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International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 603
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Original Article
Complementary and Alternative Medicine (Cam) Use Among Turkish
Surgical Patients
Ilkay Culha, MSc
Research Assistant, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Nedime Kosgeroglu, PhD
Professor, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Aysun Türe, MSc
Lecturer, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Ozlem Kersu, MSc
Anesthesia Intensive Care Nurse, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir,
Turkey
Ayse Ayvazcık, MSc
Neurosurgery Intensive Care Nurse, Eskisehir Osmangazi University, Faculty of Medicine,
Eskisehir, Turkey
Correspondence: Ilkay Culha, Research Assistant, Eskisehir Osmangazi University, Faculty of Health
Science, Eskisehir,Turkey, e-mail: ilkayc.ilkay@gmail.com
Abstract
Background: The use of complementary and alternative medicine (CAM) in both Turkey and throughout the
world is on the increase among the general population.
Objectives: To determine the factors affecting use of and frequency use of CAM among Turkish surgical
patients.
Methodology: The research was carried out at surgical clinics with 276 patients between 1 July 2015-1 August
2015. Data were collected with a questionnaire containing socio-demographic information and CAM usage and
were evaluated by Pearson's chi-square test and Fisher's exact test.
Results: 67% of patients have been using some kinds of CAM. Green tea / herbal tea (31.5%), garlic (19.6%)
and ginger (16.3%) were the most herbal products. Praying (39.9%), massage (34.8%) and thermal water / spa
(26.1%) were the most alternative therapies. Reasons for using CAM were pain 44.6%), stress (32.6%) and also
8.7% of patients have used these methods to cope with the problem that requires surgery. Surgical patients have
beliefs that CAM methods could support medical treatment (42.8%) and cause physically relaxing (33.3%).
Sources of information about CAM were relatives/neighbors (57.2%), friends (36.6%) and TV / radio (36.6%)
respectively. There was found significant relationship between gender, profession, income level and having
chronic disease (p = 0.001; p = 0.012; p = 0.030; p = 0.041 respectively).
Conlusions: More than half of the patients in the study use CAM, nearly half of them think CAM could support
the medical treatment. Most sources of information are people around them.
Key words: complementary and alternative medicine, supportive treatment, herbal medicine, surgery patient
Introduction
Alternative medicine is defined as all types of
health treatments which take the place of medical
treatments but not accepted by modern bio-
medicine or treatments, while complementary
medicine is the treatment and care system which
is applied together with and in addition to
medical treatments (Muslu & Ozturk 2008).
Background
The National Centre for Complementary and
Alternative Medicine (NCCAM) has classified
CAM methods in five groups, as alternative
medical system treatments (acupuncture,
ayurveda), treatments of the mind and body
(meditation, relaxation, prayer), practices with a
biological foundation (herbal remedies),
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manipulative applications practices which take
the body as their basis (hydrotherapy,
reflexology) and energy treatments (reiki) (NIH
2012). The use of CAM in both Turkey and
throughout the world is on the increase among
the general population, and it is generally used in
problems related to such arthritis, allergies,
tiredness, headaches, neck and back pain,
hypertension, diabetes, insomnia, and lung and
digestion problems (Ozcakır & Aydın 2007).
According to the 2007 National Health Statistics
report, it was stated that 4 adults out of every 10
(38.3%) in the USA had resorted to CAM
applications, and that herbal and natural
medicines was the most frequently used method
(Barnes et al. 2008). In general, the most
important reason why patients resort to CAM was
determined as being increasing the quality of life
by ensuring the control of the symptoms, in
chronically ill patients (Pal 2002). The vast
majority of the studies concerning the use of
CAM in Turkey are comprised of cancer patients
and between the years of 2001-2007 among
cancer patients in Turkey, as being, on average,
46.2% (Kav et al. 2008). In a study where the use
of CAM applications by surgical patients was
evaluated, it was determined that 57.4% of the
patients used any one of the CAM applications
while the most frequently used CAM form of
treatment was prayer (25.2%) (Wang et al. 2003).
Even if it is considered that the use of CAM
methods is natural and harmless, the interaction
between CAM applications and the existing
medical treatment and unfavourable aspects are
also mentioned (Can 2013). CAM methods have
side effects such as delaying or leaving or
refusing modern treatments, material and
spiritual losses, and the development of feelings
of hopelessness, depression and failure (Muslu &
Ozturk, 2008). The use of herbal medicines can
lead to an increase in morbidity rates caused by
physiological changes in surgical patients and the
use of multiple types of medications, in the pre-
operative period. The use of herbal medication
may cause clotting disorders and interact with the
medication given prior to the operation, resulting
in various complications such as myocardial
infarction, stroke, bleeding, extended or
insufficient narcosis, and rejection by the body in
organ transplants (Adusumilli et al. 2004;
Skinner & Rangasami 2002). The immune-
suppressive effects of certain herbs may give rise
both to a predisposition to surgical infections and
an increase in infections of the site of the wound.
Together with the increase in the use of CAM,
where patients do not notify health workers that
they have been using herbal products, where
health workers fail to question this, and where
they are not sufficiently informed of the effects
of these products, this can lead to serious
problems during the surgical process (Cay &
Korkmaz 2015). It is recommended that clinical
practices guidelines are prepared in connection
with this matter (Kumar et al. 2005).
Methodology
Design, Setting and Sample
This was a descriptive study which was carried
out at surgical clinics in an university hospital in
Eskisehir between 1 July 2015-1 August 2015.
276 patients, aged over 18 and who have been
admitted to urology, neurosurgery, ENT,
orthopedics, general, plastic, cardiac, vascular,
gynecology clinics and who were willing to
attend were included in the study. Those
undergoing emergency surgical procedures and
patients with cognitive impairment were
excluded from the study.
Instruments
The questionnaire used in the study was prepared
based on a literature search for the aim of
determining the types of CAM methods (herbal
products and alternative teraphies) used in
Turkey and other countries in the world. The
questionnaire included questions including socio-
demographics (age, gender, surgical procedure,
level of education, level of income, occupational
status etc.), current use of CAM methods, types
of CAM methods, reasons for using CAM and
sources of CAM information.
Data collection and procedures
CAM was described to the patients by
researchers and then data were collected by
researchers using face to face interviews with
patients and each meeting took 5-10 minutes.
Ethical consideration
Data were collected by face- to- face interview
method after obtaining informed and written
informed consent of patients. The protocol was
approved by Hospital Ethical Review Committee.
Data analyses
Data were analyzed by IBM SPSS (v. 21.0)
statistics package programme Pearson’s chi-
square test and Fisher’s exact test were used for
comparisons between users and non-users of
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CAM. p < 0.05 was accepted as statistical
significance.
Results
The participants ranged from 18-91, mean
50.55±16.60. 129 of the patients (46.7%) were
female, 211 (76.4%) were married, 80 (29%)
were housewives, 98 (35.5%) had completed
only primary education, 200 (72.5%) were part of
a nuclear family, 172 (62.3%) stated “equal to
income” level and 118 (42.8%) of the patients
had at least one chronic illness hypertension
(23.2%), diabetes (15.2%), COPD, asthma and
lung cancer (4.7%) and heart failure (3.6%).
(Table 1).
The CAM use status of the surgical patients
who took part in the study, according to some of
their characteristics, is given in Table 1. There is
a significant difference between the genders,
occupations and income levels, and whether they
suffer from a chronic illness, and their use of
CAM (X2=12.06, p=0.001; X2=16.364, p=0.012;
X2=7.040, p=0.030; X2=4.187, p=0.041,
respectively) (Table 1).
Table 1. Some sociodemographic characteristics and use of CAM
n(%)* CAM use
n(%) X2 ;p value
Age
18-30 15(16.5) 32(17.3)
0.99; 0.911
31-43 14(15.4) 22(11.9)
44-56 25(27.5) 58(31.4)
57-69 27(29.7) 55(29.7)
>70 10(11.0) 18(9.7)
Gender
Woman 29(31.9) 100(54.1) 12.06; 0.001
Man 62(68.1) 85(45.9)
Marital status
Married 69(75.9) 142(76.8) 0.000; 0.983
Single 22(24.2) 43(23.2)
Education
Literate-illiterate 9(9.8) 29(15.7)
6.210;0.286
Primary school 31(34.1) 67(36.2)
Secondary school 15(16.5) 27(14.6)
High school 25(27.5) 53(28.6)
University 11(12.1) 9(4.9)
Profession
Student 9(9.9) 18(9.7)
16.364; 0.012
Working(Public
servant, employee)
23(25.2) 32(17.3)
Retired 33(36.3) 44(23.8)
Self-employement 8(8.8) 14(7.6)
Housewife 13(14.3) 67(36.2)
Other (teacher etc.) 5(5.5) 10(5.4)
Income Levels
Less than income 28(30.8) 58(31.4)
7.040; 0.030 Equal to income 52(57.1) 120(64.9)
More than income 11(12.1) 7(3.8)
Chronic disease
Yes 31(34.1) 87(47.0) 4.187; 0.041
No 60(65.9) 98(53.0)
*n refers to patients who don’t use CAM
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Figure 1.Prevalance of reasons for CAM use
32,6%
16,3%
28,6%
44,6%
8,7%
12,3%
27,5%
8,7%
19,9%
17,8%
0,0% 5,0% 10,0%15,0%20,0%25,0%30,0%35,0%40,0%45,0%50,0%
Stress
Psychological problems
Sleep related problems
Pain
Cope with situation requiring surgery
Chronic dieases
Tiredness
Nausea and vomiting
Cold sore
Advice
Table 2. Prevalance of CAM methods
Herbal products* Other alternative therapies*
n % n %
Herbal tea/green tea 87 31.5 Massage 96 34.8
Garlic 54 19.6 Aromatherapy 12 4.3
Ginger 45 16.3 Cupping 24 8.7
Stinger 32 11.6 Relaxing exercises 36 13.0
Olive oil/almond oil 29 10.5 Breathing exercises 33 12.0
Aloe vera 11 4.0 Meditation-yoga and
acupuncture 0 0.0
Others (parsley, lemon, onion
juice, linseed, henna, cumin,
henna)
13 4.7
Praying/religious practices
110 39.9
Leech 23 8.3
Music 35 12.7
Thermal/spas 72 26.1
* Marked multiple options
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Figure 2.Prevalance of CAM use with type of surgical procedure
CAM use
67% (185) of the surgical patients who took part
in the study, had used CAM methods other than
medicinal treatment, at any period of their lives.
When the methods which had been used are
examined in detail, 7.2% of the patients had only
used herbal products, 16.3% had only used other
alternative treatment methods, and 43.5% had
used both. The herbal products used most by the
patients were green tea / herbal tea (31.5%),
garlic (19.6%) and ginger (16.3%), respectively,
while the alternative treatments used most by the
patients were praying (39.9%), massage (34.8%)
and thermal spas (26.1%) respectively (Table 2).
On the other hand the reasons for the use of
CAM methods by the patients were mostly pain
(44.6%) and stress (32.6%), while 8.7% of the
patients had used them in order to be able to deal
with the problem which required surgery (Figure
1). The CAM positions of the patients according
to the surgical clinics are shown in figure 2, these
methods were used most by the patients in the
plastic surgery clinic (85.0%) (Figure 2).
When the thoughts of the surgical patients
concerning the use of CAM were evaluated,
42.8% of the patients who took part in the study
believed that the herbal products / alternative
treatments could support the medication /
medical treatment, 33.3% said that they gave
them physical comfort and 31.9% said they made
them feel psychologically more comfortable,
while 17.0% found there to be no benefit from
these methods.
When the resources from which the surgical
patients obtained information related to CAM
methods were evaluated, these were found to be
relatives and neighbours (57.2%), the television /
radio (36.6%), friends (36.6%), the internet
(24.3%), written sources (11.6%) and health
workers (10.5%).
Discussion
This study has been carried out with the purpose
of determining the use by surgical patients of
complementary and alternative treatment
methods (CAM), and the factors which influence
this.
The ratio of CAM use among the surgical
patients in the study is 67%. Both higher (Akıncı
et al. 2011; Efe et al. 2012) and lower (Aksu et
al. 2008; Akyol et al. 2011; Ceylan et al. 2009;
Güven et al. 2013; Tokem et al. 2011) rates of
CAM use have been determined in studies, which
posses a different sample, and which have been
carried out on individuals with different illnesses,
in our country. In a scan of the literature, where
16 studies on the use of CAM were examined, it
is stated that the frequency of CAM use ranges
from 24-98% (Bebis et al. 2014). On the other
hand, when we look at studies carried out abroad,
in the study conducted by Wang et al. (2003), the
rates of CAM use among surgical patients were
found to be lower (57.4%) than in our study.
The CAM use position of the patients who took
part in our study vary according to their gender,
occupation, whether they suffer from chronic
illnesses, and their income level. CAM use is
more widespread among female patients than
among male patients. This may be influenced by
the fact that the majority of the women in our
study were housewives, and that they spend more
time with their environments and sources of mass
communication. There are other studies within
75,9%
75,0%
68,0%
44,4%
45,0%
75,0%
55,6%
85,0%
45,8%
0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0% 80,0% 90,0%
Neurosurgery
General surgery
Ophthalmic surgery
Gynecology
ENT
Cardiovascular surgery
Orthopedics
Plastic surgery
Urology
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the literature which also state that the use of
herbal products among women is higher than
among men (Guven et al. 2013; Grauer et al.
2004; Loya et al. 2009; Mahomoodally &
Roumysa 2013; Tindle et al. 2005). A significant
relationship may also have been determined
between CAM use and occupations in our study,
again due to the high number of retired women.
In the literature it is stated that a high percentage
of patients with chronic illnesses preferred
alternative treatments (Ottom et al. 2006; Bell et
al. 2006; Miller et al. 2008). In contrast to
expectations, in our study, CAM use among those
without chronic illnesses was higher. It can be
said that the fact that the CAM use rates of
patients directed at chronic illnesses or their
existing problems was low, also influenced this.
In the study, the highest percentage of CAM use
was found among patients who expressed their
income levels as “balanced income and
expenditure”. The fact that the number of patients
at this income level was higher than the number
of patients at other income levels may have
influenced this result.
In the studies concerning the use of CAM
methods within the literature, the usage status of
herbal products and other alternative treatments
by individuals was evaluated. When CAM
methods are examined in detail in the study, the
percentage of patients who used only herbal
products (7.2%) is lower than those who used
only other alternative methods of treatment
(16.3%). The percentage of patients who used
only herbal products was quite low, while almost
half of those who use CAM (43.5%), used both
methods. In the other studies conducted in our
country, higher rates of herbal product use have
been determined when compared to our results
(Cay et al. 2015; Efe et al. 2012; Erdogan et al.
2012; Güven et al. 2013; Kurt et al. 2013; Sagkal
et al. 2013). Akyol et al. (2011) and Grauer et al.
(2004), on the other hand, state a higher
percentage of use of herbal products than our
study, but one that is lower than the other studies
(16.8%). The rates of use of herbal products in
the studies conducted abroad are also
considerably higher than the results reached in
our study (Adusumuli et al. 2004; Wood et al.
2003). In a systematic compilation where 24
studies directed at CAM use were examined, it
was stated that the method most used among the
CAM methods was herbal product support
(Posadzki et al. 2013).
In terms of the other alternative methods of
treatment in our study, the most prevalent are
prayer / religious practices (39.9%). Similar
results have also been found in the other studies
conducted in our country (Araz et al. 2007;
Erdogan et al. 2012; Erdogan et al. 2013). The
patients which took part in the study have not
stated the use of methods such as acupuncture,
meditation and yoga. Similarly, Karacan et al.
(2012) also determined just one person each who
perform reiki and yoga, in his study. While the
use of other alternative treatments such as
acupuncture, hypnosis, homeopathy (Adusumuli
et al. 2004; Posadzki et al. 2013), yoga, tai-chi
(NIH 2012), reflexology and massage (Posadzki
et al. 2013) abroad is lower than the use of herbal
products, there are instances where these are
selected by patients. Matters such as cultural
differences between countries and regions,
differences in the income levels of individuals, a
lack of knowledge on these methods, and ease of
reach of the methods are able to influence the
extensiveness of these methods.
In the study the patients have mostly used more
than one herbal product. The most frequently
used herbal products by the patients are Herbal
tea/green tea (31.5%), garlic (19.6%) and ginger
(16.3%), respectively.
In the other studies conducted in our country, the
most frequently used herbal products can be
listed as follows: garlic (Akyol et al. 2011;
Erdogan et al. 2013; Zerrin et al. 2012); parsley
(Erdogan et al. 2012), linden / sage (Akyol et al.
2011), mint, nigella (Erdogan et al. 2013),
stinging nettle (Aksu et al. 2008, Karacan et al.
2012, Kurt et al. 2013, Zerrin et al. 2012), ginger
(Zerrin et al. 2012), thyme (Cay et al. 2015). On
the other hand, in the studies conducted abroad,
the most frequently used herbal products are
products such as aloe vera (Adusumuli et al.
2004; Grauer et al. 2004), ginseng (Adusumuli et
al. 2004; Grauer et al. 2004; Skinner &
Rangasami 2002), garlic (Adusumuli et al. 2004;
Grauer et al. 2004; Skinner & Rangasami 2002;
Wood et al. 2004), echinacea, (Adusumuli et al.
2004; Grauer et al. 2004; Hodges & Kam 2002;
Skinner & Rangasami 2002; Wood et al. 2004),
and it can be said that the use of different herbs is
widespread in different cultures.
The reasons why the surgical patients who took
part in the study used CAM were mostly pain
(44.6%), stress (32.6%), sleeping problems
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(28.6%), and tiredness (27.5%), while only 8.7%
of the patients use these methods in order to be
able to deal with problems which require surgery.
In contrast to our study, there are also studies
which state that these methods are used mostly
for the treatment of the illness (Adusumuli et al.
2004; Efe et al. 2012; Guven et al. 2013; Akyol
et al. 2011; Karacan et al. 2012; Cay et al. 2015;
Zerrin et al. 2012). Apart from these, cancer
patients use CAM methods for the purposes such
as the supporting of their treatment, directed at
the side effects of the treatments and for
strengthening the immune system (Mutlu et al.
2013; Ozcelik & Fadıloglu 2009). The results
support the notion that individuals use CAM
applications in order to be able to deal with their
existing illnesses. When the thoughts of the
patients concerning the use of CA methods is
within the study are evaluated, while 42.8% of
the patients who took part in the study believed
that the herbal products / alternative treatments
could support the medication / medical treatment,
33.3% said that they gave them physical comfort
and 31.9% said they made them feel
psychologically more comfortable, and 17.0%
found there to be no benefit from these methods.
In the other studies which have been conducted,
it was determined that patients found CAM
methods to be beneficial (Erdogan et al. 2012;
Erdogan et al. 2013; Mahomoodally & Roumysa
2013) and that they resulted in the patients
feeling better (Erdogan et al.2012; Erdoğan et al.
2013).
It can be seen that the surgical patients who took
part in the study mostly acquired information
concerning CAM methods from their
environment (relatives and neighbours) and
through the media. When the other studies
conducted in our country are evaluated, it can be
seen that the close environment of the patients
are in first place among the sources of
information, and that the media and the internet
are the other sources where a high level of
information is acquired (Bicen et al.2012; Cay et
al. 2015; Efe et al. 2012; Erdogan et al. 2012;
Guven et al. 2013; Ottom et al. 2008). The
studies conducted abroad have reached similar
results, determining that patients mostly used
their close environment and the social media as
sources of information (Adusumuli et al. 2004;
Wood et al. 2003). While the results support our
study, the accuracy of the information obtained
from these sources is thought provoking. In
contrast with our study, there are also studies
which show that the sources of information for
CAM are individuals who suffer from similar
illnesses (Akyol et al. 2011; Ucan et al. 2007).
Conclusion
It has been determined that more than half of the
patients who took part in the study used CAM
methods, close to half believed that these
methods can be a support to the medical
treatment, and that the sources of information
concerning these methods were mostly the people
in the environment of the patients. A significant
relationship was determined between the position
of CAM use according to gender, occupation,
whether the patient is suffering from a chronic
illness and income levels.
Relevance to clinical practice
For the reason that there could be interactions
with the current treatment, anesthesia,
intraoperative and postoperative process
especially when using herbal products it's
essential that surgical patients should be asked
about CAM usage by surgical staffs especially
nurses. Furthermore there could be planned
training programs about CAM use for surgical
staffs and also for patients.
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... The use of CAM is on the increase among the general population in both the developed and developing nations. It is commonly used in conditions such as fever, headache, neck and back pain, insomnia etc [4]. Globally, the prevalence of CAM use ranges from 30 to 75% [5]. ...
... For the current CAM users 30.4% of the participants were using CAM for their surgical complaint, the remaining were using CAM for non-surgical complaints. In another study by Culha et al[4], pain (44.6%) accounted for the main indication for CAM use, other complaints include stress, sleeping problems and tiredness. Compared to this study, only 8.7% of their patients used CAM to deal with problems which required surgery. ...
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Objectives The use of complementary and alternative medicine (CAM) stemmed from the search of humans for other means of relieving pain and managing diseases which has plagued its existence. CAM use is on the increase among the general population in both the developed and developing nations and also among surgical patients. There is therefore a need to ascertain the perceived adverse effects, the safety perception and the determinants of its use so as to improve the advocacy for adequate regulation. Methods It was a cross-sectional study carried out among surgical outpatients in a tertiary hospital. One hundred and fifty patients between the ages of 18 and 85 years were recruited. An interviewer-administered questionnaire was used to collect data from each participant. Data was analyzed using SPSS version 22. Results The lifetime prevalence of CAM use among the respondents was 76 % while the point/current prevalence was 37.3 %. The percentage of current users using CAM for surgical complaints was 30.4 %. Biological based therapy accounted for 110 (72 %) of CAM used and unbranded herbal products was responsible for more than two-third of it. Almost a third of the patients (46, 30.7 %) perceived that CAM is safe while 62 (41.3 %) were not sure of its safety. Only 15 (13.2 %) and 6 (5.3 %) have ever recorded side effects and drug interactions respectively. Older age group, income less than 10,000 Naira, positive safety perception and belief about CAM were identified as determinants of CAM usage. Conclusions The prevalence of CAM usage among surgical outpatients was quite high and the major determinants of its use are the patient's age, safety perception and their level of income.
... Therefore, we believe that massage and balneotherapy treatments are prevalent in the studies performed in Turkey. 7,15,21 We consider that the fact that the majority of individuals are conservative in our country and the environment, in which we conduct our study, maybe a reason for frequent use of cupping therapy, hajamat, and prayer practices. We think that apart from health literacy, the variability of health care insurance coverage and protocols of medical practice in countries also alter the familiarization and frequency of implementation of the TCM practices. ...
... 6 In another research, in which the frequency of usage and motives behind using TCM practices in 276 patients who underwent surgery was investigated, it has been revealed that 67% of the patients used any sort of TCM practices, and the most common reason for using them was to have pain complaints (44.6%). 21 Pain complaint is considered to be an important symptom that leads patients to use TCM practices. ...
... Between December 2020 and April 2021, to acquire information about CAM use, structured face-to-face interviews were carried out at Rafidya Hospital and NNUH via a questionnaire in the native Arabic language on the basis of a literature review and was introduced to the participants in five sections (Yazici et al. 2019;Shakeel et al. 2008;Çulha et al. 2016;Velanovich et al. 2006;Schieman et al. 2009). ...
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Background The use of complementary and alternative medicine (CAM) has increased substantially around the world; various global studies have documented the use of CAM by surgical patients in the preoperative period, with rates of herbal medications and other nonherbal treatments ranging from 12 to 69%. This study aimed to identify the prevalence of CAM and its patterns of use among surgical patients. Methods From December 2020 to April 2021, a descriptive cross-sectional study was undertaken in Palestine. A face‒to-face interview questionnaire was used. The participants were asked questions regarding sociodemographics, clinical information, CAM usage, reasons for its use, and opinions on its efficacy. Results Among the 300 surgical patients who were interviewed in this study, 252 (84.0%) reported that they had ever used CAM, while a total of 122 (48.4%) had used CAM before their surgery, 81.7% of the respondents used herbal methods, and 64.7% of them used nonherbal methods. CAM use among our study population was not linked to specific demographics or other characteristics, except health insurance (p = 0.004). The most commonly used herbs among surgical patients are Salvia officinalis L. (Sage) (84.1%) and Pimpinella anisum L. (Anise) (75.5%). The highest percentage was found among patients with university qualifications (73.2%), who used more than three methods (p < 0.001). In addition, 59.4% of the females used more than three therapies, whereas 45.9% of the males did (p = 0.032). Conclusions The herbal methods used are common among surgical patients in Palestine and are consistent with the enormous increase in the use of CAM. Therefore, awareness should be raised among the public regarding the risks and benefits of CAM use.
... A similar study in Oriental Morocco also indicated that the most five HMs used by Morocco population were Salvia officinalis, Trigonella foenum-graecum, Olea europaea, Artemisia herba-alba, and Origanum vulgare [26]. Another similar study in Turkey revealed that the most frequently used HMs by the patients are green tea, garlic, and ginger [27]. Different HMs might be used in different areas with different levels as a result of difference in accessibility of the herb and information dissemination among patients with diabetes. ...
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Introduction. The majority of the population in developing countries including Ethiopia still relies on traditional medicines (TMs). Patients with chronic illness like diabetes mellitus (DM) are dissatisfied with conventional medicines and thus are more likely to simultaneously use herbal medicines (HMs). However, such practice could result in potential herb-drug interaction. This study aimed to identify the commonly used HMs among patients with DM and determine the magnitude of concomitant use of herbal and conventional antidiabetic medicines. Method. A health facility-based cross-sectional study design was employed using both quantitative and qualitative data collection methods to determine the magnitude of concomitant use. Patients with DM and prescribers from four public hospitals were the study population for the quantitative and qualitative study, respectively. Simple descriptive statistics were used to describe variables for the quantitative data, and content analysis had been conducted manually for qualitative data. Result. Out of 791 respondents, 409 (51.7%) used traditional medicine at least once in their life time, and 357 (45.1%) used traditional medicine in the last six months prior to data collection. A majority (288 (80.7%)) of the respondents used HMs after starting the conventional antidiabetic medicines within the last six months. Moringa stenopetala, Thymus vulgaris, Trigonella foenum-graecum, Nigella sativa, and Allium sativum were among the frequently mentioned HMs. Prescribers were requesting patients’ HM use when they saw sign of liver toxicity and skin disease, and they were not documenting their history in the patient’s chart. Conclusion. Concomitant use of herbal and conventional antidiabetic medicines was a common practice. Cognizant of its potentially serious herb-drug interactions, efforts should be made to improve awareness and knowledge of healthcare providers about HM potential effects. Further studies on dose, frequency, duration, and modes of interaction are recommended. 1. Introduction Traditional medicines (TMs) cover a heterogeneous spectrum of ancient to new-age approaches to prevent or treat disease. They include the use of herbal medicines (HMs), spiritual healing, and practices such as bone setting [1]. TMs were used for age-related chronic diseases such as hypertension and diabetes mellitus (DM) for which no modern medicine or only palliative therapy is available [2]. The use of HMs, either alone or combined with conventional medicines, has been practiced widely particularly in low-resource setting countries. Their use in patients with chronic disease like DM is very common, owing to its natural origin and perceived lesser side effects or dissatisfaction with conventional medicines [3–5]. DM is one of the largest global health emergencies of the 21st century. In 2015, 14.2 million people were estimated to be living with DM in Africa, and this is projected to 34.2 million by 2040 [6]. The prevalence of DM in Ethiopia among adults aged 20–79 was estimated to be 0.2% and 0.28% in 2010 and 2030, respectively, with mean annual increment 0.06% [7]. Literature showed that patients with DM who were dissatisfied with conventional medicine were more likely to use HM to enhance the effect of conventional treatment [8]. However, simultaneous use of herbal and conventional medicines may result in potentially serious herb-drug interactions leading to negative effect on patient outcomes [4]. Mostly, HMs are complex mixtures of more than one active ingredient which increase the possibilities of interactions [9, 10]. For instance, treatment with St. John’s wort (SJW) significantly increases the apparent clearance of gliclazide [11]; administration of Ginkgo biloba extract increased hepatic clearance of insulin and oral hypoglycemic agents, hence resulting in an increased glucose level [12]. Adverse effects such as hypoglycemia and lactic acidosis were also detected among patients with diabetes who were taking herbal antidiabetic products in China [13]. Such adverse reactions could involve all systems, age groups, and severity [9]. Until recently, however, herb-drug interaction was often unsuspected by healthcare providers. Most trained physicians lack adequate knowledge on HM and its potential for drug interactions [14]. Patients may also not always inform their doctor of the simultaneous use of HM [15]. Ethiopia is not an exception to this worldwide phenomenon as HM is still the main source of healthcare for many millions of people [16]. However, information on most commonly used HM and extent of concomitant use with conventional medicines in DM is scanty. This study aimed to determine the extent of concomitant use of herbal and conventional antidiabetic medicines and also to identify the commonly used HMs among patients with DM. 2. Methods 2.1. Description of the Study Area The study was conducted in Addis Ababa, the capital city of Ethiopia. Addis Ababa is divided administratively into 10 subcities and has a total population of 3.43 million [17]. 56 hospitals (11 public, 3 army, and 42 private hospitals), 760 private clinics, 96 health centers, and 720 pharmacies were available in the city administration [18]. 2.2. Study Design A health facility-based prospective cross-sectional study design was carried out to determine the prevalence of concomitant use of herbal and conventional medicines among patients with DM. Data were collected between April and August, 2016. 2.3. Source and Study Population The source population for the quantitative data constituted all patients with diabetes attending treatment in outpatient clinics of public hospitals in Addis Ababa City Administration (AACA). Patients with diabetes from four public hospitals in Addis Ababa, two hospitals from AACA (Yekatit 12 Hospital Medical College and Zewditu hospital) and two hospitals from Federal (St. Paul’s Hospital Millennium Medical College (SPHMMC) and Tikur Anbessa Specialized Hospital) were the study population. On the contrary, all prescribers working in the diabetic clinics were considered as the source population for the qualitative data. 2.4. Inclusion and Exclusion Criteria Patients aged ≥18 years and taking antidiabetic medicines were eligible for the survey. Patients with DM who were physically or mentally not capable for the interview and those who were health professionals were excluded from the study. For the qualitative interview, prescribers who were working in diabetic clinics and had no previous diagnosis of DM were recruited. 2.5. Sampling and Sample Size Determination The sample size was determined using the single population proportion formula [19]. A total of 845 patients with DM were included by considering 50% proportion of concomitant use of herbal and conventional medicine, with 95% confidence interval, 5% margin of error, design effect of 2, and 10% nonresponse rate. Based on ownership, hospitals were stratified into those administered by AACA and Federal Government. Then, from each stratum, two hospitals, Zewditu Memorial Hospital (ZMH) and Yekatit 12 Hospital Medical College, from AACA and Tikur Anbessa Specialized Hospital (TASH) and St. Paul’s Hospital Millennium Medical College (SPHMMC) from federal hospitals were selected using simple random sampling technique. The sample size was proportionately allocated considering total patients with diabetes of each hospital of which 336 were from TASH, 206 from SPHMC, 132 from ZMH, and 171 from Yekatit 12 Hospital Medical College. Recruitment of the respondents was achieved through the consecutive sampling approach. For the qualitative data, selection of participants was based on the purposive sampling method. Key informants were recruited on the basis of their professional role and work experience in the diagnosis and treatment of diabetes mellitus. Selection of participants was continued until theoretical saturation was achieved. 2.6. Data Collection Instrument For the concomitant use of herbal and conventional medicine assessment, a total of 45-item questionnaire was adopted from the previous literature (supplementary 1) [20]. Questions addressing the patients’ sociodemographic characteristics (age, sex, average income, marital status, and educational status), traditional medicine use, type of traditional medicine chosen, time of use of traditional medicine (before, after, or during the conventional medicine treatment), reason to use the traditional medicine, perceived effectiveness of the herbal medicine, and adverse effects experienced were included in the assessment questionnaire. On the contrary, a semistructured open-ended interview guide with flexible probing techniques was employed to explore prescriber’s experience of history taking about herbal medicine use during examination of patients with DM. 2.7. Data Collection Procedures Two trained pharmacists were recruited as data collectors for each hospital. As part of the training, data collectors conducted pretesting of the instrument in Ras Desta Damtew Memorial Hospital under the supervision of the principal investigator, and modifications were done accordingly. All key informant interviews were administered by the principal investigator, who was trained on qualitative research methods. All interviews were recorded, and notes were also taken during interviews to expand later. The interviews were done in Amharic (a local language), and any ambiguities raised from the interviewees were cleared at the time of the interview. Questionnaires prepared in English were translated into Amharic and backtranslated into English to ensure consistency. 2.8. Data Analysis After the data collection, the principal investigator coded each question, and data entry was made using Epi Info version 3.5.4 and transferred to SPSS version 20 for analysis. Descriptive statistics were used to summarize the data. The qualitative data were analyzed using content analysis. It involved intensive reading and rereading through the data, and content analysis had been conducted manually, focusing on similarities and differences of perspectives between different informants. 2.9. Ethical Consideration Ethical approval was obtained from the Ethics Review Committee of the School of Pharmacy, Addis Ababa University, and AACAHB Ethics Review Board. The study was conducted after obtaining permission from the respective hospitals. Participants of the study were also asked for verbal consent before participating in the study. Participants were assured about confidentiality of the information obtained in the course of the study, and there was no use of personal identifiers. 3. Results 3.1. Quantitative Findings 3.1.1. Demographic Characteristics of Respondents From 845 respondents, 791 completed the interview, making up a response rate of 93.6%. Males and females accounted almost similar proportion of sample size of 402 (50.8%) and 389 (49.2%), respectively. The age of the respondents ranged from 18 to 83 with the mean age of 49.07 ± 14.76 years. Among the respondents, one-third of them were housewives, and two-thirds of respondents had attended at least elementary school. A majority (667 (84.3%)) of the respondents were reported as residents of Addis Ababa (Table 1). Variable Frequency Percent Gender Male 402 50.8 Female 389 49.2 Age 18–40 290 36.7 41–64 368 46.5 >64 133 16.8 Marital status Single 159 20.1 Married 526 66.5 Divorced 43 5.4 Widowed 63 8.0 Residency Addis Ababa 667 84.3 Oromia 111 14.1 Others 13 1.6 Religion Orthodox Christian 590 74.6 Muslim 97 12.3 Protestant Christian 89 11.2 Others 15 1.9 Educational level Unable to read and write 187 23.7 Nonformal education 80 10.1 Elementary school 166 21.0 High school 190 24.0 TVET college and above 168 21.2 Occupation House wife 231 29.2 Government employee 146 18.5 Merchant 70 8.8 Daily laborer 80 10.1 Student 45 5.7 Jobless 75 9.5 Others 144 18.2 Tigray, SNNP, and Amhara regions; Jehova’s Witness and Pagan; retired, contract employee, and handicraft.
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Decreased quality of life is observed in individuals who fear surgery or experience severe symptoms due to urinary system stone disease (USSD). As a result, some patients seek complementary and alternative medicine (CAM) methods. This research evaluates preoperative CAM usage and its effects on quality of life for patients who experience renal colic (RC) due to USSD. The research was conducted between April 2020 and 2021 in the application and research center of a university. One hundred ten patients who were scheduled to have surgery due to USSD were included in the study. The data were collected using the "personal information form," "Use of CAM Methods of Individuals," and 36-item Short-Form Health Survey (SF-36) forms. Of research participants, 47.3% reported using at least one CAM method. The most common methods were exercise combined with phytotherapy (16.4%) and dietary supplements (15.5%). The proportion of participants who reported using 1 or multiple CAM methods for pain was 48.1%. The Social Functioning scores obtained from the SF-36 of the CAM users were statistically significant. For the participants who used a CAM method, the average Role-Emotional score obtained from the SF-36 was statistically significant. Health professionals should know which CAM methods patients may prefer and to what extent various CAM methods affect quality of life. More studies are needed to identify factors affecting the use of CAM methods in patients with RC attacks and to understand the relationship between CAM method(s) and quality of life.
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bsbd@balikesir.edu.tr www.bau-sbdergisi.com ÖZET AMAÇ: Hipertansiyon tedavisinde, ilaç tedavisine ek olarak veya tek başına nonfarmakolojik önlemlerin de önemli bir yeri vardır. Bilinçsizce kullanılan Tamamlayıcı Alternatif Tedavi (TAT)'ler hastalık tablosunun ağırlaşmasına ve ortaya çıkan yan etkiler nedeniyle organ fonksiyon bozukluklarına neden olabilmektedir. Araştırma, hipertansiyonu olan bireylerin TAT kullanma durumlarını belirlemek amacıyla yapılmıştır. YÖNTEMLER: Tanımlayıcı tipteki araştırma 347 esansiyel hipertansiyonlu hasta ile yapılmıştır. Verilerin toplanmasında bireylerin demografik özellikleri ve TAT kullanma durumlarını belirlemek amacı ile anket formu kullanılmıştır. Verilerin değerlendirilmesinde sayı, yüzdelik, ki-kare testi kullanılmıştır. BULGULAR: Araştırma sonucunda, çalışma kapsamındaki bireylerin %68.9'unun kadın, %30.1'in 60-69 yaş grubu arasında olduğu ve %83.6'sının evli olduğu tespit edilmiştir. Hastaların %52.7'sinin TAT yöntemi kullandığı, medeni durum ve gelir düzeyi ile TAT kullanma durumu arasında ki ilişki istatistiksel olarak anlamsız iken(p>0.05), yaş, cinsiyet, aile tipi, eşlik eden kronik hastalık, ikamet edilen yer ve eğitim durumu ile TAT kullanma durumu arasındaki ilişkinin istatistiksel olarak anlamlı olduğu (p SONUÇ: Hipertansiyon hastaları TAT yöntemlerini sık kullandıkları için hemşireler hipertansif bireylerde TAT kullanımını belirlemelidir. Hemşirelerin kronik hastalığı olan bireylere güvenli TAT kullanımı hakkında eğitim ve danışmanlık yapması gerektiği ve hemşire öykü formlarının TAT kullanımına ait soruları içermesi önerilebilir. Anahtar Kelimeler: Hipertansiyon, tamamlayıcı ve alternatif tedavi SUMMARY OBJECTIVE: This study was carried out as a descriptive study in order to examine the use of complementary and alternative treatment in the patients with hypertension. METHODS: This descriptive study was conducted with 347 patients. The data was collected by using questionnaire consisting of the information about the patient's demographic characteristics and using state of complementary and alternative treatment. Data that was collected from the study was analyzed by using means, percentage and chi-squared test. RESULTS: The result of the study has shown that 52.7% of the patients use complementary and alternative treatment, marital status and income with use of complementary and alternative treatment were found not to be statistically significant (p>0.05), age, gender, family type, in addition to hypertension availability chronic disease, residing and education with use of complementary and alternative treatment were found not to be statistically significant (p<0.05). CONCLUSION: The patients having hypertension use complementary and alternative treatment. Nurses should determine the use of complementary and alternative treatment for individuals with chronic disease. It is suggested that patients with chronic disease should compose training and counseling programmes related to the safe use of complementary and alternative treatment and nurse medical history forms should include the usage questions about complementary and alternative treatment.
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Öz • en • tr The complementary and alternative medicine (CAM) are commonly encountered by cancer patients. In this study, the methods of CAM used by Turkish cancer patients were documented, and its frequency and the changes in the use of CAM over time were evaluated. Totally of 559 patients were enrolled from Kayseri Training and Research Hospital. Of CAM using patients, 11.8% used alternative medicine products, 60.1% used complementary medicine, and 28% received support from both. Patients with breast cancer were most frequently subgroup using CAM methods. Urtica dioica, nigella sativa and salvia officinalis were frequently used herbal products. Music, exercises and praying were the most common used methods of complementary medicine. Among Turkish cancer patients, the use of CAM methods have switched from alternative medicine which may interact with the cancer therapy, to the methods of complementary medicine not interact with the cancer therapy. The complementary and alternative medicine (CAM) are commonly encountered by cancer patients. In this study, the methods of CAM used by Turkish cancer patients were documented, and its frequency and the changes in the use of CAM over time were evaluated. Totally of 559 patients were enrolled from Kayseri Training and Research Hospital. Of CAM using patients, 11.8% used alternative medicine products, 60.1% used complementary medicine, and 28% received support from both. Patients with breast cancer were most frequently subgroup using CAM methods. Urtica dioica, nigella sativa and salvia officinalis were frequently used herbal products. Music, exercises and praying were the most common used methods of complementary medicine. Among Turkish cancer patients, the use of CAM methods have switched from alternative medicine which may interact with the cancer therapy, to the methods of complementary medicine not interact with the cancer therapy.
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