Nicola Robinson

Glycated haemoglobin and blood pressure‐lowering effect of cinnamon in multi‐ethnic Type 2 diabetic patients in the UK: a randomized, placebo‐controlled, double‐blind clinical trial

Diabet. Med. 27, 1159–1167 (2010)

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.

Complementary medicine use in multi-ethnic paediatric outpatients.

OBJECTIVEnTo determine the prevalence and determinants of complementary medicine (CM) use in a multi-ethnic paediatric outpatient population.nnnMETHODOLOGYnA parent-completed questionnaire survey of paediatric outpatients attending general and sub-specialist outpatient clinics at a North West London hospital during September to December 2005.nnnRESULTSnParents use of CM for their children in this multi-ethnic population was higher than expected at 37%. Use was correlated with parental CM use and education but independent of ethnic group. Parental CM use and childs health status were significant predictors of child CM use. The main reason for using CM was word of mouth (45%) and the main source of information was friends and family (51%). The most popular treatments used for children were homeopathy and herbal medicine (used by 30% and 28% of CM users, respectively). 88% of CM was bought over the counter and 53% of CM use was not reported to their doctor. Parents also used traditional complementary remedies for their children.nnnCONCLUSIONSnThese results suggest that CM use in children is higher than previously estimated in the UK. This indicates the need for greater professional awareness of CM as part of clinical care. There is a need to acknowledge the beliefs that inform parents decision-making process.

Adherence to Antiretroviral Therapy: Appropriate Use of Self-Reporting in Clinical Practice

Abstract Purpose: This study investigated the factors that may affect adherence to antiretroviral therapy in people with HIV infection and compared the use of three self-report tools to determine client adherence. Method: A descriptive, cross-sectional study of 260 HIV-infected clients attending nine HIV outpatient centers in England was conducted using researcher-administered instruments. Self-reports of adherence were assessed using the Morisky Medication Adherence Scale (MMAS), Reported Adherence to Medication Scale (RAM), and the Patient Adjustment to Medication Scale (PAM). Results: Univariate analysis of clients’ self-reports indicated a number of associations with adherence. Significant associations with less adherent behavior identified by two or more self-report tools were the reported use of recreational drugs, p = .001; living alone, p = .041; feeling depressed, p = .02; being influenced by the media, p = .037; and lack of a close confidant, p = .037. Greater adherence was associated with clients reporting a positive mental attitude to HIV infection, p = .038. Principal component analysis (PCA) of each self-report tool identified two well-recognized constructs: intentional nonadherence and nonintentional nonadherence. In addition, a third construct of following instructions was identified from PAM, a scale developed by the authors. Subsequent regression analysis failed to confirm the associations with adherence suggested by the univariate analysis. Conclusion: This study suggests that the design and use of self-report tools to identify client’s adherence to complex antiretroviral regimens may need to measure individual constructs of adherence to accurately assess adherence behavior.

Integrative medicine — Traditional Chinese medicine, A model ?

The paper explores the concept of integrative medicine (IM) in relation to complementary and alternative medicine (CAM). It contrasts IM available in China to its availability in the West. The second part of the paper highlights tools which could facilitate opportunities for IM. The paper concludes with a plea to ensure and maintain the integrity of traditional Chinese medical practice, and to continue to increase developing the evidence base through a funded European Coordination Action between EU member states and China.

Extent of acupuncture practice for infertility in the United Kingdom: experiences and perceptions of the practitioners

OBJECTIVEnTo investigate acupuncture practitioners experience and perceptions of supporting patients presenting with fertility issues.nnnDESIGNnQuestionnaire survey.nnnSETTINGnBritish Acupuncture Council.nnnPATIENT(S)nBritish Acupuncture Council acupuncture practitioners.nnnINTERVENTION(S)nQuestionnaire designed for the study, by post and online.nnnMAIN OUTCOME MEASURE(S)nQuestions on education and training, size and nature of practice, liaison with conventional care, and perceptions about use of acupuncture for fertility issues.nnnRESULT(S)nQuestionnaires were sent to 2,580 practitioners. Of 861 responses, 15% of practitioners supporting fertility issues said this constituted a large proportion of their case load. Eighty percent of practitioners reported most fertility work was related to assisted conception. More than 60% had specialist training. Practitioners perceived benefits included stress reduction, relaxation, regulation of menstrual cycle, and emotional support. Emotional burden on both patients and practitioners was recognized and the limits of therapy. Point-specific acupuncture protocols were common (70%). Thirteen percent reported problems working with physicians. Use of acupuncture for male fertility issues was uncommon.nnnCONCLUSION(S)nA minority of acupuncturists have become specialists in supporting fertility issues. The use of an acupuncture protocol is common but does not conform to traditional acupuncture as it is taught and practiced for other conditions.

An investigation into the effectiveness of traditional Chinese acupuncture (TCA) for chronic stress in adults: A randomised controlled pilot study

AIMSnThe aim of this exploratory, pragmatic randomised controlled trial was to investigate the effectiveness of traditional Chinese acupuncture (TCA), using an individually targeted treatment protocol delivered by a traditionally trained Chinese acupuncturist. The trial examined the treatment of chronic stress as perceived and reported by the participants, with all its diversity of presenting symptoms, rather than using a cohort approach based on a single stress-related symptom.nnnMETHODSnParticipants (n=18) with high self-reported stress levels were randomised into 3 groups. Group 1 received weekly TCA for 5 weeks; group 2 received weekly attention only (practitioner present and participant supine) for 5 weeks and group 3 acted as a waiting list control. The Perceived Stress Scale 14 (PSS-14) and the Measure Yourself Medical Outcome Profile (MYMOP) were completed before and after a 5-week intervention.nnnRESULTSnAfter 5 weeks, group 1 reported significant changes in MYMOP profile score and both MYMOP reported symptoms (p<0.05); group 2 had significant changes in MYMOP profile score and 1 symptom (p<0.05); group 3 showed no changes. The PSS-14 scores decreased in all 3 groups, but the difference between pre- and post-study within and between the groups did not reach significance in this small study. In addition, there were self-reports of improvements for group 1 for other health problems encountered during treatment.nnnLIMITATIONS AND CONCLUSIONSnThe lack of clarity concerning the definition of stress makes it complex to investigate. This pilot study suggests that TCA may be successful in treating the symptoms of stress, through a combination of specific and non-specific effects; but may not relate directly to how a person perceives their stress.

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

Parents' and primary healthcare practitioners' perspectives on the safety of honey and other traditional paediatric healthcare approaches

BACKGROUNDnTraditional and complementary healthcare approaches (TCA) are widely used for children, often because of perceived safety. Honey is a traditional remedy for upper respiratory tract symptoms in infants. Health officials currently advise limiting honey use because of the risk of botulism.nnnOBJECTIVEnThis paper discusses honey as a traditional healthcare approach for children in a multi-ethnic community, and parents and primary healthcare practitioners (PHPs) perceptions of its safety.nnnDESIGNnAs part of a larger study exploring beliefs about TCA, this paper focuses on perceived safety and use of honey, using data extracted for detailed analysis. Eleven parent focus groups (n= 92) and 30 interviews with PHPs were conducted. Qualitative data analysis used the Framework approach.nnnSETTINGnLondon Boroughs of Brent and HarrownnnRESULTSnTCA, particularly home remedies, dietary and religious approaches were popular for children. Honey was a particularly common TCA, reportedly used by 27 (29%) parents for their children. Honey was believed to be traditional, acceptable, accessible, natural and safe. It was most commonly used for respiratory tract symptoms and administered with hot water and lemon juice. PHPs were more concerned about the safety of TCA than parents. Almost half (40%) of PHPs mentioned the use of honey for children, few perceived it as a treatment or were concerned about botulism. Others were aware of the risks and some reported challenges in communicating risk to parents.nnnCONCLUSIONnTCA are commonly used for children, honey in particular for respiratory tract symptoms. Parents and some PHPs appear unaware of the risk of botulism from honey use in infants. Healthcare practitioners should ask routinely about the use of honey and other TCA, and consider different parental belief systems in ethnically diverse populations. Further research is required on the use and efficacy of honey for infants, to raise awareness of its benefits and risks.

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.