Herbal products and conventional medicines used by community-residing older women

Relevance of Dietary Supplement Use in Gastrointestinal-Cancer-Associated Cachexia

Cancer cachexia is a multi-organ syndrome with unintentional weight loss, sarcopenia, and systemic inflammation. Gastrointestinal (GI) cancer patients are more susceptible to cachexia development due to impaired nutrient absorption and digestion. Given the widespread availability and relatively low cost of dietary supplements, we examined the evidence and effects of fish oil (omega-3 fatty acids), melatonin, probiotics, and green tea for managing symptoms of GI cancer cachexia. A literature review of four specific supplements was conducted using PubMed, Google Scholar, and CINAHL without a date restriction. Of 4621 available literature references, 26 articles were eligible for review. Fish oil decreased C-reactive protein and maintained CD4+ cell count, while melatonin indicated inconsistent findings on managing cachexia, but was well-tolerated. Probiotics decreased serum pro-inflammatory biomarkers and increased the tolerability of chemotherapy by reducing side effects. Green tea preparations and extracts showed a decreased risk of developing various cancers and did not impact tumor growth, survival, or adverse effects. Among these four supplements, probiotics are most promising for further research in preventing systemic inflammation and maintaining adequate absorption of nutrients to prevent the progression of cancer cachexia. Supplements may benefit treatment outcomes in cancer cachexia without side effects while supporting nutritional and therapeutic needs.

Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009-2014 National Health and Nutrition Examination Survey

The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28-1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13-1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were "personal choice or influenced by advertisements or word of mouth," "improve health," and "specific health conditions" (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.

Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey

Background

Polypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults.

Aim

To establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions.

Design and setting

Cross-sectional survey of older adults registered at two general practices in South East England.

Method

A questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug.

Results

In total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal^® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions.

Conclusion

GPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.

Dietary Supplement and Complementary and Alternative Medicine Use Are Highly Prevalent in Patients with Gastrointestinal Disorders: Results from an Online Survey

The use of complementary and alternative medicine (CAM) is widespread among adults in the United States to self-treat a range of disorders, including gastrointestinal (GI) disorders. This study determined the self-reported use of CAM, including dietary supplements, in managing GI symptoms among Internet users and investigated perceived effects of supplement use on GI symptoms. We used a cross-sectional, descriptive, correlational design. A Qualtrics online survey was utilized to collect data through various websites. Focused areas include demographics, health evaluation, health issue(s), supplement and CAM use, and GI symptoms. Of the participants included in the study, a majority (88%) were women and half (50.1%) were between the ages of 26 and 45. Most participants (84.5%) reported use of herbal supplements, and 84.8% of the participants used herbal supplements for a specific health problem. The most common reported health condition was gastroesophageal reflux (44.4%). The attrition rate was low at 22%. The novelty of using an anonymous online survey to collect data on supplement use in GI disorders indicated a high prevalence of dietary and herbal supplement use among persons with GI disorders comparable to previous reports. Health-care providers should ask patients about supplement use in addition to prescribed medications and communicate effectively if conventional pharmacotherapy is not sufficient to manage symptoms or patients are inclined to use supplements.

Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review

Background

The use of herbal medicinal products (HMPs) is common among older adults; however, little is known about concurrent use with prescription drugs, as well as potential interactions associated with such combinations.

Objective

The aim of this systematic review was to identify and evaluate the literature on concurrent prescription and HMP use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use.

Methods

Systematic searches were conducted in the MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane databases from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults ≥ 65 years of age. Quality was assessed using the Joanna Briggs Institute checklists. And the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three-stage approach to mixed method research was used to synthesise data.

Results

Twenty-two studies were included. A definition of HMPs or what was considered an HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3 and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, β-blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were Ginkgo biloba, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to the use of Ginkgo biloba, garlic or ginseng with aspirin or warfarin was the most reported herb–drug interaction. Some data suggest being female, and having a lower household income and less than a high-school education were associated with concurrent use.

Conclusion

The prevalence of concurrent prescription drugs and HMP use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals in appropriately identifying and managing patients at risk. Systematic Review Registration Number: PROSPERO 2014:CRD42014009091.

Electronic supplementary material

The online version of this article (10.1007/s40266-017-0501-7) contains supplementary material, which is available to authorized users.

Natural Health Product Interactions with Medication

Natural health products (or dietary supplements) refer to those products found in oral dosage forms, containing 1 or more active ingredients considered to be a nutrient, an herbal product, or any other nonnutrient/nonherbal substance. Their use continues to increase in the general population and in patients seen by nutrition support clinicians. Aside from an appraisal of product safety and effectiveness, attention should be paid to the potential for these product ingredients to interact with medication. Estimates are that at least 15 million adults in the United States are at risk for supplement-drug interactions. These can occur through both pharmacokinetic and pharmacodynamic mechanisms. This review describes the influence of dietary supplements on both the disposition and the effect of medication and provides numerous examples. Patients at greatest risk for interactions are those with chronic disease, who use multiple medications-particularly those with a narrow therapeutic range-have genetic variants in drug metabolism, impaired organ function, and are at either end of the age spectrum. Knowledge of the specific effects on drug absorption, metabolism, and effect is still incomplete. Relative to the large number of possible interactions between supplements and medication, only a small number of combinations have been examined or reported. The greatest limiting factor remains the quality or reliability of the existing evidence, as many widely accepted interactions are only theoretical based either on in vitro data or known pharmacology. A distinction needs to be clearly drawn between "documented" interactions and "potential" interactions. Although drug-drug interactions have been widely recognized, supplement-drug interactions may be as important to recognize, report, and manage.

Herbal Medicines: challenges in the modern world. Part 5. status and current directions of complementary and alternative herbal medicine worldwide

INTRODUCTION

Herbal medicine (HM) use is growing worldwide. Single herb preparations, ethnic and modern HM formulations are widely used as adjunct therapies or to improve consumer wellbeing. Areas covered: This final part in the publication series summarizes common tendencies in HM use as adjunct or alternative medicine, education of healthcare professionals and consumers, current and proposed guidelines regulating of production. We discuss potential HM-HM and HM-drug interactions that could lead to severe adverse events in situations where HMs are taken without proper medical professional oversight. Expert commentary: A number of serious problems have arisen with the steady global increase in HM use. HM interaction with conventional drugs (CD) may result in inadequate dosing of CD or adverse reactions; HM-HM interaction within herbal supplements could lead to toxicity of formulations. Inadequate education of clinicians and patients regarding medicinal properties of HMs must be addressed regionally and globally to ensure consumer safety.

Herbal Product Use by African American Older Women

The purposes of this study were to identify patterns of herbal product use for health promotion and self-care management among older African American women, to explore their use of herbal products to manage disease-specific symptoms, and to compare users of herbal products to nonusers. The sample consisted of 57 community-residing African American women age 65 years and older. Of the sample, 33% used herbal product(s) within the past year. Those who used herbal products perceived their overall health to be better than those who did not use herbal products. However, differences in demographic characteristics and locus of control between herbal users and nonusers were not significant. More than 40% of the herbals used were not discussed with health care providers. Most participants using herbals were mixing herbal, prescription, and overthe-counter products. Indiscriminate use of herbal products in combination with or in place of conventional medicines can be problematic and costly.

Influence of adjunctive classical homeopathy on global health status and subjective wellbeing in cancer patients - A pragmatic randomized controlled trial

OBJECTIVES

The use of complementary and alternative medicine has increased over the past decade. The aim of this study was to evaluate whether homeopathy influenced global health status and subjective wellbeing when used as an adjunct to conventional cancer therapy.

DESIGN

In this pragmatic randomized controlled trial, 410 patients, who were treated by standard anti-neoplastic therapy, were randomized to receive or not receive classical homeopathic adjunctive therapy in addition to standard therapy. The study took place at the Medical University Vienna, Department of Medicine I, Clinical Division of Oncology.

MAIN OUTCOME MEASURES

The main outcome measures were global health status and subjective wellbeing as assessed by the patients. At each of three visits (one baseline, two follow-up visits), patients filled in two different questionnaires.

RESULTS

373 patients yielded at least one of three measurements. The improvement of global health status between visits 1 and 3 was significantly stronger in the homeopathy group by 7.7 (95% CI 2.3-13.0, p=0.005) when compared with the control group. A significant group difference was also observed with respect to subjective wellbeing by 14.7 (95% CI 8.5-21.0, p<0.001) in favor of the homeopathic as compared with the control group. Control patients showed a significant improvement only in subjective wellbeing between their first and third visits.

CONCLUSION

Results suggest that the global health status and subjective wellbeing of cancer patients improve significantly when adjunct classical homeopathic treatment is administered in addition to conventional therapy.

Factors contributing to the use of complementary and alternative medicine in rural older women with chronic pain in South Korea

AIM

The aim of this study was to assess the prevalence of complementary and alternative medicines (CAM) use for managing pain and to investigate the factors predictive of current CAM use among rural older women in South Korea.

BACKGROUND

Access to medical care among older adults in rural areas is poorer than in urban areas.

METHODS

A cross-sectional descriptive study with a stratified sample of 139 women aged over 65 with chronic pain residing in rural areas of Jeju Island, South Korea. A self-reported questionnaire was used to collect data.

RESULTS

Most subjects reported using at least one type of CAM for relieving pain within the past 12 months. Almost half of them reported currently using CAM. Herbs were the most commonly used CAM. Only 'severity of pain' was presently associated with an increased use of CAM.

CONCLUSION

It is imperative to take socio-geographic-cultural factors into consideration when planning health promotion programs and caring for clients.

Adverse effects of unconventional therapies in the elderly: A systematic review of the recent literature

Unconventional therapies are increasingly popular, not least in populations of elderly individuals. This review summarizes the evidence regarding the risk unconventional therapies may entail for the elderly. Computerized literature searches were performed to locate all reports with original data on this topic. Most of the evidence found was anecdotal by nature and thus has obvious limitations. The results show that elderly patients can suffer harm from unconventional therapies. Herbal treatments are associated most frequently with adverse events. They can cause both direct toxicity and unwanted herb-drug interactions. Acupuncture, spinal manipulation and even massage therapy have also been implicated. Indirect risks exist if unconventional therapies are employed as a substitute for conventional treatments. It is concluded that unconventional therapies are not risk-free for elderly patients. All parties involved ought to be educated with a view of minimizing this risk, and more research is needed to increase our understanding of this area.

Herbal supplement use among adult dental patients in a USA dental school clinic: prevalence, patient demographics, and clinical implications

OBJECTIVE

This study assessed the frequency and patterns of utilization of herbal supplement products by adult dental patients at a USA dental school clinic.

STUDY DESIGN

A self-reporting questionnaire was used to collect patient demographics and frequency of herbal supplement utilization along with other information. The questionnaire was distributed and collected at a dental visit. Herbal utilization was related to patient demographics using descriptive analysis. The clinical implications of the findings are discussed.

RESULTS

Out of 1,240 questionnaires, 1,119 were returned as completed. Of these, 12.6% reported using ≥1 of 21 herbal products. The majority of the users were middle-aged educated caucasian women. Green tea, garlic, echinacea, ginkgo biloba, and ginseng were the top 5 products used. Mostly, supplements were consumed in combination with drugs.

CONCLUSIONS

The type, prevalence, and frequency of herbal supplement utilization by adult dental patients in this USA dental clinic were generally similar to those reported for other population groups. This observation, coupled with the documented effects of the commonly used herbal products, should alert dental health caregivers to inquire about herbal supplement use when evaluating or treating their patients.

Use of complementary and alternative medicine by patients with arthritis

AIMS AND OBJECTIVES

The aims of this study were to determine the prevalence of complementary and alternative medicine use in patients with arthritis, the types of complementary and alternative medicine used, pertinent socio-demographic factors associated with complementary and alternative medicine use and its perceived efficacy.

BACKGROUND

Arthritis is a major health issue, and the use of complementary and alternative medicine among patients with arthritis is common.

DESIGN

This is a descriptive cross-sectional study.

METHODS

Data were obtained from 250 patients with arthritis at the physiotherapy and immunology clinics Atatürk University Hospital in eastern Turkey between May-July 2005 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage.

RESULTS

Seventy-six per cent of participants reported use of at least one form of complementary and alternative medicine in the previous year. Complementary and alternative medicine users and non-users were not significantly different in most socio-demographic characteristics including age, gender, marital status and education level with the exception of economic status. We categorised treatment into six complementary and alternative medicine categories: 62.6% of patients used thermal therapies; 41.5% used oral herbal therapies; 40.5% used hot therapies; 32.6% used externally applied (skin) therapies; 28.4% used massage and 12.6% used cold therapies. All forms of complementary and alternative medicine except thermal and oral herbal therapies were perceived as very effective by more than half of study participants.

CONCLUSIONS

Complementary and alternative medicine therapy is widely used by patients with arthritis and has perceived beneficial effects.

RELEVANCE TO CLINICAL PRACTICE

It is important for nurses and other health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing care to patients with arthritis because of possible interactions with other treatments, delays in seeking care and the potential for poor quality products. It is also essential for health professionals to discuss treatment options with patients and to monitor treatment efficacy.

Herbal Product Use in a Patient with Polypharmacy

A 70-year-old homebound patient was experiencing new onset porthostatic hypotension and lightheadedness. The pharmacist conducted a thorough medication review, which revealed the use of several herbal products, including St. John's wort, in addition to several prescription medications. The pharmacist counseled the patient on the potential hazards of using herbal products with prescription medications. This prompted the patient to discontinue all herbal supplements with the subsequent resolution of his lightheadedness and orthostasis. He also experienced improvement in his pain control. Pharmacists need to be vigilant in establishing a dialogue with their patients about the pros and cons of herbal product use, particularly with prescription medications.

Concomitant use of prescription drugs and dietary supplements in ambulatory elderly people

OBJECTIVES

To analyze baseline data on concomitant use of prescription drugs and dietary supplements in elderly people from the Ginkgo Evaluation of Memory (GEM) Study, in which information was collected on all drugs and supplements used by participant.

DESIGN

Cross-sectional correlation analysis.

SETTING

GEM Study sites in California, Maryland, North Carolina, and Pennsylvania.

PARTICIPANTS

Three thousand seventy ambulatory individuals aged 75 and older enrolled between September 2000 and June 2002.

MEASUREMENTS

Use of prescription drugs and dietary supplements identified through bottles brought to the clinic.

RESULTS

Almost three-quarters (74.2%) of the cohort combined use of at least one prescription drug and one dietary supplement, with 32.5% using three or more prescription drugs and three or more supplements. The 15 most-prevalent prescription drugs exhibited substantial concomitant use with dietary supplements, ranging from 77.6% for diuretics to 93.6% for estrogen preparations. Although supplements were taken concomitantly with all classes of prescription drugs, the use of supplements was more likely in individuals using nonsteroidal anti-inflammatory drugs, thyroid drugs, and estrogens. The use of drugs for diabetes mellitus was negatively associated with the use of supplements, with most of this attributed to low use in those taking multivitamins, glucosamine and chondroitin, and echinacea.

CONCLUSION

There is substantial concomitant use of prescription drugs and dietary supplements in elderly people. Further investigations are needed to define the clinical importance of this concomitant use, especially in elderly patients who consume multiple prescription drugs or have experienced an adverse event secondary to their prescription medications.

Four common herbs seen in dental practice: properties and potential adverse effects

The use of herbal supplements in North America is steadily growing and raises concerns about safety, efficacy, and how they affect safe patient care. The most notable and direct health risks associated with herbal supplements include hypertension, prolonged bleeding, and the potential for drug-herb interactions, which is of particular concern for patients undergoing anesthesia, both general and local anesthesia. In this article, four of the most commonly used herbs today in North America will be discussed: garlic, gingko, ginseng, and ginger. The pharmacology, benefits, and possible side effects of these herbs will be presented. Awareness of the rising use of herbs is important to prevent, recognize, and treat potential problems that can arise from herbal preparations taken alone or in conjunction with prescription medications.

Use and safety perceptions regarding herbal supplements: a study of older persons in southeast Idaho

Herbal supplements (HS) are used by older persons and are often perceived as safe, although there is limited research that examines why this perception exists. A questionnaire was developed and pilot tested to investigate the use and perceived safety of HS among a convenience sample of 112 adults aged 60 to 92 in southeast Idaho. Fifty-five percent of the participants (n = 62) reported using HS in the past. Ninety-five percent (n = 59) of those using HS and 75% (n = 37) of nonusers reported they believed most or some HS were safe. Perception of herbal supplement safety was greatly influenced by family and friends, and HS users had a greater perception of safety than nonusers (p < or = .001). The top reasons for perceived safety given by HS users were that HS: (1) can be purchased without a prescription, (2) can be purchased in many locations, and (3) are natural.

Team management of dysphagia in the institutional setting

The capacity to swallow effectively and safely is a basic human need, yet nearly 40% of Americans over age 60 experience dysphagia. Since the resources in acute-care hospitals often are unavailable in institutional settings, the daily involvement of nursing and the dietitian's screening and continuous assessment are critical to timely, effective dysphagia identification, referral, and management. Upon referral, the speech pathologist executes comprehensive evaluation, leading the design and implementation of a team treatment plan. Literature highlighting a sample of dysphagia screening tools and interventions, care transitions and aspiration prevention strategies is reviewed herein to guide current practice and future research.

Use of self-chosen therapies by depressed people in primary care

AIMS

This paper focuses on attitudes towards and use of self-chosen treatment among people prescribed antidepressants and discusses the implications for practitioners involved in medicines management.

BACKGROUND

In the wide-ranging debate around the extension of non-medical prescribing in the UK the relationship between complementary and alternative therapies and prescribed medication has received little attention. Research indicates that self-treatment, including use of complementary and alternative therapies is burgeoning, yet there is uncertainty about the degree to which practitioners should be knowledgeable about therapies or be capable of advising clients on their use. Complementary and alternative therapy use is common among people with depression and greater knowledge of their use may be appropriate if health practitioners are to be able to support and inform people with depressive symptoms.

METHODS

Qualitative methodology was adopted and 60 people from four primary care practices in the West Midlands, UK were interviewed individually and their self-reported treatment journeys documented.

RESULTS

Almost two-thirds of participants had attempted to use self-chosen therapies during their recent illness though few had discussed their use with health service practitioners. Use of a range of self-chosen therapies was supported by a belief that they were natural, combined with a desire to avoid consulting health practitioners. Reasons for non-use of such therapies included confidence in health practitioners and caution about the possibility of drug interactions.

CONCLUSIONS

Health practitioners require an awareness that people with mental health problems are using a range of self-chosen treatments and might consider the appropriateness of initiating discussions on self-chosen treatments with clients. This area requires greater debate and if necessary identification of an appropriate knowledge base.

RELEVANCE TO CLINICAL PRACTICE

Assessment of common mental health problems should include discussion of patients' previous and current self-treatment. Such discussions will assist in identifying attitudes and beliefs towards health service treatment and provide a basis for selecting appropriate interventions.

Family Medicine Physicians′ Advice about Use of Nonconventional Modalities for Menopausal Symptom Management

AIMS

This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management.

METHODS

Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief.

RESULTS

Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed.

CONCLUSIONS

These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.

Self-application of complementary and alternative medicine by patients with gynecologic cancer

OBJECTIVES

In this study we aimed to determine the epidemiology and demographic data on complementary and alternative medicine (CAM) use along with the medical/surgical treatment modalities in patients with gynecologic cancers in Turkey.

MATERIALS AND METHODS

A cross-sectional study was designed to determine demographic data on CAM use of patients with gynecologic cancers who had medical and/or surgical treatments. Semistructured questionnaires were used for collecting data from 126 patients.

RESULTS

When the CAM use ratio of patients was evaluated with respect to demographic characteristics, patients using any type of CAM were younger and more educated, and there were no significant differences between the patients who used and who did not use any type of CAM with respect to geographical region. There were no significant correlations between the use of CAM and the type of malignancy, treatment modality and time period after diagnosis.

CONCLUSION

There is critical concern about the probable serious risks associated with non-educated CAM practitioners. Therefore, informed and educated healthcare professionals should inform and help in relieving patients in a more professional and multidisciplinary way.

Comprehensive, Integrative Management of Pain for Patients with Sickle-Cell Disease

PURPOSES

The study was conducted to: (1) investigate both pharmacologic and complementary therapies used for pain management by caregivers of children with sickle cell disease (SCD), (2) investigate the prevalence and types of complementary therapies used for pain management by caregivers of children with SCD, and (3) explore caregivers' interests in using complementary therapies in the future.

METHODS

A cross-sectional, descriptive design was used. Sixty-three caregivers of children with SCD were asked to complete a questionnaire while they visited a SCD clinic. Chi-square tests were performed to compare demographic variables, examine use of pharmacologic therapies for pain management between age groups, and compare use of pharmacologic and complementary therapies.

RESULTS

The most frequently used pain medications for children with SCD (mean age 9 years) were ibuprofen (37.5%), acetaminophen with codeine (32.1%), and acetaminophen with oxycodone (14.5%). More than 70% of 63 caregivers (mean age 33 years) were using some form of complementary therapies (3.67 +/- 2.95, range: 0-9) for their child. The most commonly used therapies were prayer, spiritual healing by others, massage, and relaxation. Complementary therapy use was significantly higher among caregivers of children who were taking two or more analgesics compared to children taking no analgesics or one analgesic (chi (2) = 3.954, p = 0.047). Although no difference was found in nonopioid analgesic use, there was significant difference in opioid analgesic use (chi (2) = 14.736, p = 0.002) and total medication use (chi (2) = 11.025, p = 0.012) between children < or = 12 years and > or =13 years.

CONCLUSIONS

Caregivers of children using greater numbers of conventional pain medications were more likely to be using complementary therapies as well. If offered in the future, many caregivers were willing to try various types of complementary therapies for pain management.

Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness. However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with "nested" data.

Effects of a red clover extract (MF11RCE) on endometrium and sex hormones in postmenopausal women

OBJECTIVE

To evaluate the effects of a non-prescription red clover extract (MF11 RCE, Melbrosin International, Vienna, Austria) on selected sex hormones and endometrium in postmenopausal women.

PATIENTS AND METHODS

One-hundred and nine postmenopausal women with an age > or =40 years were randomly assigned to one of two groups either two capsules of MF11RCE (80mg isoflavone) per day for a 90 day period, or placebo of equal design. After a 7 day washout period, medication was crossed-over for another 90 days.

RESULTS

Combined evaluation demonstrated that supplementation with MF11RCE (verum), in contrast to placebo, significantly increased plasma testosterone levels and decreased endometrial thickness.

CONCLUSION

MF11RCE exerts a moderate effect on testosterone levels in postmenopausal women, while estradiol levels remained unchanged. The observed reduction of endometrial thickness provides further support for a safe role for isoflavones in terms of endometrial hyperplasia.

Natural Health Products in the Prevention and Treatment of Osteoporosis: Systematic Review of Randomized Controlled Trials

Background:

Consumers are increasingly looking to natural health products to manage specific diseases such as osteoporosis. As a result, healthcare providers need evidence-based information on which to base recommendations regarding use and efficacy.

Objective:

To identify natural health products (NHPs, ie, dietary supplements) advocated for the prevention and treatment of osteoporosis and systematically review the evidence from randomized controlled trials for the effect of NHPs on bone mineral density (BMD)/fracture rate in women.

Methods:

MEDLINE, Natural Medicines Comprehensive Database, and the Internet were initially searched to identify NHPs advocated for prevention and treatment of osteoporosis. For NHPs having evidence to support their claim, the aforementioned sources, along with International Pharmaceutical Abstracts, the Cochrane Library, the International Bibliographic Information on Dietary Supplements, the Cumulative Index to Nursing & Allied Health, and HerbMed, were searched to locate randomized controlled trials published in English between 1966 and October 2004. Bibliographies of identified articles were also searched. Randomized controlled trials were selected if they evaluated the use of a single NHP in women, using BMD/fracture rate as the outcome measure. NHPs were excluded from further evaluation if a review had already been published. Data were extracted using predetermined criteria and studies appraised using the Jadad scale. Forty-five NHPs were identified that the authors claimed to be beneficial in prevention and treatment of osteoporosis, with 15 having evidence to support their claim. Calcium; copper; evening primrose oil; fish oils; fluoride; magnesium; manganese; strontium; vitamin D; and black, green, and oolong tea did not meet study criteria.

Results:

Results from randomized controlled trials evaluating dehydroepiandrosterone (DHEA), phytoestrogens, and vitamin K2 (menaquinone or menatetrenone) were promising; however, study limitations suggest the need for confirmatory evidence.

Conclusions:

Although no definitive conclusions can be drawn, the relative safety of phytoestrogens, DHEA, and vitamin K2 at the studied doses, as well as preliminary positive results from randomized controlled trials, provides some initial support for the use of these NHPs in the prevention and treatment of osteoporosis in women.

Dietary supplement information and intention to continue and recommend supplements

This posttest only two-group design study with 113 adults tested how reading a pamphlet based on the United States' Federal Drug Administration (FDA) Tips for the Savvy Supplement User affects intention to use and recommend supplements. A total of 23.7% fewer people with health problems who prior to reading the pamphlet believed that supplements were safer than medications planned to recommend their dietary supplement to family and friends after reading the pamphlet than in the comparison group. A lower probability of recommending dietary supplements is a helpful starting point for safer dietary supplement use by consumers.

Herbal, Prescribed, and Over-the-Counter Drug Use in Older Women: Prevalence of Drug Interactions

Older adults are at particular risk for drug and herbal interactions because they have multiple health problems that require treatment and are generally more susceptible to adverse drug effects. This study used a database containing self-reported herbal, prescription, and over-the-counter (OTC) drugs concurrently taken by a sample of 58 women who were aged 65 years or older. Drug-drug interactions (DDIs) were identified using a Web-based pharmaceutical program. At least 1 moderate or high-risk DDI was identified in 74% of participants, with 136 total DDIs identified. Fifty-two percent (71) of total DDIs were between prescribed and OTC or herbals, with 63% (45) of these involving nonsteroidal antiinflammatory drugs (NSAIDs). It is imperative that health care providers identify all prescribed, OTC, and herbal drugs taken by their patients and assess all interactions in order to avoid the possibility of adverse drug effects.

Prevalence of natural health product use in healthy postmenopausal women

OBJECTIVES

Population studies examining dietary supplement use reveal that users are more likely to be women of older age, yet there are few focused studies among postmenopausal women. The purpose of this study was to determine the prevalence of natural health product (NHP) use, as well as the attitudes and motivations associated with NHP use, among postmenopausal women.

DESIGN

Healthy postmenopausal women were recruited from shopping malls and community centers to complete a questionnaire that collected information regarding use of NHPs; attitudes and motivations about NHPs; and demographic, health, and lifestyle characteristics.

RESULTS

The prevalence of NHP use among the 204 subjects was 83.3%. There were no significant differences in characteristics between NHP users and non-users, with the exception of a lower body mass index among NHP users (P = 0.01). The most commonly consumed NHP was calcium, followed by multivitamins/minerals, vitamin C, and vitamin E. Almost all NHP users (98.8%) believed that NHPs improved their overall health, and most (70.6%) attributed specific positive effects to their NHPs. Three quarters of NHP users believed that their NHPs could not cause adverse effects, and 64.2% believed that their NHPs could not interact negatively with medications. The most common source of NHP information was magazines/books, and 71.8% of NHP users indicated they did not need further information about their NHPs.

CONCLUSIONS

In this study, we found that the prevalence of NHP use among a sample of 204 healthy postmenopausal women was 83.3% and that, apart from body mass index, there were no variables that predicted NHP use.

Trends in Complementary and Alternative Medicine in Eastern Turkey

OBJECTIVE

To investigate the types and prevalence of complementary and alternative medicine (CAM) use among adults in eastern Turkey and to evaluate the relationship between the use of CAM and sociodemographic characteristics.

DESIGN

This study was a random-sampled survey examining patterns of use of complementary therapies in two university hospitals in the Eastern Anatolia region of Turkey.

SETTING AND SUBJECTS

Seven-hundred-fourteen (714) adult participants were interviewed at two sites: two university hospitals both located in Erzurum. Subjects were excluded if they did not speak Turkish because this may sometimes cause communication problems between patients and health care professionals. Patients younger than 18 years old and those residing outside of the eastern region of Turkey were not included in this study.

MEASUREMENT

Use of CAM within the previous year.

RESULTS

Seventy percent (70%) of participants reported the use of CAM. Herbs (41%) were the most frequently cited therapies. Although 87% of the subjects reported that they were satisfied with their use of CAM, the majority (84.8%) did not discuss the use of these therapies with their primary physicians.

CONCLUSIONS

This study revealed that there is a high prevalence of use of alternative therapies by individuals living in eastern Turkey.

Perceived Health Promotion Practice by Older Women: Use of Herbal Products

Women age 65 and older appear to use herbal products as well as multiple prescribed and non-prescribed drugs as part of their health-promoting practice. The purpose of this study was to identify changes in herbal-product use in a sample of older women during an 18-month period and to explore differences in locus of control and perceived health competence between herbal-product users and non-users. A longitudinal and descriptive study design was used. Instruments used to guide the two sets of structured interviews included the Multidimensional Health Locus of Control (MHLC), the Perceived Health Competence Scale (PHCS), and a questionnaire about herbal-product use. The prevalence of herbal-product usage and the number of products used remained consistent between the initial and follow-up interviews, with 43% of the participants using an average of 2.6 herbal products. Neither MHLC nor PHCS scores differed between herbal-product users and non-users. Mean scores of women in the study indicated higher internal than external locus of control.

Use of herbal therapies by older, community-dwelling women

BACKGROUND

Herbal medicines, products and therapies are a subject of great public interest both nationally and worldwide. Use of herbal therapy is most common among women and patients with chronic health problems.

AIM

This paper reports a study to determine the prevalence of herbal therapy use among women over 65 years who live independently in the community, and to compare the socio-demographic characteristics and health status of older women who use herbal therapies and those who do not.

METHODS

This was a cross-sectional study. Random samples of 385 older participants took part in structured interviews at five primary health care centres in Turkey between September and December 2002.

RESULTS

Herbal therapies were used by 48.3% of the sample in the previous 12 months. No differences in demographic characteristics were found for users and non-users. We found that herbal therapy use was substantially higher among older women who: (1) reported any disability in activities of daily living, (2) had poor self-reported health, (3) had very frequent physician visits, and (4) had chronic conditions such as cardiac problems, diabetes, stroke, cancer, asthma, pneumonia or urinary problems.

CONCLUSIONS

It is important for community health nurses to be knowledgeable about the use of herbal therapies when providing care to older women because of possible interactions with other treatments, delays in seeking care, and poor quality products.

Herbal product use and perioperative patients

IT IS VITAL for perioperative team members to assess the effects of increasingly used herbal and nontraditional medications on a patient's surgical course. THIS LITERATURE REVIEW provides a knowledge base so nurses can appropriately assess the possible effects of herbal medication use by perioperative patients. THE HISTORY OF HERBAL REMEDY USE, existing regulatory guidelines, effects on consumer safety, and socioeconomic and insurance issues are discussed. Additionally, the role of an herbal medicine practitioner is explored. Finally, the eight most commonly used herbal medications are examined, particularly in regard to perioperative patients.

An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies

PURPOSE

To describe and assess the current utilization of complementary and alternative medicines (CAMs) in women with a diagnosis of either gynecologic or breast cancer and evaluate their reasons for use.

PATIENTS AND METHODS

This study included 250 female patients from the Multidisciplinary Breast Center and 250 patients from the Gynecologic Oncology Center of The University of Texas M.D. Anderson Cancer Center (Houston, TX). Patients were selected by having an odd-numbered medical record number, and they were contacted before their clinic visit. The goals of the study were explained, and verbal consent was obtained. Patients who agreed to participate were asked to bring a written list and the medication bottles of all over-the-counter prescriptions and CAMs with them to clinic. In clinic, the investigator obtained a written informed consent and administered the survey. All patients and surveys were assessable.

RESULTS

The most frequently used herbal products and megavitamins/minerals were identified from the patient medication histories. Overall, we found the proportion of patients using CAM to be 48% (95% CI, 44% to 53%; 241 of 500 patients). CAM use was related to patients' educational status: 62% had postgraduate degrees, 50% had college degrees, 56% had some college, and 33% had a high school education or less. Also, among patients using CAMs, only 53.5% had spoken to a healthcare provider regarding CAM therapy.

CONCLUSION

The use of CAM is common among women with cancer. Studies need to be conducted to establish if there are any potential drug interactions and/or therapeutic benefit of CAM products. Moreover, there is a need to educate patients and healthcare providers on appropriate and safe use of CAM products.

Nurses and nutraceuticals. Knowledge and use

Increasing use of herbal products by the American public should prompt nurses to routinely address herbal use during patient interactions. However, whether nurses possess the knowledge required to discuss risks and benefits of herbal use with patients is unknown. This study was undertaken to investigate registered nurses' knowledge about and use of five common herbal products: ginkgo, St. John's wort, ginseng, garlic, and echinacea. One hundred forty-nine (30%) of 500 randomly selected nurses responded to a mailed questionnaire addressing the frequency of use, purpose, side effects, and interactions of the above products. Most respondents had neither used nor suggested use of the products. Respondents were relatively unfamiliar with product characteristics, although somewhat more familiar with purpose than with side effects or interactions. No knowledge differences were identified according to practice area or number of years in practice, but differences were noted according to educational level and use of specific products.

Herbal Supplement Use by Persons Aged Over 50 years in Britain

BACKGROUND

The use of herbal and nutritional supplements by older British people is increasing and despite the risks of adverse effects and negative herb-drug interactions, doctors are often not informed of their use. The number of herbal and nutritional supplements used most frequently by older people, and which particular herbal extracts are used, are unknown. This study aimed to identify how many herbal and nutritional supplements and which herbal extracts are most frequently used by British people >50 years of age, and to identify which herb-drug interactions represent the greatest risk to this age group.

METHOD

A self-completed survey was promoted through websites and a popular magazine aimed at people >50 years of age.

RESULTS

Respondents (n = 271) used a mean of 2.26 prescription drugs and 5.91 herbal and nutritional supplements, including 2.66 herbal extracts. The use of herbal medicines by older British people frequently involves the use of several herbs, often involves concomitant use with several nutritional supplements, is poorly reported to doctors and places older people at risk of negative herb-drug interactions. The most frequently used herbs and associated risks of negative interactions with prescription drugs are identified.

CONCLUSIONS

Older people should be encouraged to report the use of herbs and nutritional supplements to their doctors, and doctors should be provided with comprehensive and up-to-date information about potential herb-drug interactions.

Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing

AIM

This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed.

BACKGROUND

Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable.

DISCUSSION

The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s).

CONCLUSION

Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.

Complementary alternative treatments used by patients with cancer in eastern Turkey

Interest in complementary-alternative medicine therapies is growing rapidly in Turkey. Therefore, the purpose of this research was to determine the types and prevalence of alternative therapies used by the patients with a diagnosis of cancer, and to determine factors influencing the choices of their therapies in Erzurum, Turkey. Approximately 10-minute face-to-face interviews were conducted with each subject in the radiation oncology department. The factors associated with the use of alternative therapies after a diagnosis of cancer were assessed by chi-square analysis. The findings indicated that complementary-alternative medicine therapies were used by 41.1% of the subjects after their diagnosis, and that all of the alternatives they used were herbs. The most commonly used herb was stinging nettle leaf (urtica dioica) or seed of nettle. Almost all (93.2%) of the herbs used were nettle. In general, especially the women and the younger patients of both genders were more likely to be using alternative therapies. There was no difference in demographic and cancer characteristics between users of alternative therapy and nonusers. More than the half of the patients using alternative therapies (54.5%) reportedly did not discuss the use of herbs with their healthcare professionals. Most of the patients using stinging nettle and other herbs therapies reported that they had heard about the use of herbs from friends or relatives (52.3%), or from the other patients in this clinic (43.2%). This study found that there is a high prevalence of alternative therapies used by patients with cancer in eastern Turkey. The use of these alternative therapies requires that nursing professionals rethink staff competency, patient assessment, and patient-focused care. Communication between patients and healthcare professionals should initiate dialogues on this topic for a better understanding of patient choices with regard to treatment options.

Botanical dietary supplement use in peri- and postmenopausal women

OBJECTIVE

To determine use of botanical dietary supplements (BDS) in women between the ages of 40 and 60 years at the University of Illinois at Chicago (UIC) clinics, including information about commonly used BDS, the reason for use, information resources used, and the overall perception of safety and efficacy of BDS.

DESIGN

Five hundred female outpatients at UIC clinics were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years.

RESULTS

BDS were used by 79% of respondents ( = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), Echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physician of BDS use.

CONCLUSIONS

A high percentage of women at UIC clinics were using multiple BDS. The respondents believed that these products were both safe and effective for the treatment of common ailments. Concomitant BDS use with prescription and over-the-counter medications was commonplace, often without a physician's knowledge. Consumer education about the possible benefits and risks associated with BDS use is urgently needed.

Nurse practitioner knowledge of complementary alternative health care: foundation for practice

AIM

With the increasing use of complementary alternative treatments by the general public in the United States of America (USA), it is critical that nurse practitioners have the most up-to-date information about the use and safety of these modalities. A strong knowledge base is crucial in delivering competent and culturally sensitive care, yet the level and source of nurse practitioner knowledge in this area is largely unknown. The purpose of this study was to investigate the level and source of nurse practitioner knowledge of complementary alternative health care practices, as well as their referral practices involving these treatments.

METHODS

Using a cross-sectional descriptive research design, a sample of 151 nurse practitioners from Missouri and Oregon completed an adapted version of Sapp's self-administered survey that explored these issues. Evaluation of the psychometric properties of the adapted instrument demonstrated good face validity, test-retest reliability (kappa = 0.81) and internal consistency reliability were 0.90 and 0.92 for two subscales with continuous response categories.

FINDINGS

Eighty-three percent of the nurse practitioners recommended complementary alternative treatments to their patients with the most frequent being massage therapy, chiropractic care, acupuncture or acupressure, nutritional therapy and herbal treatment. However, only 24% reported that formal nurse practitioner education was a source of knowledge about these treatments. Instead, over 60% relied on their personal experiences for this knowledge, as well as lay and professional journals.

CONCLUSION

Nearly 9 out of 10 nurse practitioners recommend the use of complementary alternative therapies to patients, but their source of knowledge is not derived from professional education. Attention needs to be given to increasing content about complementary alternative therapies in formal academic programs, professional conferences and in-service education opportunities.