Complementary Health Practice Review recent issues

Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress

Coffey, K. A., Hartman, M. — 2008-04-29

Both dispositional mindfulness and mindfulness-based interventions have been found to be associated with less psychological distress. The current study investigated three mechanisms by which mindfulness might exert its beneficial effects: emotion regulation, nonattachment, and reduced rumination. Correlational self-report data were collected from two independent, nonclinical samples of undergraduates. Structural equation modeling was then used to test the role of these three mechanisms in mediating the relationship between mindfulness and a psychological distress factor, consisting of measures for depressive and anxious symptomatology. The model was respecified based on the first sample and retested in the second sample. Results confirmed an inverse relationship between mindfulness and psychological distress. Furthermore, emotion regulation, nonattachment, and rumination significantly mediated this relationship.

Safe Effective Nondrug Treatment of Chronic Depression: A Review of Research on Low-Voltage Cranial Electrical Stimulation and Other Adjunctive Therapies

Shealy, C. N., Thomlinson, P. — 2008-04-29

Although clinical practice guidelines tend to emphasize pharmacological treatments for chronic depression, safe and effective nondrug treatments are available. This article reviews three decades of research at the Shealy Institute on nonpharmacological treatments for chronic depression in chronic pain patients via low-voltage electrical stimulation and other adjunctive therapies. More than 30,000 chronically depressed patients have been treated with cranial electrical stimulation at 1 to 2 mA at 15,000 Hz, modulated at 500 and 15 Hz. Approximately half of patients treated with this approach experienced marked clinical improvement. When combined with photostimulation at 1 to 7 Hz, 85% of patients improved adequately without use of antidepressant drugs and without complications. Magnesium replacement and nutrition education are useful adjuncts. This program is cost effective and can be carried out by a nurse practitioner and an assistant. Further controlled clinical research and research on mechanisms of action would strengthen the validity of these findings and increase the application of these therapeutic approaches.

Uninformed Complementary and Alternative Supplement Use: A Risky Behavior for Cardiovascular Patients

Bristol, M. N., Sonnad, S. S., Guerra, C. — 2008-04-29

Growing use of complementary and alternative supplements (CAS) is of concern because of the potential for herb—drug interaction among cardiovascular patients. Literary searches were conducted on PubMed to identify reports of extent and purpose of CAS use, disclosure of use by patients, physician knowledge, and possible drug—CAS interactions for cardiovascular patients. Additional published studies were located through the Web sites of various organizations. Further searches of case reports, case series, controlled trials, and laboratory evidence were performed for each of the top 10 CAS and their possible cardiovascular drug interactions. More research is needed to understand supplement—drug interactions, particularly in terms of how this potentially affects patients taking cardiovascular drugs. With this lack of research and clarity on supplement—dug interactions and the underreporting of CAS use by many patients, physician education is also in need of improvement.

A Dialogue-Building Pilot Intervention Involving Traditional and Biomedical Health Providers Focusing on STIs and HIV/AIDS Care in Zambia

2008-04-29

Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre- and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community.

CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools

Elder, W.G., Hustedde, C., Rakel, D., Joyce, J. — 2008-04-29

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician—patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.

Consumer Decision Factors for Initial and Long-Term Use of Complementary and Alternative Medicine

Sirois, F. M., Purc-Stephenson, R. J. — 2007-12-18

Guided by the conceptual framework of the consumer decision-making model, the present study compared the factors associated with initial and long-term use of complementary and alternative medicine (CAM) providers. A survey was completed by 239 people recruited from the offices of physicians and CAM practitioners. Conventional medicine clients (n = 54), new or infrequent clients (n = 73), and established CAM clients (n = 112) were compared to identify the decision factors for initial and long-term CAM use. Consistent with the components of this model, we found support for the roles of external influences (age, social recommendations), decision process factors (symptom severity, egalitarian provider preference), and post-decision factors (dissatisfaction with conventional care) depending on whether the pattern of CAM use was new or infrequent or established. Overall, this study provides preliminary support for the utility of the consumer decision-making model as an integrative framework for understanding the roles of correlates of CAM use.

Integrative Medicine and Clinical Practice: Diagnosis and Treatment Strategies

Salkeld, E. J. — 2007-12-18

Although the definition of integrative, complementary and alternative medicine (CAM) remains under discussion by members of the clinical community, the medical literature contains few reports on the process of integration of CAM methods into clinical practice. This report describes a study of the clinical approach of holistic clinicians in one clinic over 14 months, based on selection of diagnoses and therapies. Methods included observations of clinical encounters and physician interviews. Findings suggest that physicians initially selected diagnoses and treatments that reflected their biomedical orientation. Subsequent diagnoses incorporated energy healing, homeopathy, and spiritual hypnotherapy. This gradual introduction of CAM modalities into practice allowed physicians to address body—mind—emotional and spiritual causes of disease. Incorporation of CAM modalities into clinical practice by these biomedically trained physicians with additional CAM experience gave them flexibility to offer patients different treatment options and alleviated the need to reconcile conflicting theories of disease etiology.

Mindfulness Meditation May Lessen Anxiety, Promote Social Skills, and Improve Academic Performance Among Adolescents With Learning Disabilities

Beauchemin, J., Hutchins, T. L., Patterson, F. — 2007-12-18

Students with learning disabilities (LD; defined by compromised academic performance) often have higher levels of anxiety, school-related stress, and less optimal social skills compared with their typically developing peers. Previous health research indicates that meditation and relaxation training may be effective in reducing anxiety and promoting social skills. This pilot study used a pre—post no-control design to examine feasibility of, attitudes toward, and outcomes of a 5-week mindfulness meditation intervention administered to 34 adolescents diagnosed with LD. Postintervention survey responses overwhelmingly expressed positive attitudes toward the program. All outcome measures showed significant improvement, with participants who completed the program demonstrating decreased state and trait anxiety, enhanced social skills, and improved academic performance. Although not directly assessed, the outcomes are consistent with a cognitive-interference model of learning disability and suggest that mindfulness meditation decreases anxiety and detrimental self-focus of attention, which, in turn, promotes social skills and academic outcomes.

Midwives Practice CAM: Feminism in the Delivery Room

Shuval, J. T., Gross, S. E. — 2007-12-18

This article focuses on midwives who practice complementary and alternative medicine (CAM) in Israel. After qualifying as nurses in mainstream biomedical institutions, these midwives have, at some point in their careers, opted to study a variety of CAM skills and practice them in hospital delivery rooms in Israel. The authors explore the relationship of selected elements of feminist ideology to the epistemology of CAM midwives. Seven context-specific themes are viewed as central to their epistemological stance: rejection of the medicalization of birth; a strong belief in the "naturalness" of childbirth; rejection of the overuse of technology; empowerment of women; nostalgia and reverence for the past; centrality of intuition, feeling, and emotion; and active advocacy. In-depth, semistructured interviews were carried out during 2004 to 2005 with 13 midwives. These narratives provided empirical material for a qualitative analysis. Evidence is shown to demonstrate the unique feminist quality of the core beliefs of the CAM midwives.

CAM Competencies for the Health Professions

Kreitzer, M. J., Mann, D., Lumpkin, M. — 2007-12-18

As consumer demand for complementary therapies has increased, so too has the public's expectation that health care professionals be knowledgeable about complementary and alternative medicine (CAM) and prepared to advise patients. In 2000, the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM) began awarding competitive, 5-year educational grants to academic institutions committed to teaching CAM content to health professional students. Fifteen awards were made under this program. Five somewhat overlapping domains of competency have emerged: awareness of CAM therapies and practices, evidence base underlying CAM therapies, CAM skill development, self-awareness and self-care, and CAM models and systems. The NCCAM R-25 projects have demonstrated the value of defining competencies in a variety of ways that can usefully guide the allopathic learner toward the broader goals of informed integrative, patient-centered practice and enhanced self-care.

Why Is the Australian Government Interested in Complementary Medicine? A Case Study of Economic Rationalism

Baer, H. A. — 2007-10-01

To address rising health costs, the Australian government has relied on several strategies: (1) covert rationing that entails limiting public health funds for particular patients or services; (2) the allocation of patients awaiting surgery to a priority level; (3) increased copayments for physician visits necessitated by practices such as physicians refusing to bulk bill; and (4) the establishment of an independent auditor for the private health insurance industry. However, the health economics literature rarely mentions that the growing support in various ways of the Australian government for complementary medicine may constitute another strategy for curtailing rising health costs. The government's main support for complementary medicine has come in the form of training programs in chiropractic, osteopathy, Chinese medicine, and naturopathy in public tertiary institutions and partnerships between private complementary colleges and public universities. Compared with biomedical education with its need for hospitals and sophisticated technology, complementary training programs are inexpensive. Furthermore, complementary services are generally not covered by Medicare but must be paid for either out of pocket or by a private health plan.

Massage Therapy: Is Its Evidence-Base Getting Stronger

Ernst, E., Pittler, M.H., Wider, B., Boddy, K. — 2007-10-01

The aim of this article is to evaluate trends in the development of the evidence-base for the effectiveness of massage therapy. For this purpose, a comparison of two systematic reviews was conducted. The first related to the evidence-base in 2000, the second to 2005. Both employed the same methodology and criteria for evaluation. The results indicate that, in several areas, the evidence has become more solid and, for anxiety and back pain, it has become more positive. For a host of other indications, the evidence seems encouraging, but more studies are required to test the effectiveness of massage therapy as well as its use for specific conditions.

Efficacy of St. John's Wort for Treating Mild to Moderate Depression

Gahlsdorf, T., Krause, R., Beal, M. W. — 2007-10-01

Current studies regarding the efficacy of the herb St. John's wort (SJW) in treating mild to moderate cases of depression show conflicting evidence. In this article, we review the literature and consider similarities and differences between studies showing some efficacy and those showing none. Twelve published reports were reviewed. The majority of studies indicated the efficacy of SJW in the treatment of mild to moderate cases of depression. Most trials have had small sample sizes and either a placebo group or a standard pharmaceutical group. Two studies (both pediatric) were uncontrolled. Studies generally reported outcomes that had positive implications for their financial supporters and/or those with whom the primary investigators had acknowledged financial affiliations. More studies that have larger sample sizes and include placebo and pharmaceutical control groups are needed.

Perspectives of Family Medicine Physicians and Licensed Acupuncture Clinicians on Caring for Persons With Unexplained Chronic Fatigue

Daly, J. M., Hartz, A. J. — 2007-10-01

Unexplained chronic fatigue (UCF) is a poorly understood condition with little known about its etiology and treatment. A wide range of health care providers, including physicians, nurse practitioners, and complementary and alternative medical practitioners, offer services for persons with UCF. This study explored perspectives of family medicine physicians and licensed acupuncture clinicians with experience in treating patients with UCF, regarding their treatment regimens and perceived success at improving their patients' energy and coping with symptoms. A sample of 141 family medicine physicians and licensed acupuncturists was surveyed via a questionnaire; 48 returned the completed questionnaire. Clinicians reported treating from 3 to 375 patients with UCF. Family physicians provided more conventional methods, and licensed acupuncturists provided alternative treatments. The reported success of the licensed acupuncturists at improving energy and stamina and helping patients cope with fatigue was significantly higher than that of the family physicians. Implications for future research are discussed.

Training Family Caregivers in Hand and Foot Massage for Hospitalized Patients: Feasibility, Challenges, and Lessons Learned

Faurot, K. R., Gaylord, S. A., Mann, J. D. — 2007-10-01

Increasingly, research is demonstrating the safety, efficacy, and patient satisfaction associated with use of nonpharmacological, complementary interventions for pain management in hospital settings. One such intervention, massage, has been found to be effective for pain and anxiety reduction in limited forms, such as described here, massage is relatively easy to learn and apply. The pilot project was designed to develop and assess a clinical intervention using hand and foot massage for management of pain and anxiety in inpatients on a rehabilitation unit. Methods included formal training of staff nurses in hand and foot massage and subsequently having them teach key family caregivers of the patient how to deliver hand or foot massage in response to reports of pain and anxiety. The report describes study rationale, project development, challenges to implementation in an academic, tertiary care, inpatient rehabilitation facility, and lessons learned for future project design and implementation. The need for a community-based participatory research perspective is addressed.

The Drive for Legitimation in Chinese Medicine and Acupuncture in Australia: Successes and Dilemmas

Baer, H. A. — 2007-06-29

This article examines the drive for legitimation on the part of Chinese medicine and more specifically acupuncture in Australia. It examines the development of Chinese medicine in Australia, the road to statutory registration of Chinese medicine in Victoria, and the niche of Chinese medicine within the context of the Australian plural medical system. Despite the opposition of organized medicine, the Victorian Parliament passed the Chinese Medicine Registration Act in May 2000, making Victoria the only Australian political jurisdiction to formally regulate Chinese medicine practitioners and acupuncturists. The legal status of Chinese medicine and acupuncture outside of Victoria resembles that of naturopathy and other natural therapies, such as Western herbalism and homeopathy, none of which has achieved statutory registration in any Australian jurisdiction. Chinese medicine has a distinct identity within the context of the Australian plural medical system. Conversely, acupuncture, as one of the modalities of Chinese medicine—and in Western societies its principal modality—has been incorporated into various other heterodox medical subsystems, particularly chiropractic, osteopathy, and naturopathy, as well as conventional systems, such as biomedicine and physiotherapy.

People's Choice: Complementary and Alternative Medicine Modalities

Robinson, A., Chesters, J., Cooper, S. — 2007-06-29

The diversity within CAM use in the community, and the beliefs, concerns, and characteristics of the users of individual CAM modalities was explored via a survey mailed to a randomly selected sample of 1,308 people in different metropolitan and rural localities in Victoria, Australia. The response rate was 40% (n = 459). The respondents' overall current CAM use was 52% and lifetime use was 85%. Chiropractic (50%), massage therapy, (50%), and vitamin or herbal supplements (39%) were the most frequently used modalities. A set of beliefs labeled holistic health care beliefs strongly predicted the use of Natural Remedy and Wellness modalities. Users of these modalities were more likely to be female, under the age of 60, and tertiary educated. Rurality characteristics did not predict rural CAM usage and were equally present in metropolitan and rural respondents. The respondents' decisions concerning CAM involved choosing a modality that fit their self-assessed health care needs.

Trusted Information Sources: The Preferred Option for Complementary and Alternative Medicine Users

Robinson, A., Cooper, S. — 2007-06-29

The objective of this article is to explore complementary and alternative medicine (CAM) users' reliance on health service providers, different forms of media, and interpersonal contacts for their health-needs information. To explore this information, a survey was posted to a random sample of 1,308 people in five rural and two metropolitan localities in Victoria, Australia. The response rate was 40% (n = 459). The overall current CAM use was 52% and lifetime use was 85%. We found that the CAM users obtained most of their health needs information from doctors and CAM practitioners, whereas the Internet and health food shops served as the least useful sources of information. The respondents who used the modalities we labeled as natural remedy modalities accessed the most health information. The study results show that although conventional medicine may question some types of health care information that forms the basis of respondents' decision making, their health care decisions are nevertheless informed decisions.

Quackery Masquerading as Complementary and Alternative Medicine (CAM) in Patients With Epilepsy

Sharma, S., Joshi, S., Khushwaha, S., Bala, K. — 2007-06-29

Patients suffering from chronic diseases like epilepsy often use complementary and alternative medicine (CAM) as first-line treatment because of myths, superstitions, and stigma attached to the disease. The present study reports on 108 patients with epilepsy presenting to an allopathic hospital with uncontrolled seizures, status epilepticus, or drug toxicity. Blood samples of these patients taking unlabeled pills from a CAM provider specializing in the treatment of epilepsy contained prescription antiepileptic drugs (AEDs) such as carbamazepine, phenytoin, valproic acid, and phenobarbitone. Serum samples in all but 5 patients demonstrated presence of one or more AEDs. Most of the patients had serum levels of these AEDs either in the subtherapeutic or in the supratherapeutic range. The authors alert clinicians that the patients resorting to "safe" or "natural" CAM may end up receiving modern prescription medicines from unauthorized CAM providers in toxic or subtherapeutic doses.

Aftermath of the Unexpected, Unexplained, and Abrupt Termination of Healing Touch and Extrapolation of Related Costs

Peck, S. — 2007-06-29

This qualitative study reports 12 patients' experiences following the unplanned and unexpected termination of their healing touch treatments. Physically disabled, chronically ill patients requiring nursing home levels of care, who were being assisted in staying at home with agency support, had been treated one to two times weekly to monthly over a period of 3 to 4 months by a healing touch practitioner, under a pilot study. Patients had been interviewed twice during their treatments and had described positive experiences with healing touch. Midway through the study, there was an abrupt stopping of treatments without warning or explanation to either patients or researchers. Naturalistic inquiry methodology was used to explore patients' subsequent reactions and experiences. Six patients had negative experiences, including increased pain and impaired functional ability, sleep, and emotional status. Six patients continued to have positive experiences after treatments were terminated. Estimates of potential cost savings with healing touch treatment, as well as ethical implications of discontinuing beneficial treatment without warning or replacement, are discussed.