The prevalence and predictors of the use of alternative medicine in presurgical patients in five California hospitals

Use of herbal medication in the perioperative period: Potential adverse drug interactions

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.

Exploration of Predictive Modeling of Defense Health Agency & Department of Veterans Affairs Beneficiaries Dietary Supplements Use

PURPOSE

The purpose of this study was to predict dietary supplements (DS) use among Defense Health Agency (DHA) and Veterans Affairs (VA) beneficiaries who were scheduled for surgical procedures.

DESIGN

This was a predictive descriptive multicenter study with a convenience sample of 2,623 adult subjects. After institutional review board exemption, data collection occurred preoperatively via electronic survey. Participation was voluntary and data unidentifiable.

METHODS

Data were collected in preoperative anesthesia clinics during preanesthetic evaluations, or in surgery holding areas immediately prior to surgery, using a validated data collection tool. The total convenience sample size was 2,623 subjects from 6 medical centers. Data were voluntarily, anonymously, and verbally obtained from subjects using electronic survey methodology. Collected data included: gender, age, rank, beneficiary status, race, body mass index, tobacco use, marital status, and knowledge of DS side effects and drug interactions. For predictive modeling of DS use, multiple logistic regression was performed for binary outcomes via SPSS.

FINDINGS

For binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P < .05), knowledge of side effects (age, race, and rank; P < .05), and believe they are having side effects (age; P < .05).

CONCLUSIONS

Understanding DS use is central to predict and anticipate potential negative sequelae in patient outcomes in anesthesia. College education, females, Caucasians, and increasing age are indicators for greater DS use. These results provide opportunities for perianesthesia nurses to improve preoperative assessments, design patient specific perianesthesia care, and enhance patient education. Further research is recommended.

Regulation of Electrolyte Permeability by Herbal Monomers in Edematous Disorders

Edema is a gradual accumulation of fluid in the interstitial tissues or luminal cavities, which is regulated by ion transport pathways and reflects dysfunction of fluid and salt homeostasis. Increasing evidence suggests that some herbal monomers significantly reduce organ/tissue edema. In this review, we briefly summarized the electrolyte permeability involved in pathomechanisms of organ edema, and the benefits of herbal monomers on ionic transport machinery, including Na+-K+-ATPase, Na+ and Cl- channels, Na+-K+-2Cl- co-transporter, etc. Pharmaceutical relevance is implicated in developing advanced strategies to mitigate edematous disorders. In conclusion, the natural herbal monomers regulate electrolyte permeability in many edematous disorders, and further basic and clinical studies are needed.

The use of dietary supplements by patients in the pre-operative period in the Czech Republic

Background The prevalence of dietary supplement use in the pre-operative period ranges from 4.8 to 80%. According to the Food and Drug Administration, some dietary supplements may show side effects before, during and after surgery. Objective The main aim of the study was to determine the prevalence of dietary supplement use in patients before surgery at University Hospital Hradec Kralove and the predictors of use. The secondary aim was to determine patient awareness regarding the correct use of and possible risks associated with dietary supplements. Setting University Hospital Hradec Kralove. Methods Between March 2017 and June 2018, a cross-sectional study focused on patients in the pre-operative period in different departments at University Hospital Hradec Kralove was conducted. The questionnaires were anonymous and entirely voluntary. The obtained data were evaluated using descriptive statistics and a regression model in Microsoft Excel 2016 and IBM SPSS version 24. Main outcome measure The prevalence and predictors of dietary supplement use in patients before surgery. Results 256 questionnaires were returned (a response rate of 77.41%). 111 dietary supplements were used by a total of 42% of the respondents in the 30-day period prior to surgery. Patients with a higher probability of dietary supplement use included patients with urogenital (OR 3.8, 95% CI 1.2, 12.1), otorhinolaryngological (OR 3.9, 95% CI 1.1, 13.8) and musculoskeletal health problems (OR 3.9, 95% CI 1.1, 13.8). The proportion of dietary supplement users increased with the number of drugs taken concomitantly, with the probability of use being more than three times higher compared with non-dietary supplement users (OR 3.4, 95% CI 1.2, 9.4). A total of 45.8% of the respondents thought there was no risk associated with their current use of dietary supplements and drugs. Conclusions There is a high prevalence of dietary supplement use in hospitalized patients, with independent predictors being comorbidity and polypharmacy. No official recommendations or guidelines exist for physicians and anaesthesiologists in the Czech Republic which focus on patients that use dietary supplements in the pre-operative period. National guidelines focusing on dietary supplement use in the pre-operative period would be appropriate.

Dietary Supplements and Current Available Evidence

Dietary supplements are frequently used in surgical patients. Surgeons should be up to date with regard to the efficacies and potential complications related to these supplements. This article provides the most updated practices and evidence of commonly used supplements.

Preoperative Use of Herbal Medicines and Vitamin Supplements

There has been a definite increase in the popularity and use of complementary and alternative medicines, including herbal medicines, in the last ten years. The aim of this study was to determine the prevalence and patterns of use of herbal medicines and vitamin supplements by patients in the preoperative period. A questionnaire was offered to all patients attending the pre-admission clinics at St. Vincent's Hospital and Box Hill Hospital, Melbourne, over an eight-month period in 2002.

In all, 1102 questionnaires were completed (91.8% response rate). The prevalence of herbal medicine use was 14.3%, with an average user age of 54.0 years and 61.4% female predominance. The five most popular herbs were Garlic, Evening Primrose, Gingko, St. John's Wort and Echinacea. The commonest reasons for herbal medicine use were acute and chronic medical conditions. 63.2% of patients had self-prescribed. 27.8% of herbal remedy users had informed the hospital doctors and 41.8% had notified their general practitioner. The prevalence of vitamin supplement use was 20.4%, with an average user age of 54.8 years and 66.2% female predominance. The five most popular vitamins were multivitamins, followed by vitamin B, C, E and D. The commonest reasons for vitamin use were maintenance of general well-being and health.

The use of herbal medicines and vitamin supplements preoperatively by patients is common. Clinicians should endeavour to familiarize themselves with the more popular and significant herbal medications and, as part of the routine preoperative assessment, ask all their patients about their consumption of herbal remedies.

Prescription patterns and characteristics of users of Chinese herbal products in the US: Analysis of a teaching center prescription database

ETHNOPHARMACOLOGICAL RELEVANCE

We know little about US use of Chinese herbal products (CHP).

AIM OF THE STUDY

To understand CHP users' sociodemographic characteristics, CHP indications for use, and prescribing patterns in an acupuncture teaching center in the United States.

MATERIALS AND METHODS

Retrospective chart review and descriptive statistics.

RESULTS

CHP users were mostly female and white with at least a college education. The most common main complaint for CHP treatment was genitourinary system. Most of the CHP users were given thirteen different herbs per prescription, and the mean number of herbs per CHP prescription was twelve. The most common dosing frequency was twice a day (BID) and the most common duration of prescription was seven days. Dang Gui / Angelicae sinensis (Oliv.) Diels was the most frequently prescribed Chinese herb.

CONCLUSION

We identified CHP users' sociodemographic characteristics and CHP prescription patterns in a teaching center in the United States. Future studies will focus on safety and the adverse effect of CHP.

Herbal Use among Presurgical Patients in Turkey: A Cross-Sectional Study

Introduction

For centuries before the advent of modern medicine, traditional medicinal plants were the major agents for primary health care. Their use declined in most developed western countries during the last century's industrialization and urbanization. But, the last two decades have witnessed a new resurgence of interest in herbal and alternative medicines.

Methods

The survey was conducted at the Anaesthesiology and Reanimation Department of Training and Research Hospital of Health and Science University among patients who had undergone elective surgery between January 1st 2016 and April 1st 2016. A questionnaire composed of 15 questions was used.

Results

A total 87 (14.5%) patients reported the use of herbal medications. Twenty five patients were taking a single herbal medication and 52 patients were taking more than one. 92.5% of patients do not know the side effects of herbal medications. 35 cases of operation patients were questioned by the physician about herbal use, and 228 cases were not questioned by the physician.

Conclusion

Anesthesiologist should be aware of the effects of herbals on body functions and possible herbal-drug interactions to take care of such potentional perioperative complications.

Perioperative Risks of Dietary and Herbal Supplements

BACKGROUND

Patients undergoing surgery often use Dietary and Herbal Supplements (DHS). We explored the risk of DHS-drug interactions in the perioperative setting.

METHODS

In this cross-sectional prospective study, participants hospitalized for surgery completed a questionnaire regarding DHS use. We used pharmacological databases to assess DHS-drug interactions. We then applied univariate and multivariate logistic regression analyses to characterize patients at risk for DHS-drug interactions.

RESULTS

Of 526 interviewees, 230 (44%) patients reported DHS use, with 16.5% reporting using DHS that could potentially interact with anesthesia. Twenty-four (10%) patients used DHS that could potentially interact with antithrombotic drugs taken perioperatively. The medical files of three patients included reports of intraoperative bleeding. The patient files of only 11% of DHS users documented DHS use.

CONCLUSIONS

DHS use poses a significant health risk due to potential interactions. Guidelines should emphasize perioperative management of DHS use.

Perioperative Herbal Supplement Use in Cancer Patients: Potential Implications and Recommendations for Presurgical Screening

BACKGROUND

Products made from botanicals that are used to maintain or improve health are known as herbal supplements, botanicals, or phytomedicines. Many herbs have a long history of use and claimed health benefits. However, many herbal supplements and botanicals have potent pharmacologic activity that can contribute to adverse effects and drug interactions. The use of herbal supplements by cancer patients in the perioperative period is common and consistent with the substantial increase in the use of alternative medical therapies.

METHODS

We reviewed the literature to examine the constituents, safety, pharmacokinetics, and pharmacodynamics of those herbal supplements that are predominantly used by cancer patients.

RESULTS

Different supplements possess antiplatelet activity, adversely interact with corticosteroids and central nervous system depressant drugs, have gastrointestinal manifestations, produce hepatotoxicity and nephrotoxicity, and produce additive effects when used with opioid analgesics.

CONCLUSIONS

With the increasing use of herbal supplements by cancer patients, surgical staff need to screen patients pre-surgically for use of these supplements. Clinical practice guidelines are needed for screening and prevention of herbal supplement usage to prevent potential adverse events that may arise from herbal medications taken alone or combined with conventional therapies during the perioperative period.

Survey of Alternative Supplement Use within a Hospitalized Population

Purpose

Study objectives were to identify the types of alternative supplements used by a group of hospital inpatients, determine if use continued within the hospital, and ascertain whether health professionals inquired about and documented patients' alternative supplement use.

Methods

One hundred patients 18 years of age or older from various hospital departments were randomly surveyed about the use of alternative supplements.

Results

Nineteen patients reported using a total of 16 herbal products. Green tea was the most commonly used herbal product. Of those who admitted taking alternative supplements, 15 of 19 patients (79%) indicated that their outpatient physicians were aware of this use. Only 9 of 19 patients (47%) indicated that their community pharmacists were aware that they used the supplements. Only 36 of 100 inpatients (36%) surveyed were asked about their alternative supplement use during their hospital stays. Of alternative supplement users who were asked about their use of alternative products, 33% indicated that they had not disclosed this use to the clinician. Additionally, 4 of 19 herbal users (21%) indicated that they were using their herbal products as inpatients, and 6 of 19 (32%) herbal users indicated an interest in using their herbs as inpatients, but had not yet done so.

Conclusions

Clinicians should encourage patients to disclose supplement use upon hospital admission. Pharmacy should be notified of inpatients' alternative supplement use so that potential drug–herb interactions can be avoided.

Complementary and alternative medicine: attitudes, knowledge and use among surgeons and anaesthesiologists in Hungary

Background

Despite their worldwide popularity the question of using non-conventional treatments is a source of controversy among medical professionals. Although these methods may have potential benefits it presents a problem when patients use non-conventional treatments in the perioperative period without informing their attending physician about it and this may cause adverse events and complications. To prevent this, physicians need to have a profound knowledge about non-conventional treatments.

Methods

An anonymous questionnaire was distributed among surgeons and anaesthesiologists working in Hungarian university clinics and in selected city or county hospitals. Questionnaires were distributed by post, online or in person. Altogether 258 questionnaires were received from 22 clinical and hospital departments.

Results

Anaesthesiologists and surgeons use reflexology, Traditional Chinese Medicine, herbal medicine and manual therapy most frequently in their clinical practice. Traditional Chinese Medicine was considered to be the most scientifically sound method, while homeopathy was perceived as the least well-grounded method. Neural therapy was the least well-known method among our subjects.

Among the subjects of our survey only 3.1 % of perioperative care physicians had some qualifications in non-conventional medicine, 12.4 % considered themselves to be well-informed in this topic and 48.4 % would like to study some complementary method. Women were significantly more interested in alternative treatments than men, p = 0.001427; OR: 2.2765. Anaesthesiologists would be significantly more willing to learn non-conventional methods than surgeons. 86.4 % of the participants thought that non-conventional treatments should be evaluated from the point of view of evidence. Both surgeons and anaesthesiologists accept the application of integrative medicine and they also approve of the idea of teaching these methods at universities.

Conclusions

According to perioperative care physicians, non-conventional methods should be evaluated based on evidence. They also expressed a willingness to learn about those treatments that meet the criteria of evidence and apply these in their clinical practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-016-1426-0) contains supplementary material, which is available to authorized users.

Herbal medicine use by surgery patients in Hungary: a descriptive study

Background

The popularity of non-conventional treatments, especially the consumption of herbs is showing an increasing tendency all over the world. The consumption of herbal medicines might cause several complications during perioperative care.

Methods

The survey was conducted at the First Department of Surgery of Semmelweis University and focused on the demographics of patients consuming herbal medicines who had undergone elective surgery between July 1^st 2014 and February 28^th 2015. A one-page questionnaire, that the patients filled in individually and anonymously, was used. The response rate was 17.3 %.

Results

Out of the 390 patients who filled in the questionnaire, 7.2 % (28 patients) used herbal medicines, 3.6 % (14 patients) of them two weeks prior to their hospitalization. The other 3.6 % (14 patients) took herbal medicines sometime in the past. The majority of those who have ever consumed herbs are women (18/28), have completed secondary or tertiary education (23/28), more than half of them suffer from tumorous diseases and only a quarter of them (7/28) informed their physician about their use of herbal medication of their own accord.

Conclusions

Attention must be paid to the exploration of herb consumption habits of surgery patients during the preoperative examinations in order to avoid potential side effects, complications or drug interactions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-015-0890-2) contains supplementary material, which is available to authorized users.

Herbal medications and plastic surgery: a hidden danger

Herbal medicine is a multibillion-pound industry, and surveys suggest that ~10% of the UK population uses herbal supplements concurrently with prescription medications. Patients and health care practitioners are often unaware of the adverse side effects of herbal medicines. In addition, because many of these herbal supplements are available over the counter, many patients do not disclose these when listing medications to health care providers. A 39-year-old nurse underwent an abdominoplasty with rectus sheath plication after weight loss surgery. Postoperatively, she experienced persistent drain output, and after discharge, a seroma developed requiring repeated drainage in the clinic. After scar revision 10 months later, the woman bled postoperatively, requiring suturing. Again, a seroma developed, requiring repeated drainage. It was discovered that the patient had been taking a herbal menopause supplement containing ingredients known to have anticoagulant effects. Complementary medicine is rarely taught in UK medical schools and generally not practiced in UK hospitals. Many supplements are known to have anticoagulant, cardiovascular, and sedative effects. Worryingly, questions about herbal medicines are not routinely asked in clinics, and patients do not often volunteer such information. With the number and awareness of complementary medications increasing, their usage among the population is likely to increase. The authors recommend specific questioning about the use of complementary medications and consideration of ceasing such medications before surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medicinal plants traditionally used in the northwest of the Basque Country (Biscay and Alava), Iberian Peninsula

ETHNOPHARMACOLOGICAL RELEVANCE

Many ethnobotanical studies show that people in industrial countries still rely on their traditional knowledge of medicinal plants for self-treatment, although the trend might not be as common as some decades ago. Given the social and public health implications of ethnopharmacological practices, this survey aims at recording and analysing the medicinal plants used in the folk medicine of the Northwest of the Basque Country focusing on how medicinal plants knowledge and practices evolve.

MATERIALS AND METHODS

Fieldwork consisted of 265 orally consented semi-structured interviews with 207 informants about medicinal uses of plants. Interviews were conducted between September 2008 and January 2011. Informants were on average 76 years old (minimum 45, maximum 95), being more than half of them (112) men. Data collected were structured in use-reports (UR). Following informants' comments, medicinal use-reports were classified as abandoned-UR, when the informants reported that the use was only practiced in the past, and prevalent-UR, when the informants reported to continue the practice.

RESULTS AND DISCUSSION

A total of 2067 UR for 139 species that belong to 58 botanical families were recorded, being the most important families Asteraceae, Liliaceae sensu latu and Urticaceae. Some of the most important species are commonly used in other European areas (e.g., Chamaemelum nobile, Urtica dioica and Chelidonium majus). However, there are also plants commonly used in the area such as Helleborus viridis or Coronopus didymus, that are scarcely used in other areas, and whose record is an original contribution of the local pharmacopeia. It is also the case of remedies such as the use of Plantago leaves against strains in a local remedy called zantiritu. Overall, and for all variables analysed (total UR, medicinal use-categories, drug preparation and administration), the percentage of UR being currently practiced (prevalence ratio) was very low (near 30%) suggesting a strong decay in the use of traditional medicinal plants. Exceptionally, some species (Chamaemelum nobile, Verbena officinalis or Anagallis arvensis) had a high prevalence ratio, reflecting the fact that this erosion process is not evolving homogeneously. Informants also reported that new species and medicinal plant uses were entering into the local pharmacopeia via non-traditional sources such as books, courses, or the internet. These modern ways are now being used to spread some traditional remedies that in the past were only orally transmitted.

CONCLUSIONS

This study shows that traditional knowledge is continuously changing, evolving and adapting to the new social and environmental conditions. The image of the local folk medicine as a dying reality doomed to disappear should be reviewed. It also shows the need of a culturally sensitive approach by the official health systems to these practices.

Nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan

AIM

To gain an insight into this issue, this study used a qualitative approach and aims to explore and describe nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan.

BACKGROUND

The integration of complementary and alternative medicine with conventional medicine has become more common worldwide in recent years. An increase in patient use and an expansion of nurses using complementary and alternative medicine has spawned further investigation. Most published studies have concentrated on the usage of complementary and alternative medicine in western societies and have focused principally on physicians' attitudes and practice patterns in this regard. Despite the large amount of time and the unique relationship that nurses share with their patients, little research has investigated the nurse's attitudes and practice regarding complementary and alternative medicine. Moreover, there has been no previous research into understanding this issue from the Taiwanese nursing perspective.

DESIGN

A qualitative research design.

METHOD

By using an exploratory, descriptive, qualitative approach, data were collected from 11 registered nurses. The methods of the data collection were in-depth, semi-structured interviews, field notes and memos and the data were analysed using the constant comparative method.

RESULTS

Three major categories emerged from the data; namely, a 'lack of clear definition', 'limited experience' and 'high interest' towards complementary and alternative medicine. These results suggest that the definition of complementary and alternative medicine is often unclear for nurses in Taiwan. Due to the organisational policies and personal knowledge base, very few nurses integrate complementary and alternative medicine into their daily practice. However, the nurses in Taiwan show a great desire to participate in complementary and alternative medicine continuing education programmes.

CONCLUSIONS

This study is not only significant in filling the gap in the existing literature, but is also important in understanding this issue from the nurses' perspective, to offer a series of recommendations for policy, nursing education, nursing practice and suggestions for further research.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of nursing attitude in the use of complementary and alternative medicine. Clinical nurses have the potential to provide appropriate information to their patients to ensure safe complementary and alternative medicine use.

The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

Ethiopian people have been using traditional medicine since time immemorial with 80% of its population dependent on traditional medicines. However, the documentation of traditional healers' clinics contribution to modern public health system in cosmopolitan cities is scanty. Studies conducted so far are limited and focused on the perceptions and practices of modern and traditional health practitioners about traditional medicine. Thus, a cross sectional study was conducted from February to May 2010 to assess the contribution of traditional healers' clinics to public health care system in Addis Ababa.

MATERIALS AND METHODS

Ten traditional healers who were willing to participate in the study and 306 patients who were visiting these traditional healers' clinics were interviewed using two types of semi-structured questionnaires. Data were summarized using percentages, tables and bar chart.

RESULTS

The diseases mostly treated by traditional healers were wound, inflammation, herpes zoster, hemorrhoids, fracture, paralysis, back-pain, liver diseases, cancer and eczema. This study showed that traditional healers' clinics considerably contribute to public health care in Addis Ababa. Fifty two percent of patients reported that traditional healers' clinics were their first choice when they faced health problems. The reasons for visiting these clinics were 175 (57.2%) efficacy, 109 (35.6%) dissatisfaction with modern medicine, 10 (3.3%) dissatisfaction with modern medicine and efficacy, 6 (2.0%) cost and 6 (2.0%) dissatisfaction and cost. Females (55.2%), young age (20-40 years, 65.0%), never married (56.9%), orthodox (73.9%), Amhara (52.3%), educational status above grade 12 (34.6%) and government employees (29.4%) were frequent visitors. Healers reported that there was no form of cooperation with modern health professionals. The reasons were lack of motivation to collaborate and communicate with modern health service workers. Family based apprenticeship was the sources of knowledge for majority of the healers.

CONCLUSIONS

The study conducted showed that for the majority of patients interviewed traditional healers' clinics were one of the options to solve their health problems that indicated the considerable contribution of these clinics to the public health care system in Addis Ababa. Nevertheless, in this study the contribution of traditional healers' clinics to the public health system would have been better shown if individuals who are not users of the traditional healers' clinics were included in the interview. However, the study might be useful as a base line data for future evaluation of the significance of traditional healers' clinics for public health system and the services rendered in these clinics.

Complementary and Alternative Drugs Use among Preoperative Patients: A Cross-Sectional Study in Italy

Complementary and alternative drugs (CADs) are widely used in preoperative patients and may lead to potential interactions and adverse reactions. The aim of our study is to evaluate the prevalence and the predictors of CADs use among preoperative patients using data from an Italian survey. This cross-sectional study, which enrolled 478 patients (response rate: 83.5%), was carried out in three Tuscany hospitals (Italy). The prevalence of CADs use was 49.8%: 233 out of 238 participants used herbal products and/or dietary supplements. Valeriana officinalis was the most reported product (19.4%). According to univariate analysis, users were commonly identified among middle-aged or older patients; unadjusted ORs were 2.1 (95% CI: 1.3–3.3) for patients aged 48–69 years, and 3.0 (95% CI: 1.9–4.7) for those of 70–95 years, when compared with individuals aged 18–47 years. Except for education and gender, adjusted estimates showed consistent results with univariate analyses: direct association was observed with higher education, and—although not significantly—with female gender. The high prevalence of CAD use in preoperative period could be suggestive of a certain risk of adverse effects due to CADs interactions. A careful medical history of CADs consumption should be ascertained before surgery.

Nutritional supplements in the surgical patient

This article presents an overview of the current knowledge, status, and use of supplements by patients before surgical operations, together with the benefits expected of the supplements by the patients. The indications, potential advantages and disadvantages, and the relationships with various aspects of the preoperative preparation and postoperative management of surgical patients are discussed, with emphasis on the significant percentage of this population that is deficient in fundamental nutrients. Recent revisions and recommendations for some of the macronutrients are presented, together with a summary of federal regulations and an oversight of supplements.

Herbal use before and during pregnancy

OBJECTIVE

We estimated the prevalence and patterns of herbal use among US women before and during pregnancy.

STUDY DESIGN

The National Birth Defects Prevention Study is an ongoing, population-based, case-control study. This analysis included 4239 women from 10 centers in the United States who delivered infants without major birth defects from 1998-2004.

RESULTS

The prevalence of reported herbal use 3 months before or during pregnancy was 10.9%. During pregnancy, prevalence was 9.4% and was highest in the first trimester. Higher prevalence was associated with age greater than 30 years and education greater than 12 years. Use varied considerably by state (5-17%). Ginger and ephedra were the most commonly reported products early in pregnancy; teas and chamomile were most commonly reported throughout pregnancy.

CONCLUSION

Potentially 395,000 US births annually involve antenatal exposure to herbal products. Health care providers should inquire routinely about herbal use and educate patients about what little is known regarding risks of these products.

Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions

BACKGROUND

Very little is known about herbal and dietary supplement disclosure in adults with chronic medical conditions, especially on a national level.

OBJECTIVE

To examine herbal and dietary supplement disclosure to conventional health care providers by adults with chronic medical conditions.

DESIGN

Data on herbal and dietary supplement use (N = 5456 users) in the previous year were used from the 2002 National Health Interview Survey. Bi-variable analyses compared characteristics between herbal and dietary supplement disclosers and nondisclosers. Multivariable logistic regression identified independent correlates of herbal and dietary supplement disclosure.

RESULTS

Overall, only 33% of herbal and dietary supplement users reported disclosing use of herbal and dietary supplements to their conventional health care provider. Among herbal and dietary supplement users with chronic conditions, less than 51% disclosed use to their conventional health care provider. Hispanic (adjusted odds ratio and 95% confidence interval = 0.70 [0.52, 0.94]) and Asian American (adjusted odds ratio and 95% confidence interval = 0.54 [0.33, 0.89]) adults were much less likely than non-Hispanic white Americans to disclose herbal and dietary supplement use. Having less than a high school education (adjusted odds ratio and 95% confidence interval = 0.61 [0.45, 0.82]) and not having insurance (adjusted odds ratio and 95% confidence interval = 0.77 [0.59, 1.00]) were associated with being less likely to disclose herbal and dietary supplement use.

CONCLUSION

Herbal and dietary supplement disclosure rates are low, even among adults with chronic conditions. These findings raise concerns about the safety of herbal and dietary supplements in combination with allopathic care. Future studies should focus on educating physicians about crosscultural care as well as eliciting information about herbal and dietary supplement use.

Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland

INTRODUCTION

Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre.

PATIENTS AND METHODS

A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy.

RESULTS

A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM.

CONCLUSIONS

Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common.

Factors associated with herb and dietary supplement use by young adults in the United States

BACKGROUND

Little is known about the association between use of herbs and dietary supplements (HDS) and lifestyle/behavior factors in young adults in the US.

METHODS

Analyzing the 2002 National Health Interview Survey (NHIS), we examined the patterns of HDS (excluding vitamins/minerals) use among young adults in the United States using descriptive statistics and logistic regression.

RESULTS

In our sample of 18 to 30 year olds (n = 6666), 26% were current smokers, 24% were moderate/heavy drinkers, 43% had high physical activity, and 54% and 76% use prescription and over the counter (OTC) medications respectively. Non-vitamin, non-mineral HDS was used by 17% of the overall sample in the last 12 months. In the multivariable analysis, the lifestyle and behavioral factors associated with HDS use include: current smoking (odds ratio 1.41 95% CI [1.16-1.72]); being a former smoker (1.50 [1.15-1.95]); moderate/heavy alcohol use (2.02 [1.53-2.65]); high physical activity levels (2.45 [1.98-3.03]); and prescription medication use (1.51 [1.26-1.81]). Among HDS users, only 24% discussed their use with a health care professional.

CONCLUSION

Nearly one in five young adults report using non-vitamin/non-mineral HDS.

Taiwanese nurses’ attitudes towards and use of complementary and alternative medicine in nursing practice: A cross-sectional survey

BACKGROUND

Increasingly, nurses in Western countries express positive attitudes to complementary and alternative medicine (CAM) but lack knowledge, access to education and organisational policy to guide practice. It is unclear whether nurses in developed Asian countries mirror or differ from this profile.

OBJECTIVES

To determine the attitudes towards and use of CAM by registered nurses in Taiwan.

DESIGN

Cross sectional survey.

SETTING

A Nursing College in eastern Taiwan.

PARTICIPANTS

Registered nurses (N=170) working in various clinical settings who were studying a post registration Bachelor of Nursing conversion course.

METHODS

Questionnaire distributed to nurses during class time.

RESULTS

Most nurses had positive attitudes to CAM and most used therapies, like massage, occasionally in practice. However, none had formal qualifications in CAM and most perceived that there were insufficient resources or organisational policy to facilitate practice.

CONCLUSIONS

Taiwanese nurses need more formal education about CAM and require access to clear policies regarding the safe use of CAM in nursing practice.

Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey

STUDY OBJECTIVE

Many people use dietary supplements or herbal products to help them sleep. We analyzed the associations between melatonin use and insomnia and between valerian use and insomnia in a representative sample of the United States population.

DESIGN AND PARTICIPANTS

The data reported upon here were collected in the 2002 Alternative Health/Complementary and Alternative Medicine (CAM) Supplement to the National Health Interview Survey. This was a survey of 31,044 personal interviews that constituted an age-representative and socioeconomically representative sample of the civilian noninstitutionalized population of the United States.

RESULTS

Of the survey sample, 5.9% used valerian and 5.2% used melatonin. Of those using valerian, 29.9% endorsed insomnia as 1 reason for CAM use, and, of melatonin users, 27.5% endorsed insomnia as 1 reason for CAM use. Relatively greater use occurred in individuals under age 60 years. The decision to use such substances was made in consultation with a health care provider less than half of the time.

CONCLUSIONS

Large segments of the United States population used valerian or melatonin for insomnia within the year preceding the survey, and usage typically fell outside the purview of the health care system.

Use of Herbal Supplements and Vitamins in Plastic Surgery: A Practical Review

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Explain what governmental regulations control the labeling and distribution of herbal supplements. 2. List the more commonly used supplements and their reported benefits. 3. List the possible postoperative complications from consumption of the more commonly used herbal supplements. 4. Explain the preoperative management of patients using herbal supplements. 5. Know additional resources to consult when unanswered questions arise.

BACKGROUND

The American public spends over $5 billion per year on herbal supplements, and approximately 20 percent of all Americans use prescription medications concurrently with herbal supplements. As the number of people who take alternative medicines rises, there is growing awareness among health care providers of the need to become educated and to educate their patients on the effects that such supplementation may have on their health. As plastic surgeons, we have an added responsibility to become informed because of potential adverse interactions with other medications and anesthesia in the elective surgical patient.

METHODS

Literature regarding commonly encountered herbal supplements and vitamins was reviewed and summarized to include reported indications for use and potential adverse effects and interactions specific to the perioperative patient.

RESULTS

Abundant literature exists regarding herbal supplementation, but very little scientific evidence exists to advocate the use of the majority of supplements available on the market. In addition, little is known about the positive and negative interactions that these supplements are capable of producing, and those interactions that are known are based on case reports.

CONCLUSIONS

With the lack of quality scientific studies to support the efficacy of most herbal products available and the limited regulation of these products by the government, health care providers are faced with a significant public health dilemma. This article provides a brief overview of information published on commonly encountered herbal supplements and vitamins taken by plastic surgery patients.

Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: a survey at an academic medical center

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

An analysis of sickness absence in chronically ill patients receiving complementary and alternative medicine: a longterm prospective intermittent study

Background

The popularity of complementary and alternative medicine (CAM) has led to a growing amount of research in this area. All the same little is known about the effects of these special treatments in every-day practice of primary care, delivered by general practitioners within the health insurance system. From 1994 to 2000 more than 20 German Company health insurances initiated the first model project on CAM according to the German social law. Aim of this contribution is to investigate the effectiveness of multi-modal CAM on chronic diseases within primary health care.

Methods

A long-term prospective intermittent study was conducted including 44 CAM practitioners and 1221 self-selected chronically ill patients (64% women) of whom 441 were employed. Main outcome measure is sick-leave, controlled for secular trends and regression-to-the mean and self-perceived health status.

Results

Sick-leave per year of 441 patients at work increased from 22 (SD ± 45.2) to 31 (± 61.0) days within three years prior to intervention, and decreased to 24 (± 55.6) in the second year of treatment, sustaining at this level in the following two years. Detailed statistical analysis show that this development exceeds secular trends and the regression-toward-the-mean effect. Sick-leave reduction was corroborated by data on self-reported improvement of patients' health status.

Conclusion

Results of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care.

A survey of Chinese herbal medicine intake amongst preoperative patients in Hong Kong

We have surveyed, by means of a questionnaire, the preoperative use of traditional Chinese medicines in 259 adult Chinese patients admitted to a Hong Kong teaching hospital. The spectrum and use of herbal remedies differed from that reported by Western sources. Of those patients surveyed 90% used Chinese herbs on a regular daily basis in traditional soups and teas while 44% had consulted a traditional Chinese medicine practitioner in the last twelve months prior to admission, but mainly for health promotion (59%) and minor ailments (30%). Only 25% sought advice for their current illness and 13% were taking regular traditional Chinese medicines prior to admission. The ingredients were difficult to identify. Patients with cancer were more likely to use ling zhi (odds ratio 5.4). Female patients with reproductive problems were more likely to visit a traditional Chinese medical practitioner (odds ratio 2.6) and use ginseng (odds ratio 5.1). The anaesthetic implications of preoperative traditional Chinese medicine in keeping with Hong Kong practices need to be investigated, and appropriate anaesthetic guidelines should be developed.

A Prospective, Randomized, Double-Blind, Placebo-Controlled Study of the Platelet and Global Hemostatic Effects of Ganoderma Lucidum (Ling-Zhi) in Healthy Volunteers

Ganoderma lucidum is a Chinese herbal medicine popular with cancer patients. Previous in vitro studies suggested that Ganoderma lucidum might impair hemostasis. In this prospective, randomized double-blind study, healthy volunteers received orally Ganoderma lucidum capsules 1.5 g (n = 20) or placebo (n = 20) daily for 4 wk. We monitored subjects before drug administration and at 4 and 8 wk thereafter by routine coagulation screen, fibrinogen concentration, von Willebrand ristocetin cofactor activity, platelet function analyzer PFA-100, and thrombelastography. There were no significant between-group differences and all measurements remained within the normal range. Ganoderma lucidum ingestion over 4 wk was not associated with impairment of hemostasis.

IMPLICATIONS

Ingestion of Ganoderma lucidum does not cause impairment of hemostatic function in healthy volunteers, despite earlier in vitro reports that it may cause platelet inhibition and may have other antithrombotic and fibrinolytic activity. The use of Ganoderma lucidum preoperatively is unlikely to increase the risk of surgical bleeding in otherwise healthy patients.

Herbal and homeopathic medication use in pediatric surgical patients

BACKGROUND

Patients who present for surgery may be using herbal or homeopathic preparations; adverse effects of some of these substances include bleeding, cardiovascular changes, and liver dysfunction. Little information is available on the frequency of use in the pediatric surgical population.

METHODS

With institutional approval, a survey was conducted to assess the use of vitamins, nutritional supplements, or herbal or homeopathic preparations in children presenting for surgery in five geographically diverse centers in the USA.

RESULTS

A total of 894 completed surveys showed that overall, 3.5% of pediatric surgical patients had been given herbal or homeopathic medications in the 2 weeks prior to surgery. Most substances were prescribed by parents. The use of these medications did not differ between children with coexisting diseases and those without; use was also not different among ethnic groups or by residence setting (city, suburban, rural). There was a significant difference between the west coast centers in the study compared with the rest of the country (7.5% of patients in Palo Alto, CA; 5.5% of patients in Seattle, WA; 1.5% of patients in Chicago, IL; and 1.9% in Virginia and Delaware used herbal or homeopathic remedies). The most prevalent substance given to children presenting for elective surgery was Echinacea.

CONCLUSIONS

Herbal and homeopathic medications are used by a small percentage of pediatric patients presenting for elective pediatric surgery patients. Use of these substances should be addressed in the preoperative history.

Herbal Product Use by Hispanic Surgical Patients

We hypothesized that the use of herbal products is highly prevalent in Hispanic surgical patients on both sides of the U.S./México border. One hundred fifteen patients were interviewed in El Paso and 112 in Ciudad Juárez from December 2001 to June 2002. This prospective, randomized study evaluated patients aged 18 years or older that were scheduled for surgery. Sixty-two per cent of our sample in the United States and 81 per cent of patients in Mexico reported using herbal products in the past year. About 58 per cent of patients in the United States and 49 per cent in México rated the products as “excellent” in treating their conditions. Ninety-two percent of U.S, and 93 per cent of Mexican patients did not inform their physician of their herbal use. Preoperative assessment of patients did not include inquiries about herbal products in either hospital. With the growing use of herbal products and because most users do not inform their physician, there is increasing concern related to the possible occurrence of herbal-related adverse events during and after surgery. The fact that health care personnel did not inquire about herbal product use before surgery is an added concern.

The protozoan Tetrahymena as a bioindicator to screen bioactive substances

Tetrahymena thermophila has been used as a "swimming receptor" to study its chemotaxis in the presence of various bioactive substances from herbal plants. Chemotaxis of this ciliated protozoan is, in part, controlled by a cyclic GMP-dependent protein kinase (PKG), which can adjust ciliary beating. In this paper, the effects of Ginkgo biloba extract (GBE) and its main functional constituents, terpene lactones, flavonol glycosides and aglycones, on the chemotaxis and PKG activity of ciliates, were systematically investigated. GBE and its constituents exerted significant inhibition of chemotaxis and PKG activity in cells of T. thermophila. The minimal concentrations to completely inhibit chemotaxis of T. thermophila were 12, 25, 50, 100, 300, 400, 400, 500 microM, 2 mg/ml for isorhamnetin, kaempferol, quercetin, myricetin, isoquercitrin, quercetin-3-beta-d-galactoside, rutin, quercitrin, and GBE, respectively. The IC(50) values for PKG were 14, 17, 20, 25, 186, 78 microM, 0.157 mg/ml for isorhamnetin, kaempferol, quercetin, myricetin, isoquercitrin, rutin and GBE, respectively. The results indicate that the chemotaxis inhibition by GBE and its constituents and their effects on PKG are similar. This suggests that T. thermophila may be a potential experimental organism for screening other bioactive substances.

Possible interaction between sevoflurane and Aloe vera

OBJECTIVE

To describe a patient with massive intraoperative bleeding after oral consumption of Aloe vera tablets.

CASE SUMMARY

A 35-year-old woman lost 5 L of blood during surgery as a result of a possible herb-drug interaction between Aloe vera and sevoflurane.

DISCUSSION

Aloe vera is a common herb used for antiinflammatory and antiarthritic activity, as well as antibacterial, hypoglycemic, and lipid-lowering effects. Compounds contained within Aloe vera can cause a reduction in prostaglandin synthesis, which may inhibit secondary aggregation of platelets. Sevoflurane inhibits thromboxane A(2) formation by suppression of cyclooxygenase activity, impairs platelet aggregation, and prolongs bleeding. Although the vascularity and size of the hemangioma were the most important factors for the massive intraoperative blood loss, concomitant use of sevoflurane and Aloe vera played a contributory role. An objective causality assessment revealed that this adverse event was possible as a result of the sevoflurane and Aloe vera interaction.

CONCLUSIONS

There is a potential herb-drug interaction between Aloe vera and sevoflurane based on the antiplatelet effects of these 2 agents. Herbal medications with antiplatelet potential should be discontinued before anesthesia and surgery.

Prevalence and predictors of herbal medication use in veterans with chronic hepatitis C

OBJECTIVE

Herbal therapies are used by a substantial proportion of persons in the United States, and use of these supplements may be even higher in those with chronic liver disease. The aims of this study were to prospectively determine the proportion of US veterans with chronic hepatitis C that are currently taking vitamins and herbal medications and to evaluate factors associated with use of herbal preparations.

METHODS

Patients with hepatitis C who were seen in the gastroenterology, infectious disease, and primary care clinics at the VA New York Harbor Healthcare System were invited to participate in this prospective study. For comparison, healthy patients without hepatitis C were enrolled from the primary care clinics at the same medical center. Patients were interviewed by trained research coordinators who obtained detailed demographic and clinical data, as well as information on the use of antioxidants (vitamin C and E), multivitamins, and herbal medications.

RESULTS

Use of vitamin C (34.8% vs. 19.6%, P < 0.001), vitamin E (25.8% vs. 13.2%, P < 0.001), multivitamins (43.6% vs. 28.0%, P < 0.001), and herbal therapies (21.0% vs. 10.4%, P < 0.001) was significantly higher in the 500 patients with hepatitis C compared with the 250 healthy controls. The most common herbal medications taken by hepatitis C patients were milk thistle (12.2%), ginseng (4.6%), and echinacea (3.0%). After adjusting for age and gender, multivariate logistic regression identified 12 or more years of education (OR 2.7; 95% CI 1.6-4.3; P < 0.001) and annual income of at least 20,000 US dollars (OR 2.0; 95% CI 1.3-3.2; P = 0.004) as the only significant predictors of herbal medication use in patients with hepatitis C.

CONCLUSIONS

The use of herbal preparations is prevalent among veterans with chronic hepatitis C, especially those with higher levels of education and higher incomes. Obtaining a detailed medical history and documentation of the use of these supplements is critical to determine the potential for herbal-drug interactions and hepatotoxicity.

Herbal product use and perioperative patients

IT IS VITAL for perioperative team members to assess the effects of increasingly used herbal and nontraditional medications on a patient's surgical course. THIS LITERATURE REVIEW provides a knowledge base so nurses can appropriately assess the possible effects of herbal medication use by perioperative patients. THE HISTORY OF HERBAL REMEDY USE, existing regulatory guidelines, effects on consumer safety, and socioeconomic and insurance issues are discussed. Additionally, the role of an herbal medicine practitioner is explored. Finally, the eight most commonly used herbal medications are examined, particularly in regard to perioperative patients.

Patterns of complementary therapy use by homebound cancer patients in Taiwan

This study explores the use of complementary therapy and factors associated with the use of such therapies by cancer patients in Taiwan who were receiving surgery, chemotherapy, or radiotherapy and lived at home. Data were collected by purposive sampling and analyzed by chi-square testing. Subjects (N = 137) from two Taipei area hospital-based oncology centers were interviewed by using a structured questionnaire. Sixty percent of the total sample used complementary therapies. Variables, such as gender, duration of illness, diagnostic stages, chemotherapy, and symptoms distress, were significantly (p <.05) related to the use of complementary therapies. Western health professionals need to know what complementary therapies their clients are using so that they can respond appropriately to questions raised by their clients, as well as help them to acknowledge diverse kinds of treatment in their therapeutic plans.