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Complementary and alternative therapy for nasal conditions.

Over two-thirds of patients have tried a complementary therapy before seeking conventional medical help. In view of this it is important that doctors keep abreast of developments in this area and of the range of therapies which are now being offered. The interaction between drugs and herbal remedies is one example where this is of particular importance. This review assesses the current evidence base for complementary therapies in nasal disease. Contemporary medicine can learn much from the patient-centred approach that is central to many complementary therapies. There is, as yet, little evidence to support the effect of complementary therapy over those of the placebo effect, cognitive dissonance and the natural resolution of many disease processes.

Cognitive Dissonance↗

Why I would want to use complementary and alternative therapy: a patient's perspective.

People are increasingly turning to complementary therapy as an adjunct to traditional care, but a large percentage do not share that information with their physician. People with rheumatic disease use alternative and complementary therapies for many reasons, and they use a wide variety of therapies. Chronic diseases are among the most difficult to treat with traditional Western medications that attack symptoms, while more alternative and complementary therapies offer relief through other means. Everyone involved--medical doctor, patient, and complementary practitioner--needs to know about the entire treatment regimen and handle it with the patient's overall, long-term health and quality of life in mind. Organizations such as the Arthritis Foundation and professional holistic groups can partner to increase knowledge and further enhance quality of life for people with rheumatic disease.

Arthritis, Rheumatoid↗

Religiosity is associated with the use of complementary medical therapies by pediatric oncology patients.

PURPOSE: To determine the prevalence of complementary and alternative medicine (CAM) use in pediatric oncology patients, the types of CAM used, and the factors associated with the use of CAM. PATIENTS AND METHODS: A questionnaire regarding CAM use was administered to patients/families seen in the pediatric oncology clinic at Wake Forest University Baptist Medical Center over a 12-month period. RESULTS: Based on 195 completed questionnaires, 91 (47%) patients reported use of CAM since diagnosis. Among CAM users, the most commonly used CAM therapies were faith healing, megavitamins/minerals, massage, other dietary supplements, relaxation techniques, and herbal medicines/teas. Forty-one percent of CAM users had not discussed CAM use with their physician(s). In bivariate analysis, CAM use was not associated with age at the time of survey, time since diagnosis, sex, race, parental education, or family income. A trend was noted between CAM use and older age at diagnosis. Families who reported themselves to be "very" religious were more likely to use CAM than those that are "somewhat" or "not at all" religious. CONCLUSIONS: Use of CAM is common among pediatric oncology patients and often is not discussed with the treating physician(s). Patients from very religious families are more likely to use CAM.

Child↗

Complementary medicine and the general practitioner: a survey of general practitioners in the Wellington area.

A questionnaire was sent to 226 general practitioners in the Wellington region to determine the relationship between the general practitioner and complementary medicine. A 77% response rate was achieved. Twenty-four % of doctors had received training and 54% wanted further training in a complementary therapy; 27% currently practised at least one therapy. The majority of doctors (94%) knew of complementary practitioners in their locality; 77% indicated they referred to other medical practitioners for complementary therapies and 80% to nonmedical practitioners. Acupuncture, hypnosis and chiropractic were the most popular therapies. The general practitioner's role was perceived as ranging from comprehensive provider of both conventional and complementary medicine to selective practitioner of some options. It is concluded that complementary medicine is of considerable interest to general practitioners; there is demand for more training and information to be made available for doctors and for better referral networks to be developed between the practitioners.

Acupuncture Therapy↗

Complementary alternative medical therapies for heart surgery patients: feasibility, safety, and impact.

BACKGROUND: Complementary therapies (touch, music) are used as successful adjuncts in treatment of pain in chronic conditions. Little is known about their effectiveness in care of heart surgery patients. Our objective is to evaluate feasibility, safety, and impact of a complementary alternative medical therapies package for heart surgery patients. METHODS: One hundred four patients undergoing open heart surgery were prospectively randomized to receive either complementary therapy (preoperative guided imagery training with gentle touch or light massage and postoperative music with gentle touch or light massage and guided imagery) or standard care. Heart rate, systolic and diastolic blood pressure, and pain and tension were measured preoperatively and as pre-tests and post-tests during the postoperative period. Complications were abstracted from the hospital record. RESULTS: Virtually all patients in the complementary therapy group (95%) and 86% in standard care completed the study. Heart rate and blood pressure patterns were similar. Decreases in heart rate and systolic blood pressure in the complementary therapies group were judged within the range of normal values. Complication rates were very low and occurred with similar frequency in both groups. Pretreatment and posttreatment pain and tension scores decreased significantly in the complementary alternative medical therapies group on postoperative days 1 (p < 0.01) and 2 (p < 0.038). CONCLUSIONS: The complementary medical therapies protocol was implemented with ease in a busy critical care setting and was acceptable to the vast majority of patients studied. Complementary medical therapy was not associated with safety concerns and appeared to reduce pain and tension during early recovery from open heart surgery.

Adult↗

Evaluating complementary and alternative therapies for cancer patients.

"Complementary and alternative" therapies are actually a vast collection of disparate, unrelated regimens and products, ranging from adjunctive modalities that effectively enhance quality of life and promising antitumor herbal remedies now under investigation, to bogus therapies that claim to cure cancer and that harm not only directly, but also indirectly by encouraging patients to avoid or postpone effective cancer care. Complementary therapies such as music and massage, herbal teas to aid digestion and relieve nausea, yoga, tai chi, meditation, and the many other well-documented techniques that relieve stress and enhance well-being should be made available to patients to augment and ease the experience of cancer treatment and recovery. Many time-tested herbal and diet-based remedies are now being studied for their abilities to induce or extend remission without toxicity. At the same time, lack of government regulatory authority leaves consumers at the mercy of those who promote unproved remedies, scores of which the grocery store and pharmacy shelves. Many of these over-the-counter products contain harmful ingredients. Herb-drug interactions, only some of which are documented, occur with frequency and are sufficiently problematic to require that patients stop taking herbal remedies prior to surgery (to prevent interactions with anesthetics and anticoagulant effects); before radiation (due to potential for increased photosensitivity); and during courses of chemotherapy (to prevent product-drug interactions). Moreover, both good information and misinformation that appear in printed materials and on the Internet appeal to better educated consumers, who are, in fact, the most likely to try complementary and alternative methods.

Complementary Therapies↗

Why do patients seek treatment in hospitals of complementary medicine?

OBJECTIVE: This exploratory study evaluated patients' reasons for entering a complementary (alternative) medicine hospital by ranking 15 medical and psychosocial factors that were thought to influence this choice. SUBJECTS AND OUTCOME MEASURES: Two hundred patients (200) from two complementary hospitals, one focusing on Traditional Chinese Medicine and one on the Western type of complementary medicine, completed an extensive questionnaire at the beginning of their inpatient treatment. The questionnaire covered personal background; disease parameters; attitude towards conventional medicine; previous experience with, and knowledge of, complementary therapies; expectations concerning the forthcoming treatment; health-related habits; personality traits; and social support. RESULTS: Optimistic attitudes towards treatment and a positive appraisal of alternative doctors were frequently stated reasons (80%), as was the disease severity (long duration: 86%; acute progression or imminent surgery: 70%). Previous successes with complementary therapies, however, ranked relatively low (53%). Negative opinions concerning conventional therapies and conventional doctors' treatments were mentioned by 68% of the patients. Many patients felt themselves to be under considerable psychologic stress (74%). A majority (73%) was well informed about complementary therapies, and 65% were curious about the forthcoming therapies. Sixty-eight percent (68%) indicated good health behaviors. Fewer patients mentioned contemplative and/or religious attitudes (44%) or lack of social support (25%). Age primarily accounted for variations in the ranking weights of the two subgroups. The specific type of complementary medicine was of minor influence. In 14 out of 21 personality dimensions, the current patient group showed significant deviations from the healthy reference, which is in good agreement with findings from conventionally treated patients.

Adolescent↗

The use of complementary and alternative therapies.

The National Center for Complementary and Alternative Medicine (NCCAM) was created by Congress in 1998 as part of the National Institutes of Health. As interest in alternative and complementary therapies among healthcare providers and consumers has increased in recent years, the NCCAM has provided research funding to determine the efficacy of various types of unconventional treatments. The Center also provides research training and acts as a clearing-house for information dissemination to practitioners and the general public. Inclusion and exclusion criteria for alternative and complementary medicine as defined by the NCCAM are provided. Interest in these non-traditional treatments will likely continue to increase over the next few years. The NCCAM is playing a vital role as it provides avenues to determine how these therapies can lead to enhanced quality of life for individuals as we enter the new millennium.

Complementary Therapies↗

Alternative and Complementary Cancer Treatments.

Alternative and complementary therapies differ importantly, and the distinction between the two is crucial for clinical oncologists. "Alternative" or unproven therapies are treatments used independent of surgery, radiation and chemotherapy. They can be dangerous directly and also by delaying patients' receipt of mainstream care. In contrast, complementary therapies typically are adjuncts to mainstream medicine. They can provide symptom control and noninvasive palliation with minimal side effects, improve patients' well-being and enhance cancer medicine. Complementary therapies represent a desired addition and balance to technologically sophisticated cancer care.

Journal Article↗

The use of guided imagery to manage pain in an elderly orthopaedic population.

BACKGROUND: The management of postoperative pain in elderly orthopaedic patients is critical for advancing patient outcomes and improving the use of healthcare resources. Adequate pain control without adverse side effects, such as confusion and sedation, is crucial to promote comfort and participation in rehabilitation therapies among all patients but particularly among elderly joint replacement patients. Without adequate pain control, physical therapy is delayed and the risk of complications increases. One area of investigation that holds promise for improved treatment outcomes involves the use of complementary therapies, such as guided imagery. PURPOSE: The purpose of this pilot study was to test the effects of a guided imagery intervention in the older adult patient who has undergone joint replacement surgery. SAMPLE AND METHODS: This pilot study used a two-group experimental repeated measures design. A sample of 13 patients, age 55 years and older, were recruited. The control group received usual care and a music audio tape. The experimental group received usual care and a guided imagery audio tape intervention. FINDINGS AND DISCUSSION: Trends in this pilot study demonstrated positive outcomes for pain relief, decreased anxiety, and decreased length of stay. Complementary therapy holds the promise of increasing positive outcomes. Further research is needed to validate these findings with a larger postoperative sample and in other populations as well. CLINICAL IMPLICATIONS: There is a critical need to incorporate the use of guided imagery and other complementary therapies into all nursing curricula. Nurses must develop expertise and be ready and able to act as patient educators and advocates in the use of these interventions in programs of care and institutional policy.

Aged↗

Perimenopausal and postmenopausal hormone replacement therapy. Part 2. Hormonal regimens and complementary and alternative therapies.

As midwives increasingly provide care to women throughout the lifecycle, they need to become familiar with a variety of treatments for perimenopausal and postmenopausal problems and preventive measures for the potentially disabling conditions that can accompany aging. This article reviews various regimens of hormone replacement therapy. It discusses types of estrogen and progestin, appropriate dosages, routes of administration, and duration of therapy. It offers guidelines for initiation, contraindications, and required follow-up. It addresses the management of side effects and problems. The article briefly reviews a variety of complementary and alternative therapies including various self-help measures, such as nutrition and exercise, and selected herbal treatments. Part 1 of this article, which appeared in the January/February 1996 issue of JNM, reviewed the literature on recommended therapeutic and preventive indications for hormone replacement therapy, providing guidelines for the provision of informed consent.

Complementary Therapies↗

Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review.

BACKGROUND/AIMS: Hepatitis C is an escalating global health problem. The recommended treatment regimen is associated with considerable expense, adverse effects and poor efficacy in some patients. Complementary therapies are widely promoted for and used by patients with hepatitis C. The aim is to systematically assess the efficacy of complementary therapies in treating chronic hepatitis C. METHODS: Systematic searches were conducted in six databases, reference lists of all papers were checked for further relevant publications and information was requested from experts. No language restrictions were imposed. RESULTS: Twenty-seven eligible randomised clinical trials were located involving herbal products and supplements. No randomised clinical trials were identified for any other complementary therapy. In 14 of the trials, patients received interferon-alpha in combination with the complementary therapy. Less than half the trials (11/27) were of good methodological quality. Compared with the control group, significant improvements in virological and/or biochemical response were seen in trials of vitamin E, thymic extract, zinc, traditional Chinese medicine, Glycyrrhiza glabra and oxymatrine. CONCLUSIONS: We identified several promising complementary therapies, although extrapolation of the results is difficult due to methodological limitations. More research is warranted to establish the role of these and other therapies in the treatment of hepatitis C.

Animals↗

Complementary, alternative, integrative: have nurses kept pace with their clients?

While medical literature reflects an interest in the use of complementary therapies, there is a paucity of studies in the nursing literature addressing the use of therapies by nurses, either on themselves or on their clients. While the utilization rate of complementary therapies by the general population has been estimated to be as high as 45%, and nurses are interacting with clients who use these therapies on a daily basis, little is known about nurses' attitudes, knowledge, or perceived efficacy of the therapies.

Complementary Therapies↗

The Cavendish Centre for integrated cancer care: assessment of patients' needs and responses.

The use of complementary therapies in combination with conventional medicine is increasing. In cancer care, as at the Cavendish Centre for Cancer Care in Sheffield, the range of therapies offered can include aromatherapy, massage, reflexology, shiatsu, acupuncture, homeopathy, counselling, visualization, hypnotherapy, relaxation, healing and art therapy. Before offering any therapy careful assessment of patients' needs is important as patients seeking complementary therapies may present with unrealistic hopes and expectations of benefit. There are wide variations in provision of services offering complementary cancer care throughout the United Kingdom but few offer a comprehensive assessment which is used as a baseline for both planning treatment and evaluating its outcome and which is conducted by a trained and objective practitioner who has no investment in any specific therapy. We describe the model of care developed at the Cavendish Centre with particular emphasis on the assessment process. Our model of assessment provides an opportunity for patients to tell their story, make sense of the illness experience, construct meaning from it and set realistic expectations for the chosen intervention. It also offers patients involvement and choice in decisions about their care. In addition we present evaluative data from a case series of 157 patients, 138 of whom (88%) reported improvement in their main concern on MYMOP (Measure Your Medical Outcome Profile).

Adult↗

Complementary, alternative, integrative: have nurses kept pace with their clients?

While medical literature reflects an interest in the use of complementary therapies, there is a paucity of studies in the nursing literature addressing the use of therapies by nurses, either on themselves or on their clients. While the utilization rate of complementary therapies by the general population has been estimated to be as high as 45%, and nurses are interacting with clients who use these therapies on a daily basis, little is known about nurses' attitudes, knowledge, or perceived efficacy of the therapies.

Adult↗