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Keller P, Hudders L, Decloedt A. Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine. Equine Vet J 2024; 56:535-543. [PMID: 37658704 DOI: 10.1111/evj.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial. OBJECTIVES Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM. STUDY DESIGN Cross-sectional study. METHOD A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM. RESULTS When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase. MAIN LIMITATIONS A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM. CONCLUSION Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.
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Affiliation(s)
- Pia Keller
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Liselot Hudders
- Centre for Persuasive Communication, Department of Communication Sciences, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium
| | - Annelies Decloedt
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Im HB, Hwang JH, Choi D, Choi SJ, Han D. Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e013412. [PMID: 38448037 PMCID: PMC10916170 DOI: 10.1136/bmjgh-2023-013412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures. METHODS A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators. RESULTS This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes. CONCLUSION Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.
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Affiliation(s)
- Hyea Bin Im
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Jung Hye Hwang
- Institute of Health Services Management, Hanyang University, Seoul, Korea
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea
| | - Dain Choi
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Dongwoon Han
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Department of Preventive Medicine, Hanyang University, Seoul, Korea
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Gumede L, Nkosi PB, Sibiya MN. Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use. Health SA 2024; 29:2381. [PMID: 38322375 PMCID: PMC10839234 DOI: 10.4102/hsag.v29i0.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/25/2023] [Indexed: 02/08/2024] Open
Abstract
Background A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. Aim This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. Setting This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. Methods An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Results Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Conclusion Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. Contribution The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.
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Affiliation(s)
- Lindiwe Gumede
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Pauline B. Nkosi
- Department of Radiography, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N. Sibiya
- Faculty of Innovation and Engagement, Mangosuthu University of Technology, Durban, South Africa
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Setyawati A, Yusuf S, Jafar N, Sagita RW. Exploring herbal remedy utilization for wound healing: Patterns, patient preferences, and implications for nursing practice. Int J Nurs Knowl 2023. [PMID: 38031257 DOI: 10.1111/2047-3095.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The utilization of herbal remedies for wound healing is a notable aspect of traditional medicine practices. Understanding herbal use among patients yields insights for nursing care enhancement. This study aimed to investigate the utilization of herbal remedies for wound healing among diabetic patients. METHODS A total of 453 participants were enrolled, with demographic data, including age, sex, occupation, education level, residence, ethnic group, distance from health service, herbal use duration, and wound duration presented. Descriptive statistics were used to analyze the data, including means, standard deviations, ranges, and percentages. FINDINGS The average participant age was 55.39 years, with most being non-civil servant workers (60.3%) and having a low education level (67.1%). Indian almond wood (9.7%) and green betel (6.8%) were the most commonly used herbs for wound healing. Family members were the primary source of information (29.1%), and 43.7% obtained herbs from personal gardens. Although 94.2% of participants did not disclose herbal use to health liaisons, 53.4% used herbs specifically for wound healing. Users reported both positive and negative effects on wounds from various herbs, indicating variability in experiences. However, the consistency of herb usage by individual patients was uncertain. CONCLUSIONS The study identified diverse herbal remedies used for wound healing among patients, driven by familial recommendations. Usage pattern diversity and effects signal necessity for researching herb safety and efficacy. Clarifying the impact of consistent herb usage on wound healing is essential for understanding patients' preferences and practices. IMPLICATIONS FOR CLINICAL PRACTICE These findings emphasize the importance of open communication between patients and healthcare providers regarding herbal remedy use. Nurses should acknowledge patients' preferences for traditional healing practices while ensuring they receive evidence-based care. Patient-centered herbal strategies enhance nursing practice, fostering holistic wound care. Further research can guide nursing interventions, facilitate informed decision-making, and improve patient outcomes.
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Affiliation(s)
- Andina Setyawati
- Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia
| | - Saldy Yusuf
- Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia
| | - Nuurhidayat Jafar
- Department of Community Nursing, Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia
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Golden J, Kenyon-Pesce L, Robison J, Grady J, Guerrera MP. Disclosure of Complementary and Alternative Medicine Use Among Older Adults: A Cross-Sectional Study. Gerontol Geriatr Med 2023; 9:23337214231179839. [PMID: 37324642 PMCID: PMC10262661 DOI: 10.1177/23337214231179839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Although use of complementary and alternative medicine (CAM) is rising among older adults, many do not discuss these healthcare practices with their primary care practitioners (PCPs). This study sought to determine the prevalence of CAM use and to identify factors associated with CAM disclosure among patients ages 65 and older. Methods: Participants completed an anonymous survey, which evaluated their CAM use over the past year and disclosure of CAM to a PCP. Additional questions queried demographics, patient health, and relationships with one's PCP. Analyses included descriptive statistics, chi-square tests and logistic regression. Results: One hundred seventy-three participants answered surveys. Sixty percent reported use of at least one form of CAM in the past year. Among those using CAM, 64.4% disclosed use to their PCP. Patients disclosed supplements/herbal products and naturopathy/homeopathy/acupuncture at a higher rate than body work techniques and mind-body practices (71.9% and 66.7% vs. 48% and 50%). The only factor significantly associated with disclosure was trust in one's PCP (odds ratio = 2.97; confidence interval = 1.01-8.73). Conclusions: Clinicians may improve CAM disclosure rates in older adults by inquiring about all types of CAM and continuing to invest in their patient relationships, specifically by building trust.
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Affiliation(s)
- Julia Golden
- University of Connecticut School of Medicine, UConn Health, Farmington, USA
| | - Lisa Kenyon-Pesce
- University of Connecticut Center on Aging, UConn Health, Farmington, USA
| | - Julie Robison
- University of Connecticut Center on Aging, UConn Health, Farmington, USA
| | - James Grady
- University of Connecticut School of Medicine, UConn Health, Farmington, USA
| | - Mary P. Guerrera
- University of Connecticut School of Medicine, UConn Health, Farmington, USA
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Abudalo R, Abudalo R, Alqudah A, Abuqamar A, Abdelaziz A, Alshawabkeh M, Taha L. Pharmacy practitioners' practice, awareness and knowledge about herbal products and their potential interactions with cardiovascular drugs. F1000Res 2022; 11:912. [PMID: 36212547 PMCID: PMC9520230 DOI: 10.12688/f1000research.121709.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products' adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients' counselling to set up safe and effective drug use. Methods: A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26. Results: Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses. Conclusions: The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.
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Affiliation(s)
- Rawan Abudalo
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan,
| | - Razan Abudalo
- Department of Radiology, Jordanian Royal Medical Services, Amman, Jordan
| | - Abdelrahim Alqudah
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Ayman Abuqamar
- Department of Oncology and Hematology, Jordanian Royal Medical Services, Amman, Jordan
| | - Amr Abdelaziz
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Maram Alshawabkeh
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Luma Taha
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
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Aizuddin AN, Zamzuri M'AIA, Mansor J, Nurumal SR, Yunus SZSA, Razak MAA, Jamhari MN, Fah TS, Miskam HM, Hod R, Yusoff HM. Perception of integrating complementary and alternative medicine practice in patient's treatment among the healthcare practitioners: a systematic review. Pan Afr Med J 2022; 43:19. [PMID: 36451723 PMCID: PMC9674529 DOI: 10.11604/pamj.2022.43.19.31133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/20/2022] [Indexed: 03/19/2024] Open
Abstract
There is a growing trend in complementary and alternative medicine (CAM) usage among the population with medical conditions. However, there is hesitancy for medical practitioners to integrate its application with the current treatment modality, despite governance by the authority. Hence, our objective is to systematically evaluate the healthcare perception towards integrating CAM in their practices. We systematically searched three large and renowned databases i.e., Scopus, Web of Science and PubMed, regarding "Perception on Integrating CAM Usage in Patient's Treatment among Healthcare Practitioners" from 2016 until 2020. At least two independent reviewers comprehensively screened and extracted the data from the accepted articles. A total of 15 studies were included in the final qualitative synthesis following a strict and rigorous assessment checked using MMAT 2018 checklist. The studies included providing the richness of information due to the qualitative nature of the study design. There were three main domains extracted i.e. knowledge, attitude, and perspective of the healthcare practitioner towards CAM integration. Limited knowledge of CAM among healthcare providers may be the possible main reason for non-supportive attitude and negative perspective on CAM. However, those who showed an inclination towards CAM were found to be more open and ready to learn about CAM if it provides benefits to the patients. There is a heterogeneity of perception towards CAM integration from healthcare providers' point of view. A proactive and systematic CAM literacy awareness program may help to improve their understanding and possibly gain more trust in its application.
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Affiliation(s)
- Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Juliana Mansor
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Siti Rohani Nurumal
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Mohamad Aznuddin Abd Razak
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Nazrin Jamhari
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Tong Seng Fah
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hazlina Mohd Miskam
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hanizah Mohd Yusoff
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Prasad R, Conde J. Bioinspired soft nanovesicles for site-selective cancer imaging and targeted therapies. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1792. [PMID: 35318815 DOI: 10.1002/wnan.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Cell-to-cell communication within the heterogeneous solid tumor environment plays a significant role in the uncontrolled metastasis of cancer. To inhibit the metastasis and growth of cancer cells, various chemically designed and biologically derived nanosized biomaterials have been applied for targeted cancer therapeutics applications. Over the years, bioinspired soft nanovesicles have gained tremendous attention for targeted cancer therapeutics due to their easy binding with tumor microenvironment, natural targeting ability, bio-responsive nature, better biocompatibility, high cargo capacity for multiple therapeutics agents, and long circulation time. These cell-derived nanovesicles guard their loaded cargo molecules from immune clearance and make them site-selective to cancer cells due to their natural binding and delivery abilities. Furthermore, bioinspired soft nanovesicles prevent cell-to-cell communication and secretion of cancer cell markers by delivering the therapeutics agents predominantly. Cell-derived vesicles, namely, exosomes, extracellular vesicles, and so forth have been recognized as versatile carriers for therapeutic biomolecules. However, low product yield, poor reproducibility, and uncontrolled particle size distribution have remained as major challenges of these soft nanovesicles. Furthermore, the surface biomarkers and molecular contents of these vesicles change with respect to the stage of disease and types. Here in this review, we have discussed numerous examples of bioinspired soft vesicles for targeted imaging and cancer therapeutic applications with their advantages and limitations. Importance of bioengineered soft nanovesicles for localized therapies with their clinical relevance has also been addressed in this article. Overall, cell-derived nanovesicles could be considered as clinically relevant platforms for cancer therapeutics. This article is categorized under: Biology-Inspired Nanomaterials > Nucleic Acid-Based Structures Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Rajendra Prasad
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - João Conde
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Centre for Toxicogenomics and Human Health, Genetics, Oncology and Human Toxicology, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Choi SJ, Kunwor SK, Im HB, Hwang JH, Choi D, Han D. Traditional and complementary medicine use among cancer patients in Nepal: a cross-sectional survey. BMC Complement Med Ther 2022; 22:70. [PMID: 35291988 PMCID: PMC8925159 DOI: 10.1186/s12906-022-03555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/08/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Traditional and complementary medicine (T&CM) is commonly used in South Asian countries such as Nepal. There are various causes and contributing factors for patients with cancer to consider using T&CM. However, little is known about the use of T&CM among the cancer population in this region. METHODS The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from two National hospitals in Kathmandu, Nepal. The survey instrument comprised 30 questions, including variables on demographics, use of T&CM, and perceived level of disease severity, and cancer treatment. Chi-square test and logistic regression were used for data analysis using SPSS ver. 23.0. RESULTS Of 908 participants, 31.6% used one or more modalities of T&CM after a cancer diagnosis. The most commonly used T&CM was Ayurveda (46.5%), followed by yoga (32.4%). About 46% of T&CM users discussed their use with their doctors. The main source of information on T&CM was their family members and relatives (55.7%). Cancer type (head and neck cancer OR: 2.30, CI: 1.23-4.29; abdominal cancer OR: 2.69, CI: 1.47-4.95; lung cancer OR: 5.88, CI: 2.69-12.89), cancer stage (Stage I OR: 1.92¸CI: 1.14-3.25; Stage II OR: 1.76, CI: 1.06-2.94), and the patients' self-rated disease severity (high perceived severity OR: 1.50, CI: 1.05-2.16) were strong predictors of T&CM use. CONCLUSION This study underlined that despite the widespread use of T&CM among cancer patients in Nepal, most patients obtained information on T&CM from informal sources and did not disclose their use to physicians. To ensure the safe use of T&CM modalities, physicians should integrate questions on T&CM use into routine patient assessments in order to facilitate active communication and improve the quality of care.
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Affiliation(s)
- Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Sangita Karki Kunwor
- Department of Global Health and Development, Graduate School, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Jung Hye Hwang
- Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, South Korea
| | - Dain Choi
- Department of Global Health and Development, Graduate School, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea. .,Institute of Health Services Management, Hanyang University, Seoul, South Korea. .,Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea.
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de Wit M, Horreh B, Hulshof CTJ, Wind H, de Boer AGEM. Effects of a training program for occupational health professionals on the cognitions and perceptions of workers: a randomized controlled trial. Int Arch Occup Environ Health 2022; 95:1059-1066. [PMID: 35024908 PMCID: PMC9203404 DOI: 10.1007/s00420-021-01823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/30/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE To evaluate the effects of a training program for occupational health professionals (OHPs) on their ability to identify the cognitions and perceptions of workers with a chronic disease that may hinder work participation, and on their ability to recommend evidence-based interventions aimed at the identified cognitions and perceptions. METHODS A randomized controlled trial was conducted in which OHPs were randomly assigned to a training program on the cognitions and perceptions of workers with a chronic disease (n = 29) or to a control group that did not receive training (n = 30). Participants received home assignments in which they had to identify the cognitions and perceptions of workers in video vignettes and had to indicate which interventions they would recommend to foster work participation. A generalized linear model repeated measures ANOVA was conducted to study the effects of the training program. RESULTS The results of the analyses showed an increase in the ability to identify the cognitions and perceptions of workers of OHPs who received the training compared to the control group (p < 0.001). The results also showed an increased ability to recommend evidence-based interventions aimed at these cognitions and perceptions (p < 0.001) as a result of participation in the training. CONCLUSION The training program helps OHPs to identify cognitions and perceptions and to recommend evidence-based interventions. This can support them in their activities to increase the work participation of workers with a chronic disease.
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Affiliation(s)
- Mariska de Wit
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Bedra Horreh
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Haije Wind
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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de Wit M, Zipfel N, Horreh B, Hulshof CTJ, Wind H, de Boer AGEM. Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation. BMC MEDICAL EDUCATION 2022; 22:20. [PMID: 34996425 PMCID: PMC8740490 DOI: 10.1186/s12909-021-03084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs' satisfaction with the training and the feasibility of the training and learned skills. METHODS The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. RESULTS The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. CONCLUSIONS OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.
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Affiliation(s)
- Mariska de Wit
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Nina Zipfel
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Bedra Horreh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Haije Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Radwan H, Hasan H, Jaafar Z, Abbas N, Rashed Saif E, Al Kitbi M, Al Hilali M, Naja F. Diets and dietary supplements used during the COVID-19 pandemic in the United Arab Emirates: A cross-sectional survey. Saudi Pharm J 2022; 30:421-432. [PMID: 35125904 PMCID: PMC8800157 DOI: 10.1016/j.jsps.2022.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 01/21/2022] [Indexed: 12/12/2022] Open
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13
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Abdelmola AO, Bahri A, Abuallut I, Refaei BA, Hakami WK, Abutaleb AK, Mahzari SM, Mashragi MA, Es'haq SA, Aldarbi KF. Prevalence, knowledge, and perception about the use of herbal medicines jazan - Saudi Arabia. J Family Med Prim Care 2021; 10:2386-2393. [PMID: 34322443 PMCID: PMC8284197 DOI: 10.4103/jfmpc.jfmpc_2475_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: This study aimed to assess the prevalence, knowledge and perception of Jazan province residents about traditional herbal medication. Materials and Methods: A cross-sectional study was done on 440 Saudi residents using an electronically distributed questionnaire. The questionnaire included 39 items divided into 4 parts. Data collected were about demographic characters, knowledge and perception about HM, and HM usage among participants. Results: Most of the participants used HM for therapeutic purposes (80.9%) and (29.5%) believed that mixing herbs together led to more effective results. The participants agreed to a very high degree that inherited culture plays an important role in HM use, however (84.5%) of them never used herbs. The participants used herbs mostly for treatment of diabetes mellitus representing (37%) and hypertension (20.5%). Age, marital status, and the job of participants had a statistically significant effect on participants’ views about HM. While, gender, educational level, income, place of residence and chronic diseases had no statistically significant effect. Conclusion: The highest percentage of the participants used HM for therapeutic purposes. Increasing awareness of Saudi population about instructions and restrictions when using HM is greatly needed.
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Affiliation(s)
- Amani Osman Abdelmola
- Department of Family and Community Medicine, College of Medicine, Jazan University, Saudi Arabia
| | - Ahmed Bahri
- Department of Family and Community Medicine, College of Medicine, Jazan University, Saudi Arabia
| | - Ismail Abuallut
- Department of Family and Community Medicine, College of Medicine, Jazan University, Saudi Arabia
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Hijazi MA, Shatila H, Omeich Z, El-Lakany A, Ela MA, Naja F. The role of pharmacists in complementary and alternative medicine in Lebanon: users' perspectives. BMC Complement Med Ther 2021; 21:81. [PMID: 33691698 PMCID: PMC7944898 DOI: 10.1186/s12906-021-03256-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Customers’ expectations and satisfaction are critical to ensure a more effective role of the community pharmacists in promoting the safe use of Complementary and Alternative Medicine (CAM). The aim of this study is to examine the perceptions and practices of customers buying their CAM products from pharmacies and explore their satisfaction with CAM-related services offered by the community pharmacists in Lebanon. Methods A national cross-sectional study was conducted among users of CAM (age > =18 years) who obtained their CAM from community pharmacies in Lebanon (n = 832). Within the proximity of the pharmacy, subjects were invited to complete a multi-component questionnaire. The latter consisted of four sections related to CAM: general beliefs, perception of pharmacists’ role, practices, satisfaction with services offered by the pharmacists. In addition, the questionnaire included questions about sociodemographic characteristics of participants. Results The majority of participants agreed to an active role of the pharmacists’ in guiding CAM use, however over half of the participants (61.3%) did not agree that the pharmacist is more knowledgeable in this field than other healthcare providers. As for practices, one in two surveyed customers (47%) did not always give feedback to their pharmacists about the outcomes after using CAM, 20% did not often ask the pharmacists about the safe and effective mode of use of the products and 28.1% did not discuss their medical history. For services offered by the pharmacist, the majority of participants reported receiving good education about the CAM product (87.1%), its side effects (87.1%) and mode of use (93.4%), while significant proportions of participants reported that pharmacists were not asking questions about their medical history before dispensing CAM products (22%) nor were they providing information on CAM-drug interactions (30%). Conclusions The results of this study highlighted important gaps between the perceptions of customers and the services they received from the pharmacists about CAM use. These findings could be used by concerned stakeholders, including public health authorities and educational bodies, to develop evidence-based interventions aimed at promoting the role of pharmacists in ensuring a safe and effective CAM use Lebanon. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03256-8.
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Affiliation(s)
- Mohamad Ali Hijazi
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Beirut Arab University, P.O. Box: 11 5020, Beirut, Lebanon
| | - Hibeh Shatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeina Omeich
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Beirut Arab University, P.O. Box: 11 5020, Beirut, Lebanon
| | - Abdalla El-Lakany
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Beirut Arab University, P.O. Box: 11 5020, Beirut, Lebanon
| | - Maha Aboul Ela
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Beirut Arab University, P.O. Box: 11 5020, Beirut, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates. .,Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
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15
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Chung VC, Wong CH, Zhong CC, Tjioe YY, Leung TH, Griffiths SM. Traditional and complementary medicine for promoting healthy ageing in WHO Western Pacific Region: Policy implications from utilization patterns and current evidence. Integr Med Res 2021; 10:100469. [PMID: 32874912 PMCID: PMC7452244 DOI: 10.1016/j.imr.2020.100469] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With increasing burden of chronic non-communicable diseases (NCD), ageing becomes a global public health concern, and the World Health Organization Western Pacific Region has no exception. To address the NCD challenge, priority should be given to promote healthy ageing across the life-course. As traditional and complementary medicine (T&CM) is popular within the Region, it is of policy interest to explore possibilities of applying T&CM for promoting healthy ageing. METHODS We first summarized sources of clinical evidence supporting the use of T&CM. We then searched publications through MEDLINE from its inception to April 2020 to identify studies focusing on the perception of T&CM among older people. Finally, taking current evidence base and patient choice into account, we generated policy recommendations for of integrating T&CM into health systems. RESULT Experiences from countries with different income levels suggested that promoting evidence-based T&CM as self-care modalities would be the most efficient way of maximizing impact among the older population, especially via a train the trainer approach. Meanwhile, popularity of natural products in the Region mandates policy makers to implement appropriate regulation and quality assurance, and to establish pharmacovigilance to detect potential harm. The role of pharmacists in advising patients on self-medication using natural products needs to be strengthened. CONCLUSION Policy-makers will benefit from continued global dialogue and sharing of experience in T&CM policy development and implementation. Harmonizing regulatory frameworks for natural products at regional and global levels, including mutual recognition of regulatory approval, to improve standards and protect patients could be a priority.
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Affiliation(s)
- Vincent C.H. Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Charlene H.L. Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Claire C.W. Zhong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yan Yin Tjioe
- School of Biological Sciences, College of Science, Nanyang Technological University, Singapore
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sian M. Griffiths
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Zhuo Q, Liang H, Bai Y, Hu Q, Hanum AL, Yang M, Wang Y, Wei W, Ding L, Ma F. Perceptions of patients undergoing percutaneous coronary intervention on pre-operative education in China: A qualitative study. Health Expect 2020; 24:121-130. [PMID: 33185951 PMCID: PMC7879546 DOI: 10.1111/hex.13156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives To explore the perceptions of patients undergoing percutaneous coronary intervention (PCI) regarding their pre‐operative health education. Methods A qualitative study using semi‐structured, in‐depth interviews was conducted in one cardiology unit in China from July 2019 to December 2019. Purposeful sampling of 17 patients undergoing PCI was interviewed about their perceptions of pre‐operative health education. Thematic analysis of the transcribed data was then used to identify the themes. Results Four themes emerged from the data:(a) triple roles of pre‐operative education with the categories of relief (reliving fear); burden (leading to stress); and meaningless (changing nothing); (b) family member involvement with the categories of shared responsibility and family members’ duty; (c) facilitators in the process of pre‐operative health education with the categories of emotional support, plain language and individualized pre‐operative education; (d) inhibitors in the process of pre‐operative health education with the categories of contradiction and threatening words. Conclusions Pre‐operative health education for patients undergoing PCI should be aligned with the individual patients’ information‐seeking styles and personal differences, emphasizing individualized patient education. Traditional Chinese philosophy should be considered in the practice of pre‐operative education for patients undergoing PCI, which emphasizes family member involvement; at the same time, patient empowerment and self‐care should also be stressed. In addition, emotional support and plain language from health professionals are important in pre‐operative health education for patients undergoing PCI; contradiction should be avoided, and threatening words should be used with caution and with consideration for cultural variations during pre‐operative education for patients undergoing PCI.
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Affiliation(s)
- Qiqi Zhuo
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongmin Liang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yangjuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiulan Hu
- ICU in Geriatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ardani Latifah Hanum
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingfang Yang
- Urology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjiao Wang
- Psychiatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Wei
- Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lan Ding
- General Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang Ma
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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17
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Lee FY, Wong HS, Chan HK, Mohamed Ali N, Abu Hassan MR, Omar H, Abdul Mutalib NA. Hepatic adverse drug reactions in Malaysia: An 18-year review of the national centralized reporting system. Pharmacoepidemiol Drug Saf 2020; 29:1669-1679. [PMID: 33064335 DOI: 10.1002/pds.5153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the incidence, demographic profile, background of reporters, causative agents, severity and clinical outcomes of hepatic adverse drug reaction (ADR) reports in Malaysia using the national ADR reporting database. METHODS The ADR reports recorded between 2000 and 2017 were retrospectively analysed to identify hepatic ADR reports. The trend and characteristics of hepatic ADR cases were described. Multivariate disproportionality analysis of the causative agents was performed to generate signals of hepatic ADRs. RESULTS A total of 2090 hepatic ADRs (1.77% of all ADRs) were reported with mortality rate of 12.7% among cases with known clinical outcomes. The incidence of hepatic ADR reporting in Malaysia increased significantly over 18 years from 0.26 to 9.45 per million population (P < .001). Antituberculosis drugs (n = 268, 12.82%) was the most common suspected class of causative agents with a reporting odds ratio (ROR) and 95% CI of 8.39 (7.26-9.70), followed by traditional/complementary medicines or herbal/dietary supplements (TCM/HDS) (n = 235, 11.24%, ROR 3.26 [2.84-3.75]), systemic antibacterials (n = 159, 7.61%, ROR 2.65 [2.25-3.13]), lipid modifying agents (n = 142, 6.79%, ROR 2.21 [1.86-2.63]) and amiodarone (n = 137, 6.56%, ROR 35.25 [28.40-43.75]). Most (72.9%) of the TCM/HDS were not registered with the authorities. CONCLUSIONS Hepatic ADR cases have increased significantly in Malaysia, with antituberculosis drugs, systemic antibacterials, and TCM/HDS being the most common causative agents reported. Most TCM/HDS reported to be associated with hepatic ADR were not registered with the authorities.
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Affiliation(s)
- Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
| | - Hin-Seng Wong
- Clinical Research Centre, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
| | - Huan-Keat Chan
- Clinical Research Centre, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Norleen Mohamed Ali
- Pharmacovigilance Section, Center For Post-Registration and Cosmetic Control, National Pharmaceutical Regulatory Agency (NPRA), Petaling Jaya, Selangor, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Centre, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia.,Gastroenterology Unit, Department of Medicine, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Haniza Omar
- Hepatology Department, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
| | - Noor Aliza Abdul Mutalib
- Hepatology Department, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
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18
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Mohammadi S, Asghari G, Emami-Naini A, Mansourian M, Badri S. Herbal Supplement Use and Herb-drug Interactions among Patients with Kidney Disease. J Res Pharm Pract 2020; 9:61-67. [PMID: 33102379 PMCID: PMC7547748 DOI: 10.4103/jrpp.jrpp_20_30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: The prevalence of herb–drug interactions and herb's adverse effects may be serious in susceptible population such as patients with chronic kidney disease (CKD). In this study, we planned to determine the usage prevalence of herbal products and herb–drug interactions in CKD patients. Methods: A cross-sectional prospective study was conducted on CKD and posttransplant patients with a history of using herbal supplements in Isfahan, Iran. The patients were subjected to a validated checklist, containing demographic and clinical information. The knowledge of herbal use, side effects, and herb–drug interactions was assessed based on patients' responses. Data were reported as prevalence (percent) of the occurrence. Findings: The prevalence of herbal supplement usage among CKD patients was 18.6% in this study. The study included 400 patients (261 males and 139 females). The majority of the study population were in the age range of 50–70 years (61.5%). Hypertension (34.36%) was the most common cause of kidney failure, while diabetes mellitus (21.80%) took the second place. The most frequently used unformulated medicinal herb was Echium (Echium amoenum) (15.27%), and the most commonly used formulated herbal products were anticough and mucolytic based on Thymus vulgaris (24.27%). Eighteen patients (4.5%) used herbal mix with unknown entity and sources. In this study, ginseng has the most possible interactions with prescription drugs (18 interactions), while this interaction (with clopidogrel, warfarin, and heparin) was severe in six cases. Conclusion: The present study provided the information on possible herb–drug interactions in CKD patients on herbal usage. Since the issue of using herbal products may be arbitrarily in the majority of the patients, and considering the importance of adverse reactions or major interactions, health-care providers should play an active role to identify these cases and inform the patients regarding herbal product safety, adverse effects, and possible interactions.
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Affiliation(s)
- Soroush Mohammadi
- Pharmacy Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Asghari
- Department of Pharmacognosy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afsoon Emami-Naini
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
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Sundararajan R, Mwanga-Amumpaire J, King R, Ware NC. Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda. BMJ Open 2020; 10:e033410. [PMID: 32317259 PMCID: PMC7204928 DOI: 10.1136/bmjopen-2019-033410] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Medical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour. METHODS In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation. RESULTS We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources. CONCLUSIONS Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Rachel King
- Global Health Sciences, UCSF Medical Center, San Francisco, California, USA
| | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Avila C, Grace S, Bradbury J. How do patients integrate complementary medicine with mainstream healthcare? A survey of patients' perspectives. Complement Ther Med 2020; 49:102317. [PMID: 32147079 DOI: 10.1016/j.ctim.2020.102317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Complementary medicines (CM) are widely consumed by Australians. However, CM is not included in policy and planning of patient-centred models of healthcare. This study aimed to explore how patients themselves manage to integrate CM with mainstream healthcare. METHODS An online survey was distributed through snowball sampling via professional networks and targeted advertising in social media to Australian consumers of CM. Data were managed in Excel and analysed using descriptive statistics in IBM SPSS v23 and Stata v13. RESULTS A total of 379 consumers of CM therapies or products completed the survey. The mean age was 51 years, 83% were female and 34% reported having a chronic disease. CM consumers consulted a wide range of healthcare providers. Almost all (97%) had seen a general medical practitioner (GP) within the past year. Overwhelmingly, participants (95%) reported that they themselves were the primary managers of their own healthcare, either on their own (60%) or in collaboration with a CM practitioner (19%) or GP (16%). Approximately 60% of participants reported that they freely discussed their visits to CM practitioners with their GP. Among those, however, males with chronic disease were less likely to disclose CM practitioner consultations (X2(1) = 4.1, p = 0.04) and over-the-counter pharmaceutical consumption (X2(1) = 3.8, p = 0.05) to GPs than males without chronic disease. Small numbers in some subgroup analyses suggested that further, larger studies on patient perspectives should particularly target males with chronic disease. Most respondents (83%) valued free choice of health practitioner as extremely or very important (83%). A sense of practitioner community was extremely or very important to the majority (76%) of participants. CONCLUSION CM consumers see themselves as primary managers of their healthcare. They want more communication between healthcare providers, which could support them in the safe integration of their total healthcare options. Healthcare policy and planning should recognise the totality of influences on patient health, including the range of CM practitioners and products used by some healthcare consumers.
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Affiliation(s)
- Cathy Avila
- School of Health and Human Sciences, Southern Cross University, PO Box 154, Lismore, NSW, 2480, Australia
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, PO Box 154, Lismore, NSW, 2480, Australia.
| | - Joanne Bradbury
- School of Health and Human Sciences, Southern Cross University, PO Box 154, Lismore, NSW, 2480, Australia
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21
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Yang X, Parton J, Lewis D, Yang N, Hudnall M. Effect of Patient-Physician Relationship on Withholding Information Behavior: Analysis of Health Information National Trends Survey (2011-2018) Data. J Med Internet Res 2020; 22:e16713. [PMID: 32012083 PMCID: PMC7016621 DOI: 10.2196/16713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' withholding information from doctors can undermine medical treatment, create barriers for appropriate diagnoses, and increase systemic cost in health care systems. To date, there is limited literature detailing the association between trends of patients withholding information behavior (WIB) and the patient-physician relationship (PPR). OBJECTIVE The aim of this study was to explore the prevalence trend of WIB after 2011 and examine the effects of PPR on WIB and its time trend. METHODS A total of 5 iterations of data from the Health Information National Trends Survey (years: 2011-2018; n=11,954) were used to explore curvilinear trends of WIB among the US population. Multiple logistic regression models were used to examine curvilinear time trends of WIB, effects of PPR on WIB, and moderation effects of PPR on the WIB time trend. RESULTS The WIB prevalence has an increasing trend before 2014, which has the highest rate of 13.57%, and then it decreases after 2014 to 8.65%. The trend of WIB is curvilinear as the quadratic term in logistic regression model was statistically significant (P=.04; beta=-.022; SE=0.011; odds ratio [OR] 0.978, 95% CI 0.957-0.999). PPR is reversely associated with WIB (P<.001; beta=-.462; SE=0.097; OR 0.630, 95% CI 0.518-0.766) and has a significant moderation effect on time trends (P=.02; beta=-.06; SE=0.025; OR 0.941, 95% CI 0.896-0.989). In general, poor quality of PPR not only significantly increased the WIB probability but also postponed the change of point for WIB curvilinear trend. CONCLUSIONS Findings suggest that the time trend of WIB between 2011 and 2018 is curvilinear and moderated by the quality of the PPR. Given these results, providers may reduce WIB by improving PPR. More research is needed to confirm these findings.
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Affiliation(s)
- Xin Yang
- Institute of Business Analytics, The University of Alabama, Tuscaloosa, AL, United States
| | - Jason Parton
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
| | - Dwight Lewis
- Department of Management, The University of Alabama, Tuscaloosa, AL, United States
| | - Ning Yang
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
| | - Matthew Hudnall
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
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Labidi S, Ennouri S, Rachdi H, El Benna H, Mejri N, Daoud N, Berrazaga Y, Boussen H. Use of complementary and alternative medicine in cancer: A Tunisian single-center experience. Bull Cancer 2020; 107:209-214. [PMID: 32000968 DOI: 10.1016/j.bulcan.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to explore the use of complementary and alternative medicine (CAM) and to identify their side effects, when used in cancer patients. We also assessed the communication of the patients and families with the oncologist about this issue. METHODS A cross-sectional survey of 120 adult patients treated for cancer in our medical oncology department between January and April 2019, using an anonymous questionnaire to assess complementary and alternative medicine use. RESULTS One hundred twenty patients participated in the survey, among them 102 used CAM (85%). A majority of users were female patients (n=72, 70.6%), and mean age was 52.4 years±11.6. Patients had breast cancer in 48% of cases. Wild herbs were the most commonly used alternative therapy (67.7%), particularly Ephedra foeminea (Alanda) in 52% of cases. Patients' families incited them to use CAM in 64.7% of cases. Internet and social network (Facebook) were the major sources of information on CAM (79.4%), followed by family and friends (72.5%). Fourteen patients (13.7%) reported nausea and vomiting secondary to CAM use. We reported disruption of liver function in 9.8% of cases, and renal failure in 1.96%, with fatal issue in one patient using Ephedra. Nineteen patients (18.6%) informed their oncologist about the alternative therapy they received. CONCLUSION The oncologist has to explore the use of alternative therapies with their patients. Communication about CAM should be a part of cancer care. It may protect patients from some dangerous side effects and improve efficacy of conventional therapy.
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Affiliation(s)
- Soumaya Labidi
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Sana Ennouri
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Haifa Rachdi
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Houda El Benna
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Nesrine Mejri
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Nouha Daoud
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Yosra Berrazaga
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hamouda Boussen
- Abderrahmen Mami Hospital, Medical oncology department SOMA, Rue de l'hôpital, 2080 Ariana, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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23
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de Wit M, Wind H, Hulshof CTJ, de Boer AGEM. Obtaining person-related information from employees with chronic health problems: a focus group study. Int Arch Occup Environ Health 2019; 92:1003-1012. [PMID: 31104126 PMCID: PMC6768897 DOI: 10.1007/s00420-019-01440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
Abstract
Purpose The objective of this focus group study is to assess how occupational physicians (OPs) and insurance physicians (IPs) can best obtain information concerning person-related factors from employees. The research question was: what is the most effective way for OPs and IPs to obtain information concerning person-related factors, in the opinion of employees with chronic health problems? Methods Three focus group discussions were conducted comprising of a total of 23 employees with work limitations due to chronic health problems. Employees discussed how physicians could best obtain information related to ten person-related cognitions and perceptions that are associated with work participation. The discussions were recorded, transcribed verbatim and analyzed through qualitative content analysis. Results Employees indicated that information addressing person-related factors could best be obtained through discussing them directly during consultations, as opposed to the use of questionnaires or diaries. Important prerequisites to having fruitful conversations include a mutual trust between employee and physician, a sense of genuine physician interest, and the understanding of the physician of employees and their health concerns. Employees described various factors that influence these conversations, including the knowledge and communication skills of physicians, employee anxiety, and the atmosphere and time frame of the consultation. Conclusions Information concerning the person-related factors of employees can best be obtained by discussing them during consultations. However, there has to be mutual trust, interest and understanding before employees feel comfortable to talk about these factors with a physician. OPs and IPs should consider these, and other identified factors, when asking about person-related factors during consultations.
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Affiliation(s)
- Mariska de Wit
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Hijazi MA, Shatila H, El-Lakany A, Aboul Ela M, Kharroubi S, Alameddine M, Naja F. Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon. BMJ Open 2019; 9:e025074. [PMID: 30852542 PMCID: PMC6429928 DOI: 10.1136/bmjopen-2018-025074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. OBJECTIVE Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. DESIGN, METHODS AND SETTING Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. RESULTS A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). CONCLUSIONS This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.
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Affiliation(s)
- Mohamad Ali Hijazi
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Hibeh Shatila
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Maha Aboul Ela
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad Alameddine
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Strategy & Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, Dubai, United Arab Emirates
| | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
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The Perspective of Cancer Patients on the Use of Complementary Medicine. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.89916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Quezada SM, Cross RK. Cannabis and Turmeric as Complementary Treatments for IBD and Other Digestive Diseases. Curr Gastroenterol Rep 2019; 21:2. [PMID: 30635796 DOI: 10.1007/s11894-019-0670-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Complementary therapies for inflammatory bowel disease (IBD) have earned growing interest from patients and investigators alike, with a dynamic landscape of research in this area. In this article, we review results of the most recent studies evaluating the role of cannabis and turmeric for the treatment of IBD and other intestinal illnesses. RECENT FINDINGS Cannabinoids are well-established modulators of gut motility and visceral pain and have demonstrated anti-inflammatory properties. Clinical trials suggest that there may be a therapeutic role for cannabinoid therapy in the treatment of IBD, irritable bowel syndrome (IBS), nausea and vomiting, and GI motility disorders. Recent reports of serious adverse effects from synthetic cannabinoids highlight the need for additional investigation of cannabinoids to establish their efficacy and safety. Turmeric trials have demonstrated some promise as adjuvant treatment for IBD, though not in other GI disease processes. Evidence suggests that the use of cannabis and turmeric is potentially beneficial in IBD and IBS; however, neither has been compared to standard therapy in IBD, and thus should not be recommended as alternative treatment for IBD. For cannabis in particular, additional investigation regarding appropriate dosing and timing, given known adverse effects of its chronic use, and careful monitoring of potential bleeding complications with synthetic cannabinoids are imperative.
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Affiliation(s)
- Sandra M Quezada
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Raymond K Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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