The phrase alternative therapy is used to explain a wide range of treatments which, generally, are not available from conventional doctors. It may be diverse for different diseases. The Alternative therapy focuses on the many things from diet to exercise and lifestyle. Many people suffering from disease are looking for the management of diseases with the help of alternative therapies. According to physicians, most of the alternative therapies started with clinical observation or scientific research. These therapies include yoga, aromatherapy, massage, hypnosis, biofeedback, herbal remedies and many others. The main advantage of these therapies is to treat the basic cause of disease and health related problems or to support the conventional therapies. Not only are the variety of alternative therapies measured to be safe and effective, they also deal individuals a wide variety of health therapy that simply do not exist through conventional treatment. This article focuses on different alternative therapies with their benefits in conventional therapies which can promise ultimate answers to treat the diseases.
One of the strategies adopted by physiotherapy has been to embed research within the undergraduate cur- ricula, thereby creating a critical mass of physiothera- pists who are familiar with, and have skills to, embed research evidence in clinical practice. Further, there has been the establishment of a dedicated research grant funding body  for which physiotherapists can apply for funding to conduct physiotherapy-related research . Physiotherapists have also successfully tapped in mainstream health and medical research grants, which have historically been accessed by medical disciplines. For example, since 2000, there has been a steady increase in the number of National Health and Medical Research Council funded grants with one or more physiotherapists as chief investigators . These are just a few strategies that have addressed the barriers of access, competency and bias in physiotherapy, which the CAM professions can perhaps learn from if it endeavours to overcome the barriers to conducting and applying research in CAM.
It is generally assumed that the Pilates method is well tolerated. Pilates teachers are not regulated in the UK and are not legally required to have any specific qualifications. It is suggested that, before going to a class, you ask the questions on pages 7 and 8. In reflexology, pressure is applied to specific areas, or zones, of the foot. These zones are believed to correspond to different areas of the body. The application of pressure is thought to improve health by increasing energy flow in the body. This concept of an underlying life force is similar to that of some other alternative healing systems such as acupuncture. One MS research study, which was not well designed, found improvement in multiple MS symptoms with reflexology, while a better designed and larger study found that there was improvement in muscle stiffness, bladder and sensory symptoms. A study looking at the effect of reflexology on pain found it was no better than a sham treatment – but both showed a clinically significant reduction in pain. A recent review of all of the published clinical trials of reflexology in many medical conditions concluded that there was not convincing evidence that reflexology was an effective treatment for any condition. Reflexology is a low risk therapy and there are no known serious side effects. It should be used with caution in those with foot conditions, including gout, ulcers, vascular disease and arthritis.
The research setting was three family medicine clinics in rural Japan located in Shizuoka and Shiga prefectures. The three clinic sites in Kikugawa, Mori-machi, and Yuge were chosen because of their affiliation with the University of Michigan Family Medicine Department, their location in rural Japanese communities, and their willingness to be a part of this research study. Kikugawa is an agricultural city that is known for green tea production, located in the western portion of Shizuoka prefecture. Mori-machi is a small inland town located in Shizuoka prefecture. Yuge is a small village that has merged to become a part of the larger Ryuo town, which is an industrial and agricultural locale near the center of Shiga prefecture. At the time of data collection, there were nine physicians (two attendings and seven residents) working at the Mori-machi clinic, 11 physicians (three attendings, two clinical fellows, and six residents) working at the Kikugawa clinic, and seven physicians (four full-time physicians, three part-time physicians) working at the Yuge clinic.
HOW ARE EVIDENCE-BASED GUIDELINES DEVELOPED? The American Academy of Neurology (AAN) established a strict process to develop evidence- based guidelines. The AAN identifies an important question and then selects a panel of unbiased experts to conduct the review. A medical research librarian then helps perform a comprehensive search of the medical literature. This allows researchers to identify articles of potential relevance to the question at hand. At least 2 researchers independently review and rate the quality of each article using an established classification system. This rating reflects how the trial was designed and conducted. For example, a clinical trial directly comparing 2 therapies would be considered higher quality than a report of a handful of patients who received just 1 therapy. The quality of studies is rated on a 4-point scale—from Class I, which is the highest quality, to Class IV, which is the lowest quality. In some situations, no recommendations
Abstract: Patients’ own account of the clinical progress is particularly important in situations of pain control, mental disturbances, and chronic problems. Chinese medicine does not directly target against a symptom or pathology, but emphasizes the maintenance of harmony between the vital forces of an individual. To achieve the harmony, usually long-termed treatment is required by consideration of the changing seasons and subject’s constitution nature. With such unique requirements in Chinese medicine, the assessment of the quality of life becomes most important. There are obvious similarities between different systems of medical care. Hence the general domains of the quality of life should ﬁ t all patients, whether they are receiving conventional, modern medical care on alternative, Chinese medical care. Like different clinicalresearch categories, speciﬁ c areas (eg, cancer, women’s problems) would need special additions of assessment. Chinese medicine is based on a uniquely different philosophy and the approach is not deductive, but individualized treatment is an essential requirement. The symptom/syndrome descriptions and interpretation are different from modern western medicine. Health-related qual- ity of life is not sufﬁ cient for clinical trials using Chinese medicine, especially when Chinese medicine experts serve as chief investigators. Early attempts to develop an additional system to cover the need for Chinese medicine have been scanty. A lot of effort needs to be given before a practical instrument taking care of both the general domains of common interests and special feelings on health, relevant to Chinese medicine, could be established and made available. Users of Chinese medicine have to rely on generally acceptable yard-sticks with the addition of self-reporting symptoms unique to Chinese medicine.
Abstract: The precision medicine (PM) initiative is a response to the dismal outlook in solid cancer. Despite heterogeneity, common mechanistic denominators may exist across the spec- trum of solid cancer. A shift from conventional research and development (R&D) toward PM will require conceptual and structural change. As individuals and as a society, we welcome innovation, but question change. We ask: In solid cancer, does PM identify and address the causes of prior failures, and, if so, are the proposed solutions feasible? And, when may we expect safer, more effective and affordable drugs in the clinic? Considerations that prompt a pragmatic rethink include a failure analysis of translational R&D in solid cancer suggesting that trials and regulations need to be aligned with the natural history of the disease. In successful therapeutic interventions in chronic, complex disease, surrogate markers and endpoints should be consistent with the Prentice’s criteria. In solid cancer, drug induced tumor shrinkage, is a drug effect and not a disease response; tumor shrinkage does not reflect nor predict interruption of the disease. Overall, we support a pragmatic, multidisciplinary, and collaborative R&D, and suggest that direction be set by clinical need and utility, and by questions, not answers. PM will prove worthwhile if it could improve clinical outcomes. The lag in therapeutics relative to diag- nostics is a cause for confusion. Overdiagnosis adds to fear and harm, especially in the absence of effective interventions. A revised initiative that prioritizes metastasis research could replicate the successful HIV/AIDS model in solid cancer. A pragmatic approach may further translational efforts toward meaningfully effective, generally available, and affordable solutions.
Use of CAM with children complicates the issues, because children do not usually decide about treatment for themselves and because of the vulner- ability of the pediatric population. Par- ents, patients, health care providers (physicians, nurses, allied health pro- viders, and CAM practitioners), and hospitals need sound information about the legal, ethical, and clinical considerations that should be taken into account in decision-making. They also need guidelines for the appropri- ate use of CAM. Meeting these needs is made more difﬁcult by the relative scarcity of pediatric research in the area, challenging questions of lan- guage, deﬁnitions, and culture associ- ated with CAM, and contention about the nature of evidence and proof that frequently marks discussions of the subject.
Parallel to the calls for more CAM research is the increasing recognition of the numerous barriers to conducting rigorous research in CAM . Furthermore, translation of evidence into practice in CAM continues to face challenges [10–15] that result in persistent know- ledge and practice gaps . While the existence of these issues in CAM research and practice are recog- nised, there is no single instrument that adequately measures the barriers to the conduct of research and the application of research evidence in CAM. While some measures are available that explore the barriers to the utilisation of research in practice, such as the “Barriers to Research Utilization Scale” (BARRIERS)  and the “Evidence-Based practice Attitude and utilization SurvEy” (EBASE) , these tools do not address bar- riers pertinent to both the conduct of CAM research and the application of research evidence in CAM practice. The former is important, as the identification of barriers to the conduct of research is the necessary first step towards improving the quality of research in CAM ; identifying the barriers to the application of research is a necessary second step to ensuring that the findings of such research are utilised in clinical practice.
The conventional biomarker development pipeline involves a discovery stage followed by a qualification stage (commonly known as biomarker validation) on large cohorts, prior to clinical implementation and designing complementary OMICs strategies. In com- mon practice, the discovery stage is performed on a MS-based platform for global unbiased sampling of the proteome, while biomarker qualification and clinical im- plementation generally involve the development of an antibody-based protocol, such as the commonly used enzyme linked ELISA assays. Although this process is potentially capable of delivering clinically important bio- markers, it is not the most efficient process as the latter is low-throughput, very costly and time-consuming. In many cases, affinity reagents for novel protein candi- dates do not even exist and it is difficult to multiplex targets without creating significant interferences and cross-reactivity. These limitations of immunoassays have called for the development of alternative approaches. The recent surge in the advance of proteomic technolo- gies centering on targeted MS and protein microarrays has provided great opportunities for researchers to use them as “bridging technologies” for clinical proteomic and OMICS investigation of disease-relevant changes in tissues and biofluids.
The number and type of sources that journalists rely on to produce CAM content appears to differ by country. In their review of CAM coverage in nine newspapers from five countries, Vastag et al.  found that an average of 4.4 sources were used per story, with newspapers based in the United States tending to use more sources than news- papers published in other countries included in their sam- ple. Canadian newspaper and magazine coverage of CAM appears to most frequently (49.1%) cite only one source . Vastag et al.  also report that conventional health care sources were cited more than twice as often as CAM sources, and for shorter articles (under 1,000 words) jour- nalists cited conventional sources almost exclusively. Bubela et al.  also noted a tendency to cite conven- tional sources over CAM sources in their review of Cana- dian, US and UK-based media reports describing published herbal remedy clinical trials. They observed
First, unbiased scientific scrutiny needs to be applied to existing therapies as well as to novel initiatives. With alarming rates of iatrogenic illness, current approaches and new ideas in both allopathic and nonallopathic care merit equal examination and critical appraisal. Clinicalmedicine should be based on credible, untainted research and reporting, reproducible observation, com- petent and compassionate health care, as well as (and most important) favourable outcomes for patients and populations—not on arbitrary notions of what is allo- pathic and what is alternative. Effective, sound science should be supported; ineffectual interventions should be discarded. However, the rigid demand that ran- domized controlled trials be required for legitimacy of any alternative care is absurd. Randomized controlled trial evidence is lacking for many conventional health- promoting interventions such as the health efficacy of seat-belt use, alcohol avoidance in pregnancy, tobacco cessation for cancer prevention, and even parachute deployment while skydiving. 52 Other forms of evidence,
There is an on-going debate about the nature, size and relevance of clinical effects in CAM. It has been repeat- edly pointed out that CAM interventions seem to be as- sociated often with strong context and meaning effects [10,22]. These so-called non-specific effects sometimes seem to be more powerful than specific effects, such as those elicited by needling a particular point in acupunc- ture . Therefore, despite small or even non-existent specific effects some CAM interventions seem to be clinically as effective or even more effective than guideline-based conventional treatments [24,25]. The context in which CAM treatments are provided appears to be important to patients, who may choose CAM be- cause of the patient-provider relationship  or their be- liefs about a treatment . Some methods have been suggested for distinguishing between specific and non- specific effects , but most CAM treatments, and indeed most clinical practice, cannot be reduced to a single therapeutic ingredient . In combination, fac- tors such as setting, diagnosis and personal interactions are likely to be responsible in part for the treatment out- come. We therefore see a strong need for research inves- tigating how, and the extent to which, these factors influence outcomes.
Typically, medical and health service studies, including CAM research, use quantitative methods. While RCTs may be effective in determining the outcome of a treat- ment’s efficacy and safety on features of a disease, quali- tative studies in CAM do not exert much influence in natural science research. However, the nature of clinical knowledge based on quantitative research methods is exposed to some limitations, for example, when phe- nomena or contexts of illness or health are to be investi- gated. Qualitative methods provide a more thorough approach for describing human behaviour . In the context of CAM, qualitative studies allow a deeper un- derstanding of subjectivity and complexity within human experience, turning them into a powerful tool for in- creasing our knowledge of important processes within CAM [5,15]. As the randomized controlled trial elimi- nates such additional or contextual factors methodo- logically, its feasibility for the evaluation of whole systems and individual aspects of human beings is lim- ited. Hence, the methods of qualitative research can ideally be applied as a conceptual frame for “whole sys- tems research” . In summary, the value of the quali- tative inquiry in CAM research lies in the in-depth understanding of complex individual details that are not captured by standardized methods [17,18]. However, there are specific challenges when conducting meta- syntheses including comprehensive literature searches in the CAM field as well as in the field of qualitative re- search. A quick search in PubMed is not considered ad- equate and may result in the introduction of bias into the findings of a review, and therefore more databases are needed for comprehensive searches . The current PubMed CAM filter has several non-specific search terms that contribute to the lack of specificity of search output and that identify some irrelevant studies as “CAM”, such as plant-derived compounds in chemother- apy . Specialized CAM databases may here provide the highest sensitivity and precision . While searches in CAM are complex to begin with, the search for qualitative research adds still more challenges [21,22]. Qualitative research represents various research method- ologies, including ethnography, phenomenology, grounded theory and narrative analysis, which might hinder retrieval depending on the database . Qualitative systematic reviewers are therefore urged to search the literature systematically in an expansive manner and to enhance transparency of the complex literature search process by giving thorough explanations of their search strategies [21,24,25]. Over and above that, when it comes to the ap- praisal of qualitative studies, there is an on-going methodo- logical debate about appropriate appraisal tools. A large range of different checklists are available in the literature
When counseling patients on CAM use, physicians should respect patients’ choices regarding self-management, while provid- ing evidence-based information about efficacy and safety or the lack thereof. Despite unclear data, a large number of patients will con- tinue using CAM in the future. As research grows in this field, physi- cians have an opportunity to help patients make decisions about the most safe and effective CAM thera- pies to consider.
This revaluation of nonspecific therapy factors is also being stimulated by an increasing collaboration between behaviour- oriented sciences such as neurology, biology and experimental, social and clinical psychology. The results of this interdiscipli- nary research questions the existence of the free will: the neo- cortex appears to be less dominant and therefore has less influ- ence on our behaviour than it would like us to believe (Dijksterhuis, 2008; Lamme, 2010). It seems that we are pre- dominantly controlled by automatic neural networks. Someone who would like to change his behaviour does not benefit much from a wonderful all-encompassing theory, but needs the disci- pline to replace all old automatisms with new ones that fit into his own (small, but subjectively significant) story (Appelo, 2011; Brewin, 2006). The treatment method that facilitates this type of learning, is no longer forcefully dictated by a particular viewpoint or school of thought. In line with the principles of evidence-based medicine, this integrative method results from the interaction between the (preferences of the) patient, the (expertise and experience of the) therapist and the number of effective interventions that are available at that moment. This gives the psychotherapeutic practice an integrated, eclectic character (Korrelboom & Ten Broeke, 2004).
Because of the unavailability of specific antiviral drugs, the therapeutic interventions in COVID-19 patients are almost always considered as supportive and most are repurposed drugs [3,4]. Antiviral treatment with interferon-alpha inhalation and Arbidol has been used . Additionally, a protease inhibitor (Lopinavir/ritonavir) in combination with ribavirin may play a role as antiviral therapy in the early phase whereas nelfinavir is a promising alternative. Other anti-viral treatments such as RNA interference, monoclonal antibody, synthetic peptides, and corticosteroids are used to suppress excessive lung damage due to an inflammatory response. The high flow oxygen supplementation and mechanical ventilation can be used for respiratory failure, and tracheotomy is required in patients requiring prolonged mechanical ventilation and intensive care [4,16,24].
To determine which trials could have used a simple adaptive design, the length of recruitment (R) was compared to the time to the primary outcome (t). Trials with either of these variables missing were excluded. A decision rule was adopted from Sully et al (2014) (16) who stated there was little benefit to conducting a futility assessment of a clinical trial if t/R T proposal that the most desirable time to conduct a futility assessment is when 75% of the participants have been recruited. We believe this rule can be extended to any group sequential design, not just futility assessments, giving the following decision rule:
The genetic biomarker-driven concept of PM has been challenged by a series of facts and evidence. Firstly, the presence or absence of the specific biomarker does not al- ways result in biological and clinical sensitivity to the cor- responding drug. For example, a subset of lung cancer patients which do not bear activating EGFR mutations can achieve clinical responses to EGFR inhibitors , or also a good proportion of BRAF mutated melanoma patients do not respond to BRAF inhibitors . The case of BRAF mutations is even more intriguing because activating oncogenic BRAF mutations are found in several other tu- mors, including colorectal, thyroid, lung cancer but in the majority of those cases they are not predictive of drug re- sponse to the same BRAF inhibitors as in melanoma. Mechanistic explanations to these findings are emerging and reside in the presence of additional genetic or epigen- etic alterations which may create from case to case “favor- able” or “unfavorable” contexts to the action of a specific target therapy. This brings us to the second line of evi- dence: tumors are in general highly heterogeneous and mutated in several driver genes.
First, the wide range and significance of impacts cap- tured in our study suggest that a clearer conceptualisa- tion and standardisation of impact measures is required in order to increase the validity and reliability of impact assessment. The issue of validity relates to the degree of certainty that the proposed indicators measure what they claim to measure, i.e. research impact. For example, it is not certain that participation on public policy commit- tees or changes to legislation reflect one’s research activ- ity rather than a sense of civic duty. The issue of reliability is concerned with the consistency of measure- ments. Without applying precise measures of impact and criteria for the attribution of impact to specific re- search activity across all universities, any impact assess- ment will be inconsistent and, thus, unreliable. While developing new standardised measures can be very costly and challenging, this can be mitigated by concen- trating on those indicators that are already standardised, e.g. research income, patents, and clinical trials. The danger of doing so, however, is that such indicators have not been specifically designed for measuring impact and thus can only be used as proxy indicators, and that the probabilities of impact associated with such proxy indica- tors are currently unknown. As discussed in the case of re- search funding, although research funding competitively- awarded for the purpose of improved patient care is much more likely to lead to improved patient care in a relatively short period of time than non-competitively-awarded funding for basic science research, the probabilities of achieving impact within specified time horizons and how