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PubMed2005

Complementary therapies in pregnancy: midwives' and obstetricians' appreciation of risk.

Complementary medicine is increasingly being integrated into maternity care, primarily by midwives in response to mothers' demands. Midwives and obstetricians must, however, develop a comprehensive evidence-based knowledge of risks, as well as benefits, to ensure that any complementary therapies in pregnancy and childbirth are not only effective but also safe. This paper discusses the results of an evaluative audit of midwives' and obstetricians' knowledge of and attitudes to complementary therapies in pregnancy in an NHS antenatal clinic which revealed a generalised lack of knowledge and poor understanding of the possible risks to women.

Attitude of Health Personnel↗

PubMed2003

Developing clinical supervision for complementary therapy educators.

To facilitate reflective practice with students of complementary therapy clinical tutors themselves require an understanding and experience of reflective practice. The aim of this study was to implement and evaluate a clinical supervision framework for clinical tutors teaching on the complementary therapy undergraduate program. Clinical supervision was conducted in small groups with a skilled clinical supervisor, and focused on issues arising in the teaching clinic. The evaluation consisted of questionnaires, interviews and focus groups with participants (clinical tutors and clinical supervision facilitators). There is strong evidence that clinical supervision groups offered a supportive learning framework for the clinical tutors, and that this was likely to impact on work with students and patients in a positive way.

Adult↗

PubMed1998

Complementary therapies: making a difference in palliative care.

Palliative care is concerned with people who have a life-threatening illness and has been at the forefront of incorporating complementary therapies into orthodox care. The reasons why such people are likely to seek out complementary therapies and recent research that links the two movements are discussed. The main focus is on the innovative programme of complementary therapies offered to both patients and carers by North Devon Hospice. Thirty-eight patients and carers discussed the provision of complementary therapies in focus groups. The therapies were seen as being an integral part of the Hospice's provision and valuable as a means of introducing people to other services offered by the Hospice. Both potential benefits and possible problems are also discussed. Suggestions are made for expanding the provision of the therapies and to improve access to them.

Adult↗

PubMed2000

Lay constructions of HIV and complementary therapy use.

This study examines the meanings that individuals with HIV attach to their use of complementary therapies. A qualitative analysis of 66 interviews completed between 1993 and 1998 showed that complementary therapies represent different things for these individuals--a health maintenance strategy, a healing strategy, an alternative to Western medicine, a way of mitigating the side-effects of drug therapies, a strategy for maximizing quality of life, a coping strategy, and a form of political resistance. We found that the meanings individuals ascribe to complementary therapies and the benefits they expect to derive from them are not idiosyncratic, but linked to social characteristics--sexuality, ethnocultural background, gender--and to beliefs about health and illness, values and experiences. We found as well that these meanings are neither mutually exclusive nor fixed. The therapies often appeal to individuals on different levels and their appeal may change over time.

Adaptation, Psychological↗

PubMed2006

Alternative and complementary therapies.

The field of complementary and alternative medicine (CAM) is broad and diverse, comprising numerous therapeutic modalities. CAM therapies are viewed as either an adjunct or a complement to conventional treatment. As of 1997, 64% of United States medical schools included elective or required CAM courses. The number of CAM practitioners in the United States is projected to increase by 88% between 1994 and 2010, and the number of conventional physicians who incorporate CAM into their practices will increase by 16%. Patients and their parents can make various health care choices; doctors need to understand and respect these options, and to support them, if safe and effective.

Acupuncture Therapy↗

PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with homeopathy. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of homeopathy; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: Eighteen out of 22 potentially relevant reviews preselected in the screening process met the inclusion criteria. Six reviews addressed the question whether homeopathy is effective across conditions and interventions. The majority of available trials seem to report positive results but the evidence is not convincing. For isopathic nosodes for allergic conditions, oscillococcinum for influenza-like syndromes and galphimia for pollinosis the evidence is promising while in other areas reviewed the results are equivocal. INTERPRETATION: Reviews on homeopathy often address general questions. While the evidence is promising for some topics the findings of the available reviews are unlikely to end the controversy on this therapy.

Asthma↗

PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: From a total of 48 potentially relevant reviews preselected in a screening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. CONCLUSIONS: A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials.

Acupuncture↗

PubMed2005

Using qualitative evaluation in a feasibility study to improve and refine a complementary therapy intervention prior to subsequent research.

Feasibility studies of complementary therapies are useful and important not only to test and evaluate the potential effectiveness of an intervention but also to refine and improve it prior to a subsequent study. A series of guided interviews were conducted with patients (n=19) undergoing stem cell/autologous bone marrow transplant (SC/ABMT) who were participating in a feasibility study of a mindfulness meditation (MM) intervention. Audiotapes of these interview sessions were transcribed and then used to create a project in the QRS NVivo software program to manage the data from the interview questions. Responses about what the participants liked and disliked and their suggestions for improving the effectiveness of the MM intervention were identified and grouped. Subsequently, the MM intervention has been refined based on this information, and additional testing in a randomized, controlled trial is planned. The cost is high to implement complementary therapies and to rigorously test them. Preliminary work using qualitative evaluation methods can provide rich and detailed information that will save time and money in the long run.

Bone Marrow Transplantation↗

PubMed2006

Complementary therapies for back pain: is the evidence getting stronger?

Back pain is the most common reason for using complementary therapies. This analysis of the trial evidence is aimed at determining whether the evidence base for or against complementary therapies for back pain is getting stronger. Two series of systematic reviews conducted with the same methodology 5 years apart were compared. The results suggest that the weight of the evidence has increased between 2000 and 2005 for a number of interventions. The direction of the evidence, however, remained unchanged for all but one therapy. We conclude that the value of complementary therapies in the management of back pain remains encouraging but not fully convincing.

Back Pain↗

PubMed2000

Adolescent use of alternative and complementary therapies. A framework for research.

Increasing numbers of U.S. adolescents are using alternative and complementary therapies, seemingly mirroring the trend among adults. Patterns of use among adolescents may be different from those of adults, however, due to the unique biological, psychological, and social factors affecting this population. Although there is a growing body of literature on utilization and efficacy of alternative and complementary therapies, few studies have included or focused on adolescents. Such research is needed. Social learning theory provides an appropriate theoretical framework to address the complex web of factors underlying health-care-seeking behavior of adolescents, allowing for consideration of the critical factor of individual expectations in their health care choices. Research on adolescents' utilization of alternative and complementary therapies is important for providers and policy makers concerned with the present and future health of youth.

Adolescent↗

PubMed2005

Natural and complementary therapies for substance use disorders.

PURPOSE OF REVIEW: To review recent studies that have examined the efficacy of natural and complementary therapies as treatments for substance use disorders and their complications. RECENT FINDINGS: Despite increasing interest in natural and complementary therapies for substance use disorders, rigorous clinical studies in this area are few in number. Recent clinical studies, although preliminary, have reported potential therapeutic effects for hypericum in the treatment of smoking cessation, for prickly pear extract in the prevention of alcohol hangover and magnesium supplementation as an adjunct to methadone treatment. Other clinical studies have reported negative findings for ginkgo as an adjunctive treatment for cocaine dependence, for artichoke in prevention of alcohol hangover, and acupuncture for alcohol withdrawal. Relevant findings from animal studies are also discussed. Neither vitamin E nor Liv 52 had a useful effect in alcohol-related liver disease. A study of silymarin in baboons, which was undertaken in an attempt to untangle the conflicting findings of human studies, reported a potential for this compound to prevent liver injury. There is increasing awareness of safety issues associated with complementary therapies. Safety issues pertinent to substance use treatment are discussed in this review. SUMMARY: Several pharmacological and psychosocial treatments for substance use disorders are solidly evidence-based and improve both individual and public health outcomes. At this stage, there remains insufficient evidence to support the use of natural and complementary therapies as a primary intervention for substance use disorders. Further clinical trials are required to clarify the potential role of particular agents.

Journal Article↗

PubMed2005

Complementary therapies for reducing body weight: a systematic review.

The prevalence of obesity is increasing at an alarming rate and a plethora of complementary therapies are on offer claiming effectiveness for reducing body weight. The aim of this systematic review is to critically assess the evidence from randomized controlled trials (RCTs) and systematic reviews of complementary therapies for reducing body weight. Literature searches were conducted on Medline, Embase, Amed, and the Cochrane Library until January 2004. Hand-searches of relevant medical journals and bibliographies of identified articles were conducted. There were no restrictions regarding the language of publication. Trial selection, quality assessment and data abstraction were performed systematically and independently by two authors. Data from RCTs and systematic reviews, which based their findings on the results of RCTs, were included. Six systematic reviews and 25 additional RCTs met our inclusion criteria and were reviewed. The evidence related to acupuncture, acupressure, dietary supplements, homeopathy and hypnotherapy. Except for hypnotherapy, Ephedra sinica and other ephedrine-containing dietary supplements the weight of the evidence is not convincing enough to suggest effectiveness. For these interventions, small effects compared with placebo were identified. In conclusion, our findings suggest that for most complementary therapies, the weight of the evidence for reducing body is not convincing. Hypnotherapy, E. sinica and other ephedrine-containing dietary supplements may lead to small reductions in body weight. However, the intake of E. sinica and ephedrine is associated with an increased risk of adverse events. Interventions suggesting positive effects in single RCTs require independent replication.

Acupuncture Therapy↗

PubMed2003

Complementary therapies and diabetes.

There is increasing recognition that people with diabetes use a range of complementary therapies (CT), for a number of conditions, but do not always inform their conventional health practitioners about their use. Controlling blood glucose levels in people with diabetes is important to reduce the consequent metabolic abnormalities and symptoms and the incidence of long-term complications. Conventional medical and nursing practitioners often incorrectly assume that they are used to control blood glucose levels, e.g. using herbal medicines to increase insulin production or reduce insulin resistance. CT can be beneficial for people with diabetes. They can also lead to adverse events. This paper describes the outcome of monitoring complementary therapy use in our diabetic outpatient services in 2001, the results of a focus group (n=10) to explore issues identified in the monitoring process and a survey undertaken with a convenience sample of diabetes educators (n=40). Twenty percent of patients used CT and there were three adverse events in the monitoring phase. Eight of the 10 focus group participants used CT and 16 of the diabetes educators used CT in patient care. Only one had a complementary therapy qualification.

Adult↗

PubMed2000

A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites.

BACKGROUND: Interest in complementary therapies in the United States is rising. We sought to characterize the use of complementary therapies among our cancer patients in our community and analyze differences in use between patients with breast versus those with other primary tumor sites. METHODS: A survey of 1,935 randomly selected patients from the tumor registry was performed. A questionnaire was mailed to 935 breast cancer patients and 1,000 patients with other primary site diagnoses. RESULTS: There were 617 responses (288 breast, 329 other). Seventy-five patients (75%) reported use of a complementary modality. Top therapies used were nutrition (63%), massage (53%), and healing herbs (44%). The most common reason for use, immune modulation (73%), was similar in both groups. Therapy was used consistently by 84% of breast patients versus 66% of others (P = 0.003). CONCLUSION: A significant number of cancer patients are using complementary therapies. Breast cancer patients are far more likely to be consistent users compared with other tumor sites.

Adolescent↗

PubMed2001

Prevalence of and satisfaction with complementary therapies and hormone replacement therapy in a specialist menopause clinic.

OBJECTIVE: To assess the usage of both conventional and complementary therapies by peri- and postmenopausal women for the treatment of menopausal symptoms. METHOD: A prospective questionnaire was completed by 200 consecutive patients attending a tertiary referral London-based specialist menopause clinic between September and December 1999. RESULTS: The median age of responders was 53.5 years (interquartile range 49-59). In total 137 women (68.5%) had ever tried an alternative treatment for the relief of their menopausal symptoms. Of these women 66% were regular users and 62% were satisfied with the effects of treatment. Women younger than the median age were significantly more likely to have used complementary therapies than older women (p = 0.036). Of the 200 participants, 184 women (92%) were current users of conventional hormone replacement therapy (HRT), and 89% were satisfied with the effects that their current HRT regimen had on their menopausal symptoms. Age was not related to satisfaction with conventional or complementary medicines. General practitioners and hospital doctors accounted only for 17% and 9%, respectively, of the primary sources of information for complementary medicines. CONCLUSIONS: High rates of usage and satisfaction were found with both conventional and complementary treatments for the relief of menopausal symptoms in our unit. For many of the women, both types of medicine are taken concurrently. Both general practitioners and hospital doctors are poor primary sources of information on complementary therapies for menopausal women.

Ambulatory Care Facilities↗

PubMedDate not supplied

Meditation as a complementary therapy in cancer.

The number of cancer patients seeking complementary therapies to deal with their disease has increased steadily in recent decades. Complementary therapies can be helpful to cancer patients because they address some of the pervasive psychosocial difficulties associated with this disease. One mind-body technique is meditation. While programs using meditation have been developed for specific health populations, such as heart disease and addictions, an equivalent, well-established program for cancer patients is lacking. This article reviews the literature and proposes a complementary meditation program designed specifically for use with cancer patients.

Humans↗

PubMedDate not supplied

Consent to use complementary therapies on critical care wards.

This article explores the use of complementary therapies as part of care within the NHS and the legal issues which arise. The employer is entitled to give or refuse consent to the use of complementary therapies by its employees on NHS patients and to lay down the conditions on which such therapies could be practised.

Aromatherapy↗

PubMed1999

Should we refuse requests for complementary therapies?

Health care providers sometimes receive requests from patients or families for complementary therapies. When should they accede to such requests, and when should they refuse them? This is not a problem peculiar to complementary therapies. It arises whenever patients or families request conventional therapies which health care professionals judge problematic in the circumstances. What follows is a set of rationalized recommendations about when health care professionals should and should not honour requests for therapies, whether they be conventional or complementary.

Attitude of Health Personnel↗