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Is complementary and alternative medicine (CAM) cost-effective? a systematic review
Patricia M Herman, Benjamin M Craig, Opher Caspi
BMC Complementary and Alternative Medicine , 2005, DOI: 10.1186/1472-6882-5-11
Abstract: The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding).A total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients.Whereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated.Complementary and alternative medicine (CAM) has a reputation for good value among health conscious consumers [1]. In the United States consumers spend over $34 billion per year on CAM therapies [2], dollars spent outside the conventional health care f
Prevalence of use of complementary/alternative medicine: a systematic review
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000200015
Abstract: reported are the results of a systematic review of the prevalence of use of complementary/alternative medicine. computerized literature searches were carried out in four databases. twelve surveys thus found were selected because they dealt with the utilization of complementary/alternative medicine in random or representative samples of the general population. data were extracted in a predefined, standardized way. prevalence of use of complementary/alternative medicine ranged from 9% to 65%. even for a given form of treatment such as chiropractic, as used in the usa, considerable discrepancies emerged. the data suggest that complementary/alternative therapies are used frequently and increasingly. prevalence of use seemed to depend critically on factors that were poorly controlled in surveys of complementary/alternative medicine. the true prevalence of use of complementary/alternative medicine in the general population remains uncertain.
Complementary and Alternative Medicine Education for Medical Profession: Systematic Review
Nana K. Quartey,Polly H. X. Ma,Vincent C. H. Chung,Sian M. Griffiths
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/656812
Abstract: Purpose. To help integrate traditional, complementary and alternative medicine (TCAM) into health systems, efforts are being made to educate biomedical doctors (BMD) and medical students on TCAM. We systematically evaluated the effect of TCAM education on BMD and medical students' attitude, knowledge, and behavior towards TCAM utilization and integration with biomedical medicine. Methods. Evaluative studies were identified from four databases. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Study outcomes were classified using Kirkpatrick's hierarchy. Results. 3122 studies were identified and 12 studies of mediocre quality met inclusion criteria. Qualitative synthesis showed usage of diverse approaches including didactic, experiential learning, varying length, teacher background and intensity of exposure. More positive attitudes and improved knowledge after intervention were noted especially when teachers were BM trained. However, few studies assessed behavior change objectively. Finally, longer-term objective outcomes such as impact on patient care were not assessed. Conclusions. Lack of use of objective and reliable instruments preclude firm conclusion on the effect of TCAM education on study participants. However, positive changes, although mostly subjectively reported, were noted in most studies. Future evaluation should use validated or objective outcome assessments, and the value of using dual trained instructors.
Assessing the quality of reports of systematic reviews in pediatric complementary and alternative medicine
David Moher, Karen Soeken, Margaret Sampson, Leah Ben-Porat, Brian Berman
BMC Pediatrics , 2002, DOI: 10.1186/1471-2431-2-3
Abstract: We assessed the quality of reports of 47 CAM systematic reviews and 19 reviews evaluating a conventional intervention. The quality of each report was assessed using a validated 10-point scale.Authors were particularly good at reporting: eligibility criteria for including primary studies, combining the primary studies for quantitative analysis appropriately, and basing their conclusions on the data included in the review. Reviewers were weak in reporting: how they avoided bias in the selection of primary studies, and how they evaluated the validity of the primary studies. Overall the reports achieved 43% (median = 3) of their maximum possible total score. The overall quality of reporting was similar for CAM reviews and conventional therapy ones.Evidence based health care continues to make important contributions to the well being of children. To ensure the pediatric community can maximize the potential use of these interventions, it is important to ensure that systematic reviews are conducted and reported at the highest possible quality. Such reviews will be of benefit to a broad spectrum of interested stakeholders.Healthcare providers, consumers, and others cannot keep up-to-date with the healthcare literature. For example, healthcare professionals attempting to keep abreast of their field would need to read, on average, 19 original articles each day [1]. Systematic reviews offer the potential to reach that elusive goal of keeping up-to-date without sacrificing quality and thoroughness. There has been a striking increase in the number of published systematic reviews, particularly of RCTs. One of the first 'medical' systematic reviews was published in 1955 [2]. Currently, in the Cochrane library alone, there are more than 1000 published systematic reviews and several hundred protocols even though it has existed for only seven years.Systematic reviewers have little control over random errors but can exert some influence over systematic errors (bias). Therefore, evalua
Measurement Properties of Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatrics: A Systematic Review  [PDF]
Karine Toupin April, David Moher, Jennifer Stinson, Ani Byrne, Meghan White, Heather Boon, Ciarán M. Duffy, Tamara Rader, Sunita Vohra, Peter Tugwell
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039611
Abstract: Objective Complementary and alternative medicine (CAM) is commonly used by children, but estimates of that use vary widely partly due to the range of questionnaires used to assess CAM use. However, no studies have attempted to appraise measurement properties of these questionnaires. The aim of this systematic review was to critically appraise and summarize measurement properties of questionnaires of CAM use in pediatrics. Study design A search strategy was implemented in major electronic databases in March 2011 and conference websites, scientific journals and experts were consulted. Studies were included if they mentioned a questionnaire assessing the prevalence of CAM use in pediatrics. Members of the team independently rated the methodological quality of the studies (using the COSMIN checklist) and measurement properties of the questionnaires (using the Terwee and Cohen criteria). Results A total of 96 CAM questionnaires were found in 104 publications. The COSMIN checklist showed that no studies reported adequate methodological quality. The Terwee criteria showed that all included CAM questionnaires had indeterminate measurement properties. According to the Cohen score, none were considered to be a well-established assessment, two approached the level of a well-established assessment, seven were promising assessments and the remainder (n = 87) did not reach the score’s minimum standards. Conclusion None of the identified CAM questionnaires have been thoroughly validated. This systematic review highlights the need for proper validation of CAM questionnaires in pediatrics, which may in turn lead to improved research and knowledge translation about CAM in clinical practice.
An Evaluation of Epidemiological and Reporting Characteristics of Complementary and Alternative Medicine (CAM) Systematic Reviews (SRs)  [PDF]
Lucy Turner, James Galipeau, Chantelle Garritty, Eric Manheimer, L. Susan Wieland, Fatemeh Yazdi, David Moher
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0053536
Abstract: Background Systematic reviews (SRs) are abundant. The optimal reporting of SRs is critical to enable clinicians to use their findings to make informed treatment decisions. Complementary and alternative medicine (CAM) therapies are widely used therefore it is critical that conduct and reporting of systematic research in this field be of high quality. Here, methodological and reporting characteristics of a sample of CAM-related SRs and a sample of control SRs are evaluated and compared. Methods MEDLINE? was searched to identify non-Cochrane SRs indexed from January 2010 to May 2011. Control SRs were retrieved and a search filter was used to identify CAM SRs. Citations were screened and publications that met a pre-specified definition of a SR were included. Pre-designed, standardized data extraction forms were developed to capture reporting and methodological characteristics of the included reviews. Where appropriate, samples were compared descriptively. Results A total of 349 SRs were identified, of which 174 were CAM-related SRs and 175 were conventional SRs. We compared 131 CAM-related non-Cochrane SRs to the 175 conventional non-Cochrane reviews. Fifty-seven percent (75/131) of CAM SRs specified a primary outcome compared to 21% (37/175) of conventional sample reviews. Reporting of publication bias occurred in less than 5% (6/131) of the CAM sample versus 46% (80/175) of the conventional sample of SRs. Source of funding was frequently and consistently under-reported. Less than 5% (11/306) of all SRs reported public availability of a review protocol. Conclusion The two samples of reviews exhibited different strengths and weaknesses. In some cases there were consistencies across items which indicate the need for continued improvements in reporting for all SR reports. We advise authors to utilise the PRISMA Statement or other SR guidance when reporting SRs.
Complementary and Alternative Medicine and Dermatology  [PDF]
Bilal Do?an,?zlem Karabudak Abuaf,Ercan Karabacak
Turkderm , 2012,
Abstract: Alternative medicine is defined as the methods used independently or instead of conventional medicine, but the complementary medicine is mainly used to describe methods used in conjunction with or to comlement the conventional medical therapies.It is known by many of dermatologists that a lot of patients with dermatological problems try to use complementary and alternative medical methods because of having no cure with the conventional medical treatments. Complementary and alternative medical condition in our country was analysed and the recipe suggestions were discussed in this review.
Informed Consent in Complementary and Alternative Medicine
Opher Caspi,Tamar Shalom,Joshua Holexa
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1093/ecam/nep032
Abstract: The objective of this study was to examine complementary and alternative medicine (CAM) practitioners’ (i) attitudes toward informed consent and (ii) to assess whether standards of practice exist with respect to informed consent, and what these standards look like. The design and setting of the study constituted face-to-face qualitative interviews with 28 non-MD, community-based providers representing 11 different CAM therapeutic modalities. It was found that there is great deal of variability with respect to the informed consent process in CAM across providers and modalities. No unique profession-based patterns were identified. The content analysis yielded five major categories related to (i) general attitude towards the informed consent process, (ii) type and amount of information exchange during that process, (iii) disclosure of risks, (iv) discussions of alternatives, and (v) potential benefits. There is a widespread lack of standards with respect to the practice of informed consent across a broad range of CAM modalities. Addressing this problem requires concerted and systematic educational, ethical and judicial remedial actions. Informed consent, which is often viewed as a pervasive obligation is medicine, must be reshaped to have therapeutic value. Acknowledging current conceptions and misconception surrounding the practice of informed consent may help to bring about this change. More translational research is needed to guide this process.
Complementary and alternative medicine in cancer patients
Jens Büntzel,Ralph Mücke,Frank Bruns,Oliver Micke
European Journal of Oncology Pharmacy , 2008,
Abstract: One thousand and thirteen cancer patients were interviewed in five German cancer centres, 30% reported a subjective improvement in quality of life due to the use of complementary and alternative medicine (CAM). The high rate of CAM use and possible interactions with basic anticancer-therapies, e.g. radiotherapy, are reasons to extend CAM anamnesis.
Malaysian Family Physician , 2009,
Abstract: This is a case of a 65 year-old-lady who presented with Cushing’s syndrome secondary to ingestion of a complementary and alternative medicine that has been adulterated with exogenous glucocorticoids. In a clinical consultation, it is important to include assessment of complementary and alternative medicine use for a comprehensive care.
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