisenstraße 57, Berlin, D- 10117, Germany.

Background: Self-care acupressure might be successful in treating menstrual pain, which is common among young women. There is a need for comparative effectiveness research with stakeholder engagement in all phases seeking to address the needs of decision-makers. Our aim was to design a study on the effectiveness of additional self-care acupressure for menstrual pain comparing usual care alone using different methods of stakeholder engagement.

Methods: The study was designed using multiple mixed methods for stakeholder engagement. Based on the results of a survey and focus group discussion, a stakeholder advisory group developed the study design.

Results: Stakeholder engagement resulted in a two-arm pragmatic randomized trial. Two hundred and twenty women aged 18 to 25 years with menstrual pain will be included in the study. Outcome measurement will be done using electronic questionnaires provided by a study specific mobile application (App). Primary outcome will be the mean pain intensity at the days of pain during the third menstruation after therapy start.

Conclusion: Stakeholder engagement helped to develop a study design that better serves the needs of decision makers, including an App as a modern tool for both intervention and data collection in a young target group.

Trial Registration: Clinicaltrials.gov identifier http://NCT01582724.
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http://dx.doi.org/10.1186/1745-6215-14-99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821547PMC
April 2013

A technique for estimating the occlusion effect for frequencies below 125 Hz.

Ear Hear 2014 Jan-Feb;35(1):49-55

1Department of Experimental Psychology, University of Cambridge, Cambridge, United Kingdom; and 2ENT Department, Addenbrookes' Hospital, Cambridge, United Kingdom.

Objectives: The level of bone-conducted sound in the auditory meatus is increased at low frequencies by occlusion of the meatus, for example, by the earmold of a hearing aid (HA). Physical measures of this "occlusion effect" (OE) require vibration of the skull. In previous research, either self-voicing or audiometric bone conduction vibrators were used to produce this vibration, with the result that the OE could not be measured for frequencies below 125 Hz. However, frequencies below this can be important for music perception by HA users. The objective was to develop and evaluate a method that gives a lower-bound estimate of the OE for frequencies below 125 Hz.

Design: A low-noise amplifier with extended low-frequency response was used to record the output of a miniature microphone inserted into the meatus of participants. The signal came from sounds of the heartbeat and blood flow of the participant, transmitted via bone conduction through the walls of the meatus. A simultaneous recording was made of the carotid pulse to permit time-locked averaging (and hence noise reduction) of the microphone signal. Recordings were made from 7 otologically and audiometrically normal participants, using clinical probe tips to produce the occlusion. Recordings were also made from an overlapping group of 9 participants, using fast-setting impression material to provide a more consistent degree of occlusion. The difference in level of the recorded signal for unoccluded and occluded conditions provided a lower bound for the magnitude of the OE.

Results: The mean OE increased with decreasing frequency, reaching a plateau of about 40 dB for frequencies below 40 Hz. For some individual recordings, the OE reached 50 dB for frequencies below 20 Hz. With occlusion, the heartbeat became audible for most participants.

Conclusions: The OE can be very large at low frequencies. The use of HAs with closed fittings, which may be used either to prevent acoustic feedback or to allow amplification of low frequencies, may lead to an unacceptable OE. The authors suggest reducing the OE with the use of a seal deep in the meatus, where the wall of the meatus is more rigid.
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http://dx.doi.org/10.1097/AUD.0b013e31829f2672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197401PMC
August 2014

Characteristics of patients with internal diseases who use relaxation techniques as a coping strategy.

Complement Ther Med 2013 Oct 17;21(5):481-6. Epub 2013 Aug 17.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address:

Objectives: To assess sociodemographic, clinical, and psychological characteristics of patients with internal diseases who use relaxation techniques as a coping strategy.

Design: Cross-sectional analysis among patients with internal diseases.

Setting: Department of Internal and Integrative Medicine at an academic teaching hospital in Germany.

Main Outcome Measures: Prior use of relaxation techniques (e.g. meditation, autogenic training), perceived benefit, and perceived harm. Potential predictors of relaxation techniques use (sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction, and health locus of control) were tested using multiple logistic regression analysis.

Results: Of 2486 participants, 1075 (43.2%) reported to have used relaxation techniques, 648 (60.3%) reported benefits, and 11 (1.0%) reported harms. Use of relaxation techniques was independently associated with female gender (Odds ratio [OR]=1.43; 95% confidence interval [CI]=1.08-1.89), higher education (OR=1.32; 95%CI=1.03-1.71), fibromyalgia (OR=1.78; 95%CI=1.22-2.61), and internal health locus of control (OR=1.27; 95%CI=1.01-1.60). Use of relaxation techniques was negatively associated with age below 30 (OR=0.32; 95%CI=0.20-0.52) or above 64 (OR=0.65; 95%CI=0.49-0.88), full-time employment (OR=0.75; 95%CI=0.57-0.98), current smoking (OR=0.72; 95%CI=0.54-0.95), osteoarthritis (OR=0.51; 95%CI=0.34-0.77), rheumatic arthritis (OR=0.59; 95%CI=0.37-0.93), good to excellent health status (OR=0.70; 95%CI=0.52-0.96), and high life satisfaction (OR=0.78; 95%CI=0.62-0.98).

Conclusion: In a German sample of patients with internal diseases, relaxation techniques were used as a coping strategy by about 43%. Users were more likely to be middle-aged, female, well-educated, diagnosed with fibromyalgia, not smoking, not full-time employed, and not to have a good health status or high life satisfaction. A high internal health locus of control predicted relaxation techniques use. Considering health locus of control might improve adherence to relaxation techniques in internal medicine patients.
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http://dx.doi.org/10.1016/j.ctim.2013.08.001DOI Listing
October 2013

Predictors of yoga use among internal medicine patients.

BMC Complement Altern Med 2013 Jul 13;13:172. Epub 2013 Jul 13.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients.

Methods: A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors.

Results: Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated with yoga use.

Conclusion: Yoga was used for their primary medical complaint by 12.19% of an internal integrative medicine patient population and was commonly perceived as beneficial. Yoga use was not associated with the patients' specific diagnosis but with sociodemographic factors, mental health, and health locus of control. To improve adherence to yoga practice, it should be considered that male, younger, and anxious patients and those with low internal health locus of control might be less intrinsically motivated to start yoga.
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http://dx.doi.org/10.1186/1472-6882-13-172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717114PMC
July 2013

Quality of life and mental health in patients with chronic diseases who regularly practice yoga and those who do not: a case-control study.

Evid Based Complement Alternat Med 2013 6;2013:702914. Epub 2013 Jun 6.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany.

While clinical trials have shown evidence of efficacy of yoga in different chronic diseases, subjective health benefits associated with yoga practice under naturalistic conditions have not yet been investigated. The aim of this study was to investigate associations of regular yoga practice with quality of life and mental health in patients with chronic diseases. Using a case-control design, patients with chronic diseases who regularly practiced yoga were selected from a large observational study and compared to controls who did not regularly practice yoga and who were matched individually to each case on gender, main diagnosis, education, and age (within 5 years). Patients' quality of life (SF-36 questionnaire), mental health (Hospital Anxiety and Depression Scale), life satisfaction, and health satisfaction (Questionnaire for Life Satisfaction) were assessed. Patients who regularly practiced yoga (n = 186) had a better general health status (P = 0.012), a higher physical functioning (P = 0.001), and physical component score (P = 0.029) on the SF-36 than those who did not (n = 186). No group differences were found for the mental scales of the SF-36, anxiety, depression, life satisfaction, or health satisfaction. In conclusion, practicing yoga under naturalistic conditions seems to be associated with increased physical health but not mental health in chronically diseased patients.
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http://dx.doi.org/10.1155/2013/702914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690235PMC
July 2013

Can a multimodal mind-body program enhance the treatment effects of physical activity in breast cancer survivors with chronic tumor-associated fatigue? A randomized controlled trial.

Integr Cancer Ther 2013 Jul;12(4):291-300

Clinic Öschelbronn CIMK, Center for Integrative Medicine and Cancer treatment, Niefern-Öschelbronn, Germany.

Unlabelled: Background. Chronic fatigue is one of the most restricting symptoms following primary breast cancer treatment, but clinical studies on symptom management are rare. The objective was to evaluate the impact of a multimodal mind-body program (MMMT), including moderate physical activity as compared with a walking intervention alone, on chronic fatigue symptoms of women with stage I to IIIA breast cancer.

Patients And Methods: Sixty-four women (mean age = 56.7 years) suffering from chronic fatigue after active tumor treatment were randomly assigned to either an experimental or a control (n = 32 each) intervention (10 weeks). Fatigue, quality of life (QoL), functional well-being, anxiety, and depression were measured with standard questionnaires at baseline, after 10 weeks, and after 3 months.

Results: Compared with baseline, both groups had reduced fatigue scores after treatment without any significant difference between groups (posttreatment, Δ = -0.3, confidence interval = -1.6 to 1.0, P = .678; follow-up, Δ = -0.4, confidence interval = -1.8 to 0.9, P = .510). All patients also improved regarding QoL and general functional well-being.

Conclusion: Since both interventions reduced fatigue symptoms and enhanced QoL to a similar extent, we observed no verifiable add-on effect of the MMMT regarding fatigue symptoms. Considering the higher costs with additional expenditure related to MMMT, home-based walking intervention is recommended.
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http://dx.doi.org/10.1177/1534735413492727DOI Listing
July 2013

An oncology mind-body medicine day care clinic: concept and case presentation.

Integr Cancer Ther 2013 Nov 16;12(6):503-7. Epub 2013 Jan 16.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Introduction: Cancer diagnosis and treatment are often associated with physical and psychosocial impairments. Many cancer patients request complementary and alternative therapies such as mind-body medicine.

Concept: The department of internal and integrative medicine at the Essen-Mitte Clinics offer a mind-body medicine day care clinic for cancer patients that is based on the Mindfulness-Based Stress Reduction Program and the mind-body medicine cancer program of the Harvard Mind/Body Medical Institute. The program encompasses mindfulness training, yoga, mindful exercise, nutrition, naturopathic self-help strategies, and cognitive restructuring.

Cases: Two patients who had participated in the day care clinic program are presented here. One patient presented with anxiety and depression after recently diagnosed breast cancer and the other with psychological impairments as a result of multiple nevi excision after malignant melanoma surgery. Both patients improved in terms of anxiety and further psychological symptoms.

Conclusions: The Essen-Mitte Clinics mind-body medicine day care clinic appears to alleviate psychological consequences of cancer and its treatment. Further studies and randomized controlled trials are necessary to confirm these results.
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http://dx.doi.org/10.1177/1534735412473639DOI Listing
November 2013

Integrative oncology for breast cancer patients: introduction of an expert-based model.

BMC Cancer 2012 Nov 21;12:539. Epub 2012 Nov 21.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany.

Background: Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient's psychological and spiritual needs.

Discussion: The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices.Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed.

Summary: Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients.
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http://dx.doi.org/10.1186/1471-2407-12-539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582454PMC
November 2012

Results of a 2-week inpatient stay at the department for internal and integrative medicine: an observational study.

Evid Based Complement Alternat Med 2012 24;2012:875874. Epub 2012 Oct 24.

Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany.

Introduction. The Department for Internal and Integrative Medicine in Essen utilizes mind/body medical elements in order to empower patients with chronic diseases to better cope with their symptoms and to adopt a healthy lifestyle. This study explored the influence and predictors of a 2-week integrative treatment program on patients' quality of life. Methods. This observational study was conducted with inpatients as part of the quality assurance program. Patients' quality of life, psychological symptoms, and health locus of control were measured on admission and discharge and again 3, 6, and 12 months after discharge. Regression analyses were conducted to determine the factors predicting improved quality of life. Results. Data from 2486 inpatients treated in 2001-2004 were included (80% female, mean age 53.9 ± 14.3 years). Response rates decreased to 50% at 12 months. Small-to-moderate effects were found on patients' quality of life, anxiety, and depression. Patients' internal locus of control significantly increased. Improved quality of life was mainly predicted by lower baseline scores. Conclusion. Results of this study suggest that a 2-week inpatient treatment might sustainably reduce patients' symptoms and increase their quality of life; however, conclusions are only preliminary. More research is needed to enable the effectiveness to be judged conclusively.
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http://dx.doi.org/10.1155/2012/875874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486419PMC
November 2012

[What we do not take as (sufficiently) true].

Onkologie 2012 10;35 Suppl 5:12-20. Epub 2012 Aug 10.

Abt. Gastroenterologie und Ernährung, Klinik für Tumorbiologie, Freiburg, Germany.

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http://dx.doi.org/10.1159/000340026DOI Listing
March 2013
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