Herbal Medicine Practitioners Research Articles

Perception and Acceptance of Herbal Medicines among Residents of Port Harcourt, Nigeria

Background: The use of herbal medicines and medicinal plants available in a locality in the treatment and control of human diseases, promotion of health and management of health conditions will continue to play a significant role in the healthcare system of the people, especially in developing countries. This cross-sectional study was carried out to assess the perception and knowledge of usage of herbal medicines among the residents of Port Harcourt, Nigeria. Methodology: Multi-stage sampling technique was used for this study.
 Results: The results indicated that out of the 273 questionnaires returned, 118 (44.9%) of the respondents were male while 144 (55.1%) were female. The average age of the respondents was 36±10 years. The prevalence of usage of herbal medicine from this study was 80.9%. The major source of information about herbal medicines was home (family and friends).The results also indicate that 180 (68.6%) of the respondents did not experience unpleasant effects such as headaches, vomiting, nausea and diarrhea, with the use of herbal medicines. Similarly, on the reasons for using herbal medicine, 134 (51.1%) of the respondents indicated that they used herbal medicines because they are effective, 66 (25.3%) said herbal medicines are always available mostly as locally sourced herbs, while 46 (17.7%) said herbal medicines are not costly. On the perception of herbal medicines, 206 (78.6%) indicated that herbal medicines are efficacious, 197 (75.3%) supported the integration of herbal medicines into the conventional health system, 243 (92.6%) supported the establishment of a Board to regulate the practice of herbal medicine in order to prevent indiscriminate use of herbal medicines while 234 (89.9%) of the respondents supported the establishment of a formal training institution for herbal medicine practitioners.
 Conclusion: It is concluded that herbal medicines have wide acceptability and perception among the study population. It is recommended that herbal medical practice be properly regulated and integrated into the conventional health system.

ETHNOMEDICINALLY IMPORTANT PLANTS USED BY THE LOCAL PEOPLE OF AL GALABAT LOCALITIES, GEDAREF STATE, SUDAN

This research aims to document the medicinal plants used by the local people in two localities of El Gadaref state in eastern Sudan. Information was obtained during several visits using a semi-structured questionnaires in group discussions at herbal medicine practitioners homes, market, and healers shops. Most of the information was obtained from respondents of age 51 to 65 years. The study documented 79 species belonging to 36 families used to treat various ailments. The most utilized plant families were Leguminosae ( 45%) followed by Combretaceae (11%). 7% of the total plants used belongs to Asteraceae, Capparaceae, and Solanaceae. This study document the use of Martynia annua fruits to treat tumors and dysentery for the first time in Sudan. Common treated diseases are abdominal pains, unary tract infections, fever, and malaria. Further pharmacological research studies are recommended to identify the active chemical components in the reported plants. KEYWORDS- Medicinal plants; local people; Gadarif state ; Sudan

Review of Antiviral Medicinal Plants used in Taraba State Nigeria: A Possible Source for COVID-19 Drug Discovery

Purpose: Coronavirus also known as COVID-19 is a viral infection that has been tagged as the greatest pandemic since the existence of humans by the WHO, resulting in the deaths of thousands of people globally; with the USA one of the highest. The full biology of the virus is yet to be known. This study reviews sixteen natural antiviral plants used in Taraba State to manage viral infections locally. Subjects and Methods: Sixteen medicinal plants popularly used as antiviral agents in Taraba State, Nigeria were surveyed based on a field-trip experience with herbal medicine practitioners in the three zones of the state. Plants that were in both zones were counted as the same. The plants that are majorly used for various viral infections are Allium sativum, Zingiber officinale, Camellia sinensis, Hibiscus sabdariffa, Cirus lemon, Azardirachta indica, Ocimum tenuiflorum, Curcuma longa, Haematostaphis barteri, Olea europaea, Melastomastrum capitatum, Astragalus canadensis, Carissa edulis, Spondias venulosa, Vitellaria paradoxa, and Euphorbia hirta. Results: Of the sixteen plants, ten have been reported to have antiviral properties against at least one of these viruses avian or bird flu, human influenza virus, infectious bronchitis virus (a type of coronavirus), herpes virus, hepatitis C virus and HIV. Conclusion: The study revealed that further research on these antiviral plants used traditionally might pave the way for the discovery of potent antiviral drugs against COVID-19.

Comparative distribution of bacterial contaminants of packaged and unpackaged polyherbal products sold in Nnewi, Nigeria

Background: The use of herbal medicine continues to remain popular despite advances in orthodox medicine largely as a result of affordability and availability. However, contaminated and potentially toxic polyherbal preparations remain a public health challenge despite regulations instituted by concerned agencies in Nigeria. The objective of this study was to determine and compare the bacterial contaminants of different polyherbal products sold in Nnewi, NigeriaMethodology: This study evaluated the bacteriological profile of 22 packaged and 22 unpackaged polyherbal preparations sold in Nnewi, Nigeria. The samples were collected from different herbal medicine shops in Nnewi by simple random sampling and were assayed for comparative bacterial loads with chromogenic media and their total viable counts evaluated following standard method for microbial load analysis.Results: Bacterial contaminants were isolated from 9 of 22 (40.9%) packaged polyherbal samples while 13 of 22 (59.1%) samples were bacteriologically sterile. For the unpackaged polyherbal, bacterial contaminants were isolated from 18 of 22 (81.8%) samples while 4 of 22 (18.2%) were bacteriologically sterile (OR 0.1538, p=0.0122). The most frequently isolated bacterial contaminant in the packaged polyherbal samples was Enterococcus faecalis with 33.3% (6/18) while Salmonella sp was the least frequently isolated with 5.6% (1/18). For the unpackaged polyherbals, the most frequently isolated bacterial contaminant was Staphylococcus aureus with 25% (7/28) while Salmonella sp and E. faecalis were the least frequently isolated with 10.7% (3/28) each. The median total viable count of the packaged group of the polyherbal products was 1.48x106 CFU/ml, while the median total viable count for unpackaged group of polyherbals was 1.95x106 CFU/ml.Conclusion: This study shows that many polyherbal products sold in Nnewi are potentially contaminated with bacterial agents. It is therefore imperative that herbal medicine practitioners be enlightened on hygienic ways of preventing microbial contamination during polyherbal production.
 Keywords: Bacterial contaminants, herbal products, Nnewi, Nigeria

Screening of the Dichloromethane: Methanolic Extract of Centella asiatica for Antibacterial Activities against Salmonella typhi, Escherichia coli, Shigella sonnei, Bacillus subtilis, and Staphylococcus aureus.

Bacterial infections are responsible for a large number of deaths every year worldwide. On average, 80% of the African population cannot afford conventional drugs. Moreover, many synthetic antibiotics are associated with side effects and progressive increase in antimicrobial resistance. Currently, there is growing interest in discovering new antibacterial agents from ethnomedicinal plants. About 60% of the population living in developing countries depends on herbal drugs for healthcare needs. This study involved the screening of Centella asiatica commonly used by herbal medicine practitioners in Kisii County to treat symptoms related to bacterial infections. Standard bioassay methods were applied throughout the study. They included preliminary screening of dichloromethane: methanolic extract of Centella asiatica against human pathogenic bacteria including Salmonella typhi ATCC 19430, Escherichia coli ATCC 25922, Shigella sonnei ATCC 25931, Bacillus subtilis ATCC 21332, and Staphylococcus aureus ATCC 25923 using agar disc diffusion, broth microdilution method, and time-kill kinetics with tetracycline as a positive control. Phytochemical screening was carried out to determine the different classes of compounds in the crude extracts. Data were analyzed using one way ANOVA and means separated by Tukey's test. Dichloromethane: methanolic extract of Centella asiatica was screened against the selected bacterial strains. Time-kill kinetic studies of the extracts showed dose- and time-dependent kinetics of antibacterial properties. Phytochemical screening of the DCM-MeOH extract revealed the presence of alkaloids, flavonoids, phenolics, terpenoids, cardiac glycosides, saponins, steroids, and tannins. The present study indicates that the tested plant can be an important source of antibacterial agents and recommends that the active phytoconstituents be isolated, identified, and screened individually for activities and also subjected further for in vivo and toxicological studies.

Interview with A/Professor Matthew Leach, Deputy Director of Education, National Centre of Naturopathic Medicine, Southern Cross University: 8 April 2020

These abstracts are brief summaries of articles in recent issues of medical journals. Articles selected are of a general nature for the information of practitioners of naturopathy and herbal medicine. A dominant theme is often present throughout the journals which will be reflected in the reviews.

Ethnomedicinal Information of Selected Members of Vitaceae with Special Reference to Kerala State

An ethnobotanical exploration of selected Vitaceae members of Kerala state was conducted from September 2014 to December 2018. During the ethnobotanical surveys, personal interviews were conducted with herbal medicine practitioners, traditional healers, elder tribal people and village dwellers. Field studies were conducted at regular intervals in various seasons in different regions of Kerala. Some of the genus belonging Vitaceae have ethnomedicinal significance stated by herbal medicine practitioners and elder tribal persons. It is an urgent need for documenting these peculiar plant species before such valuable knowledge becomes inaccessible and extinct.

Evaluation of the Antidiarrheal Activity of Hydromethanol Crude Extracts of Ruta chalepensis and Vernonia amygdalina in Mice.

Background The herbal medicine practitioners in Ethiopia have used a wide range of medicinal plants as antidiarrheal agents. Among these, Ruta chalepensis and Vernonia amygdalina were claimed to have antidiarrheal activity in Ethiopian folklore medicine. Hence, the aim of the present study was to evaluate the antidiarrheal activity of the crude extracts of Ruta chalepensis and Vernonia amygdalina in mice. Methods The crude extracts were obtained by cold maceration with 80% methanol, and its antidiarrheal activities were evaluated using a castor oil-induced diarrheal model. The test groups were treated with 100, 200, and 400 mg/kg body weight (bw) of the crude extract of each plant, while the positive controls and negative controls were given loperamide (3 mg/kg.bw) and 2% Tween 80 (10 ml/kg.bw), respectively. Results In the castor oil-induced model, the crude extract of Ruta chalepensis (200 and 400 mg/kg.bw) significantly prolonged the onset of diarrhea in mice. Besides, it also showed a significant reduction in the frequency of stooling and weight of feces. Contrastingly, the crude extract of Vernonia amygdalina had a significant effect in delaying the onset of time of diarrhea and reduction of the frequency of stool and the weight of feces only at the maximum tested dose (400 mg/kg.bw). Conclusion The present study demonstrated that the crude leaves extract of Ruta chalepensis (200 and 400 mg/kg.bw) and Vernonia amygdalina (400 mg/kg.bw) possessed significant antidiarrheal activity in the castor oil-induced diarrheal model.

Doc Hay: A Chinese Herbalist Combating the 1918-1919 Influenza Pandemic in America.

This is a story about a Chinese herbalist Ing “Doc” Hay who combated the 1918-1919 influenza pandemic in the America West. As an immigrant, he came to the States as a laborer, but he had knowledge of Chinese herbal medicine due to his family heritage. This made it possible for him to start practicing in the Chinese community in John Day, Oregon, until 1948 when he retired. During the time of the pandemic running wild in the 1910s, he prescribed formulas aimed at flu and boiled herbal decoction, personally delivering it to a working site for those Chinese laborers as well as non-Chinese patients. None of the laborer patients treated by him died during this deadly pandemic. Due to his success and fame, his practice was booming even after the Chinese community disappeared in John Day in later years. Doc Hay is always remembered in the history of earlier development in eastern Oregon, so that the site of his practicing, Kam Wah Chung and Co. Building, is now a national historic landmark. And more importantly, he has also been remembered by Chinese herbal medicine practitioners in the United States.

Indigenous Knowledge and Practices on Medicinal Plants Used by Local Communities of Gambella Region, South West Ethiopia

Indigenous knowledge and practices on medicinal plants used by local communities of Gambella region, south west Ethiopia was conducted to investigate those potential and popular medicinal plants used for the treatment of various diseases in Gambella region. A total of 100 purposively selected inhabitants were employed in the study of which 84 were male and 16 were females. A traditional use of plants information was obtained by semi structured oral interviews from experienced rural elders, Focus group discussion and through questionnaire administered to traditional herbal medicine practitioners of the study area. 81 medicinal plants were identified for the traditional treatment of both human (25) and animal (16) disease. The highest numbers of medicinal plants for traditional uses utilized by this community were belonging to shrubs 30(37.03%) followed by trees (32.10%). The result reviled that 15.2% of the remedies are prepared from root part and squeezing accounts 17(20.99%) followed by chewing 14(17.28%). The major routs of administration of traditional medicines were reported oral 50(61.73%). Urine, placental retention and milk let down accounts higher informants’ consensus factor value (0.96). The findings showed that sheferaw and leele have higher fidelity level which is 100 and 92 respectively. Various factors were recorded as the main threats of medicinal plants in the study area. In conclusion, the community carries a vast knowledge of medicinal plants but this knowledge is also rapidly disappearing in this community. Such type of ethno-botanical studies will help in systematic documentation of ethno-botanical knowledge and availing to the scientific world plant therapies used as antivenin by the Gambella community and further research on plant species identification and chemical extraction is recommended.

Treatment Interventions for the Management of Intestinal Permeability: A Cross-Sectional Survey of Complementary and Integrative Medicine Practitioners.

Objectives: This study aims to explore the treatment interventions complementary and integrative medicine (CIM) practitioners use in the management of an emerging health condition, increased intestinal permeability (IP), and the association these methods have on the observed time to resolve this condition. Design and setting: A cross-sectional survey of Australian naturopaths, nutritionists, and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network. Outcome measures: Frequencies and percentages of the treatment methods, including chi-square analysis to examine the associations between treatment methods and observed time to resolve IP. Results: Thirty-six CIM practitioners responded to the survey (response rate 15.9%). CIM practitioners were found to use a multimodal approach in the management of IP with 92.6% of respondents using three or more categories of treatment interventions (nutritional, herbal, dietary, and lifestyle) with a mean total of 43.0 ± 24.89 single treatment interventions frequently prescribed. The main treatments prescribed in the management of IP were zinc (85.2%), probiotics: multistrain (77.8%), vitamin D (75.0%), glutamine (73.1%), Curcuma longa (73.1%), and Saccharomyces boulardii (70.4%). CIM practitioners also advocate patients with IP to reduce alcohol (96.3%), gluten (85.2%), and dairy (75.0%) consumption. Evaluation of antibiotics (75.0%) and nonsteroidal anti-inflammatory drugs (73.1%) prescriptions were frequently advised by CIM practitioners. A longer observed time to resolve IP was seen in CIM practitioners who did not reduce intense exercise in the management of IP (p = 0.02). Conclusions: This study represents the first survey of the treatments prescribed by CIM practitioners for IP and suggests that CIM practitioners use numerous integrative treatment methods for the management of IP. The treatment interventions frequently prescribed by CIM practitioners align with preclinical research, suggesting that CIM practitioners prescribe in accordance with the published literature. The findings of this study contribute to the implementation of clinical research in the management of IP, which considers multiple concurrent treatments.

A naturalistic study of herbal medicine for self-reported depression and/or anxiety a protocol

BackgroundMental health conditions including anxiety and depression account for around 8% of the global disease burden. Anxiety and depression often coexist and impose a high individual and social burden. Patients with mental and behavioural conditions may be at increased risk of co-morbidities and are often high health-care utilisers. Herbal medicine is estimated to be used by up to 80% of the worlds population, and by 22% of Australian women seeking care for depression. The holistic and tailored treatment approach offered by practitioners of herbal medicine is difficult to capture in randomised controlled trials and as such there is a paucity of research demonstrating the outcomes of real-life practice. This project aims to address this gap with a whole practice, observational model. MethodsThe study will employ a naturalistic observational design. Two-hundred patient participants will be recruited to be treated by 15 clinician participants from different naturopathic clinics. The observed changes in anxiety and depression symptoms of patients will be documented across three consultations using validated patient-reported outcome measures (SF-36, DASS-21, GHQ-28 and POMS-2). DiscussionClinical studies investigating the efficacy of individualised herbal medicine treatment as prescribed by a naturopath are rare. Our study attempts to fill this gap with a longitudinal observation of individualised care as practiced by naturopaths in Australia; to offer valuable insights into the effectiveness of individualised herbal medicine practice and provide contextualisation of data currently focused on individual herbal medicines in specific conditions. Trial RegistrationAustralian and New Zealand Clinical Trials Registry: ACTRN12616000010493

Exploring the role of information managers in knowledge transfer and preservation among the “Elewe Omos” (Indigenous herbal medicine practitioners) of the Yorubas in Nigeria

Indigenous herbal medicine as an arm of indigenous knowledge has lived with man from existence. In spite of the peculiarity of their mode of operation and services, their method of knowledge transfer and retention remains secretive and largely informal. This is because hardly is there any formal system of learning or a stipulated number of years of study when compared with orthodox medicine. Thus the study investigates how the custodians of indigenous herbal medicine (IHM) popularly called „‟Elewe Omos‟‟ among the Yorubas of the South Western Nigeria transfer their acquired knowledge of herbal medicine from one generation to another. This is a qualitative study and so data was gathered through focus group discussion. Respondents were drawn from key practitioners from members of the National Association of Traditional Medicine Practitioners (NATMP). The study leveraged on the recent herbal fair organised by the NATMP. Thirty-eight (38) practitioners from the 6 South-western states participated in the fair. The study employed a random sampling technique to select one (1) out of every six (6) practitioners. The outcome of the study revealed among others that indigenous herbal medicine knowledge is devoid of any form of secrecy or spiritism, The study concludes that the process of knowledge transfer of indigenous herbal medicine, can be effectively coordinated by effort of information managers in preserving this age long knowledge of the African people for onward transmission to coming generation and for improved health care system. Keywords : Indigenous Herbal Medicine, Knowledge Transfer, Preservation, Information Managers, Yorubas,

Treating People with Arthritis with Traditional Chinese Medicine (Tcm): An Examination of the Perception of Tcm Practitioners

Emerging evidence has shown that traditional Chinese medicine (TCM) has a positive effect on arthritis. This research provides the first critical, systematic examination of TCM practitioners' perceptions of TCM use for people with arthritis. An online survey was distributed to all TCM professionals including acupuncturists and Chinese herbal medicine practitioners registered with the Practitioner Research and Collaborate Initiative (PRACI) practitioner database. The survey questions focus on practitioner characteristics, practice characteristics and clinical management approaches regarding arthritis care. The survey attracted a response rate of 53% (n=52). The average age of the respondents was 49.9 years, more than half were female, and the majority held a bachelor degree or higher qualification. More than two thirds of TCM practitioners in our study worked with other health professionals, while they had a high level of referral relationships with a wide range of conventional, allied health and complementary and alternative medicine (CAM) providers. Most of the TCM practitioners reported that their patients with arthritis used other treatments alongside TCM and a large number of the TCM practitioners who participated believed that TCM was effective for treating arthritis. The TCM profession represents a substantial component of the healthcare field in Australia, and treating patients with arthritis appears to be an important area of TCM practice, among others. Further detailed research is needed to help ensure effective, safe patient care for those with arthritis who may be utilising TCM alongside a broader range of conventional medicine, allied health, and other CAM treatments.

The diagnostic and clinical management of individuals recommended gluten free diets by complementary medicine practitioners

ObjectivesExcluding gluten containing foods from the diet is medically indicated for the management of coeliac disease, wheat allergy, gluten ataxia, non-coeliac gluten sensitivity, and dermatitis herpetiformis. However, the number of people following a gluten free diet (GF diet) far exceeds the number of people with an indication for such dietary restriction. It has been suggested that 70% of individuals who are recommended GF diets by complementary medicine practitioners have not had coeliac disease adequately excluded. The aim of this study was to describe the diagnostic and clinical management practices of naturopaths, Western herbalists and nutritionists (non-dietetic) associated with recommending GF diets. Design, subjects and outcome measuresA cross-sectional 40-item questionnaire was developed and administered online to 145 Australian naturopaths, nutritionists (non-dietetic) or Western herbal medicine practitioners via professional associations and a practice based network (PRACI) between February and April 2017. Demographic data and practice information related to recommending GF diets was collected. ResultsA total of 56.5% (82/145) practitioners reported that in the majority of cases they did not undertake any recommended diagnostic process, and 48% (71/145) of practitioners referred to a general practitioner to exclude medical conditions related to gluten ingestion prior to recommending a GF diet. A total of 10% (15/145) ordered coeliac serology through local laboratories, and 17% (24/145) through functional pathology companies. Non-coeliac gluten sensitivity was diagnosed by 56% (82/145) through an elimination and reintroduction diet, and 61% (88/145) used a diet and symptom diary. IgG antibody tests were used by 23% (33/145) of practitioners, and 5% (7/145) used kinesiology prior to recommending a GF diet. ConclusionClinical guidelines for the diagnosis of gluten related disorders are not followed by a substantial number of complementary medicine practitioners prior to recommending a GF diet. Strategies are required to improve the standard of practice in this area.

Investigation into complementary and integrative medicine practitioners' clinical experience of intestinal permeability: A cross-sectional survey

BackgroundThis study aims to explore the conditions complementary and integrative medicine (CIM) practitioners associate with increased intestinal permeability (IP) and the methods they employ to assess IP. MethodsA cross-sectional survey of naturopaths, nutritionists and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network. ResultsCIM practitioners (n = 36, response rate 15.9%) associate IP with gastrointestinal (100.0%), autoimmune (91.7%), skin (91.7%), neurological (80.6%), respiratory (55.6%) and liver-related conditions (44.4%). CIM practitioners frequently treat IP (72.7%); observing a minimum 3 months of treatment is required to resolve IP. Patient's signs and symptoms were the main reasons CIM practitioners suspected IP (94.1%). ConclusionCIM practitioners observe a clinical link between IP and a wide range of conditions, including those not yet recognised within the literature. The clinical experience of CIM practitioners holds substantial value to the advancement of research and the clinical management of IP.

In Vivo Hypoglycemic Effect of Kigelia africana (Lam): Studies With Alloxan-Induced Diabetic Mice.

The claims by the traditional herbal medicine practitioners that Kigelia africana has bioactivity against several diseases, including diabetes mellitus, were investigated in this study. Type I diabetes mellitus was induced in mice by intraperitoneal administration of alloxan monohydrate followed by treatment with the therapeutic doses of the aqueous and ethyl acetate leaf extract of K africana to the experimentally diabetic mice. The treatment effects were compared with the normal control, diabetic control, and diabetic control rats treated with a standard antidiabetic drugs (insulin administered intraperitoneally at 1 IU/kg body weight in 0.1 mL physiological saline or glibenclamide administered orally at 3 mg/kg body weight in 0.1 mL physiological saline). Phytochemical composition of the leaf extract was assessed using standard procedures and mineral elements assessed using atomic absorption spectrophotometry and total reflection X-ray fluorescence system. Oral and intraperitoneal administration of the aqueous and ethyl acetate leaf extract caused a statistically significant dose-independent reduction in plasma glucose level in alloxan-induced diabetic mice. The observed hypoglycemic activity of this plant extract could be attributed to the observed phytochemicals and trace elements, which have been associated with exhibiting antidiabetic properties. Therefore, the data appear to support the hypoglycemic effects of K africana validating its folkloric usage.

Writing a case report an introductory guide for practitioners of herbal medicine

Case reports are well suited for capturing real life clinical events by herbal practitioners. There is an ancient tradition of producing such reports from Hippocrates (460B.C to 370B.C.) onward (Garrison, 1929) The process of writing one can benefit a practitioners understanding of a medical area and lead to improved patient care (Caban-Martinez and Beltran, 2012). It is particularly apt for those interested in developing their academic writing skills and research activity. Reports can generate hypotheses and support case based learning, influence a professional body’s practice guidelines, and provide data on rare or adverse effects. They can promote trust and cooperation with fellow healthcare practitioners by clearly communicating what it is professionals using herbal medicine do. Furthermore, publishing is a way to share your clinical experience with your own community of practitioners and to contribute to the growing knowledge and literature on herbal medicine. This article develops for herbal practitioners previously published guidelines that aim to provide those with little or no research experience with a tool kit to enable them to write a case report fit for submission to a professional journal.

Compassion and its role in the clinical encounter – An argument for compassion training

Empathic communication, (i.e. emotionally engaging with a patient), is an important part of the therapeutic relationship. It hasbeen shown to improve the health and therapeutic outcomes for patients by improving diagnosis and compliance. In the West, front-line medical professionals, including herbal medicine practitioners, put themselves at risk of burnout and compassion fatigue by giving emotionally intensive care. While treatments for compassion fatigue and burnout are available, another way forward is needed to ensure healthcare professionals do not become ill; one that will enable both patients and healthcare professionals to receive the care needed. In this paper it is argued that compassion, which is defined in this paper, involves different neural circuitry to empathy and can protect healthcare professionals from the effects of stress that can, if not addressed, lead to burnout. Traditional Buddhist meditation techniques such as loving-kindness meditation have been shown to increase compassion in non-meditative states. Short daily sessions of such mediation practices have been shown to improve compassion in a way that protects healthcare professionals from burnout.

Standardised Chinese herbal treatment delivered by GPs compared with individualised treatment administered by practitioners of Chinese herbal medicine for women with recurrent urinary tract infections (RUTI): study protocol for a randomised controlled trial

BackgroundIn the UK, urinary tract infections (UTIs) are the most common bacterial infection presented by women in primary care. Recurrent urinary tract infections (RUTIs) are defined as three episodes of UTI in the last 12 months, or two episodes in the last 6 months. Between 20 and 30 % of women who have had one episode of UTI will have an RUTI, and approximately 25 % of these will develop subsequent recurrent episodes. RUTIs can have a significant negative effect on the quality of life, and have a high impact on health care costs as a result of outpatient visits, diagnostic tests and prescriptions. Chinese herbal medicine (CHM) has a recorded history of treatments for the symptoms of UTIs for more than 2000 years. More recent clinical research in China has provided some preliminary evidence that CHM can alleviate the symptoms of UTIs and reduce the rate of recurrence, but more rigorous investigation is required.Methods/designThe RUTI trial is a double-blind, randomised, placebo-controlled, feasibility trial. A total of 80 women will be randomised to ‘individualised’ herbs prescribed by a Chinese herbal practitioner or to ‘standardised’ herbs provided by primary care clinicians. Both arms will have herbs for prevention of UTIs and treatment of acute episodes. Treatment duration is for 16 weeks.The primary outcomes are the number of episodes of recurrent UTIs during the trial period and in the 6 months of follow-up, and the number of days of symptoms rated moderately bad or worse based on patient diaries. Secondary outcomes will assess participant expectations and beliefs, adherence to the treatment, adverse events and health economics and provide quantitative and qualitative assessments of the impact of recurrent infections on the lives of women.DiscussionThe RUTI trial is the first instance of CHM delivered as a clinical trial of an investigatory medicinal product in the UK. This study provides important information regarding the feasibility and acceptability of researching and using CHM in Primary care. Once completed, it will provide provisional estimates of the variance of change in continuous outcomes to inform a power calculation for a larger, more definitive trial.Trial registrationEudraCT, 2013-004657-24. Registered on 5 September 2014. Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1471-5) contains supplementary material, which is available to authorized users.