Ava Lorenc

How parents choose to use CAM: A systematic review of theoretical models

BackgroundComplementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM.MethodsA systematic search of the literature was carried out. A two-stage selection process with predetermined inclusion/exclusion criteria identified studies using a theoretical framework depicting the interaction of psychological factors involved in the CAM decision process. Papers were critically appraised and findings summarised.ResultsTwenty two studies using a theoretical model to predict CAM use were included in the final review; only one examined child use. Seven different models were identified. The most commonly used and successful model was Andersens Sociobehavioural Model (SBM). Two papers proposed modifications to the SBM for CAM use. Six qualitative studies developed their own model.ConclusionThe SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and policy.

The rise of traditional Chinese medicine and its materia medica: A comparison of the frequency and safety of materials and species used in Europe and China

ETHNOBOTANICAL RELEVANCE Due to the global rise in the use of traditional Chinese medicine (TCM), Chinese materia medica (medicinal materials, or CMM) are giving cause for concern over their evidence base, safety/possible toxicity, questionable quality and use of endangered species of both animals and plants. However, little if anything is actually known about the range of species used to produce CMM used in Europe and even in China. This study represents the first attempt to identify and compare the most important CMM used in both regions, to begin the process of assessing the risks to public health and possible future benefits. MATERIALS AND METHODS Data were collected from a convenience sample of TCM practitioners in the EU and mainland China, using a paper/online survey. Among other questions, respondents were asked (1) which conditions they most commonly treated using CMM and the likelihood of them using herbal manufactured products and decoctions in addition to raw herbs; (2) the perceived frequency with which they observed adverse events to CMM; (3) the frequency and reasons for use of 1 herbal formula and 6 specific individual herbs; (4) an open question about other CMM they used, including materials of non-plant origin. Data were entered into PASW statistics package and analysed using frequency tables, cross-tabulations and chi-squared tests to compare EU and Chinese results. RESULTS From a total of 747 useable questionnaires (420 from China, 327 from the EU) of those responding from the EU, TCM was generally more commonly used for obstetric/gynaecological and dermatological conditions, compared to neurological and gastrointestinal diseases in China. Disorders treated by Chinese practitioners were more varied, and often more serious, than those treated by their European counterparts, and the range of materials used in China was wider. The potential for toxicity was not high in either region, but although greater in China due to the use of more potent CMM, the incidence of side effects was perceived to be higher by EU practitioners. CONCLUSIONS Very few of the species used to prepare CMM in the EU in this study give rise to safety concerns from what is known from the scientific and other literature, and in China only a few toxic CMM appear to be commonly used, some of them only after processing and mainly for serious disorders. The main cause for concern is likely to be interaction with prescribed medication, especially in central nervous system and cardiovascular conditions where drug interactions have previously been reported most frequently and which would currently be more applicable in China than Europe.

A review of the use of complementary and alternative medicine and HIV: Issues for patient care

HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The complex health and social issues associated with living with HIV mean that people living with HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM). This article provides an overview of the literature on HIV and CAM. Databases were searched using keywords for CAM and HIV from inception to December 2012. Articles in English and in Western countries were included; letters, commentaries, news articles, articles on specific therapies and basic science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%, with national studies suggesting CAM is used by around 55% of PLWHA, practitioner-based CAM by 15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater number of medications/symptoms, with CAM often used to address limitations or problems with antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can have potentially serious side effects or interactions with ART. CAM was used as a self-management approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians, particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to encourage valuable self-management and ensure patient safety.

Responding to patient demand: community pharmacists and herbal and nutritional products for children

The attitudes and behaviour of pharmacists working in a multi‐ethnic community regarding herbal and nutritional products (HNPs) for children, were explored in depth. Qualitative interviews with four pharmacists were analysed using Framework Analysis. Quantitative diary recording of all HNP‐related events for child customers in four pharmacies was carried out over two separate week periods between March and June 2008. Of 29 events recorded, most involved parents buying products for their child, especially herbal and nutritional supplements and topical products, and asking for advice. Pharmacists were generally open to herbal and nutritional products and perceived an increasing demand which they were keen to meet. Although they reported feeling competent to give advice, pharmacists wished to increase their knowledge as information on HNPs was limited, and the need to maintain professionalism at all times was recognized. Pharmacists appear to understand and empathize with customer demand for HNPs and are uniquely positioned within the National Health System to provide product advice and support. However, to maintain professionalism, pharmacists may require further information on herbal and nutritional products and continuing professional training, especially since herbal and nutritional supplements may interact with prescribed and over‐the‐counter drugs. Copyright

Meditative movement for respiratory function: a systematic review

BACKGROUND: Meditative movement, such as tai chi, yoga, and qi gong, may benefit people with cystic fibrosis (CF), as a form of gentle exercise incorporating meditation, breathing, and relaxation. Respiratory function is the most common issue in CF. In this systematic review we synthesized the evidence on the effect of meditative movement on respiratory function in patients with CF. METHODS: We searched Chinese and English language databases with terms relating to tai chi/yoga/qi gong, and respiratory function/cough/dyspnea. Articles were screened and selected by 2 researchers. We included controlled studies published in English or Chinese after 1980, and extracted data using a specially designed spreadsheet. Two researchers independently evaluated study quality and reporting, using 3 standardized checklists. Meta-analysis was not possible due to heterogeneous methods. RESULTS: We found 1,649 papers, included 43 (30 in English, 13 in Chinese), 23 of which were randomized controlled trials, and 20 were non-randomized trials. No studies were concerned with CF. Eleven studies included patients with respiratory disorders, and 27 included healthy people. Very few studies were high quality. The main problems with the randomized controlled trials was the randomization and non-random and/or poorly reported sampling. The main problems with the non-randomized studies were poor reporting of samples and non-equivalent groups. Although no clinically important changes were found, meditative movement may improve FEV1 in healthy people, compared to no treatment/exercise (the intervention groups showed effect-size changes from 0.07 to 0.83), but meditative movement did not appear to affect FEV1/FVC in subjects with COPD. Key study limitations were: poor reporting of sampling or methods; inadequate sample size; non-randomized design; inadequate description of randomization; randomization by center; no blinding; lack of reporting of important aspects of meditative movement; and short-term follow-up. CONCLUSIONS: The available evidence does not support meditative movement for patients with CF, and there is very limited evidence for respiratory function in healthy populations. The available studies had heterogeneous populations and provided inadequate sampling information, so clinically relevant conclusions cannot be drawn. Well powered, randomized studies of meditative movement are needed.

The integration of healing into conventional cancer care in the UK

Healing encompasses Reiki, therapeutic touch and healing touch, and is often used by cancer patients to supplement their health care, but the extent of healing provision in conventional cancer care is unknown. This study used snowball sampling to map the healing provision in UK conventional cancer care settings. Sixty-seven individuals at 38 centres were identified who provided healing within conventional care, 16 NHS-based. Less than half were paid or had specialist cancer training. Self-referral was the usual route to healing, followed by hospital nurse referral. Healing was perceived as well accepted and useful by healers. Providing healing in conventional cancer care may improve patient empowerment and choice. Despite the value to patients, staff and healers, many services receive little financial support. Exchange of information and communication on referral possibilities between healers and conventional staff needs to be improved. Voluntary healer self-regulation will facilitate the safe incorporation of healing into conventional care.

Using population segmentation to inform local obesity strategy in England

Little is known about the views of obese people and how best to meet their needs. Amongst London boroughs Barking and Dagenham has the highest prevalence of adult obesity at 28.7%; the lowest level of healthy eating and of physical activity; and is the 22nd most deprived area of England. The study aimed to gain insight into the attitudes, motivations and priorities of people who are obese or overweight to inform the social marketing of an obesity strategy. Two hundred and ten obese or overweight adults were recruited through visual identification in public thoroughfares to attempt to recruit those seldom seen in primary care. One hundred and eighty-one street-intercept and 52 in-depth interviews were conducted. Thematic analysis was followed by psychographic segmentation. Eleven population segments were identified based on their readiness to change, the value accorded to tackling obesity, identified enabling factors and barriers to weight management and perceived self-efficacy. This population showed considerable variation in its readiness to change and perceived control over obesity but considerable similarity in the exchange value they attributed to tackling their obesity. Even within a relatively homogenous socio-demographic community, there needs to be a range of interventions and messages tailored for different population segments that vary in their readiness to change and confidence about tackling obesity. The dominant emphasis of policy and practice on the health consequences of obesity does not reflect the priorities of this obese population for whom the exchange value of addressing obesity was daily functioning especially in relation to family life.

A tool to improve patient and public engagement in commissioning sexual and reproductive health and HIV services

Patient and public engagement (PPE) consists of involving, consulting and listening to patients and the public, to make services responsive to patients’ needs and improve clinical outcomes and patient experience. PPE has a central role in the UK National Health Service (NHS), at every level, from planning to delivery, including commissioning.1 NHS England state that “engaging and involving communities in the planning, design and delivery of health and care services can lead to more joined-up, co-ordinated and efficient services that are more responsive to local community needs” . The 2012 Health and Social Care Act made PPE a legal duty for health care commissioners.2 PPE supports NHS and government agendas to improve quality through new ideas and increasing patient empowerment, and can also reduce costs by providing and implementing services that patients want and will use, resulting in the reduction of unnecessary services.3 PPE can improve the patient experience, add value to services and support good governance, and co-production with patients can improve services3 ,4 and clinical outcomes.1 A recent report entitled ‘Changing Care, Improving Quality’, developed by the Academy of Medical Royal Colleges, NHS Confederation and National Voices, discusses the need for ‘reconfiguration’ of NHS services and puts forward a case for patient engagement:3 “Where patients and their organisations are engaged from the start as equals in shaping the case for redesigning services, it is much more likely that reconfiguration will meet their needs and preferences and succeed in delivering better experience and outcomes.” 3 Absence of a culture of listening to patients can cause serious problems, as identified in a recent inquiry into a case of “appalling” NHS hospital care.5 PPE is particularly challenging in sexual and reproductive health and HIV/AIDS (SRHH) services due to stigma and confidentiality issues.6–8 …

‘No one wants to be the face of Herpes London’: a qualitative study of the challenges of engaging patients and the public in sexual and reproductive health and HIV/AIDS services

To explore barriers, challenges and best practice within patient and public engagement (PPE) in sexual and reproductive health and HIV (SRHH) services in London.

Solutions on Stress (SOS): programmes, packages and products for helping teenagers

Purpose – Recent research and media attention has highlighted soaring levels of stress among young people. As part of a programme of research based across a number of universities in London and the South‐West of the UK (called WestFocus) a team of psychologists, social scientists and complementary practitioners have started to investigate this issue with the aim of introducing stress management interventions into the school environment. This paper aims to examine their findings.Design/methodology/approach – This paper summarises the set up, progress, results and implications of a six‐week stress management intervention piloted and evaluated with teenagers at school. The intervention aimed to provide a holistic approach to stress management teaching students both psychological techniques (such as cognitive behavioural therapy) and complementary therapy approaches (such as Indian head massage and aromatherapy).Findings – Structured assessments and qualitative feedback taken at the beginning and end of the p...