Category Archives: Integrative Medicine

TUCSON Faculty at the University of Arizona Center for Integrative Medicine and their collaborators successfully demonstrated the feasibility and effectiveness of an online approach to train more family medicine residents in integrative medicine.

The American Board of Physician Specialties defines integrative medicine "as the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing."

Effective online training in integrative medicine is important given the increased demand for physicians with expertise in integrative medicine coupled with the call from medical and public health organizations for alternatives to traditional medical approaches to such matters as pain management.

With that in mind, Dr. Patricia Lebensohn, professor of Family and Community Medicine at the UA College of Medicine-Tucson, directed the development of an Integrative Medicine in Residency program, a robust, online curriculum with the aim of establishing integrative medicine as a routine part of family medicine residency education throughout the country.

An in-depth evaluation of the project and its results was published in the July-August 2017 issue of the journal Family Medicine.

The study tested a 200-hour online curriculum, at eight sites offering integrative medicine residencies across the United States. Study subjects included 186 family medicine residents who participated in the IMR and 53 residents in other programs without integrative medicine training who served as controls.

Of the 186 IMR residents, 77 percent completed the program and tested significantly higher in their medical knowledge of integrative medicine than the control residents.

"Despite how busy the residents were, there was a very high completion rate," says Dr. Victoria Maizes, executive director of UACIM. "The level of knowledge improves in those who complete the curriculum and doesn't change in those who don't."

"When we started this study in 2008, it was a novel idea to deliver common curriculum online across eight sites," says Maizes. "This curriculum is now shared at 75 residencies and has expanded well beyond family medicine. We started with this project in family medicine. Now, we're in pediatrics, internal medicine, preventive medicine and we have a pilot program in psychiatry."

"I am pleased with the results of the residents' evaluation of the high clinical utility of the curriculum and the ease of navigating the online delivery," says Lebensohn. "Most of the residents in an exit survey stated that they intend to utilize integrative medicine approaches in their future practice of family medicine."

Additional study authors included Audrey J. Brooks and Paula Cook, UA; Dr. Benjamin Kligler, Icahn School of Medicine at Mount Sinai; Dr. Raymond Teet, Albert Einstein School of Medicine, New York; and Dr. Michele Birch, Carolinas Medical Center, Charlotte, North Carolina.

Submitted by the University of Arizona Communications

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UA integrative medicine residency program flourishes - Sierra Vista Herald

The Osher Center for Integrative Medicine, Harvards outreach into complementary medicine recently announced a partnership where three researchers associated with the Harvard Osher Center will each summarize a top recent publication from the burgeoning mind-body literature and provide commentary on why they chose to shine a light on it. Harvard is not alone in this effort. Just Tuesday Wolters Kluver announced Ovid Insights,a current awareness service, citing the exponentially expanding volume of research.

As the volume of research worldwide continues to increase, staying current on the latest medical findings and practice guidelines is an overwhelming, yet necessary, task for healthcare professionals.

Ironically, the academics first filled, in the sense of a firehouse filling a cup, the journals with studies predicated on the concept of publish or perish. And having overwhelmed our attention, they now introduce a solution, the era of curated journal reading.

Harvards collaborative partner is the Journal of Alternative and Complementary Medicine (JACM) considered to be in the top quartile of journals covering this area. To give you a sense of the journals academic reach you might considertwo reported measures of citation rates. The SJR, a size independent measure of scientific influence is 0.581, for comparison, the New England Journal of Medicine's (NEJM) is 17.736. The SJR puts JACM 17th among their peers (96 journals) after the Journal of Natural Products and Journal of Ginseng Research. Citations per document reflect how often a journal is cited; it is a commonly used measure of the journals impact on research. Here JACM has a value of 1.537 (the NEJM is 33.902) placing it 22nd amongst its peers, just after Chiropractic and Manual Therapies but before Chinese Medicine [1]

The three Harvard faculty members [2], all JACM associate editors, select a theme and then choose one study from the literature to abstract and to comment upon. I read the articles they presented, while they are a bit too touchy feely for me, and have the usual problems that plague the literature (small sample size, p-hacking, and data mining), they were all thoughtful articles to read and consider. My concern was the descriptions of studies within their abstracts, for example:

Cherkin and colleagues' beautiful randomized prospective studyThis powerful study demonstrates

In an elegantly designed and rigorously conducted comparative effectiveness trial supported by the National Center for Complementary and Integrative Health (NCCIH)/National Institutes of Health (NIH)

Stephen Ross and colleagues conducted a small but methodologically elegant double-blind, placebo-controlled, crossover trial

Perhaps it is me, but I detect a tone of advocacy, and with advocacy comes conflicted interests. I have no issue with knowledgeable people suggesting reading, but there is a fine line between organizing and sorting of information dispassionately and content curation that is, an editorial process. It's a mix of art and science. It requires a clear and definable voice,and editorial mission,and an understanding of your audience and community.[3] Can we reliably expect these academics to cite articles that do not favor alternative and complementary medicine? So far, in the year of this collaboration, no article they have chosen has taken an unfavorable view. Are the Harvard faculty acting as fair witness or advocates, do they shed light or only increase the echo? The goals of JACMs editor, John Weeks, JACMs editor, provides additional clues when he states that his goal that JACM becomes an arbiter of the conversation and content that shapes the course of healthcare. Perhaps I am mistaken, but I want my journals to provide me with unbiased research so that I can form my own view and be the arbiter of my conversations.

[1] The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators [that] can be used to assess and analyze scientific domains.

[2] Osher Center's Director of Research Peter Wayne, PhD, Gloria Yeh, MD, MPH, Research Fellowship Director, and Darshan Mehta, MD, MPH, the center's Director of Education

[3] Is Curation Overused? The Votes Are In

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Harvard's Continued Embrace of Integrative Medicine Finds a Partner and a New Conflict of Interest - American Council on Science and Health

She wielded a kitchen knife, not a scalpel, but Serena Silberman was doing her part Saturday to heal the human body, one chop of parsley, peach and pomegranate at a time.

Food can be medicine, said Silberman, an instructor at the University of California San Diego Integrative Medicine Natural Healing Cooking Program, as she prepped a meal for more than 200 people at the Sanford Consortium for Regenerative Medicine in La Jolla.

Her feast was to commemorate the debut of UC San Diegos Centers for Integrative Health, an initiative throughout the university and health network to unify current research, education and clinical programs ranging from nutrition and acupuncture to meditation and yoga.

Saturdays all-day conference rang in the new collaborative health effort at UC San Diego by discussing how western science can be better wedded to traditional folk cures and alternative medicine to offer better outcomes for patients.

Charlie Neuman/U-T

At the Sanford Consortium, UC San Diego on Saturday launched the new Centers for Integrative Health. At the beginning of the event attendees participate in meditation.

At the Sanford Consortium, UC San Diego on Saturday launched the new Centers for Integrative Health. At the beginning of the event attendees participate in meditation. (Charlie Neuman/U-T)

To Silberman, that means parsley. Rich in antioxidants, the green leaves naturally contain the anti-inflammatory luteolin; Vitamin A to boost the white blood cells that attack infection; and folate, which can help protect patients from heart attack, stroke and hardened arteries.

And then theres her generous dusting of turmeric, the orange-colored herb from the ginger family that doubles as a curry spice and dye. Researchers are studying whether it might heal heart disease and diabetes with very few side effects.

Indian cooks have only been doing it for 5,000 years, so they might know something, said Silberman, punctuating her point with the chop-chop-chop of peaches.

None of this is new to UC San Diego. The Center for Integrative Medicine, for example, was established seven years ago and now treats more than 10,000 patients annually, but organizers hope future consultations will seamlessly involve the Centers for Mindfulness, Integrative Research, Integrative Nutrition and Integrative Education into a one-stop experience.

That means 26 practitioners in 10 clinics within eight departments throughout the health system will be integrated.

Dr. Dan Slater, a physician and UC San Diego professor of family medicine and public health, presented to a packed Sanford Consortium audience a case study he thinks might guide future patient care.

Charlie Neuman/U-T

Attendees to the launch of UC San Diego's Centers for Integrative Health get acupuncture and massages while listening to therapeutic harp music by Carolyn Worster.

Attendees to the launch of UC San Diego's Centers for Integrative Health get acupuncture and massages while listening to therapeutic harp music by Carolyn Worster. (Charlie Neuman/U-T)

A 61-year-old woman was suffering from symptoms suggesting ulcerative colitis, a painful inflammatory bowel disease. The wait had grown to six months in her small town for a colonoscopy that peeked at the lining of her intestine and took a sample of the tissue, a procedure Slater noted was not cheap and was not necessarily convenient.

So he and his team of integrative health specialists prescribed a diet high in fiber, fruits and vegetables and low in fats and sweets. A little more turmeric and a few dollops of probiotics good bacteria to boost the digestive system and within three months she was feeling better. By the time her colonoscopy rolled around, her condition was either in remission or cured.

To Slater, that highlights what the Centers for Integrative Health might do best researching many pathways to a cure but letting the body do most of the work by exploring everything from aromatherapy to zen.

cprine@sduniontribune.com

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Top UCSD researchers pitch yoga, massage and integrative ... - The San Diego Union-Tribune

Physicians practicing integrative medicine have improved quality of life and spend more time with their patients, according to a new survey.

The study, conducted by Pure Branding, a market research company, looked at why doctors leave conventional practices for integrative medicine, which pairs standard treatments with complementary therapies to care for a patients mind, body and spirit. The study included 1,133 integrative medical doctors and doctors of osteopathyfrom 49 states.

As more doctors report burnout, which has increased by 25% in just four years, a rapidly growing number of doctors are exploring integrative approaches to clinical care. The study identified five factors that define integrative medicine:

These ... doctors are at the forefront of a paradigm shift in medicine that will significantly impact the value chain from healthcare systems and payers to medical schools and suppliers, said Yadim Medore, founder and CEO of Pure Branding.

RELATED: Alternative medicine becomes a lucrative business for U.S. top hospitals

Some of the findings from the survey included:

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Integrative medicine physicians say quality of life is better - FierceHealthcare

A new nonprofit created by heavy hitters from Nevadas business and medical communities gave the state a D grade on its first report card on the states health care system.

The report card was released Wednesday by the Nevada Medical Center and is intended to focus attention on improving access to quality health care in the state.

Larry Matheis, the NMCs CEO, said the report card will help state leaders focus on the gaps that must be filled to improve Nevadas medical standing. Currently, he said, the states medical system resembles a series of isolated communities due to the lack of collaboration among medical professionals and the dearth of thought given to enhancing our communitys reputation.

The report cards grades, based on analysis of data supplied by the Centers for Disease Control and Prevention and other government agencies, show how Nevada fares in the categories of health care access, chronic disease, nutrition and activity, mental health and substance abuse. The grades werent all bad, with the state receiving a passing C grade on chronic disease and a better-than-average B on nutrition and activity.

The report is online at http:// nvmedicalcenter.org/nevada- healthcare-statistics/.

A guide and resource

Matheis, former executive director of the Nevada State Medical Association, said the report is intended to guide policymakers and recommend new approaches.

We are creating a Nevada Health Commission to use the report as a basis for recommending health policy priorities to the private and public sectors, said Matheis, We also are working with the UNLV School of Medicine to explore the potential for integrative medicine.

Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a persons health.

The report card, unveiled Wednesday evening at Delta Point, a community health center near downtown Las Vegas, is among the NMCs first major public initiatives. The organization was founded in 2013 by Eric Hilton, who died in 2016 after 49 years directing the Hilton hotel chain established by his father, Conrad Hilton.

Earlier this month, NMC partnered with the Las Vegas-Clark County Library District to organize play camps at two area libraries, aimed at demonstrating the impact of purposeful play on physical and mental health to young children, Matheis said. It also is developing a similar demonstration program with the Clark County School District to be rolled out at elementary schools in the fall, he said.

Though NMC boosts some high-profile talent board members include New York-New York CEO Cynthia Kiser Murphey and Dr. Florence Jameson, founder of the nonprofit Volunteers in Medicine of Southern Nevada the organization had largely stayed out of the public spotlight before the release of the report card.

The rankings, based on statistics from the 50 states and the District of Columbia, gave the state an F for access to health care through primary care doctors and insurance availability.

Only Mississippi had a worse rate of primary care providers, 53 per 100,000 people, compared with Nevadas 56. The nations capitol, with 116 providers per 100,000 people, fared best.

No quick fix for doctor shortage

Given that Nevadas explosive growth the population nearly doubled from 1.5 million in 1995 to nearly 3 million in 2016 is expected to continue, the NMC set a modest target for access improvement: only one more provider per 100,000 by 2020. Even the creation of the new UNLV School of Medicine its 60 graduates wont be entering residencies for graduate medical education for four years cant do much to help offset retirements by doctors in the near future.

The report cards chronic disease section tracks cases and deaths rates for cancer, diabetes, heart disease and stroke, respiration and kidney disease.

Nevada ranked 21st nationally in the age-adjusted death rate from all forms of cancer, with 157 deaths per 100,000 people per year. Kentucky, at 196 deaths, and Utah, at 125 deaths per year, represented the worst and best states, respectively. The NMC set an improvement target of 155 deaths per 100,000 people for Nevada by 2020. The national average is 159.

Although Nevada received an overall grade of C on issues pertaining to mental health, it received a D on the rate of suicides, with 18 per 100,000 people. Wyoming, at 28 suicides, had the nations highest rate, while the District of Columbias was the lowest at five. The national average is 13. NMC set an improvement target of 17 by 2020.

On substance abuse, Nevada earned an overall C, ranking 26th in the nation on excessive drinking, 21st in smoking, 14th in impaired driving accidents and 39 in fatal drug overdoses.

Nevada did its best on nutrition and activity, largely because of exercise opportunities and physically active adults. The NMC noted, however, that Nevada ranks at or below average in food insecurity (D) and food environment (C), meaning Nevada has room for improvement in making sure people have enough good and the right foods.

The NMCs report card is similar to rating systems used by other organizations to measure Nevadas health care delivery system, including recent reports that found the state lacking on hospital safety and the overall health of its senior citizens.

Contact Paul Harasim at pharasim@reviewjournal.com or 702 387-5273. Follow @paulharasim on Twitter.

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Nevada earns D on nonprofit's new health-care report card - Las Vegas Review-Journal

Are you ready for a fresh approach to your health?Whether you have a chronic medical condition, want to lose weight, have a specific concern, or are simply looking to optimize your general health, Dr. Carin Nielsen can work with you to create a health care plan that is personalized for your individual needs.

Working with an experienced, board-certified physician makes a difference.

Dr. Nielsens innovative approach to treating a variety of medical concerns begins as soon as you walk through the door. One of the hallmarks that sets Dr. Nielsen apart from other physicians is the amount of time she spends getting to know you and discussing your concerns. Your questions will be answered and you will leave with the comfort of knowing that you are receiving a higher level of medical care than you have experienced in the past. Physician services include:

We are Petoskey's Integrative Medicine Specialists, providing Integrative and Functional Medicine and Medical Weight Loss in Petoskey, Harbor Springs, Bay Harbor, Walloon Lake, and across Northern Michigan.

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Integrative Medicine | Carin Nielsen, MD Serving Northern ...

NORTHAMPTON, Mass., Aug. 15, 2017 /PRNewswire/ --The first-ever Integrative Physician Market Landscape study, conducted by Pure Branding, addresses a lack of market intelligence about the rapidly growing practice of integrative medicine among Medical Doctors (MD) and Doctors of Osteopathy (DO).

"I have never seen such a rigorous and insightful study of the integrative physician community," said Leonard A. Wisneski, MD, FACP, professor of medicine at Georgetown University, George Washington University and University of Colorado. "For anyone wishing to understand and engage with the field of integrative medicine, this research study and its insights will be invaluable."

A rapidly growing number of doctors are exploring integrative approaches to clinical care as a solution to perceived inabilities to offer better healthcare options to their patients through conventional medical practices.

The study provides a consensus on the definition of integrative medicine, with respondents identifying the top five factors as:

"Anyone distressed about the state of healthcare in America need look no further than this inspiring community of integrative physicians for hope," says Yadim Medore, founder and CEO of Pure Branding. "These cutting-edge doctors are at the forefront of a paradigm shift in medicine, that will significantly impact the value chain from healthcare systems and payers to medical schools and suppliers."

Key Findings:

This research study included 1,133 integrative MDs and DOs from 49 states, the largest pool of currently practicing integrative physicians ever surveyed for a landscape report. Lists were provided by association and media partners including Academy of Integrative Health & Medicine (AIHM), Academy of Integrative Pain Management (AIPM), American College for Advancement in Medicine (ACAM), American Academy of Medical Acupuncture (AAMA), Functional Forum and Today's Practitioner, and numerous commercial sponsors.

"The findings in this report are representative of the integrative medical community as a whole, with a confidence level of 95% and the margin of error at +/-2.9%," said Mr. Medore.

Informationabout the study can be found at: http://www.purebranding.com/integrative-physicians

About Pure BrandingPure Branding is a strategic consulting, market research and brand development agency for health and wellness companies. Since 1999, they have helped global clients build loyalty and grow market share through innovative research and actionable insights. For more information: http://www.purebranding.com

View original content with multimedia:http://www.prnewswire.com/news-releases/new-study-confirms-why-doctors-abandon-conventional-practices-for-integrative-medicine-300504287.html

SOURCE Pure Branding

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New Study Confirms Why Doctors Abandon Conventional Practices for Integrative Medicine - Markets Insider

The Maryland University of Integrative Health is establishing a school of naturopathic medicine and plans to admit the first students to the program next year.

The school of naturopathic medicine will be the first in the mid-Atlantic region and one of only a handful of schools nationwide that operate within a regionally accredited university, officials with the university of integrative health said.

Naturopathic medicine is an alternative practice based on the idea that the body can heal itself. Naturopathic doctors use a combination of traditional treatments with alternative therapies such as acupuncture and herbal medicines.

In establishing our School of Naturopathic Medicine, MUIH is taking a bold step to address some of the most challenging issues in healthcare, Steven Combs, the universitys president and CEO, said in a statement. We expect the graduates of this program to help fill the gap caused by the shortage of primary care physicians and to provide patients with cost-effective, compassionate care based on preventative and natural methods. Patients are demanding this approach and our nation needs these graduates.

The number of naturopathic practitioners has tripled in the last ten years as more states offer licenses. Nineteen states, including Maryland, and Washington D.C. license naturopathic care providers and several more are in the legislative process toward licensing.

amcdaniels@baltsun.com

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Maryland school of alternative medicine to offer new naturopathic program - Baltimore Sun

Sonoma Valley Hospital and Vintage House will continue the lively and informative series this fall themed Active Aging: Live Your Best Life Now. The lectures provide insight and information on how to get the most out of your senior years.

The talks are open to the community without charge and will be held in Stone Hall at Vintage House, from 1:30 to 3 p.m. on four consecutive Thursdays, Sept. 21 and 28, and Oct. 5 and 12. Light refreshments will be provided.

Topics and speakers include:

Sept. 21: Sitting On a Secret. Many experiencing colon or rectal health issues are often reluctant to bring it up with their physician. Sabrina Kidd, MD, will discuss common colon and rectal problems people face as they age and do so with candor, sensitivity and a touch of humor. Topics range from hemorrhoids and common constipation and diarrhea to incontinence and diverticular disease, along with more serious issues as colorectal cancer, the third most common cancer in both women and men today. Kidd is a dual-board certified colorectal and general surgeon with a practice located at the Sonoma Valley Specialty Clinic.

Sept. 28: Four Scientific Ways to Become Happier! Patricia Brooks will discuss some amazing new findings from recent neuroscience research about how to increase our happiness index, focusing on four simple rituals that neuroscientists claim will change our brain activity and boost our sense of well-being. Brooks is a licensed Clinical Social Worker and earned a Ph.D. in healing psychology and integrative medicine in 2003. She has worked in the health care field for over 40 years.

Oct. 5: Shaking Up Your Exercise Routine is the topic of the talk by Marek Grzybowski. We know its critical to exercise regularly as we age, but Grzybowski discusses why its also important to add variety to ones routine, and provides ideas on ways to accomplish this. Doing so not only boosts the benefits from exercise, but also makes it more fun, says Grzybowski, a physical therapist and Outpatient Rehabilitation Manager for Sonoma Valley Hospital.

Oct. 12: A Look Inside Our Emergency Department. In this special session, two emergency medicine physicians discuss what to expect when you visit the Emergency Room. Speakers are Robbie Cohen, Chief Medical Officer for Sonoma Valley Hospital who has many years experience in emergency medicine, and Cynthia Lawder, the Medical Director of the hospitals Emergency Department. They will discuss what typically happens when a patient visits the ED, including the protocols the medical team follows when presented with serious symptoms, such as for stroke or cardiac arrest. There will be time for audience questions.

Vintage House is located at 264 First St. E. RSVP to Vintage House at 996-0311, or info@vintagehouse.org.

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Series explores active aging - Sonoma Index-Tribune

Traditional Chinese medicine provides Dr. Sally Barchman an opportunity to create a unique pain management treatment plan for each veterinary patient.

Dr. Barchman performing acupuncture with her dog. | Photo courtesy of Troy Van Horn.

For Sally Barchman, DVM, CVA, owner of State Line Animal Hospital and Holistic Health in Leawood, Kansas, her interest in acupuncture and traditional Chinese medicine stems from honoring the memory of a late colleague and friend. Today, inside the spa-like atmosphere of her integrative medicine space, pets in pain find relief.

I was practicing in the main hospital and it wasnt as zen I imagined it could be. So now in the space we have a running fountain and use an essential oil diffuser, and the walls are in a softer-color paint. We have the tools that we need but try to keep it minimalistic, Dr. Barchman says. Soft music and comfortable rugs on the floor and exam table complete the space, which is in a leased building across the street from the main hospital.

Traditional Chinese medicine is composed of five components: acupuncture, food therapy, Chinese herbs, exercise and tui na, which is a type of massage. At Dr. Barchmans practice, instead of massage, a chiropractor not only performs chiropractic adjustments on the animals but also does deep tissue manipulation and myofascial release. Dr. Barchman is certified in veterinary acupuncture and is also working toward her certification in food and Chinese herbs.

When an animal presents with signs of pain, Dr. Barchman completes a traditional exam, but then also checks the pets tongue and pulse diagnosis to direct her treatment plan.

A view of Dr. Barchman's treatment space. | Photo courtesy of Troy Van Horn.

You look at the tongues color and whether it is dry or wet, and feel the strength and speed of their pulses, to see whats going on, she says. Dr. Barchman also discusses food and Chinese herbs with clients in addition to acupuncture.

There are yin and yang properties in every food, so if an animal presents with hot signs, you want to cool them down; with cool signs you want to warm them up. This can be done with things like changing up the protein in the pets dry food or home-cooking meals, she says.

When combined with food and herbs, acupuncture can be performed less frequently, Dr. Barchman says. Acupuncture is the more expensive part of it, so if we can use food and herbs to help balance out the body, the acupuncture treatments can be done less often, she says.

The plan is tailored to what each patient and client needs and is able to do. If a client says I just cant cook for my pet right now, well discuss other options, Dr. Barchman explains.

The essential oils that Dr. Barchman diffuses in her treatment space. | Photo courtesy of Troy Van Horn.

It depends on whats going with that animal on that day. It goes a little deeper than just giving an NSAID and moving on, Dr. Barchman says. Whatever the client wants to do is what well do and what works best for the animal. Well often try a combination of Eastern and Western medicine. I tell the client, A quick fix is medication, but it doesnt always fix the underlying cause. So sometimes if its a really painful condition well start with medication but then follow up with acupuncture and herbs to try and get them off the medication eventually or prevent the condition from occurring again.

The flexibility of combining alternative and traditional therapies allows Dr. Barchman to provide a complete solution for each patients she sees, she says. And even though these modalities typically require follow-up appointments over a period of time, she doesnt have problems with client compliance. Usually the people who are seeking out holistic care are really dedicated, so we dont have too much of a problem with people not coming back, she says. One thing that helps is that often, especially with painful conditions, results are seen after just one session, she says.

Thats not always the case, though, so Dr. Barchman came up with a package plan to encourage follow-through. If people buy four follow-up treatments, they receive half off of their consult price. In five treatments you should see whats going to happen, so I encourage the package. If they arent really believers I try to have more than just one treatment to have a chance to help the animal, Dr. Barchman says.

Our purpose is loving on people by loving on their pets through high-quality, integrative medicine, Dr. Barchman says. So well tailor the plan to whatever the client wants to do.

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A soothing experience: Custom pain management through alternative therapies - dvm360