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PubMed2000

Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives.

OBJECTIVE: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. METHODS: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. RESULTS: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. CONCLUSION: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.

Adult↗
PubMed2003

Cultural related complementary therapies: their use in critical care units.

Complementary therapies are becoming widely used in health care in the United States. Most nurses, as are many Americans, are familiar with complementary therapies such as imagery, aromatherapy, massage, and healing touch. Many nurses, however, are not familiar with complementary therapies that are widely used in other countries and cultures. This article delineates reasons necessitating nurses to increase their knowledge about other health systems, provides examples of therapies used in selected cultures, and describes ways in which critical care nurses can incorporate these into the plan of care for patients in critical care units.

Complementary Therapies↗
PubMed2002

Water soluble fractions of rose-scented geranium (Pelargonium species) essential oil.

The essential oil of rose-scented geranium (Pelargonium species, family: Geraniaceae) obtained through steam or water plus steam distillation of shoot biomass is extensively used in the fragrance industry and in aromatherapy. During distillation, a part of the essential oil becomes dissolved in the distillation water (hydrosol) and is lost as this hydrosol is discarded. In this investigation, hydrosol was shaken for 30 min with hexane (10:1 proportion) and the hexane was distilled to yield 'secondary' or 'recovered' essential oil. The chemical composition of secondary oil was compared with that of 'primary' oil (obtained directly by distilling shoot biomass of the crop). Primary oil accounted for 93.0% and secondary oil 7.0% of the total oil yield (100.2 ml from 100 kg green shoot biomass). Fifty-two compounds making up 95.0-98.5% of the primary and the secondary oils were characterized through gas chromatography (GC) and gas chromatography-mass spectroscopy (GC--MS). Primary oil was richer in hydrocarbons (8.5-9.4%), citronellyl formate (6.2-7.5%), geranyl formate (4.1-4.7%), citronellyl propionate (1.0-1.2%), alpha-selinene (1.8-2.2%), citronellyl butyrate (1.4-1.7%), 10-epi-gamma-eudesmol (4.9-5.5%) and geranyl tiglate (1.8-2.1%). Recovered oil was richer in organoleptically important oxygenated compounds (88.9-93.9%), commercial rhodinol fraction (74.3-81.2%), sabinene (0.4-6.2%), cis-linool oxide (furanoid) (0.7-1.2%), linalool (14.7-19.6%), alpha-terpineol (3.3-4.8%) and geraniol (21.3-38.4%). Blending of recovered oil with primary oil is recommended to enhance the olfactory value of the primary oil of rose-scented geranium. Distillation water stripped of essential oil through hexane extraction can be recycled for distilling the next batch of rose-scented geranium.

Biotechnology↗
PubMed2003

Postmodern values, attitudes and the use of complementary medicine.

OBJECTIVES: To examine the relationship between postmodern values, demographic variables and people's attitudes towards and use of acupuncture, aromatherapy and naturopathy. DESIGN: One hundred and seventy-one adults completed a survey measuring postmodern values about health, attitudes towards and use of complementary and alternative medicine (CAM), age, gender, education, and current and recent health. SETTING: Griffith University, Gold Coast, Australia. MAIN OUTCOME MEASURES: Attitudes to CAM and use of CAM. RESULTS: Postmodern values significantly predicted attitudes to CAM and actual use of CAM. Age also significantly predicted attitudes to CAM. CONCLUSIONS: The results highlight the importance of patients' belief in natural remedies and in their active involvement in the healing process.

Adolescent↗
PubMed1995

The human face of elderly care?

Communication and interactions between nurses and patients with dementia of the Alzheimers type is often inadequate. It would be inappropriate to suggest that nursing staff make no effort to communicate with patients who have dementia, but the communication difficulties that confront them require that a conscious effort is made to invest extra energy to provide meaningful communication. A number of interactive approaches are used by staff, traditionally those of reality orientation, behaviour modification, reminiscence therapy, and more recently, music therapy, touch therapy and aromatherapy. This paper overviews one other therapy which specifically addresses the communication needs of patients who suffer from dementia of the Alzheimers type, validation therapy.

Aged↗
PubMed1996

Traditional and complementary therapies used together in the treatment, relief and control of Chron's disease and polyarthritis.

A diagnosis of polyarthritis and later Chron's disease was initially treated by traditional treatments and medicines, which was later supported by aromatherapy and acupuncture, but the turning point to a full recovery followed from a visit to a naturopath and the commencement of an individual/personal diet regime. Over the months of the acute phase of the illness, a valuable insight was gained to the challenges of a physical disability and the difficulties of immobility, and the loss of independence. Also, the experience of being a patient rather than a nursing practitioner, gave first hand experience of the different situations patients meet on a daily basis throughout the health care services, both traditional and complementary, from a patient's perspective rather than from a nursing point of view. The following paper will hopefully help others to consider a fresh individual situations, reflect on the collaboration of traditional and complementary treatments, and treatment of underlying cause as well as symptoms.

Arthritis↗
PubMed1997

Review of literature on the effectiveness of reflexology.

Public interest in complementary therapies continues to grow and many nurses and midwives are incorporating complementary therapies such as reflexology, aromatherapy and massage into their clinical practice. However, there are concerns regarding the use of such therapies when their effectiveness has not been clearly demonstrated. This article is a review of the literature relating to the effectiveness of reflexology. Anecdotal evidence is described and concerns relating to the literature's reliance on personal beliefs and experiences are presented. The need for research evidence to demonstrate effectiveness is highlighted. A critical review of published research studies is presented which focuses in particular on methodological issues such as the use of the randomized controlled trial to determine the effectiveness of complementary therapies such as reflexology.

Diffusion of Innovation↗
PubMed2004

'Thinking outside the box': complementary and alternative therapies use in paediatric oncology patients.

The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use among children with cancer who had received or were receiving treatment at a large hospital in the UK, including the identification of the most commonly used therapies and parental motives for doing so. Using a cross-sectional survey design, questionnaires were sent to parents of paediatric patients diagnosed with cancer. Of the 49 respondents, 32.7% reported using some type of CAM. The most commonly used therapies included multivitamins, aromatherapy massage, diets and music as therapy. Most children had used more than one therapy. Many of the factors that motivated parents to use CAM were related to helping or supporting their child's medical treatment. The main benefits identified from using CAM included increased confidence, pain relief and relaxation. The longer the time since diagnosis the more children tended to use CAM. The reasons for parents not using CAM included the child doing well and therefore not seeing the need for CAM use; not being aware of CAM; CAM not being offered and lack of information available. Parents identified a need for more information to be available both at ward level and for information about CAM to be discussed by medical staff, particularly at the start of treatment. The results indicate that CAM is frequently used by children and young people with cancer and that their use plays a substantial role in helping children through their conventional cancer treatment.

Adolescent↗
PubMed2003

Bioactivity of Backhousia citriodora: antibacterial and antifungal activity.

Backhousia citriodora products are used as bushfoods and flavorings and by the aromatherapy industry. The antimicrobial activity of 4 samples of B. citriodora oil, leaf paste, commercial tea (0.2 and 0.02 g/mL), and hydrosol (aqueous distillate) were tested against 13 bacteria and 8 fungi. Little or no activity was found to be associated with the leaf tea and hydrosol, respectively. Leaf paste displayed antimicrobial activity against 7 bacteria including Clostridium perfringens, Pseudomonas aeruginosa, and a hospital isolate of methicillin resistant Staphylococcus aureus (MRSA). The 4 essential oils were found to be effective antibacterial and antifungal agents; however, variation was apparent between oils that did not correlate with citral content. The antimicrobial activity of B. citriodoraessential oils was found to be greater than that of citral alone and often superior to Melaleuca alternifolia essential oil. B. citriodora has significant antimicrobial activity that has potential as an antiseptic or surface disinfectant or for inclusion in foods as a natural antimicrobial agent.

Anti-Bacterial Agents↗
PubMed2001

[Using interaction-intensive therapeutic nursing measures and "home remedies" in nursing care. An explorative study as a plea for integrated nursing practice].

BACKGROUND: Until today there existed no major studies about the wide range of currently utilized methods or potential sociodemographic and institutional influences on utilization despite an immense interest among nurses in alternative nursing methods (in this study referred to as home remedies). METHODS: In this study, from standardized questionnaires with a convenience sample of three different settings of nursing practice, i.e. acute-care, nursing homes, and home health care were analyzed using the statistical program SPSS. RESULTS: Our analysis showed that a wide range of traditional home remedies is being utilized, e.g. application of heat and cold or herbal infusion (herbal teas). Furthermore, lay approaches such as aromatherapy were also commonly used. The statistical analysis revealed complex influences of age, duration of nursing practice and institutional setting in the utilization of home remedies. CONCLUSION: There is need for more systematic studies to further examine the alternative methods or home remedies so popular among nurses and their patients. Regarding a more consistent naming of the variety of different methods coming from naturopathy, folk and lay medicine, the authors suggest the term "integrative nursing care".

Adult↗
PubMed1998

Complementary therapists and cancer patient care: developing a regional network to promote co-operation, collaboration, education and patient choice.

Complementary therapies, particularly aromatherapy, reflexology and relaxation techniques are increasingly valued by cancer patients. However, many health professionals doubt their value, and often question whether therapists claim inappropriate benefits, lack understanding of cancer-related issues and pose a potential danger to patients. The Lynda Jackson Macmillan Centre for Cancer Support and Information, which has provided therapies since 1993, explored some of these issues and attempted to identify common areas of interest, possible collaboration, and an additional source of meeting patient needs. Two hundred and fifty questionnaires were sent to aromatherapists and reflexologists within the region served by the hospital to: (1) identify and profile interested therapists; (2) assess the need for cancer-related educational programmes; and (3) address some of the professionals' concerns. One hundred and four responses described work patterns, qualifications, cancer-related experience, the contribution of therapies to cancer care and interest in cancer-related training. A lack of information on cancer was identified. Therapists appeared to be working sensitively, even over-cautiously, and misgivings concerning this group appeared to be unfounded. Subsequent workshops resulted in a therapists' network, whose members collaborate with the centre in various ways. Patients and carers appreciate access to therapists informed about cancer, treatments and related issues.

Community Networks↗
PubMed2002

Allergic contact dermatitis following exposure to essential oils.

Allergic contact dermatitis from the topical use of essential oils is not widely recognized as an occupational hazard. Four cases of allergic contact dermatitis to essential oils occurring in three aromatherapists and one chemist with a particular interest in aromatherapy are described. All presented with predominantly hand dermatitis and demonstrated sensitization to multiple essential oils. One patient developed a recurrence of cutaneous symptoms following ingestion of lemongrass tea. Workers within this industry should be aware of the sensitization potential of these products and the risk of limiting their ability to continue employment.

Adult↗
PubMed1999

The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review.

OBJECTIVE: This paper provides a systematic review of research findings published between 1989 and 1998 concerning non-pharmacological strategies to alleviate behavioural disturbances in elderly persons with dementia. METHOD: Data collection strategies included computer literature searches, manual searches of selected journals and checks of references listed in previous reviews. To warrant inclusion, studies were required to include some measure of behaviour before and after the introduction of an intervention. Papers were appraised in the following domains: design, sampling technique, setting, behaviours studied, measurement tools, data collection methods, type of interventions and feasibility. An overall validity rating was assigned to each article using predetermined rules. RESULTS: Forty-three studies met criteria for inclusion including five randomised controlled trials. Validity ratings were as follows: one strong, 15 moderate, and 27 weak. Areas of scientific weakness included small numbers of subjects, inadequate descriptions of study participants, imprecise data collection methods, high attrition rates and insufficient statistical analysis. Despite this, there is evidence to support the efficacy of activity programs, music, behaviour therapy, light therapy, carer education and changes to the physical environment. The evidence in favour of multidisciplinary teams, massage and aromatherapy is inconclusive. CONCLUSIONS: It was easier to interpret the results of rigorously designed studies that focused on a single behaviour or single intervention tailored to the needs of individuals and carers. Future studies should seek to replicate the findings outlined here, improving methodologies where necessary and including outcome measures that encompass the interests of people with dementia, family caregivers and health professionals.

Aged↗
PubMed2000

How the public classify complementary medicine: a factor analytic study.

OBJECTIVES: To see how lay people group or classify various CAM therapies. DESIGN: Nearly 600 adults rated 39 relatively familiar branches of complementary medicine on four dimensions: whether they had heard of it, whether they think they know how it works; whether they had tried it; and a rating of efficacy on a 10-point scale. RESULTS: As predicted those most heard of were acupuncture, aromatherapy, herbal medicine, hypnosis, massage and yoga while those with lowest ratings were autogenic training, ayurveda, biochemic tissue salts, chelation cell therapy and ozone therapy. A number of multivariate statistical techniques were used to attempt to investigate the perceived dimensional structure of the different therapies. Slightly different structures emerged depending on the question asked and the analysis computed. CONCLUSION: The 'bottom-up' empirically derived taxonomization of therapies was interpretable and showed 10 different factors. The issue of classifying or taxonomizing complementary medicines is discussed.

Adult↗
PubMed2000

Complementary medicine and general practice: an urban perspective.

BACKGROUND: Complementary medicine appears to be an increasingly popular option amongst both doctors and patients. General practitioners in more affluent parts of Britain have showed considerable interest in its use. OBJECTIVES: To ascertain use of and attitudes towards complementary medicine, amongst general practitioners working in a socioeconomically deprived urban area. METHODS: A postal questionnaire survey of all general practice principles in Liverpool, using freepost envelopes and one reminder after 3 weeks. With respect to eight common complementary therapies, respondents were asked whether they treat with, refer to or endorse each therapy; for their views on NHS funding, effectiveness, adverse reactions, training needs, and theoretical validity, for each therapy. RESULTS: The response rate was 131/252 (52%), higher amongst women and doctors aged under 40. During the previous week 74 (56%) of respondents had been involved in complementary medical activity with their patients: 13% had treated directly, 31% had referred to and 38% had endorsed one or more complementary therapies. Acupuncture was most popular as an NHS option, and along with osteopathy and chiropractic was the therapy most highly regarded by respondents in terms of effectiveness. Homeopathy and hypnotherapy received a mixed reaction, while medical herbalism, aromatherapy and reflexology were viewed more sceptically. Sixty-two per cent of respondents reported successful outcomes of complementary treatments, compared with 21% reporting adverse reactions. Knowledge and training desires were highest for homeopathy and acupuncture. Respondents were generally uncertain about the theoretical validity of these therapies: 50% though acupuncture had a valid basis, compared with only 23% for homeopathy and 8% for reflexology. CONCLUSIONS: The degree of support for complementary medicine therapies amongst general practitioners in this socioeconomically deprived urban area was similar to that found elsewhere in Britain. These general practitioners appeared to tolerate high levels of clinical uncertainty, endorsing a wide range of therapies, despite little knowledge of their content or conviction of their validity.

Attitude of Health Personnel↗
PubMed2001

Use and expenditure on complementary medicine in England: a population based survey.

OBJECTIVES: Many claims are made that complementary medicine use is a substantial and growing part of health-care behaviour. Estimates of practitioner visits in the USA and Australia indicate high levels of use and expenditure. No reliable population-based estimates of practitioner use are available for the UK. METHODS: In 1998, a previously piloted postal questionnaire was sent to a geographically stratified, random sample of 5010 adults in England. The questionnaire focuses on practitioner contacts, but also asked about the purchase of over-the-counter remedies. Additional information was requested on socio-demographic characteristics, perceived health, and recent NHS resource use. Information on use included reason for encounter, expenditure, insurance, and location of visit. MAIN OUTCOMES MEASURES: Population estimates (by age group and sex) of lifetime use and use in the past 12 months for acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbalism, osteopathy. Estimates for two additional therapies (reflexology and aromatherapy), and homoeopathic or herbal remedies purchased over-the-counter. Estimates of annual out-of-pocket expenditure on practitioner visits in 1998. RESULTS: A crude response rate of 60% was achieved (adjusted response rate 59%). Responders were older and more likely to be female than non-responders. Usable responses (n = 2669) were weighted using the age/sex profile of the sample frame. From these adjusted data we estimate that 10.6% (95% CI 9.4 to 11.7) of the adult population of England had visited at least one therapist providing any one of the six more established therapies in the past 12 months (13.6% for use of any of the eight named therapies, 95% CI 12.3 to 14.9). If all eight therapies, and self-care using remedies purchased over the counter are included, the estimated proportion rises to 28.3% (95% CI 26.6 to 30.0) for use in the past 12 months, and 46.6% (95% CI 44.6 to 48.5) for lifetime use. All types of use declined in older age groups, and were more commonly reported by women than men (P < 0.01 for all comparisons). An estimated 22 million visits were made to practitioners of one of the six established therapies in 1998. The NHS provided an estimated 10% of these contacts. The majority of non-NHS visits were financed through direct out-of-pocket expenditure. Annual out-of-pocket expenditure on any of the six more established therapies was estimated at pound 450 million (95% CI 357 to 543). CONCLUSION: This survey has demonstrated substantial use of practitioner-provided complementary therapies in England in 1998. The findings suggest that CAM is making a measurable contribution to first-contact primary care. However, we have shown that 90% of this provision is purchased privately. Further research into the cost-effectiveness of different CAM therapies for particular patient groups is now urgently needed to facilitate equal and appropriate access via the NHS.

Adult↗
PubMed2001

Attitudes to and use of complementary medicine among physicians in the United Kingdom.

OBJECTIVES: To evaluate the use of attitudes to complementary and alternative medicine (CAM) among UK physicians. DESIGN: Postal questionnaire. SUBJECTS: All Members and Fellows of the Royal College of Physicians. RESULTS: Twelve thousand, one hundred and sixty eight Members and Fellows were surveyed and a response rate of 23% (n = 2,875) was obtained. Responses from the small numbers of general practitioners (n = 127) were not included in the analyses, resulting in a sample size of 2,748: 79% of respondents were in NHS practice, 32% of respondents practised CAM themselves, and 41% referred patients to CAM; of those who referred patients, 78% referred between 0-3 patients per month. CAM is used by physicians more frequently in private as compared to NHS practice. Acupuncture, aromatherapy and manipulative medicine (osteopathy and chiropractic) are the most commonly referred to and the most commonly practised therapies. Eighty seven percent of those using CAM themselves, or as part of their clinical team's commitment, had not had any CAM training. Attitudes to CAM were generally positive, particularly among those in palliative care, rehabilitation, nuclear medicine, and genito-urinary medicine. CONCLUSIONS: Our conclusions must be tempered by the limited response rate, but assuming all non-responders were disinterested in CAM, then at least one in ten UK specialist physicians are actively involved in CAM treatments, although only 13% of our sample had received any CAM training.

Attitude of Health Personnel↗
PubMed2002

The Cavendish Centre for integrated cancer care: assessment of patients' needs and responses.

The use of complementary therapies in combination with conventional medicine is increasing. In cancer care, as at the Cavendish Centre for Cancer Care in Sheffield, the range of therapies offered can include aromatherapy, massage, reflexology, shiatsu, acupuncture, homeopathy, counselling, visualization, hypnotherapy, relaxation, healing and art therapy. Before offering any therapy careful assessment of patients' needs is important as patients seeking complementary therapies may present with unrealistic hopes and expectations of benefit. There are wide variations in provision of services offering complementary cancer care throughout the United Kingdom but few offer a comprehensive assessment which is used as a baseline for both planning treatment and evaluating its outcome and which is conducted by a trained and objective practitioner who has no investment in any specific therapy. We describe the model of care developed at the Cavendish Centre with particular emphasis on the assessment process. Our model of assessment provides an opportunity for patients to tell their story, make sense of the illness experience, construct meaning from it and set realistic expectations for the chosen intervention. It also offers patients involvement and choice in decisions about their care. In addition we present evaluative data from a case series of 157 patients, 138 of whom (88%) reported improvement in their main concern on MYMOP (Measure Your Medical Outcome Profile).

Adult↗