Complementary and Integrative Medicine and Eating Disorders in Youth: Traditional Yoga, Virtual Reality, Light Therapy, Neurofeedback, Acupuncture, Energy Psychology Techniques, Art Therapies, and Spirituality.

Eating disorders (EDs) are a non-heterogeneous group of illnesses with significant physical and mental comorbidity and mortality associated with maladaptive coping. With the exception of lisdexamfetamine (Vyvanse) for binge eating disorder, no medications have been effective for the core symptoms of ED. ED requires a multimodal approach. Complementary and integrative medicine (CIM) can be helpful as an adjunct. The most promising CIM interventions are traditional yoga, virtual reality, eye movement desensitization and reprocessing, Music Therapy, and biofeedback/neurofeedback.

Barriers to the Engagement of Complementary and Integrative Health Providers in Public Health Responses to COVID-19: Recommendations From a Multidisciplinary Expert Panel.

OBJECTIVE: The purpose of this project was to explore barriers to the involvement of complementary and integrative health (CIH) providers in the public health response to COVID-19 and potential solutions for future involvement in public health crises. METHODS: An expert panel of 10 people, which included doctors of chiropractic, naturopathic doctors, public health practitioners, and researchers from the United States, was convened for a day-long online panel discussion. Facilitators asked panelists how CIH practitioners could contribute and be mobilized. We summarized themes and recommendations from the discussion. RESULTS: Despite their skills and resources, few CIH providers participated in public health efforts like testing and contact tracing during the COVID-19 pandemic. Panelists described that CIH professionals may not have participated in those efforts due to the CIH providers possibly not having sufficient public health training and limited contact with public health professionals, as well as policy and financial challenges during the pandemic. Panelists proposed solutions to these barriers, including more public health training, stronger formal relationships between CIH and public health organizations, and improved financial support for both CIH care and public health efforts. CONCLUSION: Through an expert panel discussion, we identified barriers that hindered the involvement of CIH providers in the public health response to the COVID-19 pandemic. During future pandemics in the United States, public health planners should recognize CIH providers as part of the existing labor resource, with clinical expertise and community-level connections that can be called upon in a crisis. During future events, CIH professional leaders should be more proactive in seeking out a supportive role and sharing their knowledge, skills, and expertise.

Evaluating the Effectiveness of Intravenous Ozonated Normal Saline in the Treatment of Severe COVID-19 Disease: A randomized control trial

Background: There is still no specific treatment strategy for COVID-19 other than supportive management. The potential biological benefits of ozone therapy include reduced tissue hypoxia, decreased hypercoagulability, modulated immune function by inhibiting inflammatory mediators, improved phagocytic function, and impaired viral replication. This study aimed to evaluate the effect of intravenous ozonated normal saline on patients with severe COVID-19 disease. Method(s): In this study, a single centralized randomized clinical trial was conducted on 80 hospitalized patients with severe COVID-19. The patients were selected by random allocation method and divided into two groups A and B. In group A (control group), patients were given standard drug treatment, and in group B (intervention group), patients received ozonated normal saline in addition to the standard drug treatment. In the intervention group, 400 mL of normal saline was weighed by 40 mug/ kg of body weight and was injected into patients within 15 to 30 minutes (80 to 120 drops per minute). This process was done daily every morning for a week. Primary and secondary outcomes of the disease included changes in the following items: length of hospital stay, inflammatory markers including C-reactive protein (CRP), clinical recovery, arterial blood oxygen status, improvement of blood disorders such as leukopenia and leukocytosis, duration of ventilator attachment, and rapid clearance of lung lesions on CT scans. The need for intensive care unit (ICU) hospitalization, the length of ICU stay, and the mortality rate in patients of the two groups was compared. Result(s): According to the results of the initial outcome variable analysis, the probability of discharge of patients who received the normal ozonated saline intervention was 33% higher than patients who did not receive this intervention;however, this relationship was not statistically significant (HR = 0.67, 95%, CI = 0.42-1.06, P value = 0.089). The chance of ICU hospitalization in patients of the intervention group was three times more than that of the comparison group, but this relationship was not significant (odds ratio = 4.4 95% CI = 1.32-14.50, P value = 0.016). The use of ozonated normal saline was found to increase the risk of death by 1.5 times but this relationship was not statistically significant (odds ratio = 1.5, 95% CI = .24-9.75, P value = 0.646). Ozonated normal saline had a significant effect on changes in respiration rate (in the intervention group the number of breaths was decreased) and the erythrocyte sedimentation rate (in the intervention group the erythrocyte sedimentation rate was increased);however, it had no significant effect on other indicators. Conclusion(s): The present study showed that ozone therapy in hospitalized patients with severe COVID-19 could help improve some primary and secondary outcomes of the disease. Governments and health policymakers should make ozone therapy an available care service so that the need for advanced treatment facilities decreases;consequently, this measure may improve patient safety, prevent lung tissue destruction, and control cytokine storms in patients. Additionally, health decision-makers need to aim for the effective clinical improvement of patients, especially severe ones, and the reduction of their mortality. However, further large-scale multicenter studies with larger sample sizes considering drug side effects and other variables influencing the clinical course of COVID-19 can provide more information on the effectiveness and importance of ozone therapy.Copyright © 2023 The Author(s);Published by Kerman University of Medical Sciences.

Deep roots: realising the public health benefits of exposure to forest environments

Forests today constitute nearly one third of land cover worldwide, sequester nearly a third of carbon dioxide, and promote, maintain and restore health and wellbeing. Recent research has begun to unravel the therapeutic effects of forest environments. Reported benefits of forest therapy include mental health, cognitive function, the immune system, glycaemic control, pain relief, and hypertension. There is some evidence that biogenic volatile organic compounds emanating from trees themselves, so-called phytoncides, may also exert an antihypertensive effect. Decreases in objective measures of anxiety and depression have been attributed to forest environment exposure, with significantly lower scores on the profile and mood state questionnaire in the negative subscales of tension-anxiety, depression, anger-hostility, fatigue, and confusion. Limitations in the evidence base include small sample sizes, lack of research into long-term health effects, inconsistency around dose reproducibility and forest/woodland typology. The benefits to public health from investment in more detailed research could be a cost-effective strategy to mitigate the expensive burden of cardiovascular disease and mental illness on society, particularly in the wake of the ongoing COVID-19 pandemic. Isolating the elements of the forest-bathing experience responsible for its health benefits is difficult, although some evidence suggests that it may be a composite product of pleasant green scenery, soil, fresh air, sunlight, clean water, sounds of streams and waterfalls, bird song and the natural aromas of trees, plants, and flowers. The concept of green prescriptions is still in its infancy. With a greater awareness of the health benefits of forest immersion, the future medical consultation is likely to incorporate specific questions on this aspect of a patient's lifestyle. There may be a role for forest therapists who can counsel patients about the optimal intensity and duration of forest exposure for their individual health needs.

Integrative Medicine in Long COVID.

Physiatry and Integrative Medicine practice approaches the care of patients holistically to achieve recovery and optimal function. The current lack of knowledge on proven treatments for long COVID has resulted in a surge in both demand and use of complementary and integrative health (CIH) treatments. This overview summarizes CIH therapies using the framework of the United States National Center for Complementary and Integrative Health, divided into nutritional, psychological, physical, and combinations of these categories. Representative therapies selected based on the availability of published and ongoing research for post-COVID conditions are described.

Emerging Complementary and Integrative Therapies for Geriatric Mental Health.

PURPOSE: The use of complementary and integrative medicine (CIM) is on the rise among diverse populations of older adults in the USA. CIM is commonly perceived as safer, less expensive, and more culturally acceptable. There is a growing body of evidence to support the use of CIM, especially mind-body therapies, diet and nutritional supplements used for mental disorders of aging. RECENT FINDINGS: We summarize the results of the recent clinical trials and meta-analyses that provide the evidence for the role of CIM in treating older adults with mood or cognitive disorders that includes the use of diet and supplements, and mind-body therapies. SUMMARY: Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of efficacy for mood and cognitive disorders. Although the use of vitamins and supplements is the most popular CIM practice, only mixed evidence supports their use with additional concerns for herb (supplement)-drug interactions. Despite increasing use of CIM by the general population, information to guide clinicians providing care for older adults remains limited with variable scientific rigor of the available RCTs for a large number of commonly used CIM interventions for the mental health of older adults.

Implementing a virtual mind-body prehabilitation program for patients undergoing thoracic surgery: A quality improvement project.

Background: Prehabilitation before thoracic surgery has been found to improve outcomes in patients with cancer; however, COVID-19 presented challenges to access on-site programs. We describe the development, implementation, and evaluation of a synchronous, virtual mind-body prehabilitation program developed in response to COVID-19. Methods: Eligible participants were patients seen at a thoracic oncology surgical department of an academic cancer center, aged 18 years or older with a diagnosis of thoracic cancer and referred at least 1 week before surgery. The program offered 2 45-minute preoperative mind-body fitness classes each week delivered via Zoom (Zoom Video Communications, Inc). We collected data for referrals, enrollment, participation, and evaluated patient-reported satisfaction and experience. We conducted brief semistructured interviews about participants' experience. Results: Among 278 patients referred, 260 were approached, and of those 197 (76%) patients agreed to participate. Among participants, 140 (71%) attended at least 1 class, with an average of 11 attendees per class. The majority of participants reported being extremely satisfied (97.8%), extremely likely to recommend the classes to others (91.2%), and indicated that classes were very much helpful in preparing for surgery (90.8%). Patients also reported that the classes helped reduce anxiety/stress (94.2%), fatigue (88.5%), pain (80.7%), and shortness of breath (86.5%). Qualitative data further suggest that the program made participants feel stronger, more connected to their peers, and better prepared for surgery. Conclusions: This virtual mind-body prehabilitation program was well received with high satisfaction and benefits and is highly feasible to implement. This approach may help overcome some of the challenges to in-person participation.

A descriptive exploration of younger and older adults' experiences of Integrative Medical Group Visits for Long COVID

Introduction: Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC;however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults' experiences of both having LC and participating in a virtually delivered IMGV for LC. Methods: This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data. Results: Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC. Conclusion: This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment. © 2023

Support for patients with MBC

Over the last decade we have witnessed rapid advances in the treatment of patients with metastatic breast cancer (MBC) with seminal discoveries in cancer biology, correlative biomarkers and clinical trials leading to multiple new drug approvals. While these milestones have improved survival, the science of survivorship in this population is just beginning. The diagnosis of MBC is life-changing and requires individualized and multidisciplinary support. The NCI defined the areas of epidemiology and surveillance, symptom management, psychosocial research, health-care delivery, and health behaviors as necessary fields to advance the state of the science in advanced cancer survivors. A multifaceted program addressing these domains is needed to assess MBC patients and their unique and ever-changing needs. With input from patients and providers, program components should include: therapeutic clinical trials, multidisciplinary specialty care, individualized patient navigation, peer support, continuing education, and patient reported outcome (PRO) collection to support patients living with MBC. Input for a program for MBC patients can be guided by a multidisciplinary steering committee in which patient advocates are a major voice. Patients can provide insight into what works for them, and what they are facing may be very different from the experience of an early-stage breast cancer patient. Clinical trials designed to advance the current scientific knowledge of breast cancer treatment are essential to patients living longer, more fulfilled lives with MBC. Clinical trials may include systemic therapy, local therapies such as surgery and radiation for MBC patients, side-effect management and quality of life (may put elsewhere). A comprehensive systemic therapy portfolio should include all biological subtypes as well as recommended treatment options (hormonal therapy, targeted therapy, chemotherapy, and immunotherapy). Multidisciplinary care is necessary to diagnose and treat any condition the MBC patient may encounter and is essential in providing quality care. Comorbidities and debilitating side effects arising from cancer treatment are known to be associated with inferior outcomes. MBC patients may experience lack of familiarity of some providers with novel MBC cancer treatment, side effects, and interactions of their cancer treatment with non-cancer conditions and treatment. With the increasing life expectancy of MBC patients, it is important to manage the medical comorbidities in coordination with the MBC patient's cancer treatment. Integrative Medicine helps support the quality of life of patients through providing clinical modalities such as stress management, yoga, meditation, acupuncture, massage and lifestyle counseling. Supportive care helps support cancer related fatigue and sleep challanges, geriatrics and hospice and palliative care for advanced cancer patients. The role of navigation for MBC patients is unique and should be designed to support the patient's many individual needs. Navigation requires assessment of individual knowledge deficit, coordination of care challenges, internal resource utilization, cultural requests, and emotional health. Navigation should also address the patient's financial and disability questions, medication assistance, symptom management, advanced care planning and goals of care discussions. Additional items to be discussed during navigation visits include primary care provider utilization, COVID-19 vaccination, illness and medication questions, and other patient questions as they arise. A comprehensive registry of MBC patient's medical records and histories will assist researchers in designing future therapeutic and quality of life clinical trials. The categories of patient demographics, clinical variables, pathological variables, treatment variables, outcomes of MBC, and PROs will create a robust registry. A comprehensive patient registry can create a rich database which can guide and inspire future innovative research. Peer support through support groups and peer-to-peer matching s pivotal to MBC patients finding and utilizing their patient voice, emotionally supporting each other and learning from other's similar experiences. Connection between patients and the creation of a community of survivors can empower patients to positively impact their care through self-advocacy and self-efficacy. Continuing patient education is also essential to providing quality cancer care. The format of a weekly virtual education webinars are helpful in creating an engaged patient community and a platform to disseminate educational resources in a reoccurring digestible format. Frequent educational webinars covering a wide variety of topics can positively influence patient interactions with their healthcare providers and influence how patients living with MBC view their own cancer experience. Educational webinars provide opportunities for patients to connect with subject matter experts, other patients like themselves, and share information with their family and friends. Informed patients can discuss and ask questions more confidently with their health care providers about information and services presented during the educational webinars. The symptom profile of patients living with MBC are impacted by numerous variables such as disease burden, treatment plan, comorbidities, supportive regimen etc. The collection of PROs has been shown to improve patient satisfaction with his/her care, improve quality of life, decrease emergency room visits and hospitalizations, and increased overall survival. The routine measurement and management of MBC patients' symptoms has been found to be integral in providing comprehensive cancer treatment. The collection of PROs improves patient and provider communication and elicits the outcome to symptoms that matter most to each patient. Patients diagnosed with MBC are living longer because of the recent advancements in therapeutic treatments. A multifaceted and comprehensive program consisting of therapeutic clinical trials, multidisciplinary specialty care, individualized patient navigation, peer support, continuing education, and PROs collection is integral to fully support patients living with MBC.

Self-care and lifestyle interventions of complementary and integrative medicine during the COVID-19 pandemic-A cross-sectional study.

Background: Complementary and Integrative Medicine (CIM), including self-care healthy life-style promotion strategies, is widely used in Germany. Aim of this study was to assess the use of self-care and lifestyle interventions as well as mental/emotional state experienced during the COVID-19 pandemic. Methods: An exploratory cross-sectional online study was conducted with adults in Germany through an online survey. Custom-developed questions in respiratory disease-status (including COVID-19), CIM-based self-care/lifestyle interventions and dietary patterns, and mental/emotional state as well as parameters for wellbeing (World Health Organization Well-Being Index, WHO-5) and self-efficacy (General Self-Efficacy Short Scale, GSE-3) were assessed. Data was analyzed using frequency and parametric measures. Results: The online survey was performed from January to March 2021 and included 1,138 participants (81.5% female; mean age: 49.2 ± 13.7 years; 54.9% holding a university degree) living in Germany, of which 62 had had a positive SARS-CoV-2 test, 4 an influenza infection and 375 participants other respiratory infections. The following individual health promotion strategies were reported: spending time in nature (90%; n = 1,024), physical activity (69.3%; n = 789), naturopathic remedies (63.1%; n = 718), plant-based diet (56.3%; n = 640), and Mind-Body interventions (54.7%; n = 623). No differences in strategies between individuals with respiratory diseases or the sample overall were found. Well-being had a mean value of 15.2 ± 5 (WHO-5) and self-efficacy 4.1 ± 0.6 (GSE-3). Nearly 8% reported a low mental/emotional state regarding the COVID-19 pandemic. Conclusion: Self-care and lifestyle interventions during the COVID-19 pandemic were reported by participants who were predominantly female, middle-aged, and well-educated. Most participants showed an overall balanced mental/emotional state. Further studies should include a representative control group from the general population. Clinical trial registration: clinicaltrials.gov, identifier NCT04653727.

Improved Survival and Quality of Life Through an Integrative, Multidisciplinary Oncological Approach: Pathophysiological Analysis of Four Clinical Cancer Cases and Review of the Literature.

Objectives: According to the National Cancer Institute, the integrative medicine (IM) approach to medical care combines standard medicine with complementary and alternative medicine practices that have proved safe and effective. Methods: We describe the clinical cases of four patients with malignant pleural mesothelioma (MPM), diffuse malignant peritoneal mesothelioma (DMPM), intrahepatic cholangiocarcinoma, and breast cancer (BC) who received supportive treatment (ST) according to an IM approach after the failure of standard cancer treatments or the appearance of serious adverse events caused by antiblastic chemotherapy. The critical role of complementary drugs in reducing the side effects of cancer treatments and normalizing the white cell count is especially apparent in the case of the patient with metastatic BC, who experienced prolonged neutropenia. Results: The IM approach was well-tolerated and had no adverse side effects. It improved the quality of life (QoL) of all patients and in two cases extended overall survival. Conclusion: The extended clinical and instrumental response to IM of the patients with malignant mesothelioma and the improved health-related QoL and good tolerance of the ST demonstrated in all cases support the value of this approach in patients whose cancer therapies have failed but who show a good performance status. Our data require confirmation in a well-designed prospective clinical trial.

Integrative Medicine in the Treatment of COVID-19: An Indian Perspective

Background: Over recent years, evidence-based modern medicine has overshadowed the use and efficacy of natural and traditional medicines. However, in the wake of the pandemic, the in-terest in the quest for therapeutic resources linked to traditional, complementary, and integrative medicine has substantially increased. This has further facilitated the research and development of potential therapeutic crude drugs or their formulations in the management of COVID-19 and the symptoms associated with the latter. This article attempts to provide a comprehensive review of the various traditional medicines used as integrative medicines in alleviating symptoms attributed to the COVID-19 infection. Method(s): The literature was thoroughly browsed for recent research articles, systematic reviews, case studies, and review articles on ScienceDirect, PubMed, and Google Scholar using keywords like complementary medicine, alternative medicine, and holistic approach to enlist a few. Subse-quently, they were thoroughly screened to include only recent studies and evidence. Additionally, the official guidelines published by the Government and other regulatory bodies were also sought to be included in the article. Study Design: The review article follows the narrative literature review method. However, the pri-mary data was skimm ed for relevance, and only recent shreds of evidence pertinent to the review were included. Result(s): The review elucidated the pharmacological activity of various treatment regimens in different systems of medicine, with available supportive clinical evidence. Additionally, it also under-scored the importance of holistic health interventions, and how these traditional and integrative systems of medicine cater to the same. Conclusion(s): The recent evidence presents a broad-spectrum effect of these therapeutic interven-tions, primarily in the fields of mental health, mild to moderate, and even severe forms of the infec-tion, employing various pharmacological pathways. These studies primarily include studies and sta-tistics pertaining to the SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) but may include supporting evidence from other respiratory viruses. This information may prove imper-ative in guiding new research, and also in designing and supporting an integrative treatment regi-men. Conclusively, any suspicion pertaining to the COVID-19 infection should be sought by follow-ing the protocols recommended by the concerned health authorities of the respective region/country. Copyright © 2023 Bentham Science Publishers.

Yoga Therapy in Cancer Care via Telehealth During the COVID-19 Pandemic.

BACKGROUND: Yoga is an evidence-based mind-body practice known to improve physical and mental health in cancer patients. We report on the processes and patient-reported outcomes of one-on-one yoga therapy (YT) consultations delivered via telehealth. METHODS: For patients completing a YT consultation between March 2020 and October 2021, we examined demographics, reasons for referral, and self-reported symptom burden before and after one YT session using the Edmonton Symptom Assessment Scale (ESAS). Changes in ESAS symptom and subscale scores [physical distress (PHS), psychological distress (PSS), and global distress (GDS)] were evaluated by Wilcoxon signed-rank test. Descriptive statistics summarized the data. RESULTS: Ninety-seven initial YT consults were completed, with data evaluated for 95 patient encounters. The majority were women (83.2%) and white (75.8%), The mean age for females was 54.0 and for males was 53.4; the most common diagnosis was breast cancer (48%), 32.6% had metastatic disease, and nearly half (48.4%) were employed full-time. Mental health (43.0%) was the most common reason for referral, followed by fatigue (13.2%) and sleep disturbances (11.7%). The highest symptoms at baseline were sleep disturbance (4.3), followed by anxiety (3.7) and fatigue (3.5). YT lead to clinically and statistically significant reductions in PHS (mean change = -3.1, P < .001) and GDS (mean change = -5.1, P < .001) and significant reductions in PSS (mean change = -1.6, P < .001). Examination of specific symptom scores revealed clinically and statistically significant reductions in anxiety (mean change score -1.34, P < .001) and fatigue (mean change score -1.22, P < .001). Exploratory analyses of patients scoring ≥1 for specific symptoms pre-YT revealed clinically and statistically significant improvements in almost all symptoms and those scoring ≥4 pre-YT. CONCLUSIONS: As part of an integrative oncology outpatient consultation service, a single YT intervention delivered via telehealth contributed to a significant improvement in global, physical, and psychosocial distress. Additional research is warranted to explore the long-term sustainability of the improvement in symptoms.

Retrospective time to event analysis of integrated medicine treatment effect on mild symptomatic COVID19 patients in facility quarantine at Kallakurichi, Tamil Nadu

Background: This study has been conducted on confirmed COVID 19 positive patients (n = 55), who had come to Kallakurichi District of Tamilnadu state from one of the containment zones in Indian State of Maharashtra. Out of the 55, 8 (14.55%) patients were symptomatic and remaining 47 (85.45%) were asymptomatic patients. 47 patients who reached in their home land on 24th May and rest on 25th may 2020. All of them have been treated with integrated medicine treatment method. Materials and Methods: Everybody was quarantined from 27th may to 7th June 2020 at Mahabharathi Engineering College, Vasudevanur, Chinna salem Taluk, Kallakurichi District. Integrative Intervention Consisting of Vitamin C Tablet, Zinc tablet for 5 days, and Kabasura Kudineer 60 ml BD Before food for all days was the treatment given for all patients. Result: Among them, three of them had co -morbid conditions like diabetes and hypertension. 27.3% were female and 72.7% are male patients. Average age was 32.33 among the range of 14 to 65years. Conclusion: All patients including who has co-morbidity were completely relieved from the disease on the day of discharge. All symptomatic patients were asymptomatic with median time of 4 days IP admission.

Where'd the Dyads Go? Enrolling Veteran-Centric Dyads into Virtual Complementary and Integrative Health Research Studies...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

The increase in complementary and integrative health (CIH) treatments and changes to healthcare delivery due to COVID-19 have expanded the need for remotely accessible, non-pharmacological treatments for chronic illnesses. This presentation describes attrition while recruiting dyads of Veterans with chronic pain and PTSD and their partners, to a study of a remotely delivered, CIH program. It also provides baseline characteristics of successfully enrolled participants and offers recommendations for effective enrollment. This RCT randomized 364 dyads to either an intervention or a wait-list control arm. Three Department of Veterans Affairs Medical Centers recruited participants between October 2019 and December 2021. Veterans with chronic pain and PTSD, and their self-elected partners (e.g., spouse). Mission Reconnect is a partnered, self-directed intervention that teaches CIH skills (e.g., meditation, partnered massage) remotely using mobile and web-based platforms. Main Outcome Measure(s): Reported outcomes include: recruitment methods;number of participants screened and onboarded;and participation barriers. Baseline characteristics of successfully enrolled participants will also be presented. Of the 364 recruited dyads, 97 (26.6%) failed to complete onboarding activities, including submission of baseline data. Reported reasons for failure to complete onboarding include loss of self-elected partner buy-in (8.2%), difficulties with using remote data collection methods and interventions (30.9%), and adverse health experiences unrelated to study activities (17.5%). Despite the high attrition rate, Veterans were successfully enrolled from 35 states and 1 US territory with nearly a fifth of successfully enrolled participants drawn from rural zip codes (18.0%). Successful enrollees represent a pool of Veterans with diverse socioeconomic characteristics and moderate-to-severe pain severity. Lessons learned from project challenges relate to recruitment, onboarding, intervention delivery, and data collection processes.Conclusion: Successful enrollment of Veterans with chronic pain and PTSD, and their partners, to studies of remotely delivered CIH treatments requires careful examination of recruitment and onboarding methodologies and simplification of processes. Accommodating the targeted study participants' symptom burden is essential for identifying and addressing possible sources of attrition. None disclosed.

Integrative Medical Group Visits for Long COVID- 19: Patient Interviews Identify Therapeutic Elements

Background and/or Objectives: To understand the experience of participants in Integrative Medicine Group Visits for Long COVID-19 (IMGV- LC) Design: Patients referred to IMGV-LC from a COVID Recovery Clinic were recruited to participate in this study. This feasibility pilot study with a pre-post interview design explored group participants' expectations, experiences, and insights related to the IMGV-LC. Semi-structured interviews were conducted before and the first of 8 weekly IMGV-LC sessions and following group completion. Qualitative data were analyzed using rapid qualitative analysis. Setting(s): Telehealth visits using Zoom software at an outpatient rehabilitation clinic affiliated with an academic medical center Participants: 10 patients aged 22 to 67 Interventions: IMGV-LC was delivered as a two-hour telehealth visit co-facilitated by a physician and yoga instructor. Sessions were held weekly from June to August 2021. The curriculum includes principles and practices of mindfulness-based stress reduction, nutrition, and lifestyle management. Main Outcome Measure(s): Qualitative interview data Results: There were 15 patients who were enrolled in the group and the average attendance was ten patients per session. Participants recommend that ideal candidates for IMGV-LC would be patients struggling and frustrated with symptoms of Long-COVID. Participants appreciated the patient-centered approach of the IMGV-LC, social support from others in the group, and increased confidence to manage symptoms. Patients found that having a mutual understanding of each other's situation was beneficial in the healing process. While anxiety about the possibility of re-infection was common, multiple patients were optimistic about the future because they had better control of their situation after experiencing IMGV. The mindfulness techniques gave them tools to tackle symptoms, respond to stressors effectively, and be resilient. Conclusion(s): By understanding patients' recommendations and perspectives, providers can help provide individualized, patient-centered care through IMGV-LC as well as understand the impact IMGV-LC has on patients' illness experience. This data can help give physicians clarity on which patients would be ideal to participate in IMGV-LC.

Management of COVID - 19 with Siddha and Western Medicine - An Integrative Case Report.

Renaissance in acceptance of the Siddha system of medicine in all over India happened during the current scenario of coronavirus disease-2019 (COVID-19) pandemic. The classical texts of Siddha medicine contain descriptions of the symptoms of COVID-19 as a syndrome like definition that may be correlated with KabaSuram. A 49-year-old female residing at New Delhi who got COVID-19 positive with comorbidity of hypothyroidism treated successfully using an integrative treatment plan (Siddha and Allopathic) as per Government-mandated COVID-19 treatment guidelines. The patient developed symptoms such as fever, sore throat, cold, cough with expectoration, difficulty in breathing, chest congestion, and body ache. Initially the patient took Western Medicine (WM) for five days but the symptoms did not subside. After five days an integrated treatment including Siddha medicine (Internal and external medicines) initiated at In Patient ward, Safdarjung Hospital. The health of the patient improved within 3 days and all her symptoms got relieved within 10 days. After completion of treatment, she tested reverse transcription - polymerase chain reaction (RT-PCR) and it was negative on 14th day. Another patient who was admitted with her got COVID-19 positive turned negative only after 30 days as she missed the integrative medicine by probability. The reported case had a prospective follow-up for six months and found to be free of post-COVID complications. Since, this case report based on a single case which shows a positive outcome is incapable of generalizing the conclusion. Further suitable clinical trials need to be conducted to assess its efficacy. The status of the summary is reported as per CAse REport (CARE) guidelines.

In vitro effect of Withania somnifera, AYUSH-64, and remdesivir on the activity of CYP-450 enzymes: Implications for possible herb-drug interactions in the management of COVID-19.

Ayurvedic medicines Withania somnifera Dunal (ashwagandha) and AYUSH-64 have been used for the prevention and management of COVID-19 in India. The present study explores the effect of Ashwagandha and AYUSH-64 on important human CYP enzymes (CYP3A4, CYP2C8, and CYP2D6) to assess their interaction with remdesivir, a drug used for COVID-19 management during the second wave. The study also implies possible herb-drug interactions as ashwagandha and AYUSH-64 are being used for managing various pathological conditions. Aqueous extracts of ashwagandha and AYUSH-64 were characterized using LC-MS/MS. A total of 11 and 24 phytoconstituents were identified putatively from ashwagandha and AYUSH-64 extracts, respectively. In addition, in silico studies revealed good ADME properties of most of the phytoconstituents of these herbal drugs and suggested that some of these might possess CYP-450 inhibitory activity. In vitro CYP-450 studies with human liver microsomes showed moderate inhibition of CYP3A4, 2C8, and 2D6 by remdesivir, while ashwagandha had no inhibitory effect alone or in combination with remdesivir. AYUSH-64 also exhibited a similar trend; however, a moderate inhibitory effect on CYP2C8 was noticed. Thus, ashwagandha seems to be safe to co-administer with the substrates of CYP3A4, CYP2C8, and CYP2D6. However, caution is warranted in prescribing AYUSH-64 along with CYP2C8 substrate drugs. Furthermore, preclinical and clinical PK studies would be helpful for their effective and safer use in the management of various ailments along with other drugs.

A Single-Blind, Randomized, Placebo Controlled Study to Evaluate the Benefits and Safety of Endourage Targeted Wellness Formula C Sublingual +Drops in People with Post-Acute Coronavirus Disease 2019 Syndrome.

Introduction: Coronavirus Disease 2019 (COVID-19) causes a wide range of symptoms, including death. As persons recover, some continue to experience symptoms described as Post-Acute COVID-19 Syndrome (PACS). The objectives of this study were to measure the efficacy of Formula C™, a cannabidiol (CBD)-rich, whole-flower terpene-rich preparation in managing PACS symptoms. Materials and Methods: This randomized, placebo-controlled, single-blind, open-label crossover study was conducted in 2021. Informed consent was obtained from participants, and they were randomized to two treatment groups. Group 1 (n=15) received blinded active product for 28 days, and Group 2 (n=16) received blinded placebo for 28 days (Treatment Period 1). Both groups crossed over to open-label active product for 28 days (Treatment Period 2) with a safety assessment at day 70. Patient-Reported Outcomes Measurement Information System (PROMIS®) scores and the Patient Global Impression of Change (PGIC) score were used to assess primary and secondary objectives. Safety assessments were also done at each visit. Results: Twenty-four participants completed study, with 8 withdrawals, none related to study product. PGIC and PROMIS scores improved across both groups at day 28. This raised questions about the placebo. A reanalysis of the placebo confirmed absence of CBD and unexpected medical concentration of terpenes. The study continued despite no longer having a true placebo. The improved scores on outcome measures were maintained across the open label treatment period. There were no safety events reported throughout the study. Discussion: For persons with PACS who are nonresponsive to conventional therapies, this study demonstrated symptom improvement for participants utilizing Formula C. In addition, the benefits seen in Group 2 suggest the possibility that non-CBD formulations rich in antioxidants, omega-3, and omega-6 fatty acids, gamma-linoleic acid, and terpenes may also have contributed to the overall improvement of the partial active group through the study. Conclusion: Given that both groups demonstrated improvement, both formulations may be contributing to these findings. Limitations include the small number of participants, the lack of a true placebo, and limited time on study products. Additional studies are warranted to explore both CBD-rich hemp products and hempseed oil as treatment options for PACS. Trial Registration ClinicalTrials.gov Identifier: NCT04828668.