Complementary And Alternative Medicine Recommendations Research Articles

Complementary and Alternative Medicine Use and Its Determinant Factors in Iranian Asthma and Chronic Obstructive Pulmonary Disease Patients

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic diseases with a high global burden of disease. Today, the use of complementary and alternative medicine (CAM) has become more popular. In general, in developing countries, easy access and low cost of traditional medicine, and in developed countries, more access to health information, the prevalence of old age and the increase in chronic diseases are the reasons for this increasing use of traditional medicine. This study aimed to determine the rate and pattern of CAM used and their relationships with demographic characteristics among asthmatic and COPD patients. This research was a cross-sectional study performed on asthma and COPD patients (n=357) referring to the Pulmonary Diseases affiliated with Ardabil University of Medical Sciences, Ardabil, Iran from 2019 to 2020. Data were collected by using semi-structured questionnaires including open and closed questions and face-to-face interviews. Three hundred and thirty-nine patients (95%) used at least one type of CAM in the last year of study. About half of the patients (49.9%) used more than two types of CAM during the last 12 months. Three hundred and four patients (85.2%) used medicinal plants. Few patients reported with the use of CAM to their physician or health care providers (16.1%, 12.5%, and 16.7% of the users of medicinal plants, bloodletting, and dry cupping respectively). Relatives and friends (77.9%) were with the most common sources of recommendation of CAM to the patients. The present study showed the high prevalence of using different types of CAM, especially herbal medicines in Iranian asthmatic and COPD patients. The main incentive for using CAM was for friends and family members, not health care providers. The use of CAM is associated with age patients age, family size, habitat, education, and occupation.

Complementary and alternative medicine mention and recommendations in inflammatory bowel disease guidelines: systematic review and assessment using AGREE II

BackgroundMany patients with inflammatory bowel disease (IBD) use complementary and alternative medicine (CAM) for disease management. There is, however, a communication gap between patients and healthcare professionals regarding CAM use, where patients are hesitant to disclose CAM use to providers. The purpose of this study was to identify the quantity and assess the quality of CAM recommendations in IBD clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.MethodsMEDLINE, EMBASE, and CINAHL were systematically searched from 2011 to 2022 to find CPGs for the treatment and/or management of IBD. The Guidelines International Network (GIN) and National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs were assessed using the AGREE II instrument.ResultsNineteen CPGs made CAM recommendations for IBD and were included in this review. Average scaled domain percentages of CPGs were as follows (overall CPG, CAM section): scope and purpose (91.5%, 91.5%), clarity of presentation (90.3%, 64.0%), editorial independence (57.0%, 57.0%), stakeholder involvement (56.7%, 27.8%), rigour of development (54.7%, 45.9%), and applicability (14.6%, 2.1%).ConclusionsThe majority of CPGs with CAM recommendations were of low quality and their CAM sections scored substantially lower relative to other therapies in the overall CPG. In future updates, CPGs with low scaled-domain percentages could be improved in accordance with AGREE II and other guideline development resources. Further research investigating how CAM therapies can best be incorporated into IBD CPGs is warranted.

Neck pain clinical practice guidelines: a systematic review of the quality and quantity of complementary and alternative medicine recommendations.

Individuals with neck pain frequently turn to complementary and alternative medicine (CAM) to seek relief. However, conventional healthcare providers often lack adequate CAM therapy knowledge to deliver informed recommendations to patients. The purpose of this study was to identify mention of CAM in neck pain clinical practice guidelines (CPG) and assess the quality of CAM recommendations using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to 2020 in addition to the Guidelines International Network and National Center for Complementary and Integrative Health websites. Eligible CPGs providing CAM recommendations were assessed twicewith the AGREE II instrument, onceto assess the overall CPG and then onceto assess the CAM sections specifically. From 643 unique search results, 15 CPGs on the treatment and/or management of neck pain were identified, and 8 made recommendations on CAM therapy. Regarding scaled domain percentages, the overall CPG scored higher than the CAM section for 5 of 6 domains (overall, CAM): (1) scope and purpose (93.4%, 93.1%), (2) stakeholder involvement (81.6%, 81.9%), (3) rigour of development (70.8%, 66.3%), (4) clarity of presentation (64.9%, 60.8%), (5) applicability (39.3%, 33.6%), and (6) editorial independence (47.9%, 45.3%). Most neck pain CPGs made CAM recommendations. The quality of CAM recommendations is lower than overall recommendations across all domains with the exception of stakeholder involvement. This disparity highlights the need for CAM recommendations quality improvement. Although many patients with neck pain seek CAM therapies, few CPGs are available for healthcare providers and patients.

Corrigendum to “CAM recommendations in type 2 diabetes clinical practice guidelines: A systematic review” [Eur. J. Integr. Med. 48C (2021)

It has been reported that up to 70% of patients with type 2 diabetes mellitus (T2DM) use complementary and alternative medicine (CAM) each year. Healthcare providers refer to clinical practice guidelines (CPGs) in order to assist patients in making evidence-based decisions, however, no resource currently systematically summarizes CAM-related recommendations across CPGs for the treatment and/or management of T2DM. The purpose of this study was to identify all CPGs that make CAM-related recommendations and summarize them in a single review. We conducted a systematic search of MEDLINE, EMBASE, and CINAHL databases, as well as the Guidelines International Network and National Center for Complementary and Integrative Health websites, to identify CPGs for the treatment and/or management of T2DM published between 2009 and 2020, inclusive. Two independent reviewers conducted a data extraction of types of CAM mentioned and how they were recommended across all eligible CPGs. Of 2607 unique search results, 27 CPGs were eligible, and 7 included CAM therapy recommendations. Recommendations relating to CAM made in these 7 CPGs included (number of recommendations in total; for/against/uncertain): cardioprotective diet (1;1/0/0), cognitive behavioural therapy (1;1/0/0), diet emphasizing dietary pulses (1;1/0/0), diet emphasising fruits and vegetables (1;1/0/0), diet emphasizing nuts (1;1/0/0), Dietary Approaches to Stop Hypertension (DASH) diet (2;2/0/0), folic acid (1;1/0/0), goal setting skills (1;1/0/0), herbs (1;0/0/1), Mediterranean diet (3;3/0/0), motivational interviewing (1;1/0/0), omega-3 (2;0/1/1), plant-based preparations (1;1/0/0), potassium (1;1/0/0), selenium (1;0/0/1), vegan/vegetarian diet (1;1/0/0), vitamin A (1;0/0/1), vitamin C (1;0/0/1), vitamin D3 (1;1/0/0), vitamin E (2;0/1/1), vitamin/micronutrient supplementation (1;0/1/0), and yoga (1;1/0/0). CAM therapies for T2DM are only represented in approximately one-quarter of CPGs. Given that a high proportion of T2DM patients use CAM, current T2DM CPGs’ neglect of CAM treatment and/or management highlights a major gap in guidance for clinicians and patients.

Headache and migraine clinical practice guidelines: a systematic review and assessment of complementary and alternative medicine recommendations

BackgroundGlobally, 3 billion people suffer from either migraine or tension-type headache disorder over their lifetime. Approximately 50% of American adults suffering from headache or migraine have used complementary and alternative medicine (CAM), however, the quality and quantity of recommendations associated with such therapies across clinical practice guidelines (CPGs) for the treatment and/or management of these conditions are unknown. The purpose of this study was to identify the quantity and assess the quality of such CAM recommendations.MethodsMEDLINE, EMBASE and CINAHL were systematically searched from 2009 to April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched for eligible CPGs. CPGs were included if they provided any therapy recommendations. Eligible CPGs included those written for adult patients with headache and migraine; CPGs containing CAM recommendations were assessed twice for quality using the AGREE II instrument, once for the overall CPG and once for the CAM sections.ResultsOf 486 unique search results, 21 CPGs were eligible and quality assessed; fifteen CPGs mentioned CAM, of which 13 CPGs made CAM recommendations. The overall CPG assessment yielded higher scaled domain percentages than the CAM section across all domains. The results from highest to lowest were as follows (overall, CAM): clarity of presentation (66.7% vs. 50.0%), scope and purpose (63.9% vs. 61.1%), stakeholder involvement (22.2% vs. 13.9%), rigour of development (13.5% vs. 9.4%), applicability (6.3% vs. 0.0%), and editorial independence (0.0% vs. 0.0%).ConclusionsOf the eligible CPGs, the CAM sections were of lower quality compared to the overall recommendations across all domains of the AGREE II instrument. CPGs that scored well could serve as a framework for discussion between patients and healthcare professionals regarding use of CAM therapies in the context of headache and migraine.

Quantity and quality of complementary and alternative medicine recommendations in clinical practice guidelines for type 2 diabetes mellitus: A systematic review

AimsApproximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and subsequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM. Data synthesisMEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.7%, 79.8%), clarity of presentation (85.7%, 48.4%), stakeholder involvement (67.9%, 28.2%), applicability (54.8%, 20.2%), rigour of development (49.7%, 35.7%), and editorial independence (44.1%, 44.1%). ConclusionsQuality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap exists for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients.

A Systematic Review and Quality Assessment of Breast Cancer Clinical Practice Guidelines Providing Complementary and Alternative Medicine Recommendations

Up to 80% of patients with breast cancer are reported to use complementary and alternative medicine (CAM). Despite this high prevalence, many healthcare providers have little knowledge and education surrounding this topic and may be inadequately prepared to discuss such therapies with their patients. Given this knowledge gap, the purpose of this study was to systematically identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of breast cancer. Thirty-four CPGs were deemed eligible, 5 of which mentioned CAM, and 4 of which made CAM recommendations. Eligible CPGs containing CAM recommendations were assessed with the AGREE II instrument. Scaled domain percentages from highest to lowest were (% overall, % CAM) as follows: scope and purpose (100.0%, 100.0%), editorial independence (100.0%, 100.0%), clarity of presentation (97.2%, 80.6%), rigour of development (80.2%, 80.2%), stakeholder involvement (88.9%, 77.8%), and applicability (58.3%, 58.3%). CPGs with favourable scores may provide practitioners with guidance on safe and effective use of CAM therapies. A need exists to improve the quality of CAM recommendations in CPGs.

The Presence of Complementary and Alternative Medicine Recommendations in Head and Neck Cancer Guidelines: Systematic Review and Quality Assessment.

A high proportion of head and neck cancer (HNC) patients use complementary and alternative medicine (CAM), however, healthcare professionals generally have little knowledge about the safety and efficacy of these therapies. The purpose of this study was to determine the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of HNC. MEDLINE, EMBASE, and CINAHL were systematically searched for HNC CPGs published between 2009 and April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also were searched. Eligible CPGs containing CAM recommendations were assessed twice with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument, once for the overall CPG and once for the CAM sections. Of 305 unique search results, 7 CPGs mentioned CAM and 4 CPGs made CAM recommendations. The overall CPG scored higher than the CAM section for 4 of 6 domains (overall, CAM): scope and purpose (93.8%, 93.8%), clarity of presentation (88.2%, 64.6%), stakeholder involvement (68.8%, 39.6%), rigor of development (58.3%, 34.6%), editorial independence (42.7%, 42.7%), and applicability (51.6%, 19.8%). Quality varied within and between CPGs. Highly scoring CPGs serve as evidence-based resources that clinicians can use to inform their patients about safe and effective CAM use; CPGs achieving variable or lower scores could be improved in future updates based on currently available guideline development/implementation tools. Future research should identify CAM therapies supported by sufficient evidence to be included as part of HNC CPGs.

A systematic review and quality assessment of complementary and alternative medicine recommendations in insomnia clinical practice guidelines

BackgroundSleep disorders encompass a wide range of conditions which affect the quality and quantity of sleep, with insomnia being a specific type of sleep disorder of focus in this review. Complementary and alternative medicine (CAM) is often utilized for various sleep disorders. Approximately 4.5% of individuals diagnosed with insomnia in the United States have used a CAM therapy to treat their condition. This systematic review identifies the quantity and assesses the quality of clinical practice guidelines (CPGs) which contain CAM recommendations for insomnia.MethodsMEDLINE, EMBASE and CINAHL were systematically searched from 2009 to 2020, along with the Guidelines International Network, the National Center for Complementary and Integrative Health website, the National Institute for Health and Care Excellence, and the Emergency Care Research Institute. CPGs which focused on the treatment and/or management of insomnia in adults were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.ResultsFrom 277 total results, 250 results were unique, 9 CPGs mentioned CAM for insomnia, and 6 out of the 9 made CAM recommendations relevant to insomnia. Scaled domain percentages from highest to lowest were scope and purpose, clarity of presentation, editorial independence, stakeholder involvement, rigour of development, and applicability. Quality varied within and across CPGs.ConclusionsThe CPGs which contained CAM recommendations for insomnia and which scored well could be used by health care professionals and patients to discuss the use of CAM therapies for the treatment/management of insomnia, while CPGs which scored lower could be improved in future updates according to AGREE II.

Guidelines for Cancer-Related Pain: A Systematic Review of Complementary and Alternative Medicine Recommendations.

Although up to 85% of patients with cancer use complementary and alternative medicine (CAM), they commonly do not disclose this information to their healthcare providers. Cancer-related pain (CRP) is one of the most common symptoms among those who may seek CAM. This study was conducted to identify the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of CRP, as this has not been explored in the literature. A systematic review was conducted to identify cancer pain CPGs. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 2009 to 2020. The Guideline International Network and the National Centre for Complementary and Integrative Health websites were also searched. Eligible CPGs on CRP in adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Of 771 unique search results, 13 mentioned CAM and 11 made CAM recommendations. Eligible CPGs were published in 2009 or later and focused on the treatment/management of CRP. Scaled domain percentages from highest to lowest ranged from (overall, CAM): 88.1%, 88.1% (for scope and purpose) to 21.0%, 8.5% (for applicability). Quality varied within and across CPGs. One CPG was recommended by both appraisers; 6 were recommended as "Yes" or "Yes with modifications." The present study has identified and summarized a number of CPGs that clinicians may consult to understand what CAMs are recommended in the context of the treatment and/or management of CRP.

Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines

BackgroundUp to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.MethodsA systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections.ResultsFrom 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers.ConclusionsThere are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.

Rheumatoid arthritis and osteoarthritis clinical practice guidelines provide few complementary and alternative medicine therapy recommendations: a systematic review.

Sixty percent of patients with arthritis have used complementary and alternative medicine (CAM) therapies at least once. The two most common types of arthritis include rheumatoid arthritis (RA) and osteoarthritis (OA). The quality and quantity of CAM recommendations for RA and OA is currently unknown. The purpose of this research was to identify the quantity and assess thequality of CAM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of RA and OA. A systematic review was conducted to identify CPGs; MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Three independent reviewers evaluated the quality of reporting for each guideline that provided CAM recommendations, and the specific section providing CAM recommendations, using the AGREE II instrument. From 525 unique search results, seven guidelines (3 OA, 4 RA) mentioned CAM and 5 guidelines made CAM recommendations. Scaled domain percentages from highest to lowest were (overall, CAM) as follows: clarity of presentation (92.2% vs. 94.1%), scope and purpose (90.1% vs. 87.4%), rigour of development (72.6% vs. 64.2%), stakeholder involvement (64.8% vs. 49.6%), editorial independence (61.1% vs. 60.6%), and applicability (51.4% vs. 33.3%). None of the 5 guidelines was recommended by both appraisers for either the overall guideline or CAM section. For the overall guideline, appraisers agreed in their overall recommendation for 3 of 5 guidelines, including 3 Yes with modifications; of the remaining 2 guidelines, 1 was rated by the three appraisers as 1 No and 2 Yes with modifications, while 1 guideline was rated at 2 Yes and 1 Yes with modifications. For the CAM section, appraisers agreed in their overall recommendation for all 5 guidelines including 1 No, and 4 Yes with modifications. Roughly half of arthritis CPGs found included in this review provided CAM recommendations. The quality of CAM recommendations are of lower quality than overall recommendations across the scope and purpose, stakeholder involvement, rigour of development, applicability, and editorial independence domains. Quality varied within and across guidelines.

Quality of complementary and alternative medicine recommendations in low back pain guidelines: a systematic review.

Individuals with low back pain (LBP) often turn to complementary and alternative medicine (CAM) to seek relief. The purpose of this study was to determine mention of CAM in LBP clinical practice guidelines and assess the quality of CAM recommendations using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. A systematic review was conducted to identify LBP guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines providing CAM recommendations were assessed with the AGREE II instrument. From 181 unique search results, 22 guidelines on the treatment and/or management of LBP were found, and 17 made recommendations on CAM therapy. With regard to scaled domain percentages, this overall guideline scored higher than the CAM section for 4 of 6 domains (overall, CAM): (1) scope and purpose (88.6%, 87.1%), (2) clarity of presentation (83.0%, 73.2%), (3) stakeholder involvement (57.0%, 41.7%), (4) rigor of development (47.2%, 44.7%), (5) editorial independence (34.8%, 34.8%) and (6) applicability (31.8%, 21.8%). The majority of LBP guidelines made CAM recommendations. The quality of CAM recommendations is significantly lower than overall recommendations across all domains with the exception of scope and purpose and editorial independence. This difference highlights the need for CAM recommendation quality improvement. Future research should identify CAM therapies which are supported by sufficient evidence to serve as the basis for guideline development. These slides can be retrieved under Electronic Supplementary Material.

Attitudes, Knowledge, Use, and Recommendation of Complementary and Alternative Medicine by Health Professionals in Western Mexico

The use of complementary and alternative medicine (CAM) has increased in many countries, and this has altered the knowledge, attitudes, and treatment recommendations of health professionals in regard to CAM. Considering Mexican health professionals׳ lack of knowledge of CAM, in this report we surveyed 100 biomedical researchers and Ph.D. students and 107 specialized physicians and residents of a medical specialty in Guadalajara, México (Western Mexico) with a questionnaire to address their attitudes, knowledge, use, and recommendation of CAM. We observed that significantly more researchers had ever used CAM than physicians (83% vs. 69.2%, P = .023) and that only 36.4% of physicians had ever recommended CAM. Female researchers tended to have ever used CAM more than male researchers, but CAM use did not differ between genders in the physician group or by age in either group. Homeopathy, herbal medicine, and massage therapy were the most commonly used CAMs in both the groups. Physicians more frequently recommended homeopathy, massage therapy, and yoga to their patients than other forms of CAM, and physicians had the highest perception of safety and had taken the most courses in homeopathy. All CAMs were perceived to have high efficacy (>60%) in both the groups. The attitude questionnaire reported favorable attitudes toward CAM in both the groups. We observed a high rate of Mexican health professionals that had ever used CAM, and they had mainly used homeopathy, massage therapy, and herbal medicine. However, the recommendation rate of CAM by Mexican physicians was significantly lower than that in other countries, which is probably due to the lack of CAM training in most Mexican medical schools.

Israeli Nurses’ Attitudes to the Holistic Approach to Health and Their Use of Complementary and Alternative Therapies

To examine nurses' attitudes to holistic and biomedical approaches to health care and the correlation between the two and to explore the extent of recommending and using complementary and alternative medicine (CAM) by nurses and its correlation with attitudes toward the holistic approach to care. In this cross-sectional correlational study, a structured questionnaire was completed anonymously by 213 Israeli hospital-based nurses from various departments. Nurses perceived both approaches as critical to optimal health care: a positive correlation emerged of attitudes to the two approaches. Nurses recommended and used CAM extensively; most therapies were recommended and/or used by 70% or more of the respondents. Nurses with more positive attitudes toward holistic care tended to recommend and use CAM to a greater extent. Biomedical and holistic approaches are perceived by nurses to coexist within nursing professional boundaries and form a broad basis for optimal health care. Nurses' attitudes to the holistic approach appear to promote recommendation and/or use of CAM in practice. More training in CAM should be offered in nursing educational frameworks and research should continue to establish evidence for CAM's effectiveness.

Use of complementary and alternative medicine by patients with cluster headache: Results of a multi-centre headache clinic survey

To evaluate the rates, pattern, satisfaction with, and presence of predictors of complementary and alternative medicine (CAM) use in a clinical population of patients with cluster headache (CH). One hundred CH patients attending one of three headache clinics were asked to undergo a physician-administered structured interview designed to gather information on CAM use. Past use of CAM therapies was reported by 29% of the patients surveyed, with 10% having used CAM in the previous year. Only 8% of the therapies used were perceived as effective, while a partial effectiveness was reported in 28% of CAM treatments. The most common source of recommendation of CAM was a friend or relative (54%). Approximately 62% of CAM users had not informed their medical doctors of their CAM use. The most common reason for deciding to try a CAM therapy was that it offered a "potential improvement of headache" (44.8%). Univariate analysis showed that CAM users had a higher income, had a higher lifetime number of conventional medical doctor visits, had consulted more headache specialists, had a higher number of CH attacks per year, and had a significantly higher proportion of chronic CH versus episodic CH. A binary logistic regression analysis was performed and two variables remained as significant predictors of CAM use: income level (OR=5.7, CI=1.6-9.1, p=0.01), and number of attacks per year (OR=3.08, CI=1.64-6.7, p<0.0001). Our findings suggest that CH patients, in their need of and quest for care, seek and explore both conventional and CAM approaches, even though only a very small minority finds them very satisfactory.

Physician Assistant Student Attitudes Toward Complementary and Alternative Medicine Before and After Completion of a Core Curriculum

Purpose: Complementary and alternative medicine (CAM) are controversial but popular modalities utilized by many Americans as an approach to health and disease. The PA program at Duke University includes a required curriculum in CAM, which presents traditional CAM modalities and stresses evidence-based integrative medicine (IM). We surveyed three cohorts of physician assistant (PA) students to determine their attitudes toward CAM therapy. Methods: We presented three student cohorts, with different levels of exposure to the CAM curriculum, with a survey about their attitudes toward CAM therapies. Responses from each cohort were tabulated and data were analyzed using the chi-square test for differences in proportions. When any cell frequency counts were less than 5, the Fisher exact test was used. Result: Responses to the survey were similar across all three cohorts; with no statistically significant differences in general attitudes toward CAM, with one exception. Similarly, except for divergence of opinion regarding the utility of chiropractic, students in all cohorts did not have significant differences of opinion about the utility of various CAM modalities, regardless of their level of training or exposure to a CAM curriculum. In attitudes about use of CAM by patients, and recommendation of CAM by practitioners, the majority of respondents agreed that CAM should be studied, recommended, and used by patients. Agreement about the utility of various CAM modalities did not vary substantially among cohorts. Conclusion: The survey showed little difference in attitudes and knowledge among the three groups, regardless of their level of training. This may reflect limited impact of the CAM curriculum, but may also reflect widespread media coverage of CAM, as well as student exposure to diverse health care settings prior to entering a PA program. Longitudinal studies of students' attitudes toward CAM, before and after exposure to a formal curriculum, may provide further data that is useful in CAM curriculum design.

Prevalence, Pattern and Predictors of use of Complementary and Alternative Medicine (CAM) in Migraine Patients Attending a Headache Clinic in Italy

The use of complementary and alternative medicine (CAM) in migraine is a growing phenomenon about which little is known. This study was undertaken to evaluate the rates, pattern and presence of predictors of CAM use in a clinical population of patients with different migraine subtypes. Four hundred and eighty-one migraineurs attending a headache clinic were asked to undergo a physician-administered structured interview designed to gather information on CAM use. Past use of CAM therapies was reported by 31.4% of the patients surveyed, with 17.1% having used CAM in the previous year. CAM therapies were perceived as beneficial by 39.5% of the patients who had used them. A significantly higher proportion of transformed migraine patients reported CAM treatments as ineffective compared with patients suffering from episodic migraine (73.1% vs. 50.7%, P < 0.001). The most common source of a recommendation of CAM was a friend or relative (52.7%). In most cases, migraineurs' recourse to CAM treatments was specifically for their headache (89.3%). Approximately 61% of CAM users had not informed their medical doctors of their CAM use. The most common reason for deciding to try a CAM therapy was that it offered a 'potential improvement of headache' (47.7%). The greatest users of CAM treatments were: patients with a diagnosis of transformed migraine; those who had consulted a high number of specialists and reported a higher lifetime number of conventional medical visits; those with a comorbid psychiatric disorder; those with a high income; and those whose headache had been either misdiagnosed or not diagnosed at all. Our findings suggest that headache clinic migraine patients, in their need of and quest for care, seek and explore both conventional and CAM approaches. Physicians should be made aware of this patient-driven change in the medical climate in order to prevent misuse of healthcare resources and to be better equipped to meet patients' needs.

Physicians Want Education About Complementary and Alternative Medicine to Enhance Communication With Their Patients

More than one third of patients in the United States use complementary and alternative medicine (CAM); most also visit conventional physicians. There is little information about how physicians and patients discuss CAM. We hypothesized that physicians frequently fielded questions about CAM treatments but felt uncomfortable discussing them owing to a lack of education. To survey physicians to see how they discussed CAM with their patients and what factors influenced discussions and referrals. A total of 751 physicians in the Denver, Colo, area were asked about their experience with CAM and communication about CAM with patients. Analyses were conducted using the SAS system (version 6, 1989; SAS Institute Inc, Cary, NC). Of the 705 deliverable surveys, 302 (43%) were returned: 76% of physicians reported having patients using CAM; 59% had been asked about specific CAM treatments; 48% had recommended CAM to a patient; and 24% had personally used CAM. Physician recommendation of CAM was most strongly associated with physician self-use (odds ratio, 6.98; P<.001). Few physicians felt comfortable discussing CAM with their patients, and the overwhelming majority (84%) thought they needed to learn more about CAM to adequately address patient concerns. Education about CAM modalities is a significant unmet need among Denver physicians, and education may help alleviate the discomfort physicians have when answering patients' questions about CAM. Physicians who use CAM treatments themselves are much more likely to recommend CAM for their patients than physicians who do not.

The Desktop Guide to Complementary and Alternative Medicine: an Evidence-based Approach

The past twenty years have seen a remarkable paradox in popular attitudes to medicine. While regulations for licensing drugs and appraising doctors have become increasingly stringent, more and more patients have turned to untested therapies supplied by unregulated practitioners. An increased demand for evidence-based medicine has been paralleled by a steady rise in therapies based on tradition and opinion. This divergence cannot be explained by two populations of patients: the evidence is that the same patients use both approaches. Patients considering any new treatment want to know if it works and if it is safe, but seem to have two different sets of rules. The divide is both linguistic and philosophical: terms such as ‘natural’, ‘traditional’ and ‘holistic’ are difficult to compare with confidence intervals and P values. So what happens if we judge both types of medicine by the same standards? Does complementary and alternative medicine (CAM) have a valid place alongside orthodox medicine? The Desktop Guide, originating edited from the University of Exeter Department of Complementary Medicine, takes a serious look at the evidence for efficacy and safety of CAM. The opening section on investigative methods sets the tone of clarity, transparency and depth that characterize the book. Section 2, which summarizes diagnostic methods from bioresonance to the Vega-test, is informative and helpful. For each technique, published studies are systematically reviewed with verdicts ranging from ‘the method is not valid’ (iridology), through ‘its value as a diagnostic tool seems limited’ (Kirlian photography), to ‘some but not all diagnostic methods are valid’ (chiropractic). Section 3 takes us through therapies from acupuncture to yoga, and section 4 herbal and non-herbal medicine from aloe vera to yohimbe. Information including constituents, rationale, pharmacological properties, clinical evidence, risks, and quality issues is clearly presented and well referenced. Phytoestrogen comes out rather well (reducing bone resorption in postmenopausal women) as does garlic, which at least in high dose reduces the frequency of tick bites. Red clover is safe but ineffective while shark cartilage is probably not even safe. A valuable series of tables summarizes herbs with adverse effects and interactions with antidiabetic and cardiac drugs, anticoagulants and oral contraceptives. Section 5 considers 38 conditions commonly treated with CAM (other conditions are indexed and discussed under individual therapies). The conclusions regarding atopic eczema—that conventional steroid treatments cannot be matched by CAM, and that therapies with the most promising evidence for efficacy are those with a psychological component—confirm my own impressions from the skin clinic. For migraine, biofeedback and possibly feverfew are effective and safer than conventional drug therapy. Similarly gingko is promising for tinnitus. Acupuncture and ginger are helpful for motion sickness and postoperative nausea. For many therapies there is insufficient evidence to recommend them, but this deficiency must not be confused with lack of effect. What about the wisdom of centuries of sages? Surely years of experience reflected in ‘expert opinion’ must be valuable? The authors actually tested this hypothesis, by comparing CAM recommendations with evidence from their systematic reviews. Not only was there lack of agreement between seven general CAM textbooks, but in some cases a therapy was recommended when there was conclusive trial evidence that it was ineffective or even contraindicated. The final section deals with general topics including legal, ethical and safety issues. Users of CAMs perceive them to be safer than conventional treatments, but must understand that ‘natural’ is not necessarily safe, unregulated preparations may be impure, and CAM providers sometimes delay or hinder access to potentially life-saving treatment if they cannot diagnose medical disorders. These concerns could all be addressed by better training and regulation of CAM providers. The bottom line is that CAM is amenable to rigorous testing and some forms of CAM are supported by evidence and do have a role in modern healthcare. The information in this book is balanced, authoritative and accessible. The enclosure of a CD-rom, with Medline links to all references as well as the whole text of the book, makes it astonishingly good value. The index might be improved in the next edition, but terms not listed (e.g. acne and psoriasis) can easily be found by searching the disc. This is a work which I will refer to every time a patient asks me about an alternative treatment.