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ABSTRACT: OBJECTIVE: To examine attitudes toward and use of complementary and alternative medicine (CAM) by obstetricians during pregnancy and childbirth. METHODS: Between 2010 and 2011, obstetricians from 7 medical centers (n=170) in Israel completed questionnaires examining the use and recommendation of CAM treatments during pregnancy and childbirth. Attitudes were examined via the CAM Health Belief Questionnaire (CHBQ). RESULTS: Over half of the participants (58.8%) reported using at least 1 CAM treatment, and nearly two-thirds had recommended or would recommend CAM to pregnant patients. By contrast, use of CAM during childbirth was recommended by only 26% of respondents. The total CHBQ score was moderately high (mean±SD, 40.4±7.30; possible range, 7.0-70.0), indicating an overall positive attitude toward CAM. Female board-certified specialists answered more favorably regarding attitudes toward CAM (P=0.004). The structural validity of the CHBQ was examined using varimax rotation factor analysis, which produced a 3-factor solution explaining 63.1% of the variance. CONCLUSIONS: Most obstetricians exhibited positive attitudes toward CAM and recommended its use during pregnancy, but did not support CAM use during childbirth. This discrepancy might be partly due to the involvement of Israeli obstetricians in predominantly high-risk cases of childbirth requiring intervention.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2013; · 1.41 Impact Factor
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ABSTRACT: OBJECTIVE: To study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients. METHODS: A convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel. RESULTS: 280 patients were interviewed (54% female), 15.4% reporting NVNM supplement use. This practice was more prevalent among female patients (p=0.045), more educated (p<0.001) and patients with more impaired quality-of-life, measured by the SF-12 tool (p<0.020). The most common factor influencing NVNM supplement use was a physician's recommendation. Most (74%) patients using NVNM supplements reported having disclosed this practice to community-based physicians, with only 23.7% disclosing to hospital staff. Six patients reported using supplements at the exclusion of conventional medication, with potentially serious implications. CONCLUSION: While the majority of patients using NVNM supplements are sharing this information with their primary-care physicians, there is little disclosure of this practice to hospital staff. This may be due to a perceived negative attitude of medical professionals to complementary medicine, and a lack of awareness by hospital staff regarding such practices. PRACTICE IMPLICATIONS: Hospital-based medical professionals need to be aware of the use of NVNM supplements and the resulting implications by their internal medicine patients.
Patient Education and Counseling 07/2012; · 2.31 Impact Factor
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ABSTRACT: The purpose of this study was to examine the effect of acupuncture on bone/joint pain, headache and fatigue, as well as quality of life in patients with Gaucher disease (GD), within the framework of an integrated treatment programme.
Patients with GD suffering from any of the above symptoms were offered a series of 10-12 weekly acupuncture treatment sessions. Prior to initiation of treatment, participants were asked to score the severity of pain, as well as to complete the Functional Assessment of Chronic Illness Therapy-Fatigue measure (FACIT-F) and the Medical Outcomes Study (MOS) Short-Form (SF) questionnaire. These tools were evaluated again at the end of the treatment period.
A total of 12 patients were evaluated. While the only pain outcome reduced by acupuncture was knee pain, a significant improvement was observed with respect to nearly all FACIT-Fatigue measures, including the Physical Well Being (PWB) subscales and the SF-12 Physical Composite Score (PCS), though not for the Mental Composite Score (MCS). Patients reported satisfaction with the treatment process, and no significant side effects were reported.
Acupuncture may play a beneficial role for patients with GD when used in conjunction with conventional therapy, reducing fatigue and improving physical function. The preliminary finding of this observational study should encourage further research.
Complementary therapies in medicine 06/2012; 20(3):131-4. · 1.95 Impact Factor
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ABSTRACT: We present a case of eosinophilic pleural effusion due to valproic acid (VPA), a rare adverse event that has been reported previously. A 30-year-old male patient presented with respiratory symptoms and right-sided pleuritic pain, within days of initiation of VPA treatment for a generalized seizure. Chest radiography revealed a moderate-sized right-sided pleural effusion, which was an exudate with a pH of 7.54 and 48% eosinophils. Symptoms resolved soon after discontinuation of the drug, as did the effusion in a repeat radiograph 3 weeks later. The likelihood that VPA was the cause of the effusion is examined.
The Neurologist 01/2012; 18(1):39-40. · 1.26 Impact Factor
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ABSTRACT: An 81-year-old woman with adenocarcinoma of the rectosigmoid presented with progressive muscle weakness and difficulty swallowing, with symptoms worsening following successful resection of the tumor. On examination, she had weakness primarily of lower limb proximal muscles, with no other abnormal findings. Laboratory tests showed significant elevation of creatine kinase, and EMG findings indicated myositis of the proximal muscles. While MRI showed increased signal intensity on T2-weighted images of the leg muscles, indicating inflammation, muscle biopsy found widespread necrosis with only weak and focal lymphocytic infiltration. A diagnosis of paraneoplastic necrotizing myopathy (PNM) was made, and immunomodulatory treatment initiated, with little response. Four months later she returned with exacerbation of symptoms, this time with skin changes pathognomonic of dermatomyositis (DM). A repeat MRI showed progression of inflammation, as well as necrotic foci. It is important to distinguish between paraneoplastic myopathies such as DM and PNM, with implications regarding treatment and prognosis.
Rheumatology International 12/2011; · 1.88 Impact Factor
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ABSTRACT: Sepsis results in significant morbidity and mortality, with current treatment options limited with respect to efficacy as well as safety. The complex homeopathic remedy Traumeel S has been shown to have both anti-inflammatory and immunostimulatory effects in the in vitro setting.
The objective was to explore the effects of Traumeel S in an in vivo setting, using a cecal ligation and puncture (CLP) sepsis model in rats, evaluating the effects of the medication on cytokine activity.
Sepsis was induced in 30 rats using accepted CLP methodology. Following the procedure, rats were randomly allocated to receive an intraperitoneal injection of either Traumeel S (n=15) or normal saline (n=15). At 6 hours post-CLP, serum cytokines (interleukin [IL]-1β, tumor necrosis factor-α, IL-6, and IL-10) were evaluated.
IL-1β levels were significantly higher in the treatment group (p=0.03) with no significant differences found between the groups with respect to the other cytokines tested.
In contrast to in vitro studies, Traumeel significantly increased IL-1β levels in an in vivo model, without influencing other cytokines. IL-1β is a proinflammatory cytokine that has been shown to have a protective effect in the CLP rat model. Further research is warranted to examine this finding, as well as its clinical implications.
Journal of alternative and complementary medicine (New York, N.Y.) 10/2011; 17(10):909-13. · 1.69 Impact Factor
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ABSTRACT: Prurigo Nodularis (PN) is a chronic pruritic skin condition for which current conventional therapies are of limited benefit and with potentially toxic effects. Acupuncture--the insertion of thin needles at specific points on the skin--has been shown to alleviate itching through a number of itch-associated mediator effects. Hypnosis has been shown to modify and reduce the intensity of itching as well. A 44 year-old woman presented with a 30-year history of a diffuse itchy rash diagnosed as PN. She had tried various antihistamine and corticosteroid medications, to no avail. A treatment regimen using hypnosis and acupuncture (hypnopuncture) was initiated, with significant reduction in the itching, size and number of skin lesions. Hypnopuncture may offer a synergistic and augmented response to treatment, though further research is needed to understand the true benefits of this combined regimen.
The American journal of clinical hypnosis 04/2011; 53(4):283-92. · 0.53 Impact Factor
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ABSTRACT: The objective of the study was to evaluate the use and attitudes of nurse-midwives in Israel toward complementary and alternative medicine (CAM).
In a cross-sectional study, nurse-midwives from 5 Israeli medical centers completed the CAM Health Belief Questionnaire, a validated tool examining data regarding personal health behavior, use of CAM therapies, and attitudes toward CAM.
One hundred seventy-three of 238 potential respondents completed the questionnaires (72.7%). Most (87.3%) reported using CAM (67.1% massage, 48.6% herbal medicine, 42.2% meditation, 40.5% touch therapies, and 39.9% prayer) and agree with many fundamental tenets of CAM such as the existence of energy forces, self-healing, and integrating patients' health beliefs and values into their care.
The majority of nurse-midwives studied reported using and recommending CAM to their patients and believe that CAM can complement conventional medical therapies. Health care providers could benefit from education with regard to the efficacy and safety of CAM modalities during pregnancy and childbirth.
American journal of obstetrics and gynecology 10/2010; 203(4):341.e1-7. · 3.28 Impact Factor
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ABSTRACT: Homeopathy is an empirical method of treatment. Hormesis, while stemming from within the rationalist tradition, has yet to be explained according to current pharmacological theory. Both share in common sub-threshold doses of toxic substances and an initial semi-toxicological insult followed by a greater compensatory (or healing) response. We question whether the differences between these fields may be amenable to scientific research. We identify five cardinal differences between homeopathy and hormesis: (1) Hormesis is a universal phenomenon, while homeopathy is highly specific; (2) Hormesis uses only measurable quantities of compounds, as opposed to homeopathy, which frequently administers medicines at dilutions far beyond the material range; (3) Preparation of hormetic solutions follows standard laboratory procedure, while homeopathy requires a sequential series of dilutions, each followed by vigorous shaking ('succussion'); (4) The effects of hormesis are moderate and temporary, while homeopathy claims curative and permanent responses and (5) Hormesis is a lab phenomenon observed primarily in healthy organisms, whereas homeopathy is a mode of treatment administered primarily to ailing individuals. We believe that all five of these differences are amenable to scientific investigation, and suggest comparing succussed to non-succussed diluted solutions as an optimal first evaluation. We conclude that while certain differences exist between hormesis and homeopathy, hormesis may in fact be a subset of homeopathy.
Human & Experimental Toxicology 07/2010; 29(7):567-71. · 1.31 Impact Factor
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Shepherd R Singer,
Michal Amit-Kohn,
Samuel Weiss,
Jonathan Rosenblum,
Guy Maoz, Noah Samuels,
Esther Lukasiewicz,
Laurence Freedman,
Ora Paltiel,
Menachem Itzchaki,
Meir Niska,
Menachem Oberbaum
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ABSTRACT: In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain.
We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery.
Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04).
Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance.
This study was registered at ClinicalTrials.gov. # NCT00279513.
BMC Clinical Pharmacology 04/2010; 10:9. · 1.36 Impact Factor
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ABSTRACT: Symptom checklists used in clinical research of gastroparesis have not been evaluated for reliability or validity. The Gastroparesis Cardinal Symptom Index (GCSI) is a reliable, validated measure whereby patients score three groups of symptoms: nausea/vomiting, postprandial fullness/early satiety and bloating.
The purpose of this study was to translate the GCSI into Hebrew and then validate the language of the translation for use in future studies.
The measure was first translated into Hebrew and then back-translated to English, followed by a comparison of the two versions. The English and Hebrew versions were then completed by 40 healthy bilingual volunteers, using a cross-over design, with half answering the English version first while the other half replied to the Hebrew version first.
The internal consistency for both measures was moderate, the English slightly lower than the Hebrew (Cronbach's alpha 0.67 vs. 0.72). Intra-class correlation values were larger than 0.7 for all but one of the symptoms (item 3, "vomiting"), although a Wilcoxian signed-rank test found this correlation to be of borderline significance (z=-1.63, p=0.50).
The Hebrew translation of the GCSI is valid for use in clinical research, although further psychometric testing is needed to test its value for this purpose. This manuscript describes the stages of measurement, translation and language validation, the difficulties that researches face and possible solutions when researches choose to use a measure which was developed in a different language.
Harefuah 02/2010; 149(2):83-6, 125.
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Shepherd Singer,
Michal Amit-Kohn,
Samuel Weiss,
Jonathan Rosenblum,
Guy Maoz, Noah Samuels,
Esther Lukasiewicz,
Laurence Freedman,
Ora Paltiel,
Menachem Itzchaki,
Meir Niska,
Menachem Oberbaum
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ABSTRACT: Abstract
Background
In spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain.
Method
We performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S<sup>® </sup>in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery.
Results
Traumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04).
Conclusions
Traumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance.
Trial Registration
This study was registered at ClinicalTrials.gov. # NCT00279513
BMC Clinical Pharmacology. 01/2010;
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ABSTRACT: The use of complementary and alternative medicine is on the rise, including among patients with epilepsy. Herbal medicine, one of the most popular forms of CAM, is considered to be both safe and effective by most consumers. Yet many herbs may increase the risk for seizures, through intrinsic proconvulsant properties or contamination by heavy metals, as well as via effects on the cytochrome P450 enzymes and P-glycoproteins, altering antiepileptic drug (AED) disposition. Herb-drug interactions may be difficult to predict, especially since the quality and quantity of active ingredients are often unknown. Since most patients do not inform their physicians that they are taking herbal medicines, health care professionals must initiate a dialogue in order to prevent complications with the combined regimen. At the same time, further research is required regarding the effect of herbs on seizure activity and interactions with AED treatment.
Epilepsia 04/2008; 49(3):373-80. · 3.96 Impact Factor
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ABSTRACT: The use of complementary and alternative medicine (CAM) is on the rise, especially among psychiatric patients. Acupuncture is considered a safe and effective treatment modality, and traditional Chinese medicine teaches that acupuncture harmonizes the body's energies. Scientific research has found that acupuncture increases a number of central nervous system hormones (ACTH, beta-endorphins, serotonin, and noradrenaline) and urinary levels of MHPG-sulfate, an adrenergic metabolite inversely related to the severity of illness in schizophrenics. Acupuncture can have positive effects on depression and anxiety, although evidence is still lacking as to its true efficacy for these conditions. To the authors' knowledge, no trials have been conducted for schizophrenia, and researchers evaluating acupuncture in cases of substance abuse have found conflicting results. Further research is warranted.
Behavioral Medicine 02/2008; 34(2):55-64. · 1.14 Impact Factor
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Noah Samuels
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ABSTRACT: Efforts to prevent adolescents from smoking have limited efficacy, with little understanding of why they smoke. We examine many of the factors which may influence a teenager's decision to start smoking.
A self-completed questionnaire was distributed among pre-draft teenagers (age 16-18 years) with questions regarding current smoking habits as well as smoking habits of family members. Smokers were asked why they started, and attitudes regarding the dangers of smoking and anti-smoking legislation were examined.
A total of 1067 questionnaires were completed (707 males, 360 females). In all, 25.7% were current smokers (26.2% of male and 21.1% of females; p=0.069), with smoking rates highest among those born in Middle Eastern countries and lowest among those born in Ethiopia. Those from single-parent families had a higher smoking rate (relative risk: 1.28), as did those with either parents or siblings who smoked. Parents who were smokers were more likely to tell their children not to smoke, while smoking teenagers were more likely to have been told by their parents not to smoke. Most smokers (58.2%) did not give a specific reason for smoking while 30.3% listed "peer pressure", 8.4% "parents smoking" and 3.1% "advertisements" as the major factor. Smokers were less likely to agree that smoking is harmful and more likely to oppose anti-smoking legislative measures.
Many factors influence a teenager's decision to smoke, including cultural norms and habits of friends and family members. Educating both adolescents and those around them may help prevent smoking among this age group.
Harefuah 04/2007; 146(3):184-6, 247.
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Integrative Cancer Therapies 01/2007; 5(4):373-90. · 2.14 Impact Factor
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Toxicology and Applied Pharmacology 09/2005; 206(3):365; author reply 365-6. · 4.45 Impact Factor
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Noah Samuels
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ABSTRACT: Viral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases. Improved socioeconomic factors, as well as the universal vaccination of infants (introduced in 1999) has resulted in a decline in infection rates in Israel. This study examines the benefits of routine testing for anti-HAV IgG in high-risk population.
A retrospective examination of the files of teenage and adult patients (aged 16-99 years; mean 33.9) in two primary care clinics found 1,017 patients who had been tested for anti-HAV IgG antibodies for either general healthcare screening or ongoing follow-up for chronic illness. Seropositive patients were then asked regarding recall of past hepatitis (i.e. jaundice, regardless of viral etiology); post-exposure prophylaxis with immune serum immunoglobulin (ISG); and active immunization with inactivated virus. Seronegative patients were subsequently sent for active immunization.
Of the 1,017 patient records studied (503 male, 514 female), a total of 692 were seropositive (354 males, 338 females; P = 0.113). Seropositivity rates increased with age (p < 0.005), and were highest among those born in Middle Eastern countries other than Israel (91.3%) and lowest among immigrants from South America (44.1%; P < 0.005). 456 of the seropositive patients were interviewed, of whom only 91 recalled past illness while 103 remembered receiving post-exposure prophylaxis (ISG) and 8 active vaccination. Those who were unaware of past infection were more likely to have been vaccinated with ISG than those who were aware (26.3% vs. 7.7%; p < 0.005).
The relatively high prevalence rate of anti-HAV seropositivity in our study may me due to the fact that the study was conducted in a primary care clinic or that it took place in Jerusalem, a relatively poor and densely populated Israeli city. Most of the seropostive patients had no recollection of prior infection, which can be explained by the fact that most hepatitis A infections occur during childhood and are asymptomatic. Routine testing for anti-HAV IgG in societies endemic for HAV would help prevent seropositive patients from receiving either post-exposure or preventive immunization and target seronegative patients for preventive vaccination.
BMC Public Health 06/2005; 5:60. · 2.00 Impact Factor
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Noah Samuels
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ABSTRACT: Acupuncture treatment uses ultrafine needles which are inserted into specified points on the skin (acupoints). Acupuncture can help alleviate pain and inflammation, possibly through the increased release of pituitary beta-endorphins and ACTH. Hypnosis can also help alleviate pain syndromes, and may have centrally mediated immunomodulatory effects. The use of these 2 treatments simultaneously may potentially assist and augment the effects of each another. Two case reports where both treatments are used together are presented: One showing how hypnosis can help in the treatment of painful acupoints, the other how the response to acupuncture may be augmented by hypnosis in the treatment of headache. Controlled trials of this combined treatment are warranted.
The American journal of clinical hypnosis 05/2005; 47(4):243-8. · 0.53 Impact Factor
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Noah Samuels
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ABSTRACT: Herbal remedies, considered to be both safe and effective by most consumers, may interact with conventional drugs. Warfarin, a vitamin K antagonist originally derived from the sweet clover plant, has a narrow therapeutic window which can be monitored using prothrombin international normalized ratios (PT-INR). Many herbs can increase the risk for bleeding when combined with warfarin, either by augmenting the anticoagulant effects of the drug (with increased PT-INR levels) or through intrinsic anti-platelet properties (without altering PT-INR levels). The increased risk for bleeding among such patients may be difficult to predict, especially when formulas which contain many herbs are used. Further research into herb-drug interactions is warranted, as are guidelines for the use of herbal remedies by patients on chronic anticoagulation therapy.
Thrombosis and Haemostasis 02/2005; 93(1):3-7. · 5.04 Impact Factor
