Search

HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The complex health and social issues associated with living with HIV mean that people living with HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM). This article provides an overview of the literature on HIV and CAM. Databases were searched using keywords for CAM and HIV from inception to December 2012. Articles in English and in Western countries were included; letters, commentaries, news articles, articles on specific therapies and basic science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%, with national studies suggesting CAM is used by around 55% of PLWHA, practitioner-based CAM by 15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater number of medications/symptoms, with CAM often used to address limitations or problems with antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can have potentially serious side effects or interactions with ART. CAM was used as a self-management approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians, particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to encourage valuable self-management and ensure patient safety. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema. Methods: A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs’ knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation. Results: HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient''s choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice. Conclusion: HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP–patient communication. Practice implications: Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time. [Copyright &y& Elsevier]

Purpose - This paper's aim is to explore older peoples' decision making regarding complementary and alternative medicine (CAM) use and their perceptions and experiences of weft-being. Design/methodology/approach - Qualitative focus groups with 37 volunteers aged over 61 years exploring health and well-being decision making were held at a community centre in southwest London. Data were content analysed. Findings - Five themes emerged: physical well-being, impact on activity, emotional issues, community and health services, and keeping positive. A range of CAM was used, most commonly mind/body or physical therapies. The main reason for CAM use was to "keep going" and maintain well-being. Conventional medicine was perceived as central to weft-being, with CAM used to address its limitations. Decision making was rarely systematic; anecdotal information dominated, and disclosure to conventional practitioners was uncommon. "Keeping going" is important for older people and often promoted by CAM, including manipulative and exercise therapies. Concurrent CAM and conventional medication use, unreliable information and/or insufficient discussion with conventional providers may have safety implications. Healthcare providers should consider exploring CAM use with older people and facilitating access to CAM information. Practical implications - Asking older people about CAM use may be integral to providing holistic, safe care. CAM use may provide an opportunity for health promotion in older people by encouraging self-management and the taking of responsibility for their own health. Originality/value - Although up to half of older people in the UK may use CAM, there is little information on their decision-making processes. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Acupuncture practice is based on the theoretical, historical and philosophical principles, which are part of Chinese medicine. Traditional acupuncture practitioners assess their patients’ conditions using Chinese medicine diagnostic techniques, which determine clinical care and treatment. Little is known about differences in the perceptions of research evidence among practitioners in the European Union (EU) and China, given the diversity of acupuncture practice. Material and methods: This study explored differences between practitioners of traditional acupuncture regarding perceived need for research evidence and prioritisation for future clinical trials, based on their practice within the EU and China. A convenience sample of acupuncturists in the EU (contacted by their professional organisation) and China (from geographically dispersed hospitals) were invited to participate in a survey, which was conducted during 2010/2011. Data collected included: practitioners’ demographic details, country of training, practice setting, acupuncture techniques, perceived adverse event reporting, diagnostic methods, conditions commonly treated, conditions perceived as needing more evidence and practitioner perceptions of conditions which could demonstrate benefit if investigated in clinical trials. Results: From 1126 survey responses, 1020 (559 EU, 461 China) could be included in the analysis for direct comparison. A response rate for the EU could not be calculated but for China was 98%. Pain was the most frequently reported commonly treated condition by EU acupuncturists and neurological conditions (mainly stroke) for Chinese practitioners. The top reported priorities for research were obstetrics/gynaecological conditions in the EU and neurological problems in China. Conclusion: The survey identified differences in practice and training between acupuncturists in China and the EU and between EU member states. These differences may inform prioritisation of health conditions for future trials. Innovative research methods are recommended to incorporate the complexity and plurality of acupuncture practice and theory. Creation of collaborative networks is crucial in overcoming these differences to facilitate international, multi-centre clinical trials. [Copyright &y& Elsevier]

Objectives: This pilot study on the use of traditional Chinese acupuncture (TCA) to treat chronic stress explored the use of the diurnal salivary cortisol profile as a potential outcome measure. Design and methods: Adult volunteers ( n=18) with high self-reported stress levels, ascertained by screening with the Perceived Stress Scale 14, were randomized into three groups. Group 1 received weekly sessions of TCA for 5 weeks; Group 2 received attention only weekly (practitioner present and subject supine) for 5 weeks, and group 3 acted as a waiting-list control. A diurnal cortisol profile was constructed for each individual at nine data points: two at baseline, five during the intervention, and two postintervention. A salivary cortisol sample was taken at four time points (on waking, 30 minutes, 3 hours, and 12 hours after waking). Outcome measures: Salivary cortisol concentrations were measured using a high-sensitivity salivary cortisol enzyme immunoassay. Results: The cortisol awakening response showed an average increase during the intervention for both TCA and attention groups, indicating that for these two groups the cortisol response had normalized and they were in a lower state of stress. These trends did not reach statistical significance due to individual variation and the small number of study participants. The control group showed an overall decrease in the average morning increase over the same period. No significant difference in the day decline in cortisol was found between groups at any point in the study. Conclusions: This pilot study suggests that TCA could reduce stress and increase the morning rise of the cortisol profile; however, this was not distinguishable from the effect of attention only. Further work with a larger sample is necessary to provide a definitive answer regarding whether this could be sustained with more TCA treatments. The morning cortisol increase could be a useful outcome measure for monitoring the effects of treatment on perceived stress. [ABSTRACT FROM AUTHOR]

Background Traditional and complementary healthcare approaches (TCA) are widely used for children, often because of perceived safety. Honey is a traditional remedy for upper respiratory tract symptoms in infants. Health officials currently advise limiting honey use because of the risk of botulism. Objective This paper discusses honey as a traditional healthcare approach for children in a multi-ethnic community, and parents' and primary healthcare practitioners' (PHPs) perceptions of its safety. Design As part of a larger study exploring beliefs about TCA, this paper focuses on perceived safety and use of honey, using data extracted for detailed analysis. Eleven parent focus groups ( n= 92) and 30 interviews with PHPs were conducted. Qualitative data analysis used the Framework approach. Setting London Boroughs of Brent and Harrow Results TCA, particularly home remedies, dietary and religious approaches were popular for children. Honey was a particularly common TCA, reportedly used by 27 (29%) parents for their children. Honey was believed to be traditional, acceptable, accessible, natural and safe. It was most commonly used for respiratory tract symptoms and administered with hot water and lemon juice. PHPs were more concerned about the safety of TCA than parents. Almost half (40%) of PHPs mentioned the use of honey for children, few perceived it as a 'treatment' or were concerned about botulism. Others were aware of the risks and some reported challenges in communicating risk to parents. Conclusion TCA are commonly used for children, honey in particular for respiratory tract symptoms. Parents and some PHPs appear unaware of the risk of botulism from honey use in infants. Healthcare practitioners should ask routinely about the use of honey and other TCA, and consider different parental belief systems in ethnically diverse populations. Further research is required on the use and efficacy of honey for infants, to raise awareness of its benefits and risks. [ABSTRACT FROM AUTHOR]

Background: Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM. Methods: A systematic search of the literature was carried out. A two-stage selection process with predetermined inclusion/exclusion criteria identified studies using a theoretical framework depicting the interaction of psychological factors involved in the CAM decision process. Papers were critically appraised and findings summarised. Results: Twenty two studies using a theoretical model to predict CAM use were included in the final review; only one examined child use. Seven different models were identified. The most commonly used and successful model was Andersen's Sociobehavioural Model (SBM). Two papers proposed modifications to the SBM for CAM use. Six qualitative studies developed their own model. Conclusion: The SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and policy. [ABSTRACT FROM AUTHOR]

Five focus group discussions were conducted with 28 (fourth-year) medical students from the Chinese University of Hong Kong (CUHK) to explore attitudes to Traditional Chinese Medicine (TCM) and its impact on the future of medical training. Most students perceived that TCM was a good alternative for certain health problems but lack of scientific evidence and the absence of regulation were major barriers. Students were concerned about the limitations of TCM, but identified their need to understand TCM to effectively communicate with their patients. Paralleled with the experience in the United Kingdom and other countries, if traditional and conventional doctors are to work effectively side by side, current medical education and health service arrangements need to change. [ABSTRACT FROM AUTHOR]

A pilot study was undertaken to examine the feasibility of auditing and developing a nationaldatabase of acupuncture practice in the United Kingdom.One hundred forty-five (145) practitioners, members of the British Acupuncture Council, were invitedto participate in the study. Those who accepted were given training and then asked to record demographicand treatment outcomes data on new patients attending their practices over a 3-month period. Two questionnaires,the Measure Your Own Medical Outcomes Profile and the College of Integrated Chinese Medicine outcomequestionnaire, were compared. Baseline health status was assessed and repeated patient feedback questionnairesemployed.Of the 31 (21%) of practitioners who responded, only 9 (6%) eventually contributed data. A totalof 69 patients participated in the study: 43 (68%) of the patients were female, and 46 (73%) were aged between30 and 59. More than half (52%) had had their presenting problem for over 5 years and most (78%) were affecteddaily by it. Nineteen (30%) had had prior acupuncture treatment for their condition. The main categoriesof complaints reported were musculoskeletal and psychologic. Thirty-two (32) out of 41 (78%) patients withcompleted final outcomes data recorded moderate or major benefit in their main complaint, with no reports ofdeterioration.Although willing to be involved, practitioners found the research process time-consuming andwere concerned how it could be balanced against the demands of a busy practice and the interests of patients.For a national audit study to succeed, the process would have to be simplified and practitioners encouraged toengage; collection of such information could then help to provide much-needed data on acupuncture treatmentin the United Kingdom. [ABSTRACT FROM AUTHOR]

Abstract: Ethnobotanical relevance: Due to the global rise in the use of traditional Chinese medicine (TCM), Chinese materia medica (medicinal materials, or CMM) are giving cause for concern over their evidence base, safety/possible toxicity, questionable quality and use of endangered species of both animals and plants. However, little if anything is actually known about the range of species used to produce CMM used in Europe and even in China. This study represents the first attempt to identify and compare the most important CMM used in both regions, to begin the process of assessing the risks to public health and possible future benefits. Materials and methods: Data were collected from a convenience sample of TCM practitioners in the EU and mainland China, using a paper/online survey. Among other questions, respondents were asked (1) which conditions they most commonly treated using CMM and the likelihood of them using herbal manufactured products and decoctions in addition to raw herbs; (2) the perceived frequency with which they observed adverse events to CMM; (3) the frequency and reasons for use of 1 herbal formula and 6 specific individual herbs; (4) an open question about other CMM they used, including materials of non-plant origin. Data were entered into PASW statistics package and analysed using frequency tables, cross-tabulations and chi-squared tests to compare EU and Chinese results. Results: From a total of 747 useable questionnaires (420 from China, 327 from the EU) of those responding from the EU, TCM was generally more commonly used for obstetric/gynaecological and dermatological conditions, compared to neurological and gastrointestinal diseases in China. Disorders treated by Chinese practitioners were more varied, and often more serious, than those treated by their European counterparts, and the range of materials used in China was wider. The potential for toxicity was not high in either region, but although greater in China due to the use of more potent CMM, the incidence of side effects was perceived to be higher by EU practitioners. Conclusions: Very few of the species used to prepare CMM in the EU in this study give rise to safety concerns from what is known from the scientific and other literature, and in China only a few toxic CMM appear to be commonly used, some of them only after processing and mainly for serious disorders. The main cause for concern is likely to be interaction with prescribed medication, especially in central nervous system and cardiovascular conditions where drug interactions have previously been reported most frequently and which would currently be more applicable in China than Europe. [Copyright &y& Elsevier]

Abstract: Relevance: Acupuncture is an intrinsic part of traditional Chinese medicine. The current understanding of the acupuncture meridian system, acupoints and the potential utilizing Omics technologies are summarized in this review. Material and methods: A systematic search for acupuncture involving Omics technologies was carried out using multiple online literature databases. The records retrieved were from the full collections of each database dated to September 2011. Data produced from functional genomic technologies were extracted from the collected acupuncture/moxibustion studies and subjected to evaluation. Analyses and comments were summarized on the advances in experimental research in acupuncture/moxibustion-related studies, and the future for strategies and approaches in the era of functional genomics highlighted. Results: An overview of articles indicated that several diseases or symptoms with evidence of effectiveness had been piloted for using functional genomic technologies, such as Parkinson''s disease, allergic disorders, pain, and spinal cord injury, most of which are chronic “difficult diseases”. High-throughput genomic and proteomic profiling of gene expression in tissues has been able to identify potential candidates for the effects of acupuncture and provide valuable information toward understanding the possible mechanisms of the therapy. However, without further holistic and sophisticated analyses in the context of metabolomics and systems biology, the current attempts and the foreseeable developments appear to be insufficient to produce firm conclusions. Noticeably, the recent rapid advances in functional molecular imaging targeting specific metabolites have shown great promise and if combined with other post-genomic technologies, could be extremely helpful for the acupuncture studies in human subjects. Conclusion: This review suggest that disease-oriented studies using the approach of multi-indexed high-throughput technologies and systems biology analyses will be a preferred strategy for future acupuncture/moxibustion research. [Copyright &y& Elsevier]

Abstract: Background and aims: GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GP-TCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions. Materials and methods: Literature studies, opinion polls and discussions among consortium members and stakeholders. Results: By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials. Conclusions: The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012. [Copyright &y& Elsevier]