W8 Complementary and Alternative medicine (AT) Flashcards
Quality of Evidence Pyramid: (for info)
- Clinical Practise Guidelines / Meta-Analysis/ Systematic reviews
- RCTs
- Cohort Studies
- Case Control Studies
- Case Report or Case series / Narrative reviews, expert opinion
- Animal and Lab Studies
Sources of Evidence- which is used for CAM?
- RCTs - gold standard but have limitations for CAM
- Clinical audits - evaluate real world practice, track outcomes
- Observational studies - monitor use, survey patient perspectives
- Anecdotal reports - traditional basis but lack controls
- Literature searching - multiple sources needed, critical appraisal key
Issues with RCTs for CAM? (3)
- Lack of funding
- Subjective vs objective measures
-Patient reported outcomes vs clinical indicators - Bias and limitations
-Confirmation bias, publishing bias, lack of replication
Evidence-Based Medicine- what to consider?
- Integrating clinical expertise, patient values, and best available
evidence - Patient preferences, practitioner expertise
What are the CAM Research Problems? (5)
- Lack of funding and prioritisation - limited resources, lack of
coordination - Placebo and blinding difficulties - sham acupuncture, homeopathy
dilutions - Lack of standardisation - variation in techniques and protocols
- Publishing bias - selective reporting of positive trials
- Other issues - small samples, lack of hypotheses, poor methodology
What to consider about Safety and Risks?
- Direct - reactions to medicines, damage from procedures
- Indirect - inaccurate diagnosis, untreated serious conditions, drug
interactions - Underreporting - lack of monitoring systems
- Need for training - stay within scope, refer as needed
- Public awareness - balance of risks vs. benefits
True or False?
Around 20% of doctors use or refer
patients to CAM therapies?
RCTs are the gold standard for
evaluating CAM therapies
=True
Herbal Medicine
- Using plant-derived materials as medicines
- Requires knowledge of potential side effects and drug interactions
- Widely used for minor conditions and preventive health
- May not be thoroughly tested for efficacy, toxicity, drug interactions
and teratogenicity. - Variation in potency between batches and correct doses are not carefully established.
- The MHRA provides a list of registered herbal medicines.
- Some herbal ingredients are toxic and cannot be used in the manufacture, import and sale of unlicensed medicines in the UK.
- Often contain mixtures of many chemical compounds obtained from
the plant although precise compositions can be variable due to the natural source. - Can interact with prescription and other conventional medicines.
- Certain herbal ingredients should be avoided or used with caution in pregnancy and while breastfeeding.
Medicines reconciliation definition?
A process of identifying an accurate list of a patient’s current medicines (inc OTC and complementary medicines) and carrying out a comparison of these with the current list in use, recognising any discrepancies
What book is used by HCPs for info re herbal medicines?
Stockley’s Herbal Medicines Interactions Book
Herbal Medicine
St John’s wort:
Is it effective/safe?
St John’s wort is one of the best-researched.
* Efficacy and safety:
-Evidence shows it may be effective for major depression, but has many
potential serious drug interactions and side effects
* Regulation and guidance:
-It is not regulated as a pharmaceutical medicine, but as a herbal remedy
-Products vary in standards of safety and quality
-NICE does not recommend its use for depression due to uncertainties about
dose, effectiveness, product variability, and drug interactions
What is Homeopathy?
- Using highly diluted substances to stimulate healing
- Based on “like cures like” principle
- Most research is low quality or inconclusive
- The MHRA does not currently require homeopathic products to demonstrate efficacy, only quality and safety
Homeopathy dilutions:
- The dilution most frequently sold in pharmacies is 6c, which is a 10-12
dilution of the original mother tincture. - A product of 6c dilution will contain just a few molecules of the initial substance
- A product of 30c (10-60 dilutions), will contain even fewer.
- Homeopathic remedies are usually safe, but less diluted ones may have more active ingredients.
- Highly diluted remedies rarely have side effects, though they may initially worsen symptoms in some people.
- They can also cause reactions in those with lactose intolerance
Homeopathy- pharmacist’ opinion?
- Pharmacists should explain that there is little evidence it works.
- Give advice relevant to the patient’s condition.
- Ensure patients don’t stop taking prescribed medication if using homeopathic products.
What is Acupuncture?
- Insertion of thin needles into specific points of the body
- Aims to restore balance of qi (energy flow)
- Used for pain relief, nausea, addiction treatment
Now recommended by NICE for certain conditions
