Field Of Complementary And Alternative Medicine Research Articles

Perceptions of complementary therapies among Swedish registered professions in surgical care

There is increasing interest in complementary and alternative medicine (CAM) among healthcare professions. However, no studies have been conducted in Sweden or in a surgical context. The aim of this study is to describe different perceptions of complementary therapies among registered healthcare professions in Swedish surgical care. Sixteen interviews were conducted with registered physicians, nurses, physiotherapists and clinical dieticians at a Swedish university hospital. Analysis was made with a phenomenographic research approach. The findings showed variations in perceptions of the definition of complementary therapies. A constructive approach toward use was observed, but there was a conflict in matters of indications and contraindications, and also criticism over a lack of knowledge. There was seen to be a need for education to be able to act professionally. Scepticism over high costs of treatment was highlighted. In conclusion, a need for policies on management, education and research in the field of CAM should be addressed.

An overview of 45 published database resources for complementary and alternative medicine

Complementary and alternative medicine (CAM) has succeeded to implement itself in the academic context of universities. In order to get information on CAM, clinicians, researchers and healthcare professionals as well as the lay public are increasingly turning to online portals and databases, which disseminate relevant resources. One specific type of online information retrieval systems, namely the database, is being reviewed in this article. This overview aims at systematically retrieving and describing all databases covering the field of CAM. One of the requirements for inclusion was that the database would also have to be published in a medical journal. The databases AMED, CAMbase, EMBASE, and MEDLINE/PubMed were searched between December 2008 and December 2009 for publications relevant to CAM databases. The authors' specialist library was also searched for grey literature to be included. All included databases were then visited online and information on the context, structure and volume of the database was extracted. Forty-five databases were included in this overview. Databases covered herbal therapies (n = 11), traditional Chinese medicine (n = 9) and some dealt with a vast number of CAM modalities (n = 9), amongst others. The amount of time the databases had been in existence ranged from 4 to 53 years. Countries of origin included the USA (n = 14), UK (n = 7) and Germany (n = 6), amongst others. The main language in 42 of 45 databases was English. Although this overview is quite comprehensive with respect to the field of CAM, certain CAM practices such as chiropractic, massage, reflexology, meditation or yoga may not have been covered adequately. A more detailed assessment of the quality of the included databases might give additional insights into the listed resources. The creation of a personalised meta-search engine is suggested, towards which this overview could be seen as a first step.

Evolution of the integrative health care literature in the CAM field—a bibliometric analysis

Background: Integrative health care (IHC) has become a popular term used in practice and research to define the blending of complementary and alternative medicine (CAM) and conventional care as an innovative approach to health care delivery. Purpose and objectives: To conduct a bibliometric analysis to develop a better understanding of the evolution of the concept of IHC in the CAM field. Methods: All articles on IHC published between 1915 and 2008 indexed in the ISI web of knowledge database were retrieved. Title and abstract review were conducted to determine eligibility. Inclusion criteria included a research report and integration of CAM and conventional therapies. A second review of the full papers will be conducted to determine the final article sample, which will be analyzed using a rigorous bibliometric analysis approach. Results: Three thousand and five articles were retrieved and 35% met the inclusion criteria in the first screening round. Descriptive and relational bibliometric indicators will be presented, including the volume of research by year, keywords used, impact of the publication and collaboration amongst researchers. Discussion and conclusion: Application of a bibliometric analysis allows for a broad and focused overview of the IHC literature within its historical and cultural context, and evaluation of the research output and its impact.

IN-CAM Outcomes Database - Its Relevance and Application in Massage Therapy Research and Practice

One of the most commonly used complementary and alternative medicine (CAM) modalities in North America is massage therapy (MT). Research to date indicates many potential health benefits of MT, suggesting that ongoing research efforts to further elucidate and substantiate preliminary findings within the massage profession should be given high priority. Central to the development of a sound evidence base for MT are the use of valid, reliable, and relevant outcome measures in research, and practice in assessing the effectiveness of MT. The purpose of the present article is to introduce MT researchers and massage therapists interested in using outcome measures in research and clinical practice to the IN-CAM Outcomes Database website by describing the Outcomes Database and identifying its utility in MT research and practice. The IN-CAM Outcomes Database is a centralized location where information on outcome measures is collected and made accessible to users. Outcome measures are organized in the database within the Framework of Outcome Domains. The Framework includes health domains relevant to conventional medicine and CAM alike, and health domains that have been identified as important to CAM interventions. Users of the website may search for information on a specific outcome measure, plan research projects, and engage in discussions related to outcomes assessment in the CAM field with other users and with members of the CAM research community. As the MT profession continues to evolve and move toward evidence-informed practice, the IN-CAM Outcomes Database website can be a valuable resource for MT researchers and massage therapists.

Knowledge and beliefs concerning evidence-based practice amongst complementary and alternative medicine health care practitioners and allied health care professionals: a questionnaire survey.

BackgroundEvidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency.MethodsTo compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs. We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops.ResultsDuring 2004–5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7%) were allied health care professionals and 65 (33.7%) practitioners stated that they work in the CAM field Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3%) or received formal training in research methods (69.9%), epidemiology (91.2%) or statistics (80.8%). Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%). Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs. More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p = 0.008). Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p = 0.02) than their less experienced colleagues.ConclusionThe results demonstrate that practitioner's learning needs do vary according to the type of profession, time since graduation and prior research experience. Our survey findings are exploratory and will benefit from further replication, however, we do believe that they warrant consideration by allied health care and CAM tutors and trainers when planning EBP teaching curricula as it is important to tailor teaching to meet the needs of specific subgroups of trainees to ensure that specific learning needs are met.

Book Review

In countries with a long history of traditional medical practice (e.g., China and India), it is customary to find patients adopting traditional therapies and “Western” medicines side by side. However, complementary and alternative medicine (CAM) is becoming increasingly popular, even in many Western countries where “conventional” treatments are readily available. Demographic studies conducted in the United States estimated that the use of CAM increased by almost 50% between 1990 and 1997, with the number of total visits to CAM providers exceeding that to all U.S. primary care physicians. Patients with epilepsy are no exception. Surveys conducted in the United States and United Kingdom suggest that up to one-third of patients with epilepsy take herbs or dietary supplements or both, and that the majority of these patients do not discuss such use with their physicians. However, as the editors of this book pointed out, the vast majority of physicians do not understand and are uncomfortable with CAM. This book is, therefore, a very timely resource publication on the topic of CAM and epilepsy. The chapters, written by CAM practitioners who presented their work during a special conference at the NYU Epilepsy Center on CAM and epilepsy, cover a very diverse range of therapies from neurobehavior, biofeedback, and meditation, to massage, aromatherapy, and from herbal medicines, nutritional approaches, oxygen therapy, to chiropractic manipulation and music and art therapies. One chapter deals with research methods for CAM. The chapters are generally well referenced, and each chapter is followed by a brief commentary by the editors to provide a perspective on the content, albeit often from the standpoint of Western medical culture. Overall, the book has served the purpose of introducing the readers coming from a Western medical background to the various CAM therapies currently used to treat epilepsy. In-depth discussion is not feasible because of the large number of treatment modalities covered (more than 20). In addition, because the chapters are written by different authors, their formats and standards are variable. I particularly like the chapter, Herbal Therapy in Epilepsy, which critically and authoritatively appraises the evidence of the efficacy and safety of a range of herbal medications and their potential interactions with antiepileptic drugs. Other chapters with more anecdotal reporting of personal experiences are well supplemented by comments from the editors to give a more balanced view on the subjects. Because most of the authors are unknown to conventional physicians unfamiliar with the field of CAM, it would be helpful if their background and affiliation could be provided to the readers. Very few books of a similar nature are available on a topic of increasing relevance to everyday clinical practice. I strongly recommend this book to all professionals caring for patients with epilepsy.

Complementary and Alternative Medicine in the Scientific Literature

To analyze the frequency and typology of scientific papers on complementary and alternative medicine (CAM) published in the period 1997-2002. We performed a systematic literature search of MEDLINE in order to identify all articles dealing with CAM, in the human setting, published from January 1, 1997 to December 31, 2002. Our attention was focused on randomized controlled trials conducted on CAM and on the impact factor (IF) of the journals in which CAM articles were published. During the period 1997-2002, a total of 20,209 articles about CAM were published, representing the 0.7% of the total number of MEDLINE-listed articles. Approximately 50% of CAM articles published in 1996-2002 appeared on journals with no IF. The proportion of randomized clinical trials was 7.6% of total CAM articles. There is an upward trend in the number of CAM articles but the number of experimental studies is low and over half of articles are published in journals without an IF. We believe there is an urgent need to conduct rigorous research in the field of CAM in order to support, for the need of the public, an evidence-based approach to these therapies.

Complementary Medicine Research Unit

One in ten of the UK population use complementary medicine each year and 50% are lifetime users. The recent House of Lords’ Report has clearly defined a public need for further research into both safety and efficacy. The Department of Health research capacity building initiative is one of the first main responses to the Select Committee’s recommendations. We know that within this emerging field we have developed a unit with cooperative ventures within the university, both intra-faculty and inter-faculty. As a consequence, we have been able to draw in major funding along with a growing body of academic publications. Our unit was established by George Lewith in 1995 with his appointment as Honorary Visiting Senior Lecturer. He now has a University contract as a Reader within the Department of Primary Care where the unit is located. The unit was initially provided with core funding by the Maurice Laing Foundation and has been able to generate substantial amounts of soft money funding for a number of minor and major projects from charitable (including Wellcome) sources as well as National Health Service Research and Development (NHS R&D) funding. Laing funding continues to provide our unit with an administrative core. Dr Lewith has been appointed as a Visiting Professor to the School of Integrated Health at the University of Westminster. The Department of Health is now providing funds for research capacity building within complementary medicine and we have been successful in obtaining Department of Health support for two post-doctoral fellows (Peter White and Sarah Brien) and two PhD students during the first 2 years of the awards. The Department of Health is also funding complementary and alternative medicine (CAM) projects within palliative cancer care (£300 000) and we have successfully applied for this funding, in conjunction with Jessica Corner as the primary investigator. Wellcome is currently funding 37% of the applications it puts out for review in the field of CAM and is considering further initiatives in the light of the Department of Health proposals. The Medical Research Council has publicly stated that it welcomes quality applications in this area: our initial asthma and homeopathy study was alpha rated, the Alexander Technique study was alpha– alpha rated and funded. There is clearly now an opportunity for substantial growth in this area of research and the track record that we have developed in Southampton makes us well placed to capitalize on these initiatives. Over the last 8 years we have created a unique multidisciplinary team (non-clinical post-docs, doctors, nurses, physiotherapists, pharmacists and health psychologists) in Southampton, which has developed considerable skill in primary clinical research within CAM. These studies have been directed at asking not only where complementary therapies may be most applicable but also whether and how they work. Furthermore, our research has led us to understand that the nature and content of the therapeutic relationship within complementary medicine is of paramount importance, and therefore we are in the process of developing clinical trial methodology that will allow us to look at the consultation independently from a particular therapeutic intervention, focusing particularly on the non-specific effects of homeopathy and acupuncture in chronic disease. The major studies in which our unit has been involved to date are as follows:

Randomized controlled trials in pediatric complementary and alternative medicine: where can they be found?

BackgroundThe safety and effectiveness of CAM interventions are of great relevance to pediatric health care providers. The objective of this study is to identify sources of reported randomized controlled trials (RCTs) in the field of pediatric complementary and alternative medicine (CAM).MethodsReports of RCTs were identified by searching Medline and 12 additional bibliographic databases and by reviewing the reference lists of previously identified pediatric CAM systematic reviews.ResultsWe identified 908 reports of RCTs that included children under 18 and investigated a CAM therapy. Since 1965, there has been a steady growth in the number of these trials that are being published. The four journals that published the most reported RCTs are The American Journal of Clinical Nutrition, Pediatrics, Journal of Pediatrics, and Lancet. Medline, CAB Health, and Embase were the best database sources for identifying these studies; they indexed 93.2%, 58.4% and 42.2 % respectively of the journals publishing reports of pediatric CAM RCTs.ConclusionsThose working or interested in the field of pediatric CAM should routinely search Medline, CAB Health and Embase for literature in the field. The four core journals identified above should be included in their collection.

Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice.

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.

The role of complementary medicine in the treatment of prostate cancer.

Complementary and alternative medicine (CAM) has recently attracted national attention in the United States because of its widespread use and associated cost. CAM covers a broad spectrum of healing philosophies and approaches. Despite its widespread use, little is known about its safety, efficacy, cost effectiveness, and mechanism of action. The role of CAM in the management of prostate cancer is becoming more apparent with its rise in use among patients who are suffering from prostate cancer. This trend is patient-driven and reflects the change in values perceived by patients toward conventional medical treatment. In this review, several complementary therapies that can be used for prevention and treatment of prostate cancer are discussed. These therapies were selected because they are supported by scientific evidence. The popularity of CAM continues to grow and CAM is here to stay. Health care professionals can no longer afford to ignore or to treat CAM as an entity outside of conventional science. To acknowledge and to monitor its use among our patients may in the future help evaluate the safety and efficacy of CAM. Our current challenge is to move the field of CAM forward scientifically and systematically with wisdom and reasoning.

Testing complementary and alternative therapies within a research protocol

In patients with cancer, the demand for complementary and alternative medicine (CAM) is considerable. Unfortunately, however, for many of these interventions there is a lack of evidence for efficacy, effectiveness and safety in patients with cancer. This review focuses on the prospective, randomised, controlled trial (RCT) as a tool for evaluating CAM. Although a number of difficulties and limitations are acknowledged, the RCT will continue to be the gold standard for evaluating the efficacy, effectiveness and safety of CAM. Developments in clinical trial methodology and in psychosocial oncology have made it more appropriate and feasible to evaluate CAM using RCT methodology. Two different kinds of RCTs are now accepted as valid, namely explanatory and pragmatic trials. The latter does not necessarily require that the patient or the therapist is ‘blind’ to the treatment being given. Furthermore, pragmatic trials can be designed to take patient preferences into account. A number of practical issues are discussed, including the choice of comparator or control interventions, ways of assessing the effects of individual differences, minimising therapist variability, the problem of finding acceptable inclusion–exclusion criteria and the assessment of treatment outcome. A number of randomised, controlled trials have demonstrated the efficacy, effectiveness and safety of various complementary and alternative interventions (the Cochrane Data Base has now established a CAM field). The publication of positive results from randomised trials of complementary interventions that have not yet been studied using this methodology would do a great deal to alleviate the scepticism of conventional practitioners towards these types of CAM and would facilitate further the integration of complementary and conventional interventions.