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Biomedical subjects

Kathi J Kemper

Publications and source records attributed to Kathi J Kemper.

32 records · Page 2Linked to original sources
PubMed2004

Treating children with therapeutic and healing touch.

HT and TT are unique touch techniques with origins in the nursing profession. They are widely available in pediatric hospitals and often are used as adjunct therapies to decrease stress, anxiety, and pain. Practitioners, as well as patients, may notice improved sense of well-being during and after treatments. Additional research is needed to determine the mechanisms by which these effects occur, the optimal duration and frequency of treatments, factors predictive of treatment response, and the overall costs and benefits of including TT and HT in treatment in addition to traditional therapies. These therapies are safe and readily available.

Child↗
PubMed2003

Complementary and alternative therapies in childhood attention and hyperactivity problems.

To determine the prevalence and factors associated with complementary and alternative medicine (CAM) use for childhood attention and hyperactivity problems, we surveyed parents of children referred for evaluation of attention-deficit hyperactivity disorder (ADHD). Parents indicated whether they had used CAM therapies (e.g., acupuncture, nutritional supplements) in the past year and rated how important different reasons were in making their therapy decisions. Overall, 62 of 114 (54%) parents reported using CAM, most commonly expressive therapies, vitamins, and dietary manipulation, to treat their child's attention problems. Parents who used CAM rated a "natural therapy" and "having more control over treatments" significantly more important in their choice of therapy than parents who did not use CAM. Only 11% of parents discussed using CAM with their child's physician. Because parents often use CAM to treat their child's attention and hyperactivity problems without their pediatrician's knowledge, pediatricians need to initiate discussions of CAM use with patients and families.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Considering culture, complementary medicine, and spirituality in pediatrics.

Whether or not it is apparent, cultural and spiritual diversity exist in many clinical encounters, both with patients and with colleagues. These issues may cloud other concerns, contribute to inadequate or misleading communication, and affect lifestyle and therapeutic choices. Given the rapid rise in complementary therapies and the growing diversity in North America, the challenges of providing sensitive, compassionate, comprehensive care are compounded. Reflecting on the ways cultural backgrounds, religious beliefs and complementary medicine affect physicians, colleagues and patients may enrich, clarify, deepen, and improve the effectiveness of our clinical practice. The cases presented here offer an opportunity for role playing and reflection to support this process.

Adolescent↗
PubMed2002

Randomized trial of an internet curriculum on herbs and other dietary supplements for health care professionals.

PURPOSE: Herbs and dietary supplements are widely used, and there is an urgent need to educate health professionals about their risks and benefits. The Internet provides an innovative way of educating busy health professionals. This study assessed the impact of an Internet-based curriculum on health professionals' knowledge, confidence, and clinical practices related to herbs and dietary supplements. METHOD: The study was a randomized crossover trial involving physicians, pharmacists, advanced practice nurses, and dietitians. Participants were invited by e-mail and randomly assigned to immediate intervention versus waiting-list groups (n = 537). The curriculum lasted ten weeks and consisted of 20 case-based modules, each involving one multiple-choice or true-or-false question and its answer, links to reliable Internet sources of additional information, and a moderated listserv discussion group. Participants were surveyed about their knowledge, confidence, and communication related to herbs and dietary supplements on enrollment, after the immediate intervention group had completed the curriculum, and after the waiting-list group completed the curriculum. RESULTS: Baseline scores for knowledge, confidence, and communication were similar in the two groups. At the first follow-up, there was greater improvement in scores for all three areas in the immediate intervention group than in the waiting-list group (improvement for knowledge, 3.0 versus 1.4; confidence, 2.6 versus 0.6; communication, 0.21 versus -0.1, p <.01 for all comparisons). After all participants had received the curriculum, scores for both groups were significantly better than at baseline and similar to one another. CONCLUSION: Internet-based education about herbs and dietary supplements for diverse health professionals is feasible and results in significant and sustained improvements in knowledge, confidence, and communication practices.

Adult↗
PubMed2002

Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression.

OBJECTIVE: To describe the attitudes and approaches of primary care pediatricians in the identification and management of postpartum and other maternal depression. METHODS: A national survey of randomly selected primary care pediatricians reported their management of the last recalled case of postpartum or other maternal depression, barriers to care, their attitudes about recognition and management, confidence in skills, and their willingness to implement new strategies to improve care. RESULTS: Of 888 eligible primary care pediatricians, 508 (57%) completed surveys. Of these pediatricians, 57% felt responsible for recognizing maternal depression. In their last recalled case, respondents used an unstructured approach for identification based primarily on maternal appearance or complaints. When maternal depression was suspected, additional assessment of any kind was done by 48% of pediatricians. Although 7% perceived themselves to be responsible for treating maternal depression, pediatricians indicated they had an active role in 66% of cases in which they provided 1 or more brief interventions. The major barriers that were believed to limit their diagnosis or management were insufficient time for adequate history (70%) or education/counseling (73%) and insufficient training/knowledge to diagnose/counsel (64%) or treat (48%). Responses with cases involving maternal depression and the specific situation of postpartum depression were very similar. Forty-five percent were confident in their ability to diagnose maternal depression, whereas 32% were confident in their ability to diagnose postpartum depression. Nearly one fourth of pediatricians were willing to change their approach to identification. Pediatricians who felt responsible for recognizing maternal depression were more likely to assess more completely and intervene in cases as well as consider implementing change in their practice. CONCLUSION: Pediatricians' current attitudes and skills that are relevant to maternal depression limit their ability to play an effective role in recognition and management. Future interventions need to address each of these issues. Educational efforts and new clinical approaches may be more effective with those who feel responsible and willing to change their approach to maternal depression.

Adolescent↗
PubMedDate not supplied

Disparities in complementary and alternative medical therapy recommendations for children in two different socioeconomic communities.

OBJECTIVE: To compare the content, quality, and cost of recommendations for children made by complementary and alternative medicine (CAM) retailers within 2 New York City neighborhoods of divergent socioeconomic status (SES). METHODS: Posing as consumers, researchers sought recommendations from CAM retailers for 2 clinical scenarios: 1) a febrile 6-week-old and 2) a 4-year-old with an upper respiratory infection (URI). All retailers selling CAM therapies outside the direction of a licensed provider within East Harlem (EH) and the Upper East Side (UES) were eligible and mapped. The febrile infant scenario was posed at sites in business in March (n = 23) and the URI scenario at sites that remained in business in April (n = 20) of 2004. RESULTS: In response to the febrile infant scenario, 33% of UES retailers referred to a MD, 0% to the emergency department, and 47% made other recommendations-of which 43% were not indicated. In EH, 50% referred to a MD, 5% to the emergency department, and 37% made other recommendations. The mean price of UES recommendations was Dollars 9.66, whereas EH was Dollars 2.33 (P = .04). In response to the URI scenario, 93% of UES and 83% of EH retailers made recommendations. The mean price of UES recommendations was Dollars 10.55 while EH was Dollars 4.26 (P = .002). CONCLUSIONS: Complementary and alternative medicine retailers made numerous recommendations for children, including some that were contraindicated for age. East Harlem retailers tended to refer an infant with a potentially serious condition to the emergency department or to an MD and made less expensive recommendations than their UES counterparts.

Black or African American↗
PubMedDate not supplied

Use of complementary and alternative medicine in pediatric pain management service: a survey.

OBJECTIVE: To survey the use of complementary and alternative medical therapies by pediatric pain management services affiliated with major universities. DESIGN: A telephone survey was conducted of pediatric anesthesia training programs accredited by the Accreditation Council for Graduate Medical Education in the United States. The survey instrument included questions on the provision of complementary and alternative medical therapies in their pediatric pain programs. RESULTS: Forty-three pediatric anesthesia fellowship programs (100%) responded to the survey. Thirty-eight institutions (86%) offered one or more complementary and alternative medical therapies for their patients. Those therapies included biofeedback (65%), guided imagery (49%), relaxation therapy (33%), massage (35%), hypnosis (44%), acupuncture (33%), art therapy (21%), and meditation (21%). CONCLUSIONS: This report documents trends in complementary and alternative medical therapies usage in the tertiary pediatric pain management service. There is a high prevalence in the integration of complementary and alternative medical therapies in pediatric pain management programs. Additional clinical research in the safety and efficacy in complementary and alternative medical therapies for pediatric pain management is urgently needed.

Academic Medical Centers↗
PubMedDate not supplied

Pediatricians' recommendations for complementary and alternative medical (CAM) therapies.

OBJECTIVES: Increasing numbers of children use complementary and alternative medicine (CAM). The purpose of this project was to assess pediatricians' attitudes and recommendations regarding CAM. METHODS: This was a national survey sent to a random sample of active members of the American Academy of Pediatrics (AAP). The survey was 8 pages long and included questions on demographic and practice characteristics, attitudes about CAM, and 3 clinical vignettes asking what therapies physicians recommended in these situations. RESULTS: The 745 eligible respondents were demographically similar to the national AAP membership. Most (87%) had been asked about CAM by a patient/parent in the 3 months prior to the survey and 34% said they or an immediate family member had used CAM in the past year. Most (66%) believed that CAM therapies could enhance recovery or relieve symptoms, but even more were concerned about possible side effects (75%) or that CAM use might delay mainstream care (74%). Only 20% routinely asked patients/parents about their use of herbs, and fewer asked about other CAM therapies. Fewer than 5% felt very knowledgeable about individual CAM therapies. For the clinical vignettes, pediatricians were far more likely to recommend medications than any CAM therapy. Over 80% of pediatricians desired additional information on CAM; the highest priorities were information about herbs, dietary supplements, nutritional therapies, and therapeutic exercise. CONCLUSIONS: Pediatricians recognize that many patients are interested in using CAM therapies, but do not feel comfortable discussing or recommending CAM therapies. Pediatricians are very interested in learning more about CAM.

Adolescent↗
PubMedDate not supplied

Cranberry use among pediatric nephrology patients.

INTRODUCTION: Recurrent urinary tract infections are common in children, and the use of complementary therapies is common in other children with recurrent illnesses. However, little is known about the use of cranberry products by children with renal disease. We hypothesized that, because cranberry is often used to prevent urinary tract infections (UTI) in adult women, many parents would give it to their children, particularly to children prone to recurrent UTI (rUTI). METHODS: Anonymous, cross-sectional, self-administered survey of parents of children seen in the pediatric nephrology clinic at Brenner Children's Hospital between June 1, 2004, and August 13, 2004. RESULTS: Of the 117 parents surveyed, the patients' average age was 10.3 years, and 15% reported rUTI as a problem. Overall, 29% of surveyed parents gave cranberry products therapeutically; as expected, use was higher among those with rUTI (65%) than among those with other renal conditions (23%); odds ratio = 6.1 (2.0, 18.4, P < .001); many parents gave cranberry to treat as well as prevent diverse renal problems. Most felt it was beneficial and only 1 parent reported a side effect (nausea). Only 23% of those who used it had discussed cranberry use with their physician. CONCLUSION: Cranberry is commonly used therapeutically among patients seen in a pediatric nephrology clinic and is perceived as useful by parents, though uncommonly discussed with physicians. Randomized controlled trials are needed to determine the effectiveness of cranberry juice therapy for rUTI in children.

Beverages↗
PubMedDate not supplied

Pediatric faculty development in integrative medicine.

As more patients use complementary and alternative medical (CAM) therapies, faculty may be asked to teach trainees about topics requiring faculty development training. Our purpose in this study was to evaluate qualitatively and quantitatively a new faculty development program covering 4 key areas of CAM: herbs and dietary supplements, mind-body therapies, massage, and acupuncture. Faculty members (N = 6) volunteered for the program and were included in the study if they completed at least 3 of the 6 scheduled sessions. For each session, participants completed a pretest evaluating their knowledge and confidence about the topic, then they received background reading and focused discussion questions. Each session was a case-based, experiential seminar led by an expert in the content area. Participants completed post-session questionnaires measuring knowledge, confidence, and communication practices at the end of each session and at the end of the series of seminars. They also were asked for feedback and suggestions for the following year. All participants strongly agreed that they gained important knowledge; scores on tests about herbs increased from 62% at baseline to 84% at completion, and scores on knowledge of acupuncture increased from 60% before the session to 98% after. All participants strongly agreed that their confidence in talking with patients, colleagues, and trainees improved; on average, confidence scores improved an average of 1.8 out of a total of 5 possible points for all topics. Participants more frequently asked patients about their use of herbs (from 50% at baseline to 75% at the end) and increased the percentage of training encounters in which they discussed CAM with trainees or colleagues from 10% to 25%. We concluded that faculty development in integrative medicine is feasible and results in qualitative and quantitative improvements in knowledge, confidence, and clinical and teaching behaviors.

Adult↗
PubMedDate not supplied

Herbs and other dietary supplements: healthcare professionals' knowledge, attitudes, and practices.

CONTEXT: Herbs and other dietary supplements (H/DS) are frequently used by the public. They have significant health implications, yet little is known about health professionals' knowledge, attitudes, or clinical practices related to H/DS. DESIGN: Cross-sectional survey of clinicians prior to participation in an Internet-based educational program on herbs and dietary supplements. PARTICIPANTS: The 537 participants included 111 physicians (MD), 30 advanced practice nurses (RN), 46 pharmacists (PharmD), and 350 dietitians (RD). In addition to demographic information, participants were asked about their knowledge, attitudes, and practices related to H/DS. RESULTS: Most participants were involved in direct patient care (85%), in practice or on faculty (84%), and from outside our local institutions (76%); 66% reported receiving professional education about H/DS in the past year. There were statistically significant differences between professional groups, with RDs scoring better than others, but even their average scores were less than 60% of possible. The average score on knowledge questions was 10/20; the average confidence score was 4 out of 10 possible, and the average communication score was 1.4 out of 4 possible. Most respondents knew the most common clinical uses of echinacea and St. John's wort, and felt confident that they knew more than their colleagues about H/DS. Key deficits were in knowledge about adverse effects, confidence in reporting side effects, routinely communicating with patients about H/DS, and recording H/DS information in the medical record. CONCLUSIONS: Despite significant interest and previous training in H/DS, these clinicians had substantial room for improvement in knowledge, attitudes, and clinical practices about H/DS. Educational interventions and institutional policies are needed to improve the quality of patient care regarding H/DS, and such interventions should be rigorously evaluated to ensure that continuous improvements occur.

Adult↗