This article explores complementary and alternative medicine (CAM) organisations\' legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal, where the legalisation of CAM therapies was a contested process over 10 years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers\' efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust-building and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy.

BACKGROUND: Consumption of complementary and alternative medicine (CAM) is widely described in cancer patient. However, their composition is not clearly defined and the proofs of safety or effectiveness are quite low. We reported here the case of a CAM-induced hepatitis.
METHODS: A 33-years-old men with Non-Small Cell Lung Cancer and treated by combination of immunotherapy and chemotherapy developed hepatitis during 5 months. Viral and iatrogenic etiologies were excluded.
METHODS: Medication reconciliation found concomitant utilisation of CAM. Some of the plants which composed CAM were found to be possible hepatotoxic. After discontinuation of this CAM, liver fonctions normalized. Close monitoring of liver function showed no other hepatitis.
CONCLUSIONS: CAM induced hepatotoxicity was suspected. Medication reconciliation included CAM is needed in cancer patient to detect drug interactions and CAM side effects to improve cancer patient management.

UNASSIGNED: We aimed to investigate the effectiveness of isopropanolic extract of Cimicifuga Racemosa (iCR) on reducing menopausal symptoms.
UNASSIGNED: A single-center observational prospective case-control study was performed to assess the improvement of menopausal symptoms in menopausal women undergone iCR administration (cases) or no treatment (controls). Menopausal symptoms were assessed through a modified version of the Menopause Rating Scale questionnaire (mMRS) at T0 (baseline), T1 (1-month follow-up), and T2 (3 months follow-up). Univariate comparisons between cases and controls were performed by using the unpaired T test for two-tailed P value with α = 0.05 significance level.
UNASSIGNED: A total of 163 women (83 cases and 80 controls) were enrolled in the study. The difference in menopausal symptoms between cases and controls from T0 to T2, and from T0 to T1, was found significant for all analyses. In particular, the difference in all menopausal symptoms was 20.56 ± 0.90 points (95%CI: 18.77-22.33, p < .001) from T0 to T2, and 10.69 ± 0.6 (95%CI: 9.49-11.88, p < .001) from T0 to T1.
UNASSIGNED: iCR may be effective in reducing menopausal symptoms, both after 1 month and after 3 months of treatment. The improvement was higher in vasomotor symptoms, sleep problems, and irritability.

Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for \"Whole Health Veterans Administration,\" \"integrative medicine,\" \"integrative health,\" \"complementary and alternative medicine,\" and, as they related to the outcomes, of \"health outcomes,\" \"cost-effectiveness,\" \"cost reduction,\" \"patient satisfaction,\" and \"physician satisfaction.\" Additional studies were identified from an initial search and the authors\' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.

Anorexia nervosa (AN) is characterized by a strong fear of weight gain and body image disorders and is classified as a mental illness that can cause direct damage to one\'s mental health and body. Many individuals with AN tend to commit suicide. Additionally, the disease can lead to chronic undernutrition and low body weight, adversely affecting each body system, exacerbating systemic medical complications, especially acute life-threatening complications. Therefore, AN has the highest mortality and disability rates among all mental diseases. There is a basic clinical need to identify and address the acute and critical complications of this disease as soon as possible. However, the current literature has a poor description of the acute and critical complications of AN and lacks a systematic review. We report a case of a patient with AN and severe hypokalemia, significant Q-T interval prolongation, stomach dilation, and intestinal obstruction who recovered after conservative treatment. The defecation method we used, to our knowledge, has not been previously reported in the literature. We also briefly review the various acute and life-threatening complications of AN.

Korean herbal medicine treatment (KHMT) involves treating with a combination of natural products, which have been used for thousands of years. Recently, it has been reported to be effective and safe in cancer patients. This case report demonstrates the efficacy of KHMT in a 49-year-old man with malignant pleural mesothelioma (MPM), a rare and highly aggressive cancer. The patient showed recurrent pleural effusion and was diagnosed with epithelioid MPM at cT3NxM0 stage III in December 2017. The multidisciplinary care team recommended multimodal treatment based on an extrapleural pneumonectomy, but he refused this because the treatment was aggressive and the effectiveness was unclear. He decided to undergo pemetrexed plus cisplatin chemotherapy if his condition worsened. He visited the Korean Medicine Cancer Center for alternative treatment options. A KHMT regimen, consisting of twice-daily Gunchil-dan and thrice-daily Bangam-tang, was initiated in December 2017. Since commencement of KHMT, computed tomography and X-ray imaging scans have shown no significant interval changes and progression. At 21 months into treatment (September 2019), no significant adverse events have occurred. Given that the median overall survival of patients with MPM is approximately 1 year, the ongoing progression-free survival of this patient for 21 months is relatively long. This case, therefore, suggests that KHMT is a potential treatment option for MPM patients.

BACKGROUND: Recurrent urinary tract infections are of importance for public health as most clinicians are faced with repeated and long-term administration of broad-spectrum antimicrobial agents leading to an increased risk of resistant bacteria. One encouraging treatment approach may be individualized homeopathy.
METHODS: Here, four female cases with recurrent urinary tract infections are reported. They were treated successfully with the homeopathic strategy after several conventional approaches revealed no improvement. The follow-up period was a minimum of 3 years and the frequency of episodes with urinary tract infection as well as of antibiotic treatment was documented. Additionally, the patients were asked to assess the treatment outcome retrospectively in a validated questionnaire.
RESULTS: The treatment resulted in a reduction of urinary tract infections and the need for antibiotics from monthly to less than 3 times a year. Three of the four women had no cystitis and related intake of antibiotics for more than 1.5 years. A relapse of symptoms could be treated efficiently with a repetition of the homeopathic remedy. All subjective outcome assessments resulted positive.
CONCLUSIONS: This case series suggests a possible benefit of individualized homeopathic treatment for female patients with recurrent urinary tract infections. Larger observational studies and controlled investigations are warranted.
Hintergrund: Rezidivierende Harnwegsinfektionen (RUTI) haben große Bedeutung für das öffentliche Gesundheitswesen, da die meisten Kliniker therapeutisch auf wiederholte und langzeitige Verabreichung von Breitbandantibiotika zurückgreifen, was wiederum zu einem erhöhten Risiko für resistente Bakterienstämme führt. Individuali­sierte Homöopathie (iHOM) könnte eine Behandlungsalternative sein. Kasuistiken: Zwischen Ende 2013 und August 2015 wurden vier Frauen mit RUTI in einer Universitätsambulanz mit iHOM behandelt, nachdem mehrere konventionelle Ansätze ihre Situation nicht verbessern konnten. Alle Patientinnen wurden mindestens drei Jahre lang beobachtet und die Häufigkeit von Harnwegsinfekten (UTIs) sowie von Antibiotika-Behandlungen (AB) dokumentiert. Zusätzlich wurden die Patienten gebeten, das Behandlungsergebnis in einem validierten Fragebogen nachträglich zu bewerten. Ergebnisse: Die Häufigkeit von UTIs und der Bedarf an AB wurden von monatlich auf mindestens weniger als 3-mal pro Jahr reduziert. Drei der vier Frauen hatten länger als 1,5 Jahre keine Blasen­entzündung oder antibiotische Therapie. Ein Rückfall der Symptome konnte jeweils mit einer Wiederholung des homöopathischen Mittels effizient behandelt werden. Alle subjektiven Ergebnisbeurteilungen fielen positiv aus. Schlussfolgerung: Diese Fallserie legt einen möglichen Nutzen von iHOM für Patienten mit RUTI nahe. Der therapeutische Ansatz sollte in größeren, kontrollierten Studien erforscht werden.

Cancer patients use health foods (HFs) as complementary and alternative medicine, although the details of their adverse events (AEs) are unclear. We searched three databases [PubMed, \"Igaku Chuo Zasshi\", and Information System on Safety and Effectiveness for Health Foods website (https://hfnet.nibiohn.go.jp/)] for case reports on AEs related to HF intake in cancer patients published before October 2018. Of the matched reports, 76 studies and 92 patients (31 in Japan, 61 overseas) that met the selection criteria were included in this review. Thus, the severity of AEs and outcomes were not related to either the concomitant use of HF with cancer chemotherapy or cancer stages of patients. AEs caused by HF intake itself accounted for 87%, while drug-HF interaction accounted for 11%. According to the Common Terminology Criteria for Adverse Events (CTCAE) classification, 70% of patients whose grades were identified had severe cases (grades 3 to 5). In Japanese patients, hepatic and respiratory disorders accounted for 52% of the severe cases. Cases were predominantly developed as a result of an allergic mechanism, and mushroom products were mostly used. Overseas, serious cases were induced by products that were already indicated for safety problems. Moreover, notable AEs were recognized, such as hypercalcemia, which were caused by intake of HF containing calcium, vitamin D, and shark cartilage, and bacterial infection caused by probiotic products. Analyzing the details of AEs related to HF intake can help health professionals and cancer patients prevent health hazards.

Lichen planus (LP) is an idiopathic, cell-mediated immune disorder, accompanied by itching. Spontaneous remission occurs. Topical and systemic therapies are utilised. Four cases of generalized LP with and without mucosal involvement treated homeopathically are presented. Case 1: A 48-year-old female presented with a 7-month history of generalized itchy rash, which had been diagnosed as LP, treated unsuccessfully with topical steroids and removal of dental fillings. Examination revealed violaceous papules on upper and lower limbs, oral mucosal lesions and an irregular, erythematous, blanching, macular rash on the chest. She received homeopathic Ignatia amara at medication dilution factor (MK) potency, weekly dose and went into remission at 3 months. Patient remains in remission. Case 2: A 65-year-old female presented with a 27-year history of generalized, LP, which had been unresponsive to topical steroids. Examination showed generalized, violaceous papules, with no mucosal involvement. She received homeopathic Aurum metallicum, MK potency, weekly, and went into remission. She relapsed at 8 months after onset of therapy, following a very stressful incident, but gained remission again with Aurum metallicum after 1 month of therapy. She remains in remission. Case 3: A 38-year-old male presented with a 21-year history of generalized LP. Medical history was significant for hepatitis B and asthma. Topical steroid therapy was only partially successful. Examination revealed generalized, violaceous papules, with oral and genital involvement. He received homeopathic Lycopodium at MK potency, weekly, and remitted by 2 months. He remains in remission. Case 4: A 41-year-old male presented with a 12-year history of generalized hypertrophic LP, which had responded partially to topical steroids and ultraviolet A therapy. Medical history was significant for reduced sense of smell. Examination revealed generalized, violaceous, hypertrophic papules and nodules. He received homeopathic Carcinosinum at MK potency and remitted at 6-months. In its long-standing, generalized form, with mucosal involvement, LP may respond to individualized homeopathy. More research may clarify homeopathy\'s place in LP therapy.

A male infant at two weeks of age was hospitalized vomiting forcefully. He had a pyloromyotomy. He did not improve with medical therapy. The diagnosis of gastroparesis was made after a nuclear medicine gastric emptying study and intestinal manometry. He required a gastrostomy tube (g-tube) and a jejunostomy tube (j-tube) for feeding. At 11 months of age, the j-tube was converted into a feeding jejunostomy with Roux-en-Y limb. For 16 years he was completely dependent on j-tube feeding. In November 2011, he experienced proximal-intercessory-prayer (PIP) at a church and felt an electric shock starting from his shoulder and going through his stomach. After the prayer experience, he was unexpectedly able to tolerate oral feedings. The g- and j-tube were removed four months later and he did not require any further special treatments for his condition as all symptoms had resolved. Over seven years later, he has been free from symptoms. This article investigates a case of PIP as an alternative intervention for resolving severe idiopathic gastroparesis when maximal medical management is not effective.