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Prevalence and pattern of alternative medicine use: the results of a household survey.
Background and objectivesAlternative medicine (AM) encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community.Subjects and methodsA multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire.ResultsOf 1408 individuals participating in the study, 39% were men. The mean (+/-SD) age for the study population was 35.5 (+/-13.9) years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM (50.3%), followed by honey (40.1%), black seed (39.2%) and myrrh (35.4%). The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians.Conclusions and recommendationsThere is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system.
Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?
AimsAmongst general practices in the NHS Borders region of Scotland, we aimed to determine compliance with the three key recommendations of the British Guideline for the Management of Asthma and to understand the nature of barriers and facilitators to their implementation.MethodsUsing piloted audit tools, a researcher extracted data from computerised and/or paper patient medical records to assess compliance with recommendations for objective diagnosis and stepwise management. Provision of asthma action plans was assessed by patient survey. Clinicians' attitude to guidelines was assessed by postal survey.ResultsFifteen of the 24 practices in the NHS Borders region participated. Audited compliance with the three key recommendations varied markedly amongst and within practices. Whilst 367/547 (67%) of patients were treated appropriately with add-on therapy, only 58/254 (23%) of patients reported having been given an asthma action plan. Barriers to implementation identified by the clinicians' survey (response rate 64/84 - 76%) were theoretical (doubt about the evidence base and relevance to primary care, lack of knowledge and skills, misconceptions) as well as practical (lack of time and resources) and were exacerbated by poor teamwork. Facilitators were good teamwork and appropriate organisation of work within the practice.ConclusionsImplementation of key recommendations was variable, particularly in the more complex intervention of issuing asthma action plans. An intervention to enhance compliance with these guideline recommendations will need to address both theoretical and practical barriers within the context of improved teamwork.
Will Systematized Nomenclature of Medicine-Clinical Terms improve our understanding of the disease burden posed by allergic disorders?
Analysis of data collected through the use of high-quality computerized systems is vital if we are to understand the health burden from allergic disease. Coding systems currently used, such as the World Health Organization's International Classification of Diseases and the Read system, have however been criticized as being unduly restrictive and hence inadequate for the detailed coding of allergic problems. Greater granularity of coding can be achieved by using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) system, which will be adopted by several countries including the United States and United Kingdom. Before the introduction of SNOMED-CT, it is important that several issues are resolved, including ensuring that adequate mapping occurs from existing systems, that the SNOMED-CT is trialled before general implementation, and that training is provided for users new to coding as part of their clinical practice. Of particular importance is that the allergy fraternity bring to light any gaps in allergy coding through the creation of a working group to advise the newly formed International Healthcare Terminology Standards Development Organisation. There is also a role for allergy experts, working in conjunction with government agencies and professional bodies, to determine a recommended set of codes, which will obviate some of the inevitable challenges raised by a very fluid coding structure for those wishing to undertake secondary analysis of health care datasets.
National survey on the roles and training of primary care respiratory nurses in the UK in 2006: are we making progress?
ObjectivesTo describe nurse-led UK general practice asthma and chronic obstructive pulmonary disease (COPD) care, and the training undertaken to support it.MethodsQuestionnaires were sent to 500 randomly-selected UK asthma and COPD practice nurses.Results382 nurses (76%) completed the practice characteristics section, 389 (78%) described their asthma roles and training, and 368 (74%) described their COPD roles and training. 96 practices (25%; 95%CI 21-29%) ran designated asthma clinics, 87 (23%; 95%CI 19- 27%) ran designated COPD clinics, and 170 (45%; 95%CI 40-49%) did not run designated respiratory clinics. Of the 255 nurses with an advanced asthma role, 51 (20%; 95%CI 15-25%) did not have accredited asthma training. Of the 215 nurses with an advanced COPD role, 111 (52%; 95%CI 45-58%) did not have accredited COPD training.ConclusionPatients are increasingly being seen outside of designated asthma or COPD clinics, often by nurses with an advanced role. It is important that nurses have the training to fulfil this role.
Promoting the use of Personal Asthma Action Plans: a systematic review.
ObjectivesTo investigate how best to encourage health professionals to promote, and for people with asthma to use, asthma action plans.MethodsSystematic review. Randomised controlled trials published between 1960 and 2006 were searched using multiple electronic databases. Unpublished and ongoing studies were identified by contacting asthma experts internationally. Included trials reported outcome data for the promotion of action plans including issue of plans by health professionals, and patient ownership and use.Results14 trials satisfied our study inclusion criteria. Of these, only four studies reported data for action plan use. Interventions included: education of doctors and people with asthma; telephone reinforcement; partially completed action plans and postal prompts inviting patients for general practice review; school asthma clinics; and asthma management systems (including the 3+ plan with patient recall for review and Internet-based physician monitoring). These interventions increased action plan ownership, use, or facilitation of use. Two of the highest quality papers were conducted in primary care and demonstrate the effectiveness of interventions directed at the organisation of asthma care in promoting action plan use.ConclusionsPrimary care professionals could encourage the ownership and use of action plans through the implementation of proactive practice-based organisational systems, though further research is required to assess their practicality and effect on sustaining use long-term. Multi-disciplinary teams working in areas where asthma action plan ownership and use is sub-optimal should therefore consider how such interventions could be incorporated into existing practices and healthcare systems.
Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure.
Typical trajectories of physical decline have been described for people with end-stage disease. It is possible that social, psychological, and spiritual levels of distress may also follow characteristic patterns. We sought to identify and compare changes in the psychological, social, and spiritual needs of people with end-stage disease during their last year of life by synthesizing data from two longitudinal, qualitative, in-depth interview studies investigating the experiences and needs of people with advanced illnesses. The subjects were 48 patients with advanced lung cancer (n=24) and heart failure (n=24) who gave a total of 112 in-depth interviews. Data were analyzed within individual case studies and then cross-sectionally according to the stage of physical illness. Characteristic social, psychological, and spiritual end-of-life trajectories were discernible. In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage. In advanced heart failure, social and psychological decline both tended to track the physical decline, while spiritual distress exhibited background fluctuations. Holistic end-of-life care needs to encompass all these dimensions. An appreciation of common patterns of social, psychological, and spiritual well-being may assist clinicians as they discuss the likely course of events with patients and carers and try to minimize distress as the disease progresses.
Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study.
BackgroundAttendance for routine asthma reviews is poor. A recent randomised controlled trial found that telephone consultations can cost-effectively and safely enhance asthma review rates; however, concerns have been expressed about the generalisability and implementation of the trial's findings.AimTo evaluate the effectiveness of a telephone option as part of a routine structured asthma review service.Design of studyPhase IV controlled before-and-after implementation study.SettingA large UK general practice.MethodUsing existing administrative groups, all patients with active asthma (n = 1809) received one of three asthma review services: structured recall with a telephone-option for reviews versus structured recall with face-to-face-only reviews, or usual-care (to assess secular trends). Main outcome measures were: proportion of patients with active asthma reviewed within the previous 15 months (Quality and Outcomes Framework target), mode of review, enablement, morbidity, and costs to the practice.ResultsA routine asthma review was provided for 397/598 (66.4%) patients in the telephone-option group compared with 352/654 (53.8%) in the face-to-face-only review group: risk difference 12.6% (95% confidence interval [CI] = 7.2 to 17.9, P<0.001). The usual-care group achieved a review rate of 282/557 (50.6%). Morbidity was equivalent in the three groups; however, enablement (P = 0.03) and confidence (P = 0.007) in asthma management were greater in the telephone-option versus face-to-face-only group. The cost per review achieved by providing the telephone-option service was lower than the face-to-face-only service (10.03 pounds versus 12.74 pounds, mean difference 2.71 pounds; 95% CI = 1.92 to 3.50, P<0.001); usual-care costs were 11.85 pounds per review achieved.ConclusionRoutinely offering telephone reviews cost-effectively increased asthma review rates, enhancing patient enablement and confidence with management, with no detriment to asthma morbidity. Practices should consider a telephone option for their asthma review service.
Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study.
BackgroundSeasonal allergic rhinitis is common globally, and symptoms have been shown to impair learning ability in children in laboratory conditions. Critical examinations in children are often held in the summer during the peak grass pollen season.ObjectiveTo investigate whether seasonal allergic rhinitis adversely impacts examination performance in United Kingdom teenagers.MethodsCase-control analysis of 1,834 students (age 15-17 years; 50% girls) sitting for national examinations. Cases were those who dropped 1 or more grades in any of 3 core subjects (mathematics, English, and science) between practice (winter) and final (summer) examinations; controls were those whose grades were either unchanged or improved. Associations between allergic rhinitis symptoms, clinician-diagnosed allergic rhinitis, and allergic rhinitis-related medication use, recorded on examination days immediately before the examination, were assessed using multilevel regression models.ResultsBetween 38% and 43% of students reported symptoms of seasonal allergic rhinitis on any 1 of the examination days. There were 662 cases (36% of students) and 1,172 controls. After adjustment, cases were significantly more likely than controls to have had allergic rhinitis symptoms during the examination period (odds ratio [OR], 1.4; 95% CI, 1.1-1.8; P = .002), to have taken any allergic rhinitis medication (OR, 1.4; 95% CI, 1.1-1.7; P = .01), or to have taken sedating antihistamines (OR, 1.7; 95% CI, 1.1-2.8; P = .03).ConclusionCurrent symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations.Clinical implicationsThis is the first time the relationship between symptomatic allergic rhinitis and poor examination performance has been demonstrated, which has significant implications for clinical practice.
Comparison of international guidelines for the emergency medical management of anaphylaxis.
BackgroundGuideline-based treatment approaches for managing anaphylaxis are widely believed to result in good outcomes, but the strength of evidence underpinning the recommendations made therein is unclear.ObjectiveTo identify and compare national guidelines for the emergency medical management of anaphylaxis and to describe the extent to which the evidence base in support of key recommendations is made clear.MethodsWe systematically searched key medical databases and contacted the World Allergy Organization and anaphylaxis charities in several countries to identify national guidelines. Full text copies of relevant papers were obtained and, where necessary, translated. Data were abstracted onto a customized data extraction sheet; this process was independently checked by a second reviewer.ResultsGuidelines originating from Australia, Canada, Russia, UK, Ukraine and the USA were identified. While these were in agreement on the broad principles of management, there were important variations in relation to the treatments to be used and the dose and route of administration of these preparations. Most guidelines failed to make clear the strength of evidence underpinning the recommendations being made.ConclusionsThere are important international differences in the recommended emergency management of anaphylaxis. It is important that an agreed core evidence-based guideline for the management of anaphylaxis is now developed, which can then be adapted for national/local use. Clinicians need to be aware of the limitations of existing guidelines.
The psychosocial impact of anaphylaxis on young people and their parents.
BackgroundAnaphylaxis is a potentially life-threatening disorder that can affect people of all ages. Young people are at a disproportionately increased risk of anaphylaxis deaths for reasons that include a failure to institute appropriate long-term management regimens. A pre-requisite for effective supported self-management of young people with anaphylaxis is a better understanding of the factors that contribute to risk-taking behaviour.ObjectiveTo explore the psychosocial impact of living with anaphylaxis on adolescents and their parents; their management of the condition; and perceptions of health care provision.MethodsIn-depth interviews were conducted with 15 participants, these comprising of seven adolescents aged between 13 and 16 years with a history of clinician-diagnosed anaphylaxis and eight of their parents, in this Scottish community-based exploratory qualitative study.ResultsAdolescents in this study typically perceived anaphylaxis as 'no big deal', describing a relatively low impact on their day-to-day life when compared with their parents. This could largely be explained by the fact that most adolescents could not remember an anaphylactic reaction. Key obstacles to effective long-term self-management included inadequate knowledge to support detailed situation-specific risk assessment, this being compounded by a lack of confidence to make further enquiries about the ingredients of meals when with peers. Parents reported anxiety about 'handing over' the main responsibility for avoidance and emergency management to their children. Medical support for these families was very limited, with primary care teams in some cases actively hindering effective self-management.ConclusionHaving a child with anaphylaxis can have a significant long-term psychological impact on parents and this anxiety may in some cases be transferred from parents onto their children. Parents and adolescents may benefit from tailored information to support the transition from parental- to self-management by adolescents. Access to appropriate national health service primary and specialist care was in some cases currently inadequate to support effective long-term management. Further, more in-depth research in a more heterogeneous group of adolescents is needed.