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Water Extract of Acori Graminei Rhizoma Attenuates Features of Rheumatoid Arthritis in DBA/1 Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3637453. [PMID: 30713571 PMCID: PMC6332975 DOI: 10.1155/2019/3637453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022]
Abstract
The dry rhizome of Acorus gramineus Solander, known as Acori Graminei Rhizoma, is used to treat dementia, stroke, eczema, and indigestion in traditional Chinese medicine, traditional Korean medicine, and traditional Japanese Kampo medicine. Previous studies have reported that Acori Graminei Rhizoma extract ameliorated cognitive impairment in Aβ1-42 injected mice. However, the effect of Acori Graminei Rhizoma on type II collagen induced arthritis (CIA) has not been elucidated. Thus, we evaluated the water extract of Acori Graminei Rhizoma (WAG) in CIA mice models. Male DBA/1 mice were separated into five groups (NOR; n=10, CON; n=10, CIA + methotrexate (MTX); n=10, CIA + 100 mg/kg WAG; n=10, CIA + 500 mg/kg WAG; n=10). CIA was induced by injecting the mice with bovine type II collagen, after which the mice were treated with WAG and/or MTX. Hematological parameters and liver and kidney serum toxicity markers were analyzed. Further, serum levels of interleukin (IL)-6, TNF-α, and type II collagen IgG were analyzed via enzyme-linked immunosorbent assay (ELISA). Treatment with 500 mg/kg WAG decreased serum levels of IL-6, TNF-α, and collagen IgG in a CIA model. Moreover, WAG treatment decreased CIA-induced swelling of mouse hind legs, infiltration of inflammatory cells into the synovial membrane, and blood neutrophil levels. WAG administration did not influence hematological parameters or kidneys and liver toxicity markers. WAG may be used to treat arthritis by reducing the inflammation indicators. However, further experiments are required to determine how WAG affects inflammation mechanisms in vitro and in vivo.
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Vestin M, Carlsson JM, Bjerså K. Emergency department staffs’ knowledge, attitude and patient communication about complementary and alternative medicine – A Swedish survey. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sellar AJ, Taylor DM, Ross ND, Chen HH, Plant LD, McLean D, Berlingeri P, Gavan R, Weiland TJ, Knott JC. The Period Prevalence of Mind and Body Practice Use by Adult Emergency Department Patients. J Altern Complement Med 2018; 24:514-524. [PMID: 29377711 DOI: 10.1089/acm.2017.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Mind and Body Practice (MBP) use (e.g., chiropractic, acupuncture, meditation) among Emergency Department (ED) patients is largely unknown. We aimed to determine the period prevalence, nature of MBP use, and perceptions of MBP among adult ED patients. DESIGN AND SETTING We undertook a cross-sectional survey of a convenience sample of patients presenting to three EDs between February and June 2016. SUBJECTS Patients were eligible for inclusion if they were aged 18 years or more and had presented for medical treatment. INTERVENTION An anonymous, self-administered questionnaire, based upon a validated pediatric questionnaire, was completed by the patient, with assistance if required. OUTCOME MEASURES The primary outcome was the nature and 12 month period prevalence of MBP use. Secondary outcomes were variables associated with use and patient perceptions of MBP. RESULTS 674 patients were enrolled. In the previous 12 months, 500 (74.2%) patients had used at least one MBP. MBP users and nonusers did not differ in gender, ancestry, or chronic illness status (p > 0.05). However, users were significantly younger and more likely to have private health insurance (p < 0.001). A total of 2094 courses of 68 different MBP had been used including massage (75.0% of users), meditation (35.2%), chiropractic (32.6%), acupuncture (32.0%), and yoga (30.6%). Users were significantly more likely (p < 0.01) to believe that MBP prevented illness, treated illness, were more effective than prescription medicines, assisted prescription medications, and were safe and provided a more holistic approach. Forty-one (6.1%) patients used MBP for their ED presenting complaint. However, only 14 (34.1%) advised their ED physician of this. CONCLUSION The period prevalence of MBP use among ED patients is high. Knowledge of the MBP used for a patient's presenting complaint may better inform the ED physician when making management decisions.
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Affiliation(s)
- Ashleigh J Sellar
- 1 Department of Emergency Medicine, Austin Health , Heidelberg, Australia .,2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia
| | - David McD Taylor
- 1 Department of Emergency Medicine, Austin Health , Heidelberg, Australia .,2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia
| | - Nicholas D Ross
- 1 Department of Emergency Medicine, Austin Health , Heidelberg, Australia .,2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia
| | - Hayley H Chen
- 1 Department of Emergency Medicine, Austin Health , Heidelberg, Australia .,2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia
| | - Luke D Plant
- 1 Department of Emergency Medicine, Austin Health , Heidelberg, Australia .,2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia
| | - Daniel McLean
- 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia .,3 Department of Emergency Medicine, St Vincent's Hospital , Fitzroy, Australia
| | - Paul Berlingeri
- 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia .,3 Department of Emergency Medicine, St Vincent's Hospital , Fitzroy, Australia
| | - Rex Gavan
- 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia .,4 Department of Emergency Medicine, Royal Melbourne Hospital , Parkville, Australia
| | - Tracey J Weiland
- 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia .,3 Department of Emergency Medicine, St Vincent's Hospital , Fitzroy, Australia
| | - Jonathan C Knott
- 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville, Australia .,4 Department of Emergency Medicine, Royal Melbourne Hospital , Parkville, Australia
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Jatau AI, Aung MMT, Kamauzaman THT, Chedi BAZ, Sha'aban A, Rahman AFA. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review. JOURNAL OF COMPLEMENTARY MEDICINE RESEARCH 2016; 5:191-7. [PMID: 27104042 PMCID: PMC4835996 DOI: 10.5455/jice.20160223105521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events.
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Affiliation(s)
- Abubakar Ibrahim Jatau
- Department of Health Sciences, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak, Kuala Terengganu, Malaysia
| | - Myat Moe Thwe Aung
- Department of Community Medicine, Faculty of Medicine, Universiti Sultan Zainal Abidin, Kampus Kota, Kuala Terengganu, Malaysia
| | | | - Basheer A Z Chedi
- Department of Pharmacology, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Abubakar Sha'aban
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Ab Fatah Ab Rahman
- Department of Health Sciences, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak, Kuala Terengganu, Malaysia
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Waterbrook AL, Southall JC, Strout TD, Baumann MR. The Knowledge and Usage of Complementary and Alternative Medicine by Emergency Department Patients and Physicians. J Emerg Med 2010; 39:569-75. [DOI: 10.1016/j.jemermed.2008.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 01/21/2008] [Accepted: 01/25/2008] [Indexed: 11/16/2022]
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Potential interactions of drug-natural health products and natural health products-natural health products among children. J Pediatr 2008; 152:521-6, 526.e1-4. [PMID: 18346508 DOI: 10.1016/j.jpeds.2007.09.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/18/2007] [Accepted: 09/12/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the frequency of concurrent use of conventional medications and natural health products (NHP) and their potential interactions in children arriving at an emergency department. STUDY DESIGN A survey of parents and patients 0 to 18 years at a large pediatric ED in Toronto, Ontario, Canada. RESULTS A total of 1804 families were interviewed in this study. Concurrent drug-NHP use was documented in 355 (20%) of patients and 269 (15%) of NHP users were receiving more than one NHP simultaneously. Theoretically possible NHP-drug or NHP-NHP interactions in the preceding 3 months were identified in 285 (16%) children. There were 35 different NHP-medication interaction pairs and 41 NHP-NHP interaction pairs. NHP-medication interactions were predominantly pharmacokinetic (modified absorption, 35%); potential NHP-NHP interactions were mostly pharmacodynamic (increased risk of bleeding, 47%). CONCLUSIONS Medications are used concurrently with NHP in every fifth pediatric patient in the emergency department and many NHP users are receiving more than 1 NHP simultaneously. One quarter of all paired medication-NHP or NHP-NHP could potentially cause interactions. Although we can not confirm that these were true interactions resulting in clinical symptoms, parents and health care providers need to balance the potential benefit of concurrent NHP-medication use with its potential harms.
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Richardson WH, Slone CM, Michels JE. Herbal drugs of abuse: an emerging problem. Emerg Med Clin North Am 2007; 25:435-57; abstract ix. [PMID: 17482027 DOI: 10.1016/j.emc.2007.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Some herbal products are emerging as popular drugs for recreational abuse. Plant and herbal supplements used recreationally can have a wide spectrum of clinical effects ranging from euphoric and stimulant effects to hallucinogenic experiences. Despite the potential for abuse, addiction, and serious adverse effects, there may be a false perception that these products are all safe, legal, and organic. These perceptions and the ease of accessibility to herbal products could result in greater potential for recreational abuse and subsequent complications presenting to emergency departments. Health care professionals must be cognizant of this emerging problem as increased media coverage and marketing have made these products accessible and recognizable to many young adults and teenagers.
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Affiliation(s)
- William H Richardson
- Department of Emergency Medicine, Palmetto Health Richland, 3 Medical Park, Columbia, SC 29203, USA.
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Taylor DM, Walsham N, Taylor SE, Wong L. Potential Interactions Between Prescription Drugs and Complementary and Alternative Medicines Among Patients in the Emergency Department. Pharmacotherapy 2006; 26:634-40. [PMID: 16637793 DOI: 10.1592/phco.26.5.634] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine the nature and prevalence of potential interactions between prescription drugs and complementary and alternative medicines (CAMs) and the reasons some patients do not advise their physicians of CAM use. DESIGN Cross-sectional survey. SETTING The emergency department of the Royal Melbourne Hospital, a tertiary referral center. PATIENTS Four hundred four adult patients (>or= 18 yrs) who visited the emergency department between February 1, 2002, and March 31, 2003. Intervention. A specifically designed, self-administered questionnaire, available in seven languages. MEASUREMENTS AND MAIN RESULTS Main outcome measures were the prevalence of potential prescription drug-CAM interactions and the reasons some patients do not advise their physicians of CAM use. Mean +/- SD patient age was 50.6 +/- 20.0 years; 220 patients were men (54.5%, 95% confidence interval [CI] 49.5-59.4%). When asked about use during the previous year, 275 patients (68.1%, 95% CI 63.2-72.5%) reported having taken a CAM; of these, 138 were also taking a prescription drug. We identified 15 documented potential drug-CAM interactions in nine patients (3.3% of CAM users, 95% CI 1.6-6.3%) and 97 theoretical potential drug-CAM interactions in 51 patients (18.6% of CAM users, 95% CI 14.2-23.8%). Aspirin and warfarin were the most commonly involved drugs. Of CAM users, 197 (71.6%, 95% CI 65.9-76.8%) never informed their physician about CAM use, most frequently because they were not asked. CONCLUSION The prevalence of potential drug-CAM interactions among patients in the emergency department is considerable, and some of these interactions could be clinically significant. Practitioners should increase their awareness of potential drug-CAM interactions, and education initiatives aimed at encouraging patient-physician discussion of CAM use are recommended, such as a CAM history in their patient evaluation. Further research is required to better determine the clinical significance of drug-CAM interactions.
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Affiliation(s)
- David McD Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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McD Taylor D, Walsham N, Taylor SE, Wong LF. Complementary and alternative medicines versus prescription drugs: perceptions of emergency department patients. Emerg Med J 2006; 23:266-8. [PMID: 16549570 PMCID: PMC2579498 DOI: 10.1136/emj.2005.026138] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The perceptions of emergency department (ED) patients towards complementary and alternative medicines (CAM) are poorly understood. We assessed these perceptions and compared CAM users with non-users, particularly regarding CAM safety and efficacy. METHODS This was an analytical, cross sectional survey of ED patients undertaken in a tertiary referral ED. A five point Likert scale evaluated patients' level of agreement with statements relating to CAM and prescription drugs. RESULTS Of 404 patients who were enrolled (participation rate 97.1%), 275 (68.1%; 95% confidence interval (CI) 63.2 to 72.5) were CAM users (had taken a CAM within the previous 12 months). There were 178 patients (44.1%, 95% CI 39.2 to 49.1) who agreed or strongly agreed that CAM are drug free, and there was no significant difference between CAM users and non-users (p = 0.77). There were 115 patients (28.5%, 95% CI 24.2 to 33.2) who agreed or strongly agreed that CAM are always safe to take with prescription drugs, and there were no significant difference between CAM users and non-users (p = 0.39). Significantly more CAM users agreed or strongly agreed that CAM are safe to take, can prevent people from becoming ill, allow people to be in charge of their own health, can treat the mind, body, and spirit, and are more effective than prescription drugs (p<0.01). Significantly fewer CAM users agreed or strongly agreed that prescription drugs are safe to take (p<0.001). CONCLUSION Considerable proportions of ED patients are CAM users yet are ignorant of the nature and potential toxicities of CAM. In addition, CAM users have significantly different perceptions of CAM and prescription drugs from non-users. The impact of these perceptions on clinical practice needs evaluation.
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Affiliation(s)
- D McD Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Grattan St, Parkville, Victoria, Australia.
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Glintborg B, Andersen SE, Spang-Hanssen E, Dalhoff K. Disregarded use of herbal medical products and dietary supplements among surgical and medical patients as estimated by home inspection and interview. Pharmacoepidemiol Drug Saf 2005; 14:639-45. [PMID: 15546157 DOI: 10.1002/pds.1049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE More and more patients use herbal medical products (HMP) and dietary supplements (DS). Due to the possibility of drug interactions and side effects, it is important that physicians are aware of the use. The aim of the present cross sectional survey was to analyse the consumption of HMP and DS among patients recently discharged from two hospital departments. METHODS Patients were visited within 1 week after discharge and interviewed about their use of HMP and DS. Stored products were inspected and registered. Hospital files and discharge letters were examined to establish the frequency of registration. RESULTS Totally, 83 surgical and 117 medical patients were included (n = 200), 139 patients (70%) were women. 53 patients (27%) stored no HMP or DS, whereas the home inventories of 147 patients (74%) comprised 343 products. 116 patients (58%) used HMP or DS daily and 25 patients (13%) used the products on demand. The most frequently used product was multivitamins (82 patients = 41%). Totally, 61% of the products were used on the patients' own initiative. In 3% of the used products, patients were aware of possible side effects. No patients were aware of possible drug interactions. Only 21% of the 211 HMP and DS used daily prior to admission were recorded in the hospital files. CONCLUSIONS The use of HMP and DS was frequent among surgical and medical patients. The use was often not recorded in the hospital files and patients' knowledge of possible side effects and drug-interactions was minimal.
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Affiliation(s)
- Bente Glintborg
- Clinic of Internal Medicine I, H:S Bispebjerg Hospital, Copenhagen, Denmark
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Perez J, Holmes JF. Altered mental status and ataxia secondary to acute Kava ingestion. J Emerg Med 2005; 28:49-51. [PMID: 15657005 DOI: 10.1016/j.jemermed.2004.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Revised: 04/02/2004] [Accepted: 04/22/2004] [Indexed: 10/25/2022]
Abstract
Kava has traditionally been used for a variety of purposes in the tropical islands of Polynesia but is becoming more frequently available in the United States health supplement market due to its calming effects in patients with anxiety. The side effect profile is poorly known but has recently gained the attention of the Food and Drug Administration (FDA). Although hepatitis and liver failure have been described with chronic ingestion, the effects of acute overdose are poorly described. We present a case of acute Kava overdose resulting in altered mental status and ataxia similar to that seen with ethanol intoxication.
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Affiliation(s)
- Juan Perez
- Division of Emergency Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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Abstract
In summary, herbs are commonly used, and it is the physician's responsibility to have better documentation of this practice by encouraging patients to report use of herbs, and to look for any unusual side effects that can occur in terms of herb-drug or herb-herb interactions.
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Affiliation(s)
- Syed H Tariq
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S Grand Boulevard, m-238, Saint Louis, MO 63104, USA.
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Isbister GK, Adams J. Investigating the relationship between emergency departments and complementary and alternative medicine use in Australia. Emerg Med Australas 2004; 16:378-81. [PMID: 15537396 DOI: 10.1111/j.1742-6723.2004.00639.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Geoffrey K Isbister
- Emergency Department, Newcastle Mater Misericordiae Hospital, Newcastle, New South Wales, Australia
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Taylor DM, Walsham N, Taylor SE, Wong L. Use and toxicity of complementary and alternative medicines among emergency department patients. Emerg Med Australas 2004; 16:400-6. [PMID: 15537401 DOI: 10.1111/j.1742-6723.2004.00644.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the prevalence and type of complementary and alternative medicines (CAM) used by ED patients, to identify patient subgroups more likely to use CAM, the conditions for which they were taken, and the prevalence of side-effects and toxicity associated with CAM use. METHODS This was an analytical cross-sectional survey of patients at a large tertiary referral ED. Consenting patients completed a specifically designed study questionnaire, in their preferred language if required. Information was collected on CAM use on the day of presentation and within the previous week and previous year. RESULTS Four hundred and four patients were enrolled (participation rate 97.1%). Fifty (12.4%, 95% CI 9.4, 16.1) patients had taken a CAM on the day of presentation, 203 (50.2%, 95% CI 45.3, 55.2) within the previous week and 275 (68.1%, 95% CI 63.2, 72.5) within the previous year. CAM users were significantly younger, better educated and more likely to be female than non-CAM users (P < 0.01). 103 different CAM had been taken for a wide variety of reasons. Side-effects were experienced in 53 of the 1182 CAM courses taken (side-effect rate of 4.5%). One patient presented suffering specifically from CAM toxicity. CONCLUSION Complementary and alternative medicines are used by a considerable proportion of ED patients. The potential for side-effects, toxicity and interaction with traditional medication indicates the need for consideration of CAM use in patient assessment.
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Affiliation(s)
- David McD Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Li JZ, Quinn JV, McCulloch CE, Jacobs BP, Chan PV. Patterns of complementary and alternative medicine use in ED patients and its association with health care utilization. Am J Emerg Med 2004; 22:187-91. [PMID: 15138954 DOI: 10.1016/j.ajem.2004.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study characterizes the use of complementary and alternative medicines (CAM) among ED patients and demonstrates patterns of healthcare utilization among users and nonusers of CAM therapies. A cross-sectional observational study was performed by administering questionnaires to ED patients at a university teaching hospital. Of the 356 patients surveyed, more than half (55%) had tried at least one complementary and alternative therapy within the past 12 months and 17% had tried CAM for their presenting medical problem. The use of CAM interventions varied significantly among different demographic groups. The number of ED visits over the past year did not differ between the users and nonusers of CAM, but those using alternative therapies did have more visits to outpatient physicians over the past 12 months (7.8 vs. 5.2; 95% confidence interval [CI], 7-4.6; P <.01). After controlling for age, ethnicity, education level, religion, income, and self-report of overall health status, users of CAM had more frequent visits to outpatient physicians (odds ratio [OR], 1.06; 95% CI, 1.02-1.1; P <.01), had no difference in their rates of hospitalization, but trended toward spending fewer days in the hospital when they were admitted (OR,.96; 95% CI,.92-1.0; P =.06). Complementary and alternative medicines are being used by a majority of ED patients with a significant number having used CAM for their presenting complaint before visiting the ED. CAM users do not differ in their utilization of the ED when compared with nonusers, but do have a significantly increased frequency of outpatient physician visits.
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Affiliation(s)
- J Z Li
- Divisions of Emergency Medicine and Biostatistics and the Osher Center for Integrative medicine, University of California, San Francisco, San Francisco, California 94143-0208, USA
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Sparber A. Complementary therapy in critical care settings: a review of surveys and implications for nurses. Crit Care Nurs Clin North Am 2003; 15:305-12. [PMID: 12943136 DOI: 10.1016/s0899-5885(02)00101-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.
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Affiliation(s)
- Andrew Sparber
- Fresh Solutions Complementary Alternative Therapies, 3 Plum Grove Way, Gaithersburg, MD 20878, USA.
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Dunn R. Reduced access block causes shorter emergency department waiting times: An historical control observational study. Emerg Med Australas 2003; 15:232-8. [PMID: 12786644 DOI: 10.1046/j.1442-2026.2003.00441.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the effect of changes in hospital occupancy and ED occupancy on ED waiting times during a 13-day period of improved bed access. METHODS A comparative, observational study of 1133 ED attendances in the study period and 2332 attendances in a historical control period. RESULTS During the study period, mean hospital occupancy decreased from 94.9% to 89.0% (P < 0.001), mean ED occupancy decreased from 19.1 to 14.8 patients (P < 0.001) and the mean ED waiting time decreased from 58.5 to 37.1 min (P < 0.001). There were statistically significant reductions in waiting times for patients in Australasian triage scale (ATS) categories 2-5. Departmental staffing levels, attendances and patient acuity were not significantly different during the study and control periods. CONCLUSIONS Modest decreases in hospital occupancy resulted in highly significant reductions in ED waiting times. Emergency department overcrowding due to large numbers of admitted patients awaiting hospital admission is a major cause of ED dysfunction.
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Affiliation(s)
- Robert Dunn
- Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
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Lanski SL, Greenwald M, Perkins A, Simon HK. Herbal therapy use in a pediatric emergency department population: expect the unexpected. Pediatrics 2003; 111:981-5. [PMID: 12728075 DOI: 10.1542/peds.111.5.981] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In recent years investigators have reported widespread use of alternative medicine. Some herbal therapies have potentially harmful side effects as well as adverse interactions with medications. Data are lacking on the use in children and caregiver understanding of these products. OBJECTIVES To determine the reported use of herbal products among a pediatric emergency department population and to evaluate the caregivers' understanding and source of information concerning these products. DESIGN/METHODS A convenience sampling of pediatric emergency department patients and their caregivers occurred during a 3-month period in 2001. The interview consisted of 18 questions regarding the types of non-Food and Drug Administration-regulated herbal products and home remedies used, general product knowledge and sources of information used by the child's caregiver (including discussions with their child's primary physician). RESULTS One hundred forty-two (93%) of 153 families approached participated in the study. The mean patient age was 5.3 years (range: 3 weeks-18 years). Forty-five percent of caregivers reported giving their child an herbal product, and 88% of these caregivers had at least 1 year of college education. Of the children receiving these therapies, 53% had been given 1 type and 27% were given 3 or more in the past year. The most common therapies reportedly used were aloe plant/juice (44%), echinacea (33%), and sweet oil (25%). The most dangerous potential herbal and prescription medication combination reported was ephedra and albuterol in an adolescent with asthma. The most unusual products reportedly used included turpentine, pine needles, and cowchips. Of all people interviewed, 77% did not believe or were uncertain if herbal products had any side effects and only 27% could name a potential side effect. Sixty-six percent were unsure or thought that herbal products did not interact with other medications and only 2 people correctly named a drug interaction. Of the people who used these therapies, 80% reported either friends or relatives as their primary source of information. Only 45% of those giving their children herbal products report discussing the use with their child's primary health care provider. CONCLUSION Herbal and home therapies are commonly used in this pediatric population. An unexpectedly wide variety of products were reportedly given to this patient population. Caregivers reported limited knowledge regarding potential adverse medication interactions and side effects. Limited discussions with the child's primary health care provider were reported. It is therefore important for health care providers to have knowledge about herbal medications, to inquire about their use and to educate families about the risk/benefit as well as potential interactions these products may have with over-the-counter and prescription medications.
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Affiliation(s)
- Steven L Lanski
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia 30322, USA.
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Glisson JK, Rogers HE, Abourashed EA, Ogletree R, Hufford CD, Khan I. Clinic at the health food store? Employee recommendations and product analysis. Pharmacotherapy 2003; 23:64-72. [PMID: 12523461 DOI: 10.1592/phco.23.1.64.31912] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To determine what products health food store employees recommend for depression, to analyze the content of these products based on label claims, and to evaluate employee statements or recommendations for accuracy and safety. METHODS Twelve health food stores were selected for the study. One investigator approached an employee in each store and asked what they recommended for depression plus five additional questions regarding product use. Thirteen products containing St. John's wort were purchased and analyzed for hypericin and pseudohypericin content using high-performance liquid chromatography (HPLC). Total hypericin content was calculated by adding the values for hypericin and pseudohypericin. RESULTS All 12 health food store employees recommended a St. John's wort supplement for treatment of depression. Furthermore, numerous comments made by employees regarding St. John's wort and the treatment of depression were unsafe and inaccurate. The HPLC analysis revealed that no product contained +/- 10% of the stated label claim for hypericin content, and two products contained 0% hypericin. The total hypericin content (hypericin plus pseudohypericin) of only two products was within +/- 10% of the label claim for hypericin. CONCLUSIONS Health food store employees offer health care advice regarding treatment of depression with dietary supplements without proper scientific and medical training. Their comments could cause significant harm to customers. In addition, the inconsistencies of dietary supplement content continue to raise concern for individuals who use these agents as medical treatment.
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Affiliation(s)
- James K Glisson
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson 39216, USA
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Abstract
This national multisite study examined complementary and alternative medicine (CAM) use by surgical patients during the two weeks preceding their surgery. A simple descriptive design consisting of anonymous self-report questionnaires was used to measure CAM use and determine participant demographics. A purposive sample of adult, English-speaking, elective outpatients from 16 hospitals representing seven US regions was used. Data were collected randomly at each site. Sixty-seven percent of participants disclosed use of all types of CAM; 27% consumed herbs, 39% used dietary supplements, 54% took vitamins, and 1% reported use of homeopathics. Thirty-four percent of participants reported using CAMs that potentially can interact with anesthetics and inhibit coagulation. The results of this study suggest that perioperative nurses should encourage patients to disclose CAM use and should educate patients about anesthetic interactions that may contribute to bleeding.
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Affiliation(s)
- Carol L Norred
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, USA
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Abu-Laban RB, van Beek CA, Quon JA, Wu J. Willingness of emergency department patients with musculoskeletal complaints to participate in complementary and alternative medicine research. CAN J EMERG MED 2002; 4:401-7. [PMID: 17637157 DOI: 10.1017/s1481803500007909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBackground:The emergency department (ED) is a unique potential location for recruitment into studies of complementary and alternative medicine (CAM) therapies. We sought to determine the stated willingness of ED patients with musculoskeletal complaints to participate in CAM research for their presenting problem, and to determine the characteristics of this population.Methods:The study was carried out in the ED of Vancouver General Hospital weekdays between 10 am and 6 pm from Oct. 16, 2000, to Nov. 21, 2000. All adults who presented with musculoskeletal complaints involving the spine, upper extremity or lower extremity, unless they had pain severe enough to impair their ability to answer questions or unless there was a language or other communication barrier, were approached by a research nurse. If it was learned that they had already been assessed by an emergency physician, they were eliminated as potential study participants. After being presented background information by the research nurse, consenting patients were asked a series of standardized questions during a 15-minute private interview prior to their assessment by an emergency physician.Results:Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). The mean age of those studied was 38 years, and 56% were male. Most presenting problems involved the ankle/foot (29%), multiple sites (19%), the lumbosacral region (14%) or the wrist/hand (14%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74% (69/93: 95% confidence interval [CI] 64.1%–82.7%); chiropractic 70% (65/93: 95%CI 59.5%–79.0%); and other CAM therapies 92% (86/93: 95%CI 85.1%–96.9%). Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study. Logistic regression modeling, performed for secondary purposes, indicated that willingness to participate in traditional Chinese medicine or chiropractic research was independent of age, sex, educational status, pain severity or prior exposure to the modality of interest.Conclusions:ED patients with musculoskeletal complaints have a high stated willingness to participate in CAM research, even if this involves outpatient follow-up or a placebo-controlled design. ED-based CAM research appears feasible and should be pursued.
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Affiliation(s)
- Riyad B Abu-Laban
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Kemper KJ, Amata-Kynvi A, Sanghavi D, Whelan JS, Dvorkin L, Woolf A, Samuels RC, Hibberd P. Randomized trial of an internet curriculum on herbs and other dietary supplements for health care professionals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:882-889. [PMID: 12228083 DOI: 10.1097/00001888-200209000-00014] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Herbs and dietary supplements are widely used, and there is an urgent need to educate health professionals about their risks and benefits. The Internet provides an innovative way of educating busy health professionals. This study assessed the impact of an Internet-based curriculum on health professionals' knowledge, confidence, and clinical practices related to herbs and dietary supplements. METHOD The study was a randomized crossover trial involving physicians, pharmacists, advanced practice nurses, and dietitians. Participants were invited by e-mail and randomly assigned to immediate intervention versus waiting-list groups (n = 537). The curriculum lasted ten weeks and consisted of 20 case-based modules, each involving one multiple-choice or true-or-false question and its answer, links to reliable Internet sources of additional information, and a moderated listserv discussion group. Participants were surveyed about their knowledge, confidence, and communication related to herbs and dietary supplements on enrollment, after the immediate intervention group had completed the curriculum, and after the waiting-list group completed the curriculum. RESULTS Baseline scores for knowledge, confidence, and communication were similar in the two groups. At the first follow-up, there was greater improvement in scores for all three areas in the immediate intervention group than in the waiting-list group (improvement for knowledge, 3.0 versus 1.4; confidence, 2.6 versus 0.6; communication, 0.21 versus -0.1, p <.01 for all comparisons). After all participants had received the curriculum, scores for both groups were significantly better than at baseline and similar to one another. CONCLUSION Internet-based education about herbs and dietary supplements for diverse health professionals is feasible and results in significant and sustained improvements in knowledge, confidence, and communication practices.
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Affiliation(s)
- Kathi J Kemper
- Pediatrics, Wake Forest University School of Medicine, Brenner's Children's Hospital, Winston-Salem, North Carolina 27157, USA
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Abstract
TOPIC Complementary and alternative medicine agents (CAMs). PURPOSE To summarize the current empirical data about the major CAMs purporting to have psychotherapeutic value. SOURCES OF INFORMATION Extant literature. CONCLUSIONS Available evidence indicates that CAMs, while generally safe, are not risk free. While CAM use grows, nurses and other health professionals have a limited knowledge base about the action, side effects, and interactions of common CAM agents. Nurses need to increase their knowledge base about CAMs in order to help patients in decision making regarding the use of these agents to treat common psychiatric symptoms.
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Affiliation(s)
- Susan McCabe
- East Tennessee State University, Johnson City, TN, USA.
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Affiliation(s)
- E P Elovic
- Traumatic Brain Injury Research, University of Medicine and Dentistry of New Jersey [corrected], West Orange, New Jersey 07052, USA.
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Abstract
OBJECTIVES To determine the prevalence of herbal and/or dietary supplement use and identify patients at risk for herb-drug interactions. METHODS A convenience sample of 944 patients were surveyed to determine the prevalence and types of supplements used. Patients with heart disease, diabetes, psychiatric disorders, and/or hypertension were assessed for potential interactions. RESULTS One hundred thirty-five (14.3%) patients reported regular use. Of these, 79.3% were taking supplements concurrently with prescription medications, and 80.0% were administered medication(s) in the emergency department. Cardiac: 19.8% (n = 33) reported regular use, with four potential interactions. Hypertension: 20.3% (n = 54) reported regular use, with two potential interactions. Diabetes: 15.9% (n = 20) reported regular use, with no known interactions. Psychiatric: 15.9% (n = 10) reported regular use, with one potential interaction. CONCLUSIONS Six patients were identified at risk for seven known herb-drug interactions. The prevalence of undisclosed herbal supplement use and lack of research on these supplements suggest that more patients may be at risk.
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Affiliation(s)
- E A Rogers
- Department of Emergency Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC 27858, USA
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