Laura L. Loehrer

Physicians' Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

Use of Complementary and Alternative Medical Therapies by Patients Referred to a Fibromyalgia Treatment Program at a Tertiary Care Center

OBJECTIVEnTo evaluate the frequency and pattern of complementary and alternative medicine (CAM) use in patients referred to a fibromyalgia treatment program at a tertiary care center.nnnPATIENTS AND METHODSnPatients referred to the Mayo Fibromyalgia Treatment Program between February 2003 and July 2003 were invited on their initial visit to participate in a survey regarding CAM use during the previous 6 months. An 85-question survey that addressed different CAM domains was used.nnnRESULTSnOf the 304 patients invited to participate, 289 (95%) completed the survey (263 women and 26 men). Ninety-eight percent of the patients had used some type of CAM therapy during the previous 6 months. The 10 most frequently used CAM treatments were exercise for a specific medical problem (48%), spiritual healing (prayers) (45%), massage therapy (44%), chiropractic treatments (37%), vitamin C (35%), vitamin E (31%), magnesium (29%), vitamin B complex (25%), green tea (24%), and weight-loss programs (20%).nnnCONCLUSIONnCAM use is common in patients referred to a fibromyalgia treatment program.

Potential for interactions between dietary supplements and prescription medications.

PURPOSEnThe objective of this study was to assess the frequency of clinically significant interactions caused by concurrent use of dietary supplements and prescription medication.nnnMETHODSnWe conducted a cross-sectional, point-of-care survey and combined the findings with a review of patient medical records. Patients treated at Mayo Clinic (Rochester, Minn) in 6 different specialty clinics were surveyed for their use of dietary supplements. Concurrent use of prescription medications was obtained from patients medical records. We used the Lexi-Interact online medication and dietary supplement interaction analysis program to assess the potential clinical significance of each interaction.nnnRESULTSnWe surveyed 1818 patients; 1795 responded (overall response rate of 98.7%) and 710 (39.6%) reported use of dietary supplements. In total, 107 interactions with potential clinical significance were identified. The 5 most common natural products with a potential for interaction (garlic, valerian, kava, ginkgo, and St Johns wort) accounted for 68% of the potential clinically significant interactions. The 4 most common classes of prescription medications with a potential for interaction (antithrombotic medications, sedatives, antidepressant agents, and antidiabetic agents) accounted for 94% of the potential clinically significant interactions. No patient was harmed seriously from any interaction.nnnCONCLUSIONSnA small number of prescription medications and dietary supplements accounted for most of the interactions. The actual potential for harm was low.

Gender-specific differences in a patient population with obstructive sleep apnea-hypopnea syndrome.

BACKGROUNDnSleep-related breathing disorders are increasingly recognized as an important cause of morbidity and mortality. Women with obstructive sleep apnea-hypopnea syndrome (OSA) are less likely to be assessed or to receive a diagnosis, and they may have poorer survival rates.nnnOBJECTIVEnThis study assessed gender-specific differences in patients with OSA.nnnMETHODSnData were collected with a prospective, point-of-care, anonymous 25-question survey about basic medical information and therapies for patients undergoing polysomnography at the sleep center of a US tertiary care center from January 1 through March 31, 2005.nnnRESULTSnOf the 646 consecutive patients who received the survey, 522 (80.8%) patients completed it, and 406 subsequently received a diagnosis of OSA. Of those 406 patients, 267 (65.8%) were men. Overall mean age was 57 years (56.4 years for men; 56.7 years for women). Alcohol use was more common in men (132 [49.4%]) than in women (43 [30.90,6]) (P < 0.001). Women were more likely to have the following associated comorbidities: obesity (body mass index > or =30) (P = 0.047), fibromyalgia (P < 0.001), migraine (P < 0.001), depression (P = 0.01), and irritable bowel syndrome (P = 0.01). The 4 most frequently reported sleep-related symptoms in both sexes were snoring (279 [68.7%]), lack of energy (235 [57.9%]), difficulty staying asleep (206 [50.7%]), and daytime sleepiness (204 [50.2%]). Lack of energy (P = 0.01), difficulty falling asleep (P = 0.02), and night sweats (P = 0.01) were observed more frequently in women than in men. There was no significant gender difference in the recalled duration of sleep-related symptoms. The mean (SD) apnea-hypopnea index (AHI) was 26.6 (26.6) for men and 22.1 (26.5) for women (P = 0.02). Conventional medications (including prescription and over-the-counter medications) for sleep-related problems were used more by women (35 [25.2%]) than by men (29 [10.9%]) (P < 0.001).nnnCONCLUSIONSnThe majority of patients who received a diagnosis of OSA were men (male-female ratio, 2:1), and the mean AHI was higher in men than in women. However, women presented with more nonspecific symptoms than did men, although there was no significant gender-specific difference in the recalled duration of symptoms. In addition, women reported more comorbidities and used significantly more conventional medications for sleep-related problems.

Patients' attitudes and preferences about participation and recruitment strategies in clinical trials.

OBJECTIVE To assess attitudes of patients about participation in clinical trials. PATIENTS AND METHODS This is a self-report survey of 400 patients who underwent general medical evaluations between September and November 2006 at a tertiary care academic medical center in Rochester, MN. We measured knowledge of access to clinical trials, attitudes toward participation, recruitment preferences, and beliefs about research integrity. RESULTS Of 485 consecutive patients, 400 (82%) completed the survey. Previous participation in clinical trials was reported by 112 patients (28%). Most were unaware of online information about clinical trials (330 [82%]), were satisfied with their current knowledge (233 [58%]), expected their treating physician to inform them about current trials (304 [76%]), and showed equal interest in participating in conventional or complementary intervention trials (174 [44%]). Of the 400 respondents, 321 (80%) found it appropriate to be contacted by mail and 253 (63%) by telephone regarding study participation. Most patients (364 [91%]) wanted to be informed about research findings or else would not participate in future clinical trials (272 [68%]). The most frequently expected compensation was free parking (234 [58%]). Most thought that their safety (373 [93%]) and privacy (376 [94%]) would be guarded. CONCLUSION Patients are interested in participating in clinical trials but commonly lack adequate information. If patients received more information (through their treating physicians), enrollment might improve. This single-site study has limited generalizability. Future studies involving a diverse group of patients from a broader geographic distribution will help provide more definitive results.

γ-heavy chain disease review of 23 cases

We report the cases of 23 patients with γ-heavy chain disease seen at our institution (8 patients previously reported, 15 new patients). There were 15 women and 8 men; the median age at diagnosis was 68 years (range, 42–87 yr). Sixteen patients had an associated lymphoplasma cell proliferative disorder, 3 had a lymphoplasma cell proliferative disorder and an autoimmune disorder, another 3 had an autoimmune disorder only, and 1 had no underlying disease. The lymphoplasma cell proliferative disorder was disseminated in 10 patients and localized in 6. Patients with localized lymphoplasma cell proliferative disorder included 3 with plasmacytoma (1 tongue, 1 submandibular area, and 1 thyroid), 2 with lymphoplasma cell proliferative disorder involving the bone marrow only, and 1 with amyloid of the skin. At the time of diagnosis, lymphadenopathy was present in 8 patients, splenomegaly in 7, and hepatomegaly in 1. A monoclonal spike on serum protein electrophoresis was documented in 19 patients. γ-Heavy chain was documented by immunofixation in the serum of all patients; 2 had an additional immunoglobulin M-λ. γ-Heavy chain was present in the urine in 19 of 22 patients. Sixteen patients were treated for lymphoplasma cell proliferative disorder or autoimmune disorder (14 with chemotherapy, 1 splenectomy, and 1 thyroidectomy followed by radiation therapy). For 5 patients, treatment was not felt to be necessary; 2 patients were thought to be too sick for treatment. Of the 16 patients treated, 6 had a complete clinical response (in 2, γ-heavy chain disappeared; in 2, γ-heavy chain persisted; and for 2, no serologic follow-up was available); in 10 patients, clinical disease persisted (in 3, γ-heavy chain disappeared; in 6, it persisted; and for 1, no serologic follow-up was available). Of 7 patients not treated, 2 died within 5 months; 1 died after 15 months; 2 had no clinical disease at latest follow-up, although γ-heavy chain persisted; and 2 had no change in clinical and serologic status. The median duration of follow-up was 33 months (range, 1–261 mo). Median survival was 7.4 years.

Measurement of quality of life and participant experience with the mindfulness-based stress reduction program

Clinical studies of MBSR have reported efficacy in treating pain, mood disorders, arthritis, sleep disturbances, and stress. Several academic medical institutions in the United States offer MBSR to their patients, but it has never been offered at Mayo Clinic. The objective of this study was to collect quality-of-life data from subjects who participated in the first MBSR program offered at Mayo Clinic. The class was taught as a collaborative effort with the University of Minnesota that had an established MBSR program. Sixteen participants completed a validated, 12-question, linear analogue self-assessment instrument, administered at the beginning and end of the program. Comparison of assessment scores using paired t-tests showed statistically significant improvement in overall quality of life (P=0.04), mental well-being (P=0.005), physical well-being (P<0.001), emotional well-being (P<0.001), level of social activity (P=.02), and spiritual well-being (P=0.006). Although positive changes also were observed for frequency of pain, severity of pain, level of fatigue, level of support from friends and family, and financial and legal concerns, they were not statistically significant. A short intervention in the education of mindfulness significantly improved quality of life for participants.

Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: 8-year follow-up at an academic medical center.

The purpose of this study was to determine changes in attitude toward complementary and alternative medicine (CAM) therapies and knowledge of specific CAM therapies among internists at our institution. We compared the results of a survey given in 2004 and 2012. During this time period, the attitudes of physicians in our department of medicine toward CAM became much more positive, and physicians showed an increased willingness to use CAM to address patient care needs. However, knowledge of and experience with many specific CAM treatments did not change. These results will be used to develop further educational interventions and research studies.

Evaluation of a Biofeedback-Assisted Meditation Program as a Stress Management Tool for Hospital Nurses: A Pilot Study

OBJECTIVEnTo assess whether a self-directed, computer-guided meditation training program is useful for stress reduction in hospital nurses.nnnDESIGNnWe prospectively evaluated participants before and after a month-long meditation program. The meditation program consisted of 15 computer sessions that used biofeedback to reinforce training. Participants were instructed to practice the intervention for 30 minutes per session, four times a week, for four weeks. Visual analogue scales were used to measure stress, anxiety, and quality of life (assessments were performed using Linear Analogue Self-Assessment [LASA], State Trait Anxiety Inventory [STAI], and Short-Form 36 [SF-36] questionnaires). Differences in scores from baseline to the studys end were compared using the paired t test.nnnRESULTSnEleven registered nurses not previously engaged in meditation were enrolled; eight completed the study. Intent-to-treat analysis showed significant improvement in stress management, as measured by SF-36 vitality subscale (P = .04), STAI (P = .03), LASA stress (P = .01), and LASA anxiety (P = .01). Nurses were highly satisfied with the meditation program, rating it 8.6 out of 10.nnnCONCLUSIONSnThe results of this pilot study suggest the feasibility and efficacy of a biofeedback-assisted, self-directed, meditation training program to help hospital nurses reduce their stress and anxiety. Optimal frequency of use of the program, as well as the duration of effects, should be addressed in future studies.

Use of complementary and alternative medicine by patients seen at the dermatology department of a tertiary care center

The use of complementary and alternative medicine (CAM) among patients with dermatologic conditions has not been well studied. The aim of this study was to evaluate the frequency and pattern of CAM use in patients referred to the dermatology department of a tertiary care center. Patients referred to the dermatology department of an academic tertiary referral center between February 2, 2010, and February 10, 2010, were invited to participate in an 86-question survey regarding CAM use during the previous year. A total of 300 patients completed the survey, of whom 154 (51%) were women. Eighty-two percent (nxa0=xa0247) of the respondents had used some type of CAM during the previous year. The most frequently used treatment and technique was massage therapy (33%), and the most commonly used vitamin was vitamin C (31%). Herbs or other dietary supplements were used by 58% (nxa0=xa0173) of patients. Seventy-eight percent (nxa0=xa0235) of patients stated that physicians should consider incorporating CAM approaches into their treatment recommendations, and 89% of patients (nxa0=xa0267) stated that our dermatology department should study CAM approaches in research studies. CAM utilization is high among patients at a large academic dermatology department. Patients indicated a strong preference for having CAM approaches incorporated into their treatment recommendations and believed in the value of clinical studies to further refine the role of CAM.