Complementary therapies in medicine
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The 'placebo effect' concept is intrinsic to the architecture of the double blind placebo randomised controlled trial (RCT), the oft quoted 'gold standard' method of clinical research whose findings are supposed to inform our understanding of the interventions used in clinical practice. The 'placebo effect' concept is often used in discussions of both clinical practice and clinical research, particularly when discussing why patients report improvements with complementary and alternative medicines (CAMs). Despite its frequent use, 'placebo effect' is a non-sequitur, thus confusion abounds. ⋯ Telling people that they might receive a placebo really complicates things. The uncertainty invoked by information that a placebo may be given can impact trial recruitment, the delivery of the intervention, and the reporting of outcomes, as can the 'meaning responses' invoked by other types of information provided to patients in standard RCT designs. Future CAM research should consider alternative RCT designs that help ensure that participants' experiences are uncontaminated by 'meaning responses' to information that they may receive fake treatments, i.e. placebos.
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Complement Ther Med · Apr 2013
The placebo effect and its ramifications for clinical practice and research. Villa La Collina at Lake Como, Italy, 4-6 May 2012.
The purpose of this workshop was to further explore the implications of the placebo effect for both research and clinical practice from a variety of angles with a group of selected experts. ⋯ There are many remaining knowledge gaps with regard to the placebo response. The evolving knowledge challenges the paradigm of the placebo controlled RCT as a gold standard for demonstrating benefit of treatments. There are a number of pointers towards alternative research designs and paradigms worthy of further exploration. The evolving knowledge can contribute to the further development of a 'meaning orientated' and patient centred healthcare system.
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Complement Ther Med · Apr 2013
Attitudes and beliefs of paediatric oncologists regarding complementary and alternative therapies.
The last decades have seen increasing patient use of complementary and alternative treatment methods (CAM) in paediatric oncology, too. However, there have been few scientific studies of paediatric oncologists' views and attitudes on CAM to date. We report the results of a cross-sectional questionnaire survey amongst paediatric oncologists in Germany. ⋯ In summary, the data presented here indicate that the majority of the responding German paediatric oncologists is open towards continuing medical education on CAM, not least in the interest of becoming more competent to advise their patients. This is in contrast to the fact that German paediatric oncologists currently tend not to actively bring up the topic of CAM in their consultations with parents. Younger doctors with shorter professional experience in paediatric oncology currently have a fundamentally more positive attitude towards CAM issues.
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Complement Ther Med · Feb 2013
ReviewThe role of acupuncture in emergency department settings: a systematic review.
Patients with non-emergent and non-life threatening conditions often present to the emergency department (ED), which hinders the efficient utilisation of healthcare resources. Acupuncture has frequently been used for such common conditions, although not in the ED context. This study aimed to evaluate the current evidence for acupuncture treatment in the ED and to inform future randomised controlled trials (RCTs) for acupuncture in ED settings. ⋯ The current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED. The effectiveness and safety as well as the feasibility of acupuncture should be tested in future RCTs.
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Complement Ther Med · Feb 2013
The multi-target capabilities of the compounds in a TCM used to treat sepsis and their in silico pharmacology.
This study aims to explain the mechanisms at the molecular level of a traditional Chinese medicine (TCM) for the treatment of sepsis. ⋯ We found that multiple active compounds contained in the TCM interact with multiple sepsis-related targets. We predicted several promising compounds for sepsis treatment, and the first 10 compounds were characterised. Among those tested, rosmarinic acid displayed the strongest biological activity in the in vitro activity test with a half-maximal inhibitory concentration (IC(50)) of 85μM. This study demonstrates a novel way of identifying naturally occurring chemical entities as new leads for sepsis treatment.