The role of complementary and alternative medicine (CAM) in Germany - a focus group study of GPs

Knowledge, attitude and dispensing practice of the pharmacists related to complementary alternative medicines in the Riyadh region of Saudi Arabia: a cross-sectional descriptive study

BACKGROUND

The use of complementary alternative medicines (CAMs) has risen globally in recent times. Such medications are exclusively and readily available in the Riyadh region of Saudi Arabia through community pharmacies and other retail outlets, exposing the consumers to various risks like harmful drug interactions. These situations take pharmacists to a responsible position where they should provide evidence-based information to help consumers make safe consumption. The consumption of CAMs can be ensured safe if pharmacists have appropriate knowledge and training about their use, dosing, side effects, etc. This study aimed to investigate and evaluate the pharmacist's factual knowledge, perception and dispensing practice related to various aspects of CAMs based on gender and experience.

METHODS

The study followed a structured self-administered questionnaire-based cross-sectional survey design. Out of 200, with a response rate of 89.5%, 179 pharmacists (115 males; 64 females) from the Riyadh region of Saudi Arabia participated in this study. The knowledge scores of male and female pharmacists were compared using an unpaired t-test. The correlation between pharmacists' knowledge and their work experience was determined using Pearson's correlation coefficient test, keeping the significance value at p < 0.05.

RESULTS

Almost all the respondents (99%) reported that they had never attended any lecture or course related to CAMs. Results show low knowledge scores, indicating poor respondents' knowledge concerning the use of CAMs. No significant difference was observed in knowledge scores based on gender, and no significant correlation between pharmacists' knowledge scores and their work experiences.

CONCLUSION

Therefore, the study concluded that both male and female pharmacists possess equal knowledge concerning the use of CAMs, and their work experience doesn't differentiate in their knowledge. Various factors like lack of time, etc., prevented respondents from interacting with patients. Regular organization of mandatory continuing education programs about the safe use of CAMs that can improve their knowledge is recommended. In addition, establishing a pharmacy connection network system can enhance patient monitoring and CAMs vigilance. This study lays a foundation for further work to assess pharmacists' knowledge and practice patterns in Saudi Arabia.

TRIAL REGISTRATION

Not applicable.

Naturopathy, complementary and integrative medicine in medical education - position paper by the GMA Committee Integrative Medicine and Perspective Pluralism

Background

A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process.

Objective

The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training.

Method

The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine.

Results

First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice.

Conclusion

Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.

What Do Academic Physicians Think of Tai Chi? A Qualitative Study

Background: Although there is extensive evidence from randomized controlled trials (RCTs) that Tai Chi maintains health, prevents injury, and mitigates the effects of a number of chronic diseases, it appears that physicians do not commonly recommend it. The objective of this study was to understand academic physicians' views on Tai Chi and why there is an apparent gap between the evidence on Tai Chi and its application in practice. Design: A qualitative study was conducted using purposive and snowball sampling and semistructured interviews with 15 academic physicians in 6 countries: Australia, Canada, France, New Zealand, the Netherlands, and the United States. The interviews were recorded and transcribed and then coded and analyzed with NVivo 12 software. Results: All participants were aware of Tai Chi. More than half had never attended a continuing education event where Tai Chi was mentioned or read a scientific article on it. Most had seen or heard of science-based evidence on it, and a few were well versed in the literature in their area of expertise. Almost three-quarters of physicians interviewed thought Tai Chi could be a therapeutic option; however, when asked how often they recommended Tai Chi, about a third indicated never, about a half said only occasionally, and a few identified it regularly. Three factors-lack of access, lack of both physician and patient awareness, and an anticipated lack of patient receptivity to it-seemed to account for most of the hesitation to recommend it. Some thought Tai Chi may be seen as foreign. All made useful suggestions on how to increase the uptake of Tai Chi, including learning from other physicians and integrating more of the evidence into knowledge products, as well as learning more about Tai Chi in undergraduate and continuing medical education. Conclusions: This exploratory study found that although all the academic physicians interviewed had heard about Tai Chi, most were unaware of the extent of evidence from RCTs supporting its therapeutic effects. To apply this evidence in their practice, they wanted to learn more about it from other physicians, have better integration of the evidence into medical knowledge products, and know that there was access, and patient receptivity, to Tai Chi classes in the communities where they practiced.

Stakeholder attitudes to the regulation of traditional and complementary medicine professions: a systematic review

BACKGROUND

There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions.

METHODS

A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions.

RESULTS

Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations (n = 6), education providers (n = 2), and policy-makers (n = 2).

CONCLUSIONS

There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .

Use of Complementary and Alternative Medicine in Patients with Primary Immunodeficiency: a Multicentric Analysis of 101 Patients

The term complementary and alternative medicine (CAM) describes a broad spectrum of health care practices that are not an integral part of the conventional health care system. Many patients worldwide use CAM on their own initiative, often in combination with their conventional medical therapy. CAM use is attractive especially to patients with primary immunodeficiency, since they suffer from frequent infections and autoimmunity. Those are frequently addressed by CAM providers. The aim of this multicentric study was to collect information on the use of CAM by these patients and to define characteristics that are associated with the use of CAM. A total of 101 patients with primary immunodeficiencies at German hospitals were surveyed on their CAM use (further 14 patients rejected to participate). Multiple psychological tests (MARS-D, WHO-5, PHQ9, EFQ) were conducted to investigate variations among personality traits associated with CAM use. Additionally, clinical and sociodemographic patient data was collected. A total of 72% of patients used CAM to treat their primary immunodeficiency. The three most frequently used methods were physical exercise or fitness training (65%), dietary supplements (58%), and homeopathy (49%). Most patients did not discuss CAM use with their doctors, mostly because they felt that there was no time for it. CAM plays an important role for patients with primary immunodeficiency in a high-resource health care setting such as Germany. In clinical practice, doctors should create a platform to discuss needs that go beyond conventional therapy.

Perspectives of physicians on medical acupuncture in Lebanon: a preliminary study

OBJECTIVES

There are no regulations governing the practice of acupuncture in Lebanon as it is not yet registered as a profession. To our knowledge, no studies have ever been conducted in Lebanon regarding the practice of acupuncture. The purpose of this preliminary study was to explore the knowledge of Lebanese physicians about acupuncture, with the intent of conducting larger scale studies and developing strategies aimed at refining this knowledge in the future, and the ultimate goal of setting guidelines for acupuncture practice in Lebanon.

METHODS

An online survey looking into physicians' knowledge of acupuncture, its mechanisms of action, effectiveness, indications and safety, and physicians' understanding of its concepts, was circulated to 4651 physicians registered in the Lebanese orders of physicians.

RESULTS

One hundred forty-nine physicians (3.2%) completed the survey. Most study respondents stated that they were unaware of the difference between traditional Chinese acupuncture (TCA) and Western medical acupuncture (WMA). Overall, 30% of respondents had personally used and/or referred patients for acupuncture. Physicians who had personally tried acupuncture were more likely to refer patients for acupuncture (p < 0.001). Those who know the difference between WMA and TCA were more likely to have tried or referred for acupuncture (p = 0.004). 72% believed that acupuncture and other integrative medicine modules should be introduced in medical curricula in Lebanon.

CONCLUSION

Interest in acupuncture among physicians in Lebanon appears to be limited, based on the low response rate. Among respondents, physicians who had tried or referred patients for acupuncture appeared to be more well informed about different acupuncture styles.

Perception of integrative care in paediatric oncology-perspectives of parents and patients

PURPOSE

For some years now, a programme for the use of integrative care in paediatric oncology has been established in a German university hospital and offers patients and parents complementary treatment options. According to their medical condition and wishes. A variety of external applications such as medical wraps, warm oil compresses and rhythmic embrocations are offered. This article analyses how patients and parents perceived and experienced the integrative care program.

METHODS

In this qualitative study, data consists of field notes conducted through participant observation, informal conversations and interviews with parents (n = 25) during the implementation phase of the program. Data was analysed on basis of thematic analysis and organized with the analysis software MAXQDA.

RESULTS

Parents and families intuitively developed strategies for dealing with crisis situations such as childhood cancer. In addition, many of the families brought with them a wealth of experience in complementary medicine. Parents perceived the integrative care treatments as soothing, relaxing and pain-relieving for their child. Patients could relax and side effects of chemotherapy were alleviated. However, children, who undergoing chemotherapy were not always open for physical touch and thus sometimes also rejected the treatments sometimes.

CONCLUSION

The analysed integrative care programme is perceived as a strong patient and family-centred approach of support during the oncological paediatric treatment. From a salutogenetic viewpoint, this program aims to strengthen the dimension of manageability within the concept of sense of coherence. Parents are given supportive means to manage side effects and ease their child's suffering, through touch and attention that can be very beneficial.

Development of an Integrative Care Program in a Pediatric Oncology Unit

PURPOSE

The aim of this article is to describe what needs to be considered in implementing care practices, in this case an integrative care program consisting of anthroposophic treatments, in an intensive care unit (ICU) of a teaching hospital.

METHODS

We used a pediatric oncology department to implement an integrative care program. We conducted a qualitative study including participant observation and semi-structured interviews with parents, nurses, doctors, and therapists. Data analysis was based on a grounded theory approach and focused on the status quo of care in the ICU.

RESULTS

The following factors needed to be considered: the structure of the ICU, communication and information dissemination, and time constraints. This led to the following components of the integrative care program: (1) a training plan in anthroposophic treatments for all nurses that was conducted by 2 trained anthroposophic nurses, and (2) the introduction of an integrative shift that was on top of regular care at the ICU and focused on delivery of integrative care to patients.

CONCLUSION

To add new care components to an ICU, the existing context has to be considered. Time constraints and high workload are factors that need to be recognized. In this particular context, a highly flexible program was the solution.

Complementary medicine in radiation oncology : German health care professionals' current qualifications and therapeutic methods

INTRODUCTION

Recently, complementary and alternative medicine (CAM) has moved more into the focus, and cancer societies such as the German Cancer Society (Deutsche Krebsgesellschaft, DKG) have established working groups to develop a guideline for CAM. The present work aims to evaluate the acceptance of CAM in the whole radiation oncology community.

METHODS

We conducted an online survey on CAM and sent the modified questionnaire that was successfully distributed to all members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynakologische Onkologie, AGO) of the DKG in 2014 to the members of the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie und Strahlentherapie, DEGRO). The survey consisted of 17 questions regarding personal information and current CAM guidelines within the workplace/clinic.

RESULTS

A total of 143 members participated. Of these, 12% had some CAM qualification. For hematological cancer in 35% and in up to 76% for breast cancer, CAM treatment is offered in German radiation oncology facilities, mainly due to fatigue symptoms. CAM is part of routine treatment in 32.2%, 22.0% are planning to incorporate it. Most physicians advise patients to partake in sports activities and recommend dietary supplements and nutritional counseling. The cost of CAM treatment is fully covered in 9.8% of all participating facilities.

CONCLUSION

Today, CAM is integrated into cancer care; however, skepticism regarding its effect still exists. Evidence-based results must be generated to convince physicians of the effectiveness of CAM methods. CAM qualifications must be included in physicians' training to improve their understanding and counseling regarding CAM options in cancer care.

Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung

Hintergrund: Inhalte aus den Bereichen der klassischen Naturheilverfahren und Komplementärmedizin sind im Rahmen der ärztlichen Approbationsordnung curricular verankert. Im Gegensatz dazu werden in den Weiterbildungsordnungen zum Facharzt für Allgemeinmedizin keine komplementärmedizinischen Inhalte abgebildet. Bisher ist nicht bekannt, ob Ärzte in Weiterbildung (ÄiW) zum Facharzt für Allgemeinmedizin innerhalb ihrer Weiterbildung mit komplementärmedizinischen Verfahren in Kontakt kommen und ob sie solche erlernen bzw. erlernen möchten. Das Ziel der vorliegenden Studie war die Erhebung der Einstellung zum und des Weiterbildungsbedarfs im Bereich Komplementärmedizin bei ÄiW zum Facharzt für Allgemeinmedizin. Methoden: In Rahmen einer Querschnittsstudie erfolgte eine Fragebogen-gestützte Umfrage unter ÄiW zum Facharzt für Allgemeinmedizin innerhalb des Weiterbildungsprogramms «Verbundweiterbildungplus Baden-Württemberg». Diese wurde onlinebasiert initiiert und durch eine papierbasierte Umfrage komplettiert. Ergebnisse: Insgesamt nahmen 138 Teilnehmer der Verbundweiterbildungplus Baden-Württemberg an der Umfrage teil. Der Gesamtrücklauf betrug damit 28%. Dabei zeigte sich, dass die Teilnehmenden ein hohes Interesse an Komplementärmedizin hatten. Gleichzeitig gaben sie an, Unsicherheiten sowohl inhaltlicher als auch formaler Art wahrzunehmen (z.B. Evidenz der einzelnen Methoden und Kostenübernahme durch gesetzliche Krankenkassen). Die große Mehrheit der befragten Ärzte befürwortete, dass in der Weiterbildung zum Facharzt Allgemeinmedizin Kompetenzen aus dem Bereich Komplementärmedizin vermittelt werden. Schlussfolgerungen: Vor dem Hintergrund der weiten Verbreitung komplementärmedizinischer Methoden im hausärztlichen Alltag muss diskutiert werden, ob im Rahmen der Weiterbildung zum Facharzt für Allgemeinmedizin Basiskompetenzen für diesen Bereich definiert werden sollten. Diese könnten beispielsweise in das «Kompetenzbasierte Curriculum Allgemeinmedizin» der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) einfließen.

Laws and guidelines governing the use of herbal supplements

In the last of a three-part series on herbal supplements, laws and guidelines impacting the use of herbal supplements are discussed. Distinct differences exist between regulations for herbal supplements and those products defined as drugs. Consideration of herbal therapy should be approached within a context of holistic treatment.

Impact of traditional Chinese medicine on age trajectories of health: evidence from the Taiwan Longitudinal Study on Aging

Although traditional Chinese medicine (TCM) is widely used, its effect on health outcomes is not well understood. This study employed a cohort sequential design to investigate levels and rates of change in health from midlife to older adulthood in TCM users and nonusers. A sample of 1,302 community-dwelling adults aged 53 to 80 was selected from individuals interviewed in the 1999 Taiwan Longitudinal Study on Aging (TLSA) and reinterviewed in 2003 and 2007. TCM users were identified as participants who reported visiting a Chinese medicine clinic in the year before each of the three interviews. Health outcomes included physical function, self-rated health, cognitive function, and depressive symptoms. Approximately one in five adults reported that they used TCM in at least one wave of the 3 interview years, but less than one in twenty across all waves. Controlling for time-varying sociodemographic and health conditions, levels and rates of change in physical and cognitive function did not differ according to TCM use. Although adults who reported using TCM had higher depressive symptoms (βTCM = 0.979, 95% confidence interval (CI) = 0.200-1.758) and poorer self-rated health (βTCM = -0.267, 95% CI = -0.267 to -0.081) at baseline, their rates of change in these outcomes did not differ from those who did not use TCM. Subgroup analyses revealed that TCM use benefited adults with higher depressive symptoms by attenuating worsening depressive symptoms (βTCM ×Age = -0.221, 95% CI = -0.434 to -0.007). Further research aimed at understanding the specific mechanisms by which TCM affects health outcomes is warranted.

Use of complementary and alternative medicine before and after organ removal due to urologic cancer

OBJECTIVE

Many patients use complementary and alternative medicine (CAM) as primary treatment or symptom relief for a variety of illnesses. This study was designed to investigate the influence of surgical removal of a tumor-bearing urogenital organ on CAM use.

METHODS

From 2007 to 2011, 350 patients underwent major urological surgery for kidney, prostate, or bladder cancer at the Goethe-University Hospital, Frankfurt, Germany. Data from 172 patients (49%), who returned a questionnaire, were retrospectively evaluated using the hospital information system along with the questionnaire to objectify CAM use 2 years before and after surgery.

RESULTS

From the 172 patients returning questionnaires, 56 (33%) used CAM before and/or after surgery and 116 (67%) never used CAM. Of the 56 CAM users, 30 (54%) used CAM presurgery and 53 (95%) used CAM postsurgery, indicating a significant change of mind about CAM use. Patients of German nationality used CAM significantly more than patients of other nationalities. Higher educational status (high-school diploma or higher) was a significant factor in favor of CAM use. The most common type of CAM used before/after surgery was an alternative medical system (63/49%), a manipulative and body-based method (50/19%), and a biological-based therapy (37/32%). Information about CAM, either provided by medical professionals or by other sources, was the main reason determining whether patients used CAM or not.

CONCLUSION

The number of patients using CAM almost doubled after surgical removal of a cancer-bearing organ. Better awareness and understanding of CAM use by medical professionals could improve patient counseling.

Using the framework of corporate culture in "mergers" to support the development of a cultural basis for integrative medicine - guidance for building an integrative medicine department or service

BACKGROUND

An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration.

PURPOSE

The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems.

METHODS

A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service.

RESULTS

Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine).

CONCLUSION

The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.

Role of complementary therapies in the understanding of primary healthcare professionals: a systematic review

Objective To identify the understanding of the healthcare professionals in relation to the role of complementary therapies in primary health care. Method Systematic review by way of the following information sources: PubMed, CINAHL, PeriEnf, AMED, EMBASE, Web of Science, Psicoinfo and Psicodoc, using the keyword Primary Health Care alone, and associated with the following keywords: Medicinal Plants, Herbal Medicine, Homeopathy, Traditional Chinese Medicine, Acupuncture, Anthroposophical Medicine. Results Twenty-two studies from 1986 to 2011 were included. We identified three styles of practice: conventional medicine, complementary therapies and integrative medicine. Positioning professional practices within these three styles may facilitate discussion of concepts of health care, enhancing the health care provided as a result. Conclusion The work process in primary care presents difficulties for conducting integrative and holistic health care, but this practice has been introduced over time by professionals who integrate conventional medicine and complementary therapies, concerned with the care and well-being of patients.

Inflammatory bowel disease professionals' attitudes to and experiences of complementary and alternative medicine

Background

Complementary and alternative medicine (CAM) use in patients with IBD is on the increase. Patients report they use CAM when their condition is unresponsive to conventional medication or when they suffer from side-effects, negative stress and disease-related concerns. CAM use may improve patients’ well-being but it can also lead to side-effects and interactions with conventional medications. Research on attitudes to and experiences of CAM among healthcare professionals working with IBD patients is not well studied. Studies in this area could lead to enhanced awareness of and improved communication about CAM between care staff and IBD patients. The aim of this study was to explore IBD professionals’ attitudes to and experience of CAM.

Methods

Sixteen physicians and nurses, 26–70 years old, who had worked with IBD patients for 1–42 years, were recruited. Semi-structured qualitative interviews were conducted. Qualitative content analysis was performed.

Results

Participants stated patients used CAM to improve their well-being generally and there conditions specifically. Participants had a positive attitude towards CAM and respected their patients’ decision to use it, but reported a lack of CAM knowledge. They required education about CAM to be able to meet patients’ needs and provide adequate information. The result of this study indicates that there is a need for CAM education to be implemented in nursing and medical school.

Conclusions

All participants had experience of IBD patients who had used CAM in an attempt to achieve improvement and well-being. Attitudes to CAM were mainly positive, although a problematic aspect was lack of knowledge and evidence in relation to CAM. Implementing CAM education in nursing and medical school will allow healthcare professionals to gain an understanding of therapies widely used by patients with IBD. In clinical practice, using a standard questionnaire regarding CAM use allow healthcare professionals to better understand their patients’ wishes and current CAM use.

CAM Use and Suggestions for Medical Care of Senior Citizens: A Qualitative Study Using the World Café Method

Background. Little data exists concerning the reasons for using complementary and alternative (CAM) therapies by seniors. Therefore, the aim of this study is to learn about motives of German seniors for using CAM therapies and their wishes for health care in general. Methods. One focus group and one “World Café” following a semistructured interview guide were conducted. All discussions were recorded digitally, transcribed, and analyzed according to Qualitative Content Analysis using the software MAXQDA. Results. In total 21 seniors participated (eighteen female, three male, mean age 72.5 ± 4.3 years). Most of the participants had lifelong experiences with medicinal herbs and home remedies due to unavailable conventional care during childhood. Also important for them were nutrition and exercise. These methods were often used as self-care to enhance wellbeing, to prevent and to cure illnesses. The participants would welcome an integration of CAM in health care services. They asked especially for more empathic physicians who are better trained in CAM and respect their experiences. Conclusion. The importance of life experience in regard to health care by senior can be seen as a resource. Qualitative studies investigating physician-patient relationships and intergenerational aspects in CAM use could be of interest for further studies.

Inpatient treatment of community-acquired pneumonias with integrative medicine

Introduction. The aim of the presented observational case series was to evaluate the experience in treating patients with community-acquired pneumonia (CAP) within integrative medicine, particularly anthroposophic medicine in a well-experienced and specialized unit. Patients and Methods. Patients with proven CAP were evaluated (CAP-study group) based on a retrospective chart review. To estimate the severity of pneumonia, the pneumonia severity index (PSI) was applied. Treatment efficacy was evaluated regarding body temperature, CRP level, leukocytes blood count, the need to be treated on ICU, and mortality. Results were compared with the inpatient data of the Pneumonia PORT Validation Cohort. Results. 15/18 patients of the CAP-study group belonged to risk class groups I–III (low and moderate risk), 2 patients to risk class IV, and one patient to risk class V (severe pneumonia). 16/18 patients were treated with anthroposophic medicine only and 2/18 got additionally antibiotic therapy (both of risk class IV). A significant reduction of body temperature, CRP level, and leukocytes blood count has been obtained by applying anthroposophic medicine, while neither complications nor pneumonia-related death occurred. Compared with the control group there was no significant difference in mortality rate, whereby no patient had to be treated on the ICU, but the duration of hospital stay was significantly longer in the presented series. Conclusion. Inpatient treatment of CAP with anthroposophic medicine without the use of antibiotics may achieve reasonable results in selected cases. Additional larger sized prospective controlled trials should further clarify the role of AM in the treatment of CAP.

Complementary and alternative medicine utilization by a sample of infertile couples in Jordan for infertility treatment: clinics-based survey

Background

Although there is little information available to quantify the use of complementary and alternative medicine (CAM), growing evidence suggests that CAM prevalence among patients seeking infertility treatment is increasing worldwide. There are many products available on the market and many infertile patients demand information about CAM from their health care providers. This paper investigates the prevalence of CAM use among infertile couples in Jordan. Additionally, trends and factors contributing to CAM use for infertility treatment among these couples have been evaluated.

Methods

A face-to-face questionnaire inquiring demographic information, use of CAM for medical conditions, in general, and types of CAM used for infertility treatment, in specific, was completed by one thousand twenty one infertile patients attending at two types of facilities; in vitro Fertilization (IVF) centers at both public and private hospitals and infertility private clinics. Both types of facilities were distributed in different areas of Amman, the capital city of Jordan. The study was conducted between May and August 2012.

Results

Our results show that CAM therapies for infertility treatment were encountered in 44.7% of the study sample. The vast majority of CAM users were females. The most commonly used CAM therapies were herbs and spiritual healing. A clear correlation between the use of CAM for infertility versus the use of CAM for other chronic medical conditions has been found.

Conclusions

The prevalence of CAM use for infertility treatment in Jordan is relatively high, particularly among young females, well educated and with a low income, in consistence with the studies reported elsewhere. Herbs and spiritual healing are widely used among patients in adjunct to conventional medical interventions. As CAM use is prevalent among patients, there is a clear need for health providers to become more aware of this phenomenon and for further research in this field.

Möglichkeiten und Grenzen einer Zusammenarbeit mit Heilpraktikern aus ärztlicher Sicht

<b><i>Hintergrund: </i></b>Deutschland weist gegenüber zahlreichen anderen Staaten die Besonderheit auf, dass neben Ärzten auch Heilpraktiker eine staatliche Zulassung zur Ausübung der Heilkunde erlangen können. Das Verhältnis der beiden Berufsgruppen zueinander gilt als schwierig - unabhängig von berufsrechtlichen Hindernissen. Ziel der Untersuchung war es zu klären, inwieweit bei niedergelassenen Ärzten eine Bereitschaft zur Zusammenarbeit mit Heilpraktikern besteht. Gleichzeitig sollten Bedingungen, Chancen sowie Hindernisse einer Kooperation aufgezeigt werden. <b><i>Methoden: </i></b>Um die ärztliche Bereitschaft zur Zusammen arbeit mit Heilpraktikern zu evaluieren, wurden mit 15 niedergelassenen Ärzten und Zahnärzten semi-strukturierte Interviews geführt. Die Fragen thematisierten Bedingungen, Chancen sowie Barrieren einer Kooperation. Im Anschluss wurden die Interviews wörtlich transkribiert und mithilfe der thematischen Inhaltsanalyse ausgewertet. <b><i>Ergebnisse: </i></b>Einer Zusammenarbeit gegenüber aufgeschlossene Ärzte sehen Heilpraktiker als ergänzende Therapeuten bei leichteren oder psychisch beeinflussten Erkrankungen. Dafür bestehen allerdings klare Bedingungen: Heilpraktiker müssten die Grenzen ihrer Behandlungsfähigkeit erkennen. Voraussetzungen seien auch transparente Regelungen der Kostenerstattung durch Krankenkassen, insbesondere dürften ärztliche Leistungen im Bereich der Komplementär- und Alternativmedizin nicht diskriminiert werden. Neben dem mangelnden Vertrauen der befragten Ärzte in die Heilpraktikerausbildung erweist es sich als hinderlich, wenn Heilpraktiker störend auf die bestehende Arzt-Patienten-Beziehung einwirken bzw. den Abbruch einer schulmedizinischen Therapie veranlassen. Gleichzeitig wird die bestehende Patientenversorgung bereits als zu komplex für eine Kooperation eingeschätzt. <b><i>Schlussfolgerungen: </i></b>Um zu reproduzierbaren Ergebnissen zu gelangen, sind Untersuchungen mit quantitativem Forschungsdesign nötig. Auch sollte geklärt werden, inwieweit aus Sicht der Heilpraktiker eine Zusammenarbeit mit Ärzten wünschenswert ist. Der Abbau von Kommunikationsbarrieren ist nötig, damit Patienten offen mit ihrem Arzt über Heilpraktiker besuche sprechen kön-nen. Das Wissen über Unterschiede in Ausbildung und Zulassung zum Arzt oder Heilpraktiker ist Grundvoraussetzung für eine informierte Entscheidung der Patienten.

Knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward complementary and alternative medicine

BACKGROUND

Complementary and alternative medicine (CAM) is a popular treatment option for many populations. The present work is aimed at studying the knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward CAM.

MATERIAL AND METHODS

In this cross-sectional survey, a multistage random sample was taken from health professionals working in hospitals in Riyadh city and surrounding governorates. Data were collected through a self-administered questionnaire, from 306 health professionals working in 19 hospitals, on socio-demographic data, knowledge about CAM and their sources, and attitudes toward CAM practices.

RESULTS

Of the participants, 88.9% had some knowledge about CAM. Respondents with a doctorate degree (94.74%) and 92.53% of those with a bachelor's degree had significantly higher knowledge of CAM than subjects with a diploma, a fellowship, or a master's degree (68.75%, 76.67%, and 85.41%, respectively, P = 0.004). Mass media represented 60.1% of sources of the knowledge of CAM followed by family, relatives, and friends (29.08%) and health educational organizations (14.71%). Participants estimated that prophetic medicine including prayer, honey and bee products, medical herbs, Hijama, nutrition and nutritional supplements, cauterization, and camel milk and urine were the most commonly used CAM practices (90.5%, 85%, 76.9%, 70.6%, 61.4%, 55.9%, and 52.5%, respectively) in addition to medical massage (61.8%) and acupuncture (55%). One hundred and fifteen (80%) physicians were ready to talk with their patients on CAM.

CONCLUSION

The willingness to improve knowledge and create a positive attitude in health professionals toward CAM has increased. Religious practices, especially those related to prophetic medicine, are more common in the region. Health educational organizations have to play a greater role by being the source of evidence-based knowledge of CAM. Talking on CAM with patients should be improved by rooting them on evidence-based practices.

Community pharmacists' attitudes relating to patients' use of health products in Japan

BACKGROUND

There is little information about Japanese pharmacists' perceived facilitators and barriers to communication with patients about orally taken health products, including herbs and dietary supplements.

OBJECTIVE

To explore Japanese pharmacists' attitudes relating to patients' use of health products.

METHOD

Qualitative study involving focus group interviews with pharmacists was conducted. Data were analyzed using the constant comparative method.

SETTING

Focus group interviews with community pharmacists were conducted in Japan. Main outcome measure Pharmacists' views and experiences about patients' health product use and their perceived facilitators and barriers to communication.

RESULTS

Sixteen pharmacists participated and were asked to describe their views and experiences about patients' health product use. Some were uncomfortable inquiring about and being asked about patients' health product use, due to lack of scientific evidence for their efficacy and safety, lack of knowledge to advise patients properly, and fear that they could not answer patients' questions. Other pharmacists had similar views or experiences, but those who were proactive in communicating with patients were motivated by certain predisposing factors, such as their professional responsibility for ensuring patients' health and safety.

CONCLUSION

This study showed that differences in opinion about their roles might create differences in pharmacists' attitudes toward patients' health product use. This highlights the importance of reconsidering pharmacists' roles in community settings. Further studies and debate are needed in order to clarify the pharmacists' roles and to ensure the design of educational objectives that would enable pharmacists to support their patients in using health products and prescription drugs safely.

Pakistani pharmacy students' perception about complementary and alternative medicine

OBJECTIVES

To assess Pakistani pharmacy students' perceptions of complementary and alternative medicine (CAM), the frequency with which they use CAM, and barriers to use of CAM.

METHOD

A CAM health belief questionnaire was administered to 595 students enrolled in a 5-year doctor of pharmacy program (PharmD) in Pakistan.

RESULTS

Attitudes of students towards CAM were positive. Lack of evidence supporting CAM practices was considered to be the major barrier toward more students using CAM. A majority of students (79%) agreed that clinical care should integrate conventional medicine and CAM practices. Many CAM-based therapies, such as dietary supplements, massage, herbal medicines, and homoeopathic medicines were used by the students. Significant gender differences in attitude were observed, with male students having more conservative attitudes toward CAM use. A high percentage of students desired more training in CAM.

CONCLUSIONS

Pakistani students exhibited positive attitudes about the value of CAM and most felt that CAM should be included in the PharmD curriculum.

Characteristics and job satisfaction of general practitioners using complementary and alternative medicine in Germany--is there a pattern?

Background

The use of Complementary and Alternative medicine (CAM) has increased over the past years. In Germany, many general practitioners (GPs) use CAM in their daily practice. However, little is known about possible differences of GPs using CAM compared to GPs not using CAM. The aim of the study was to explore differences in personal and practice characteristics, work load and job satisfaction of GPs depending on their use of and attitude towards CAM. Furthermore, predictors for CAM use should be explored.

Methods

A questionnaire was developed based on qualitatively derived data. In addition, a validated instrument assessing job satisfaction was included in the questionnaire, which was sent to 3000 randomly selected GPs in Germany.

Results

1027 returned the questionnaire of which 737 indicated to use CAM in daily practice. We found that GPs using CAM are more female, younger and have a trend towards a healthier life style. Their practices have higher proportions of privately insured patients and are slightly better technically equipped with ultrasound. GPs with a positive attitude had significant better values within the job satisfaction scale and lower working hours per week compared to GPs with neutral/negative attitude. Significant predictors for CAM use were a positive attitude towards CAM, holding a special qualification in CAM, own CAM use and the availability of an ultrasound in practice.

Conclusions

The identified differences suggest that those GPs using and believing in CAM have a different medical orientation and approach which in turn may influence their job satisfaction. With this finding CAM use turns out to be a relevant factor regarding job satisfaction and, with this, may be a possible lever to counteract the growing dissatisfaction of GPs in Germany. This finding could also be important for designing strategies to promote the recruitment of young doctors to general practice.

Complementary and Alternative Medicine: Comparison of Current Knowledge, Attitudes and Interest among German Medical Students and Doctors

Although it has been agreed that complementary and alternative medicine (CAM) should be included in the German medical curriculum, there is no consensus on which methods and how it should be taught. This study aimed to assess needs for CAM education by evaluating current knowledge, attitudes and interests of medical students, general physicians and gynecologists. Two instruments based on established and validated questionnaires were developed. One was given to seventh semester medical students and the other to office-based doctors. Data were analyzed by bivariate correlation and cross-tabulation. Altogether 550 questionnaires were distributed-280 to doctors and 270 to medical students. Completed questionnaires were returned by 80.4% of students and 78.2% of doctors. Although 73.8% (160/219) of doctors and 40% (87/217) of students had already informed themselves about CAM, neither group felt that they knew much about CAM. Doctors believed that CAM was most useful in general medicine, supportive oncology, pediatrics, dermatology and gynecology, while students believed that dermatology, general medicine, psychiatry and rheumatology offered opportunities; both recommended that CAM should be taught in these areas. Both groups believed that CAM should be included in medical education; however, they believed that CAM needed more investigation and should be taught "critically". German doctors and students would like to be better informed about CAM. An approach which teaches fundamental competences to students, chooses specific content based on evidence, demographics and medical conditions and provides students with the skills they need for future learning should be adopted.

Information resource needs and preference of queensland general practitioners on complementary medicines: result of a needs assessment

Objectives. To explore in a cohort of Queensland (Qld) GPs' their attitudes to; knowledge about; and practice behaviour regarding complementary medicines (CMs), and to identify their perceptions of need for information resources on CMs. Design. A faxed self-administered survey to a random sample of 800 GPs in Qld. Participants. 463 completed surveys were returned, representing a 58% response rate. Results. The majority of GPs had a positive attitude about incorporating CMs in their clinical practice; however, only 12% perceived they had adequate knowledge to be able to advise patients about CMs. GPs most preferred evidence-based resources for receiving information on CMs (fact sheets, booklets, and journals) that contain clinical, pharmacological, and toxicological information. Most GPs perceived a need for an information resource on herbal medicines, vitamins, minerals, and trace elements, and nutritional supplements. Conclusion. GPs are open to integrating CMs into their clinical practice. They identify a current lack of knowledge coupled with a substantive level of interest to learn more. GPs perceive a high level of need for information resources on CMs. These resources should be developed and readily available to GPs to increase their knowledge about CMs and better equip them in communicating with patients about CMs use.

What about N? A methodological study of sample-size reporting in focus group studies

BACKGROUND

Focus group studies are increasingly published in health related journals, but we know little about how researchers use this method, particularly how they determine the number of focus groups to conduct. The methodological literature commonly advises researchers to follow principles of data saturation, although practical advise on how to do this is lacking. Our objectives were firstly, to describe the current status of sample size in focus group studies reported in health journals. Secondly, to assess whether and how researchers explain the number of focus groups they carry out.

METHODS

We searched PubMed for studies that had used focus groups and that had been published in open access journals during 2008, and extracted data on the number of focus groups and on any explanation authors gave for this number. We also did a qualitative assessment of the papers with regard to how number of groups was explained and discussed.

RESULTS

We identified 220 papers published in 117 journals. In these papers insufficient reporting of sample sizes was common. The number of focus groups conducted varied greatly (mean 8.4, median 5, range 1 to 96). Thirty seven (17%) studies attempted to explain the number of groups. Six studies referred to rules of thumb in the literature, three stated that they were unable to organize more groups for practical reasons, while 28 studies stated that they had reached a point of saturation. Among those stating that they had reached a point of saturation, several appeared not to have followed principles from grounded theory where data collection and analysis is an iterative process until saturation is reached. Studies with high numbers of focus groups did not offer explanations for number of groups. Too much data as a study weakness was not an issue discussed in any of the reviewed papers.

CONCLUSIONS

Based on these findings we suggest that journals adopt more stringent requirements for focus group method reporting. The often poor and inconsistent reporting seen in these studies may also reflect the lack of clear, evidence-based guidance about deciding on sample size. More empirical research is needed to develop focus group methodology.

Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial

OBJECTIVES

Migraine is one of the most prevalent neurological disorders in Europe, severely affecting ability to work and quality of life. Medical therapies are considered to be the "gold standard" of treatment. This study addresses osteopathic treatment for acute therapy or prophylactic therapy as an alternative to traditional therapies.

DESIGN

Forty-two (42) female patients with migraine were randomized into an intervention group (n = 21) and a control group (n = 21). Outcomes were evaluated with three questionnaires before the treatment (t1) and 6 months later (t2).

INTERVENTIONS

The intervention group received five 50-minute osteopathic manipulative treatments (OMT) over a 10-week period. The control group did not receive OMT, sham treatment, or physical therapy. Patients of this group only filled the questionnaires. Both groups continued with previously prescribed medication.

METHODS

The Migraine Disability Assessment (MIDAS) and Short Form-36 (SF-36) questionnaires as well as a German "pain questionnaire" were used to assess pain intensity, the impact of migraine on daily life and health-related quality of life (HRQoL), and the number of days subjects suffered from migraine.

RESULTS

Three (3) of the eight HRQoL domains of the SF-36 form in the intervention group showed significant improvement (from t1 to t2), with a general betterment exhibited in the other domains. The total MIDAS score, pain intensity, and disturbance in occupation due to migraine as well as number of days of disablements were also significantly reduced. The control group showed insignificant differences in these areas.

CONCLUSIONS

This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.

Integration of complementary and alternative medicine into family practices in Germany: results of a national survey

More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners ("Heilpraktiker"). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.

Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study

Background

Infertility patients are a vulnerable group that often seeks a non-medical solution for their failure to conceive. World-wide, women use CAM for productive health, but only a limited number of studies report on CAM use to enhance fertility. Little is known about traditional and religious forms of therapies that are used in relation to conventional medicine in Turkey. We investigated the prevalence and types of complementary and alternative medicine (CAM) used by infertile Turkish women for fertility enhancement.

Methods

A face-to-face questionnaire inquiring demographic information and types of CAM used for fertility enhancement were completed by hundred infertility patients admitted to a primary care family planning centre in Van, Turkey between January and July 2009.

Results

The vast majority of infertile women had used CAM at least once for infertility. CAM use included religious interventions, herbal products and recommendations of traditional "hodja's" (faith healers). Of these women, 87.8% were abused in the last 12 months, 36.6% felt not being supported by her partner and 80.5% had never spoken with a physician about CAM.

Conclusions

Infertile Turkish women use complementary medicine frequently for fertility enhancement and are in need of information about CAM. Religious and traditional therapies are used as an adjunct to, rather than a substitute for, conventional medical therapy. Physicians need to approach fertility patients with sensitivity and should be able to council their patients about CAM accordingly.

Complementary and alternative medicine and the search for knowledge by conventional health care practitioners

The use of complementary and alternative medicines (CAM) is growing rapidly within the western world and the nexus with conventional health care services is expanding. Many nurses and other conventional health care providers are not only using CAM themselves but see many of their clients using these medicines and therapies. The attitudes to CAM can influence client satisfaction and client use of different therapies and many practitioners of conventional health care are seeking education and information to enhance their knowledge and use of CAM. This paper reflects on the attitudes to CAM and the education needs and services in the field of CAM as identified by western health care providers, in particular nurses.

Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners

Background

Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.

Methods

Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.

Results

Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.

Conclusions

The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.

Prolonged endoplasmic reticulum stress induces apoptotic cell death in an experimental model of chronic cyclosporine nephropathy

BACKGROUND/AIMS

Apoptosis contributes to cyclosporine (CsA)-induced renal cell death. This study tested the effects of CsA-induced endoplasmic reticulum (ER) stress on apoptotic cell death in an experimental model of chronic CsA nephropathy.

METHODS

CsA (15 mg/kg per day) was given to rats for 7 or 28 days. The ER stress response was evaluated with BiP expression, and the proapoptotic response was assessed with CHOP and caspase 12 expression. ER structure was evaluated by transmission electron microscopy, and apoptotic cell death was detected with TUNEL staining.

RESULTS

Short-term treatment of CsA for 7 days activated both the ER stress response (induction of BiP mRNA and protein) and the proapoptotic response (upregulation of caspase 12 and CHOP mRNAs and proteins). However, long-term treatment with CsA for 28 days decreased BiP and further increased CHOP. The imbalance between the two responses coincided with the timing of the appearance of apoptotic cell death and the disruption of the ER structure.

CONCLUSION

Prolonged CsA-induced ER stress causes apoptotic cell death by depleting molecular chaperones and activating the proapoptotic pathway.