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Biomedical subjects

A Bensoussan

Publications and source records attributed to A Bensoussan.

At least 19 recordsLinked to original sources
PubMed2005

Are national quality standards for traditional Chinese herbal medicine sufficient? Current governmental regulations for traditional Chinese herbal medicine in certain Western countries and China as the Eastern origin country.

Traditional Chinese herbal Medicine (TCHM) has been gaining interest and acceptance world wide. TCHM provides on the one side promising perspective of scientific interest and on the other side possible health risks if TCHM drugs are not controlled with respect to quality standards or if practitioners for TCHM are not well trained. This paper outlines an introduction to the scientific aspects and potential risks of TCHM therapy followed by a brief, exploratory overview of the current status of TCHM regulations in certain Western countries like the USA, United Kingdom, Germany, Australia and in China as the Eastern origin country of TCHM. Legal foundations to establish quality and safety standards for TCHM crude drugs and ready-made formulas exist in some countries on a local basis but in practice are poorly enforced, where this products have no drug status. In addition practitioners treating patients with TCHM should be well versed in the pharmacology, side effects, and interactions of these substances with Western medicines and should be certified on a regular basis.

Consumer Product Safety↗
PubMed2004

Naturopathic and Western herbal medicine practice in Australia-a workforce survey.

BACKGROUND: Despite substantial growth in the use of complementary medicine, no comprehensive national study has been undertaken of the naturopathic and Western herbal medicine component of the healthcare workforce in Australia. This study aimed to examine the nature of these practices and this currently unregulated workforce in Australia. METHODS: A comprehensive survey questionnaire was developed in consultation with the profession and distributed nationally to all members of the naturopathic and Western herbal medicine workforce. RESULTS: The practices of herbal medicine and naturopathy make up a sizeable component of the Australian healthcare sector, with approximately 1.9 million consultations annually and an estimated turnover of $AUD 85 million in consultations (excluding the cost of medicines). A large proportion of patients are referred to practitioners by word of mouth. Up to one third of practitioners work in multidisciplinary clinics with other registered sectors of the healthcare community. The number of adverse events associated with herbal medicines, nutritional substances and homoeopathic medicines recorded in Australia is substantial and the types of events reported are not trivial. Data suggest that practitioners will experience one adverse event every 11 months of full-time practice, with 2.3 adverse events for every 1000 consultations (excluding mild gastrointestinal effects). CONCLUSION: These data confirm the considerable degree of utilisation of naturopathic and Western herbal medicine practitioners by the Australian public. However, there is a need to examine whether statutory regulation of practitioners of naturopathy and Western herbal medicine is required to better protect the public.

Attitude of Health Personnel↗
PubMed2002

Regulation of complementary medicine practitioners in Australia: Chinese medicine as a case example.

Complementary and alternative medicine (CAM) forms a significant part of the health economy. CAM practices are under increased scrutiny from consumers, clinicians, scientists and regulators. Australian authorities have explored a range of regulatory approaches. This paper outlines initiatives to regulate the practice of CAM in Australia and examines relevant issues with a particular focus on the registration of Chinese medicine practitioners in the State of Victoria.

Attitude of Health Personnel↗
PubMed2001

Application of the general health status questionnaire SF36 to patients with gastrointestinal dysfunction: initial validation and validation as a measure of change.

OBJECTIVE: To determine whether the Short Form (SF36) Health Status Survey is a valid measure of health status and health change for patients with irritable bowel syndrome (IBS). METHODS: The SF36 was self-administered by 116 patients with IBS at the commencement and end of a controlled clinical trial. Patients were recruited through two Sydney teaching hospitals and through private gastroenterologists during 1997 and treated with Chinese herbal medicine. RESULTS: The SF36 health concepts demonstrated internal consistency, construct validity and concurrent validity when applied to patients with significant bowel dysfunction. Patient scores on two health scales of the SF36 (bodily pain, general health) correlated significantly with the bowel symptom scores recorded by patients and gastroenterologists at the beginning and end of the trial period. Actively treated patients significantly improved their scores in four out of eight of the health scales of the SF36 and reported overall improvement compared with inactively treated patients. CONCLUSIONS: The SF36 is a valid measure of general health status in IBS patients, is sensitive to the presence of IBS, and is adequately sensitive to gastrointestinal change in IBS patients. IMPLICATIONS: While the SF36 general health measure is used by the Australian Bureau of Statistics and widely overseas, until recently no data have been available on the sensitivity of the SF36 to gastrointestinal dysfunction or numerous other disorders. The SF36 is not only sensitive to the presence of IBS, it also provides a useful adjunct to current methods of evaluating treatment outcomes for IBS, and potentially other disorders.

Adolescent↗
PubMed2001

Establishing evidence for Chinese medicine: a case example of irritable bowel syndrome.

Traditional Chinese medicine (TCM) is now used by a broad cross-section of the western community. It offers some attraction because it provides new options for treatment, an individualized approach, and potentially avoidance of harsh drugs or surgery. However, despite this growing popularity there is debate as to its evidence base. Few TCM trials have been performed in the West, and previous Chinese TCM trials have been perceived to lack methodological rigour. Establishing and applying stronger clinical trial methodologies in TCM is imperative for its integration with modern medicine and achieving the end goal of creating options for patient care. A clinical trial was designed using a variety of approaches to promote methodological rigour whilst allowing the flexibility required in TCM practice. Irritable bowel syndrome (IBS) was selected as the disease focus, creating the possibility of tailoring TCM treatments to the variable clinical presentations of IBS. Patients were randomised to receive individually tailored treatment (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35) for 16 weeks. Patients, gastroenterologists and herbalists were all blinded as to treatment group. Both standard and individualized treatments were significantly more effective than the placebo treatment on all key outcome measures. However, this study failed to confirm the added value of tailoring treatments. Chinese herbal formulations individually tailored to the patient proved no more effective than the standard treatment on all measures. Nevertheless, the trial demonstrates it is possible to test individualization of treatment whilst adhering to conventional trial protocols. Clinical trials can be designed that accommodate nuances of TCM practice. This study also shows Chinese herbal medicine may offer assistance to some patients with IBS and may prove as effective as current pharmaceutical approaches. Further validation of TCM interventions is required.

Clinical Trials as Topic↗
PubMed2000

Complementary medicine. Searching for the evidence.

BACKGROUND: Complementary and alternative medicines form significant parts of the health economy and are therefore increasingly scrutinised by consumers, clinicians and scientists, all of whom have an interest in understanding what works and what is safe. OBJECTIVE: To examine issues relevant to the evidence based assessment of complementary and alternative medicines. DISCUSSION: There are a large number of systematic reviews on complementary and alternative practices and many hundreds more randomised, controlled trials which form a growing body of original research. However, given the extensive nature of the discipline, and the difficulty in performing rigorous trials, appropriate clinical trial evidence is still required for many of these interventions. On the other hand, consumers are using these medicines and seem unlikely to rely on positive clinical trials to be convinced of the potential effectiveness and relative safety of a medicine with a long tradition.

Acupuncture Therapy↗
PubMed1999

The otolaryngologic manifestations of gastroesophageal reflux: when is a pH study indicated?

PURPOSE: The aim of this study was to evaluate the pertinence of pH studies for persistent ear, nose, and throat (ENT) symptoms and their eventual relationship to gastroesophageal reflux (GER). METHODS: Retrospective analysis was performed of age, reason for referral, pH study, treatment, and follow-up of patients with ENT symptoms suspected to have GER. RESULTS: Of 3,000 esophageal pH studies performed over 16 years, 105 children were referred for ENT symptoms by an otorhinolaryngologist to rule out GER. Mean age was 33 months; 65% were boys. Reasons for referral included (number and mean age): stridor (n = 31, 8 months), laryngomalacia (n = 18, 13 months), recurrent otitis (n = 12, 42 months), laryngitis (n = 16, 50 months), dysphonia (n = 14, 59 months), laryngeal papillomatosis (n = 8, 62 months), sinusitis (n = 5, 56 months), and dysphagia (n = 1). Overall, 41% of study results were positive: stridor (58%), laryngomalacia (61%), laryngitis (56%) and sinusitis (40%). Patients with otitis, dysphonia and laryngeal papillomatosis had GER in 1%, 14%, and 25%, respectively. Follow-up in the three larger groups of patients showed resolution of the ENT symptoms after medical treatment of the reflux in 83% of patients with stridor and reflux, 86% with laryngitis and reflux, and 80% with laryngomalacia and reflux. Four fundoplications were performed: one neurologically impaired patient, and four nonresponders. CONCLUSIONS: The authors recommend that a pH study be performed in children with stridor, laryngomalacia, laryngitis, and sinusitis when faced with failure of the usual treatment. However, a pH study does not seem as beneficial for recurrent otitis, dysphonia, or laryngeal papillomatosis.

Child↗
PubMed1999

[Evaluation of a two-stage surgical strategy for the treatment of skin carcinomas. Retrospective study of 367 cases].

The treatment of skin carcinomas in France is mainly based on surgical resection. However, when the cutaneous surgical defect cannot be sutured, repair by skin graft or skin flap can be either immediate or delayed. The aim of the present study is to evaluate the value of delayed repair. A six-month retrospective study was designed between November 1997 and April 1998, on a total of 367 resections of skin carcinomas and/or premalignant lesions. Two parameters were recorded: management of the skin defect, and the histological results. Out of the 367 resections, there were 275 resections with suture, 42 resections with skin graft, 11 resections with skin flap, and 39 resections without wound closure. In 41 cases further re-excisions were performed because the tumors were incompletely excised. Incompletely excised tumors were found in 6% of sutures, 9% of skin flaps, 24% of skin grafts, and 36% of delayed repairs. The high rate of incomplete surgical resections supports two-step surgery without wound closure when the defect cannot be sutured. This attitude is reinforced by the difficulty of the re-excision when a skin graft or a skin flap has been previously performed.

Basal Cell Carcinoma↗
PubMed1998

Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial.

CONTEXT: Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment. OBJECTIVE: To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997. SETTING: Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group. MAIN OUTCOME MEASURES: Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients. RESULTS: Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.

Adolescent↗
PubMed1998

Preliminary report of a randomized, double-blind placebo-controlled trial of a Chinese herbal medicine preparation CH-100 in the treatment of chronic hepatitis C.

The treatment of chronic hepatitis C is relatively unsatisfactory and many patients have turned to unproven alternative medicines to modify the course of their illness. We report a study of a Chinese herbal medicine preparation CH-100 in the management of chronic hepatitis C. Patients with documented chronic hepatitis C were randomly allocated to receive active herbal or placebo tablets (five tablets thrice daily). Patients were followed monthly and evaluated by a Western and a traditional Chinese medical practitioner. Therapy was monitored by measurement of liver function tests, creatinine and full blood count on a monthly basis. Twenty patients in each group were well matched for age, sex, duration of illness, previous interferon therapy and alcohol intake. Active Chinese herbal medication was associated with a significant reduction in alanine aminotransferase (ALT) levels over the 6 month study period (P < 0.03). No patient cleared the virus but four normalized their ALT on treatment. Appropriately prescribed Chinese herbal medicine may have a role in the management of chronic hepatitis C and further controlled studies are indicated.

Adolescent↗
PubMed1993

Prolonged pH monitoring is of limited usefulness for gastroesophageal reflux.

OBJECTIVE: To assess the diagnostic value of pH monitoring. DESIGN: A prospective study. SETTING: Pediatric university hospital serving as a secondary and tertiary referral center. PARTICIPANTS: Thirty-eight infants, aged 1 to 12 months, and 26 children, aged 13 months to 18 years, admitted during a 2-year period because of clinically significant gastroesophageal reflux (GER). INTERVENTIONS: Prolonged (20-hour) pH monitoring as well as endoscopy and biopsy of the esophagus were carried out in all patients who, on the basis of clinical data, were classified as having mild, moderate, or severe GER disease. RESULTS: In the infant group, results of prolonged pH monitoring were abnormal in 34 (89.5%). In the older group, results were abnormal in less than half (11 [42.3%]) of the cases. In both groups, pH monitoring data did not correlate with the severity of GER disease or of esophagitis. Severity of GER disease was not predictive of esophagitis. CONCLUSIONS: (1) Endoscopy and biopsy of the esophagus should be the first procedures whenever there are clinical findings of moderate to severe GER disease. (2) Monitoring of pH should be restricted to those patients without a clear-cut history of GER disease.

Adolescent↗
PubMed1986

[Treatment of acute perforated appendicitis with intraperitoneal cefazolin].

Until recently intra-abdominal sepsis following surgery for perforated appendicitis has remained a frequent occurrence. In 1975 Fowler reported an incidence of one intra-abdominal abscess in 36 perforated appendicitis treated with a protocol consisting of saline irrigation at surgery, followed by intraperitoneal administration of cephaloridine q. 6 hours for 48 hours. The same antibiotic was then given i.v. for 72 hours. He concluded that this method was an effective way to minimize post-op intra-abdominal abscess, and that the intraperitoneal route was more effective, for this purpose, than systemic administration. More recently, with better knowledge of the role of anaerobes, improved results have also been obtained by adding clindamycin or metronidazole to the antibiotic regimen. A prospective study based on two groups of patients randomly assigned to two protocols was undertaken. The study group consisted of 45 children operated for perforated appendicitis with abscess or generalized peritonitis. These patients were treated with Fowler's protocol. Because it is less nephrotoxic and is active against the same organisms, cefazolin was used instead of cephaloridine. The control group consisted of 43 patients, also operated for perforated appendicitis, treated with saline irrigation at surgery, with either i.v. gentamycin or tobramycin and clindamycin or metronidazole for an average of 7.8 +/- 3.1 days. Both groups were fairly well matched in terms of age, sex, severity of disease, and bacterial flora. They showed an identical 6% post-op intra-abdominal sepsis rate. Days before afebrile, days under gastric suction, complications and average hospital stay were comparable in both groups. The wound infection rate was 20% in the study group and 9% in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1985

[Crohn's disease in children and adolescents].

93 children and adolescents with Crohn's disease have been studied. Terminal ileum (25.8%) and ileum and colon (61.3%) were the most common sites of involvement as determined by X-ray examination. The mean age at the time of diagnosis was 13.2 years. A familial incidence of chronic inflammatory bowel disease was found in 12 patients (12.9%). The most common symptoms were: abdominal pain, anorexia, lassitude, diarrhea, loss of weight. Weight below the third percentile, pain on abdominal palpation, anal lesions, mouth ulcers and clubbing of the fingers were the most common clinical signs at the time of diagnosis. Growth retardation (below the third percentile) was present in 22 of 79 children (27.8%) with a mean follow-up of 40 months. 16 patients out of 75 had initial rectal biopsies with histologic changes characteristic of Crohn's disease. 27 patients had surgical treatment; six of them experienced a relapse within a mean period of 26.7 months. Lastly, the authors show that continuous elemental enteral alimentation (CEEA) during 3 weeks induces a remission. CEEA on a longer period is specially targetted to the treatment of growth retardation.

Adolescent↗