A Survey of Complementary and Alternative Medicine (CAM) Awareness Among Neurosurgeons in Washington State (original) (raw)
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OBM Integrative and Complementary Medicine
Art as a way of healing is primordial in many cultures. Expressive Arts Therapy (ExAT) uses art, music, dance, and writing to help individuals navigate their healing journey. Patient self-expression as a mode of recovery has been observed in patients with Parkinson’s disease, epilepsy, Amyotrophic Lateral Sclerosis (ALS) and cancer. Complementary medical approaches such as acupuncture and mindfulness have also demonstrated benefits in patients suffering from neurological injury. Complementary medicine and ExAT are not mainstream approaches following neurosurgical procedures. There are very few systematic studies evaluating the benefits of expressive arts in neurosurgery. Advances in telemedicine and mobile applications may facilitate the incorporation of complementary medicine and ExAT into patient recovery. The purpose of our study is to explore the use of complementary medicine and ExAT in neurosurgical recovery. We start with a brief introduction of ExAT followed by available tre...
International Journal of Physical Medicine and Rehabilitation, 2015
Background: Acquired brain injury (e.g., stroke and traumatic brain injury or TBI) and associated sequelae are highly prevalent in the United States (U.S.), impacting both civilians and military populations. Because conventional treatments can be limited and functional recovery incomplete, complementary and alternative medicine (CAM) is often sought out. The popularity of CAM exists despite inconclusive research findings for CAM treatments for injuryassociated sequelae. Apparent methodological limitations in CAM studies include issues related to experimental design, control groups, sample size, blinding and disparities in outcome measures. Overcoming these limitations poses challenges, but not insurmountable ones. Objective: Delineate and describe the necessary evidence-based infrastructure so that efficacious CAM treatments can be identified and this information disseminated to individuals seeking CAM therapies. With the full information of both risks and benefits, there is a increased likelihood of resources being invested in treatments that will achieve outcomes of interest. Design: The present review of a published body of work will describe, step-by-step, the fundamental framework within which researching the CAM intervention acupressure for two types of acquired brain injury (traumatic brain injury/TBI and stroke), can be accomplished using the highest methodological rigor. Results: Included is a review and description of the "choice points" encountered in the decade-plus of published research from the CAIRR (Clinical Assessment of Injury, Recovery and Resilience) Neuroscience Laboratory, the methodological framework underlying these choice points, and how decisions at each choice point were made to optimize rigor. Conclusions: Cogent scientific research is essential for identifying effective treatments for acquired brain injury, regardless of whether the treatments are conventional or CAM-based. In terms of CAM, such work will provide the opportunity to characterize both efficacy and limitations of CAM treatments, so that CAM may be fully understood and accessed appropriately by both treatment teams and those engaged in rehabilitation.
Randomized controlled trials in neurosurgery
Surgical Neurology International
Randomized controlled trials (RCTs) have become the standard method of evaluating new interventions (whether medical or surgical), and the best evidence used to inform the development of new practice guidelines. When we review the history of medical versus surgical trials, surgical RCTs usually face more challenges and difficulties when conducted. These challenges can be in blinding, recruiting, funding, and even in certain ethical issues. Moreover, to add to the complexity, the field of neurosurgery has its own unique challenges when it comes to conducting an RCT. This paper aims to provide a comprehensive review of the history of neurosurgical RCTs, focusing on some of the most critical challenges and obstacles that face investigators. The main domains this review will address are: (1) Trial design: equipoise, blinding, sham surgery, expertise-based trials, reporting of outcomes, and pilot trials, (2) trial implementation: funding, recruitment, and retention, and (3) trial analysi...
Neurosciences, 2016
Basic concepts for the appraisal and application of scientific information to patient care (Part II
Patterns of usage of complementary and alternative medicine in general surgical patients
International Journal of Surgery, 2006
Background: Use of complementary and alternative medicine (CAM) is becoming increasingly common. The purpose of this study was to determine the prevalence among general surgical patients, whether its use is related to disease type, and if postoperative patient-perceived problems and actual complications may be related to some CAM use. Methods: One hundred fifty-one consecutive patients over a 3 month period were queried. Demographic information was obtained from the medical record pertaining to age, gender, race, marital status, treatment and postoperative complications. CAM practices were divided into three categories: body/structure, herbal medications/supplements, and mind/spirit. Data were analyzed for overall use of CAM and type of CAM. Relationships of CAM use to gender, age, race, and disease type, patient-perceived postoperative problems, and actual incidence of postoperative complications were determined. Results: Sixty patients (40%) used some type of CAM: 17% body/structure interventions, 31% herbal medications, and 3% mind/spirit practices. Demographics of CAM use: 47% of Caucasians, compared to 29% of African-Americans (OR ¼ 2.2, p ¼ 0.03); 44% of females, compared to 34% of males (p ¼ NS); 49% of patients 60 years old, compared to 32% of patients > 60 years old (OR ¼ 2.0, p ¼ 0.04); 48% of patients with a cancer diagnosis, compared to 31% of patients with a benign diagnosis (OR ¼ 3.1, p ¼ 0.04). Thirty-three of CAM patients reported some type of postoperative problem, compared to 26% of non-CAM patients (p ¼ NS). Actual complication rates were 8% for CAM patients, compared to 11% for non-CAM patients (p ¼ NS). Conclusions: Use of CAM is relatively common, with younger, Caucasian patients with malignancies being the most common users. However, there seems to be no difference in perceived postoperative problems, nor actual postoperative complications between CAM and non-CAM users.
Springer eBooks, 2019
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Neurosciences (Riyadh, Saudi Arabia), 2016
Every neurosurgeon ought to be acquainted with the basics of research methods to enhance the comprehension of the research process and critical appraisal procedures of a scientific write-up. This in turn will ensure the appropriate application of scientific knowledge to patient care. Recent publications reveal that a significant proportion of articles published in neurosurgery are mislabeled with dire consequences on the sorting and indexing of evidence. Furthermore, many clinicians report that they feel unqualified to read the medical literature critically hence, it is for this reason that we conducted this review. Herein, we present a simple algorithm to facilitate the comprehension of research methods, as well as elucidate on the anatomy of common study designs in neurosurgery. Illustrative examples are provided when necessary. Understanding research methods and the critical analysis of published reports of clinical investigation is a fundamental skill of the physician to enable ...
Evidence-based clinical management and utilization of new technology in European neurosurgery
Acta Neurochirurgica, 2013
Background Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. Methods We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidencebased treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. Results A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. Highvolume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals.