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Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings
Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al
Journal of Asthma and Allergy , 2009, DOI: http://dx.doi.org/10.2147/JAA.S7184
Abstract: nthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings Original Research (5763) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al Published Date November 2009 Volume 2009:2 Pages 111 - 128 DOI: http://dx.doi.org/10.2147/JAA.S7184 Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications. Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome); symptoms (1–4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children) at 12-month follow-up. Results: Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20), median therapy duration was 120 days (84–184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32); cough 0.93 (95% CI: 0.60–1.25); dyspnea 0.92 (95% CI: 0.56–1.28); exertion-induced symptoms 0.95 (95% CI: 0.64–1.25); frequency of asthma attacks 0.78 (95% CI:0.41–1.14); awakening from asthma 0.90 (95% CI: 0.58–1.21); AQLQ overall score 1.44 (95% CI:0.97–1.92); and KINDL asthma module 14.74 (95% CI: 9.70–19.78). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Anthroposophic Therapy for Anxiety Disorders: A Two-year Prospective Cohort Study in Routine Outpatient Settings
Harald J. Hamre, Claudia M. Witt, Gunver S. Kienle, Anja Glockmann, Renatus Ziegler, Stefan N. Willich and Helmut Kiene
Clinical Medicine Insights: Psychiatry , 2012,
Abstract: Background and Methods: Anthroposophic treatment for anxiety disorders includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 64 consecutive adult outpatients starting anthroposophic treatment for anxiety disorders under routine conditions. Main outcomes were Anxiety Severity (physician and patient ratings 0–10), Self-rating Anxiety Scale (0–100), Center for Epidemiological Studies Depression Scale, German version (CES-D, 0–60), and SF-36 Mental Component Summary. Results: Mean age was 42.3 years. Most frequent diagnoses were generalized anxiety disorder (44% of patients, n = 28/64) and panic disorder (39%). Median disease duration was 4.5 years. The anthroposophic treatment modalities used were medications (56% of patients), eurythmy therapy (41%), art therapy (30%), and rhythmical massage therapy (3%). Median number of eurythmy/art/massage sessions was 12, median therapy duration was 120 days. From baseline to six-month follow-up, all outcomes improved significantly; average improvements were: Physician-rated Anxiety Severity 3.60 points (95% confidence interval 2.97–4.22, p < 0.001), patient-rated Anxiety Severity 3.50 (2.88–4.12, p < 0.001), Self-rating Anxiety Scale 11.88 (7.70–16.05, p < 0.001), CES-D 8.79 (5.61–11.98, p < 0.001), and SF-36 Mental Component 9.53 (5.98–13.08, p < 0.001). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with anxiety disorders under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings  [cached]
Harald J Hamre,Claudia M Witt,Gunver S Kienle,et al
Journal of Asthma and Allergy , 2009,
Abstract: Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene11Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, SwitzerlandBackground: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications.Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome); symptoms (1–4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children) at 12-month follow-up.Results: Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20), median therapy duration was 120 days (84–184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32); cough 0.93 (95% CI: 0.60–1.25); dyspnea 0.92 (95% CI: 0.56–1.28); exertion-induced symptoms 0.95 (95% CI: 0.64–1.25); frequency of asthma attacks 0.78 (95% CI:0.41–1.14); awakening from asthma 0.90 (95% CI: 0.58–1.21); AQLQ overall score 1.44 (95% CI:0.97–1.92); and KINDL asthma module 14.74 (95% CI: 9.70–19.78). All improvements were maintained until last follow-up after 24 months.Conclusions: Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.Keywords: anthroposophy, art therapy, asthma, combined modality therapy, drug therapy, eurythmy therapy, prospective studies, quality of life
Anthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients
Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al
International Journal of General Medicine , 2010, DOI: http://dx.doi.org/10.2147/IJGM.S11725
Abstract: nthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients Original Research (3843) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al Published Date August 2010 Volume 2010:3 Pages 239 - 253 DOI: http://dx.doi.org/10.2147/IJGM.S11725 Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christoph Meinecke3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Pediatric Consultant, Community Hospital Havelh he, Berlin, Germany; 4Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic treatment for attention deficit hyperactivity disorder (ADHD) includes special artistic and physical therapies and special medications. Methods: We studied 61 consecutive children starting anthroposophic treatment for ADHD symptoms under routine outpatient conditions. Primary outcome was FBB-HKS (a parents’ questionnaire for ADHD core symptoms, 0–3), and secondary outcomes were disease and symptom scores (physicians’ and parents’ assessment, 0–10) and quality of life (KINDL total score, 0–100). Results: A total of 67% of patients fulfilled the DSM-IV criteria for ADHD, 15% had an exclusion diagnosis such as pervasive developmental disorders, while 18% did not fulfill ADHD criteria for another reason. Anthroposophic treatment modalities used were eurythmy therapy (in 56% of patients), art therapy (20%), rhythmical massage therapy (8%), and medications (51%). From baseline to six-month follow-up, all outcomes improved significantly; average improvements were FBB-HKS total score 0.30 points (95% confidence interval [CI]: 0.18–0.43; P < 0.001), FBB-HKS inattention 0.36 (95% CI: 0.21–0.50; P < 0.001), FBB-HKS hyperactivity 0.29 (95% CI: 0.14–0.44; P < 0.001), FBB-HKS impulsivity 0.22 (95% CI: 0.03–0.40; P < 0.001), disease score 2.33 (95% CI: 1.84–2.82; P < 0.001), symptom score 1.66 (95% CI: 1.17–2.16; P < 0.001), and KINDL 5.37 (95% CI: 2.27–8.47; P = 0.001). Improvements were similar in patients not using stimulants (90% of patients at months 0–6) and were maintained until last follow-up after 24 months. Conclusion: Children with ADHD symptoms receiving anthroposophic treatment had -long-term improvement of symptoms and quality of life.
Anthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients  [cached]
Harald J Hamre,Claudia M Witt,Gunver S Kienle,et al
International Journal of General Medicine , 2010,
Abstract: Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christoph Meinecke3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene11Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Pediatric Consultant, Community Hospital Havelh he, Berlin, Germany; 4Society for Cancer Research, Arlesheim, SwitzerlandBackground: Anthroposophic treatment for attention deficit hyperactivity disorder (ADHD) includes special artistic and physical therapies and special medications.Methods: We studied 61 consecutive children starting anthroposophic treatment for ADHD symptoms under routine outpatient conditions. Primary outcome was FBB-HKS (a parents’ questionnaire for ADHD core symptoms, 0–3), and secondary outcomes were disease and symptom scores (physicians’ and parents’ assessment, 0–10) and quality of life (KINDL total score, 0–100).Results: A total of 67% of patients fulfilled the DSM-IV criteria for ADHD, 15% had an exclusion diagnosis such as pervasive developmental disorders, while 18% did not fulfill ADHD criteria for another reason. Anthroposophic treatment modalities used were eurythmy therapy (in 56% of patients), art therapy (20%), rhythmical massage therapy (8%), and medications (51%). From baseline to six-month follow-up, all outcomes improved significantly; average improvements were FBB-HKS total score 0.30 points (95% confidence interval [CI]: 0.18–0.43; P < 0.001), FBB-HKS inattention 0.36 (95% CI: 0.21–0.50; P < 0.001), FBB-HKS hyperactivity 0.29 (95% CI: 0.14–0.44; P < 0.001), FBB-HKS impulsivity 0.22 (95% CI: 0.03–0.40; P < 0.001), disease score 2.33 (95% CI: 1.84–2.82; P < 0.001), symptom score 1.66 (95% CI: 1.17–2.16; P < 0.001), and KINDL 5.37 (95% CI: 2.27–8.47; P = 0.001). Improvements were similar in patients not using stimulants (90% of patients at months 0–6) and were maintained until last follow-up after 24 months.Conclusion: Children with ADHD symptoms receiving anthroposophic treatment had -long-term improvement of symptoms and quality of life.Keywords: anthroposophy, attention deficit disorder with hyperactivity, combined modality therapy, prospective studies, quality of life
Insufficient depression treatment in outpatient settings
Schneider, Frank,Kratz, Sandra,Bermejo, Isaac,Menke, Ralph
GMS German Medical Science , 2004,
Abstract: Background: The present status of outpatient treatment of depression in Germany was evaluated with respect to the adherence of general practitioners (GPs) and specialists of psychiatry to clinical practice guidelines. Methods: In total, 488 depressed patients' psychopathology, diagnostic assessment, therapeutic measures and referral frequency were documented at inclusion into study by 43 general practitioners and 23 specialists of psychiatry in three regions of Germany. The investigation of change in depressive symptoms after six to eight weeks by means of self-assessment could be evaluated for 165 patients. Results: The results of diagnostic assessment demonstrated that diagnoses of depression were not always based on the diagnostic criteria for depression (ICD-10): 33% of GPs' and 17% of specialists' patients were included as depressed patients into the study despite not fulfilling the ICD-10 criteria in the standardized documentation. Therapeutic undertreatment was more often found in the group of GPs. Referrals were found not to be oriented towards guidelines. After six to eight weeks, one half of patients reported a reduction in depressed symptoms, the other half of patients reported a stagnation or even a progression. Conclusions: The study has shown that physicians in outpatient settings still fail to orient themselves towards guideline recommendations. This reflects the need for physicians to receive guideline training, with the aim of improving the quality of care for depression. A quality management intervention program consisting of guideline training and an interdisciplinary quality circle to improve depression treatment and networking was supported by the authors and is currently being evaluated.
Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study
Harald J. Hamre, Anja Glockmann, Michael Fischer, David S. Riley, Erik Baars and Helmut Kiene
Drug Target Insights , 2012,
Abstract: Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections. Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED. Results: Two patients had confirmed ADR to AMED: 1) swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2) sleeplessness after intake of Pneumodoron 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327) of all different AMED used, 0.28% (2/715) of patients, and 0.004% (3/73,443) of applications. Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated. Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study
Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study
Harald J. Hamre,Anja Glockmann,Michael Fischer,David S. Riley
Drug Target Insights , 2007,
Abstract: Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections.Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED.Results: Two patients had confirmed ADR to AMED: 1) swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2) sleeplessness after intake of Pneumodoron 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327) of all different AMED used, 0.28% (2/715) of patients, and 0.004% (3/73,443) of applications.Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated.Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study
Outpatient Healthcare Settings and Transmission of Clostridium difficile  [PDF]
Lucy A. Jury, Brett Sitzlar, Sirisha Kundrapu, Jennifer L. Cadnum, Kim M. Summers, Christine P. Muganda, Abhishek Deshpande, Ajay K. Sethi, Curtis J. Donskey
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0070175
Abstract: Background Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI. Methods We performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point–prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI. Results Of 67 CDI patients studied, 54 (81%) had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32%) had skin contamination and 12 (27%) contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14%) had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94%) had an outpatient visit during the 12 weeks prior to onset of diarrhea. Conclusions Patients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.
Health costs in anthroposophic therapy users: a two-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-65
Abstract: 717 consecutive outpatients from 134 medical practices in Germany, starting anthroposophic therapies for chronic diseases, participated in a prospective cohort study. We analysed direct health costs (anthroposophic therapies, physician and dentist consultations, psychotherapy, medication, physiotherapy, ergotherapy, hospital treatment, rehabilitation) and indirect costs (sick leave compensation) in the pre-study year and the first two study years. Costs were calculated from resource utilisation, documented by patient self-reporting. Data were collected from January 1999 to April 2003.Total health costs in the first study year (bootstrap mean 3,297 Euro; 95% confidence interval 95%-CI 3,157 Euro to 3,923 Euro) did not differ significantly from the pre-study year (3,186 Euro; 95%-CI 3,037 Euro to 3,711 Euro), whereas in the second year, costs (2,771 Euro; 95%-CI 2,647 Euro to 3,256 Euro) were significantly reduced by 416 Euro (95%-CI 264 Euro to 960 Euro) compared to the pre-study year. In each period hospitalisation and sick-leave together amounted to more than half of the total health costs. Anthroposophic therapies and medication amounted to 3%, 15%, and 8% of total health costs in the pre-study year, first year, and second study year, respectively. The cost reduction in the second year was largely accounted for by a decrease of inpatient hospitalisation, leading to a hospital cost reduction of 519 Euro (95%-CI 377 Euro to 904 Euro) compared to the pre-study year.In patients starting anthroposophic therapies for chronic disease, total health costs did not increase in the first year, and were reduced in the second year. This reduction was largely explained by a decrease of inpatient hospitalisation. Within the limits of a pre-post design, study findings suggest that anthroposophic therapies are not associated with a relevant increase in total health costs.Complementary therapies are popular and extensively used. In Germany and Switzerland some complementary therapie
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