Use of and attitudes held towards unconventional medicine by patients in a department of internal medicine / oncology and haematology

A sizeable percentage of patients receiving conventional medical treatment also use unconventional medicine (UM). Surveys indicate that the prevalence of and motivation for the pursuit of the different approaches of UM is subject to individual, geographical, cultural and disease-related factors. We were interested in the concurrent use of and attitudes towards UM in patients who underwent conventional medical treatment in our oncologically orientated department of internal medicine in a regionally dominant teaching hospital. A representative sample (n = 131) of all inpatients and outpatients receiving treatment in the department or in its oncological/haematological outpatient clinic were asked to participate in a cross-sectional interview study on the use of unconventional therapies. In all, 128 patients (97.7%) agreed to participate in the study, and 65% of these patients were suffering from malignancies. Use of unconventional treatment was reported by 24% of all patients for their current medical problem, and 16% of the remaining patients had been thinking of adjunctive use. The use of UM was significantly higher among oncological patients (32%), and among oncological outpatients in particular (50%), than among patients with acute or chronic non-malignant diseases. Female patients predominated among the users of UM (71%). UM mainly took the form of various pharmacological and dietary approaches. Patients availing themselves of UM most frequently identified physicians (41%) as the source of treatment recommendation. Only 18% of the users of UM relied on these methods as a chance of cure. Use of UM was not generally motivated by dissatisfaction with conventional medical care. Only half the users informed their hospital physician of their adjunctive use of UM. Nearly 2 out of 3 of the users contended that UM had contributed to a mild or distinct improvement in their physical or psychological wellbeing. The use of UM in modern health care systems represents a widespread and intricate phenomenon, which cannot be understood by focusing exclusively on the objective assessment of clinical efficacy. Use of UM may be related more to a disease's unfavourable attribution than to its medically expected outcome. Coherence with individual illness paradigms and perceived efficacy are apparently important factors in patients' use of UM. These subjective aspects need to be recognised in caring patient-doctor communication.     

Unkonventionelle, alternative Therapieverfahren in der Onkologie

Zum Thema Es kommt im Alltag ?rztlicher Praxis h?ufig vor, da? Tumorpatienten oder deren Angeh?rige sich mit dem Schicksal ihrer Erkrankung nicht abfinden wollen und weitere Therapie als die bisherigen einfordern, die nicht von der „Schulmedizin” angeboten werden. Dies geschieht nicht selten mit forderndem Unterton, verbunden mit irrationalen Vorstellungen über die Vorenthaltung wirksamer Behandlung und über sich vermeintlich kontrovers gegenüberstehende medizinische Lager: hier Schulmedizin, dort „Alternativ”medizin.> Die Regel ist, da? man als Arzt auf dem Boden wissenschaftlicher Medizin von den zahllosen sogenannten unkonventionellen Krebstherapien, -Di?ten, -Medikationen und anderen Verfahren meistens wenig Ahnung hat. Das irritiert den Patienten zus?tzlich und best?rkt ihn eher in seiner Absicht, sich entsprechend behandeln zu lassen, egal ob von seinem Arzt, von einem anderen spezialisierten „Krebs”-Arzt, einem Heilpraktiker oder gar von einem Wunderheiler.> In der vorliegenden ausführlichen übersicht wird über eine Unzahl unkonventioneller Krebsbehandlungsmethoden referiert. Deren Kenntnis ist eine wichtige ?rztliche Argumentationshilfe bei dem Patientenwunsch nach unkonventionellen Verfahren. Nur wer auch darüber etwas wei?, wird das Vertrauen des Tumorpatienten nicht verlieren und ihn ?rztlich und menschlich weiterhin betreuen k?nnen, vor allem aber sorgf?ltig darüber wachen, da? wirksame konventionelle Ma?nahmen nicht unterbleiben.     

Characterization of Meibomian gland innervation in the cynomolgus monkey (Macaca fascicularis)

To characterize the innervation of the cynomolgus monkey (Macaca fascicularis) Meibomian (tarsal) glands, upper lids of six cynomolgus monkeys were investigated with electronmicroscopical and double-labeling immunocytochemical methods. Antibodies against calcitonin gene-related peptide (CGRP), dopamine-β-hydroxylase (DBH), neuropeptide Y (NPY), nitric oxide synthase (NOS), protein gene product 9.5 (PGP 9.5), substance P (SP), tyrosine hydroxylase (TH), and vasoactive intestinal peptide (VIP) were used. In addition, sections were processed for NADPH-diaphorase (NADPH-d) histochemistry. Staining for PGP 9.5 and electron microscopy showed that Meibomian gland acini were surrounded by a network of unmyelinated nerves and terminal varicose axons. The terminals contained small agranular (30–60 nm) and large granular vesicles (65–110 nm), and were observed in close contact with the basal lamina of the acini, but never internally to the basal lamina. Meibomian axons showed like-immunore-activity (LI) for the neuropeptides SP, CGRP, NPY, and VIP. In addition, the axons stained for TH, DBH, NOS, and NADPH-d. VIP-LI, NOS- and NADPH-d-positive axons appeared to be more numerous, TH- and DBH-positive axons more rare than others. Most SP-LI axons were double-labelled for CGRP-LI, some for VIP-LI or NPY-LI. In addition, some VIP-LI axons were double-labeled for NPY-LI. NPY/VIP-LI and NPY/SP-LI axons were only observed close to the Meibomian acini. Conversely, NPY-LI colocalized with TH-IR or DBH-IR predominated in perivascular nerves of Meibomian gland vasculature. The close association of varicose axons with the acini of Meibomian glands indicates that nervous signals modulate meibomian secretion. Meibomian gland nerve fibers in the cynomolgus monkey appear to utilize various neuropeptides, catecholamines and nitric oxide as transmitter substances, and seem to derive from the pterygopalatine, superior cervical and trigeminal ganglion respectively.     

Unkonventionelle Verfahren

Many cancer patients are interested in and use unconventional methods as a part of their coping with the illness. In contrast, for oncologists, these methods represent an ambiguous phenomenon, afflicted with many contradictory peculiarities and without a consistent body of knowledge, hence a difficult ?borderland“. Therefore handling this issue is challenging and confronts conventional oncologists with a complex array of ethical conflicts. With a phenomenologically oriented approach ways of decision making and communicating the issue of unconventional methods are suggested. Concrete steps are provided which facilitate dealing with this topic in daily practice thus enabling a strengthening of the physician-patient relationship.     

Methodological quality of patient-reported outcome research was low in complementary and alternative medicine in oncology

OBJECTIVE: To evaluate the methodological robustness of patient-reported outcomes (PROs) evaluation in complementary and alternative medicine (CAM) randomized controlled trials (RCTs) in oncology. STUDY DESIGN AND SETTING: CAM RCTs with a PRO endpoint were retrieved from a number of electronic databases. CAM interventions were defined according to the five major categories of the National Center for Complementary and Alternative Medicine. The "Minimum Standard Checklist for Evaluating HRQOL Outcomes in Cancer Clinical Trials" was used to assess the quality of the PRO reporting in these trials. RESULTS: Forty-four RCTs enrolling 4,912 patients were identified: six studies involved alternative medical systems, 14 involved mind body interventions, 15 dealt with biologically-based therapies, seven involved manipulative and body-based methods, and two energy therapies. Eighty-nine percent of studies used a PRO as a primary endpoint and 59% documented PRO missing data. Although 84% of the studies used a validated PRO questionnaire, only 37% stated an a priori hypothesis and 20% addressed clinical significance of the outcomes. Overall, 64% of the studies analyzed exhibited a number of methodological drawbacks. CONCLUSIONS: To facilitate the interpretation of results from such CAM RCTs, investigators are encouraged to pay greater attention to key methodological issues as identified in this study.     

Bedeutung komplementärmedizinischer Verfahren bei Patienten mit Prostatakarzinom

Background

In Germany, many prostate cancer patients use complementary medicine (CM) or have an interest in these treatment approaches; however, the information and consultation situation of cancer patients is insufficient and therefore the Competence Network Complementary Medicine in Oncology (COCON) was launched by the German Cancer Aid Society. One of the projects of the COCON examines the use of CM and the information and counseling needs regarding these topics in various groups of cancer patients. The focus of this article is on the qualitative study reporting selected results for the subgroup of prostate cancer patients.

Study design and study methods

A total of 19 semi-structured qualitative interviews with prostate cancer patients were conducted regarding the use of CM as well as their information and consultation needs.

Results

It was found that the patients interviewed discussed various issues surrounding nutrition, particularly a healthy diet, the selective use of certain foods and the use of dietary supplements. Additional themes mentioned by interviewees were physical exercise, psychological well-being, mistletoe therapy, homeopathy and traditional Chinese medicine. Patients indicated that they wanted more information and counseling opportunities with regards to CM. They also expressed a desire for more holistic care.

Conclusion

The results show that prostate cancer patients use a range of CM and have a need for information about CM. Prostate cancer patients are in a special situation because of a regular feedback on the prostate-specific antigen (PSA) value. This should be taken into consideration in consultation with prostate cancer patients regarding CM.     

Komplementärmedizin in der Onkologie

best practice onkologie -     

Alterations in anterior segment dimensions in eyes with retinitis pigmentosa

Background: In visually deprived primate eyes there is a correlation between alterations in growth parameters and changes in retinal neurotransmitters. Progressive retinal degeneration also leads to alterations in retinal neurotransmitters. In this study we wanted to investigate whether alterations in the dimensions of the anterior eye segment are also present in human donor eyes of patients with hereditary retinal degeneration. Methods: Sagittal sections through anterior segments of 47 eyes from donors with different types of retinitis pigmentosa (RP) and of 59 eyes from normal donors were investigated morphometrically using a PC-based morphometric system. Results:. In the RP eyes there was a significant shortening of the distance between the peripheral end of Descemet's membrane and the posterior end of Schlemm's canal and of the length of the pars plana of the ciliary body. These changes varied markedly among the different types of RP. The most pronounced shortenings were found in eyes of men with X-linked recessive RP, which had the most severe retinal changes. RP eyes showed, in contrast to normal eyes, significant age-related elongation of the ciliary body and the chamber angle. A significant increase of the axial diameter with age was also found in RP eyes. Conclusion: Our study reveals for the first time that there are changes in the anterior segment dimensions in human eyes with hereditary retinal degeneration. Measurements of anterior eye segment parameters might provide additional indices for the severity of RP and for the diagnosis of RP subtypes.