Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures. METHODS: Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome. RESULTS: Eleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use of Zingiber officinale (ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with Rosa damascena (damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs). CONCLUSIONS: There is very low-certainty evidence regarding the efficacy of both Zingiber officinale and Rosa damascena in reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs. PROSPERO REGISTRATION NUMBER: CRD42016042838.

Herbal medications for surgical patients: a systematic review protocol.

INTRODUCTION: Postoperative nausea and vomiting (PONV) affect approximately 80% of surgical patients and is associated with increased length of hospital stay and systemic costs. Preoperative and postoperative pain, anxiety and depression are also commonly reported. Recent evidence regarding their safety and effectiveness has not been synthesised. The aim of this systematic review is to evaluate the efficacy and safety of herbal medications for the treatment and prevention of anxiety, depression, pain and PONV in patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgical procedures. METHODS AND ANALYSIS: The following electronic databases will be searched up to 1 October 2016 without language or publication status restrictions: CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and LILACS. Randomised clinical trials enrolling adult surgical patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgeries and managed with herbal medication versus a control group (placebo, no intervention or active control) prophylactically or therapeutically will be considered eligible. Outcomes of interest will include the following: anxiety, depression, pain, nausea and vomiting. A team of reviewers will complete title and abstract screening and full-text screening for identified hits independently and in duplicate. Data extraction, risk of bias assessments and evaluation of the overall quality of evidence for each relevant outcome reported will be conducted independently and in duplicate using the Grading of Recommendations Assessment Development and Evaluation classification system. Dichotomous data will be summarised as risk ratios; continuous data will be summarised as standard average differences with 95% CIs. ETHICS AND DISSEMINATION: This is one of the first efforts to systematically summarise existing evidence evaluating the use of herbal medications in laparoscopic, obstetrical/gynaecological and cardiovascular surgical patients. The findings of this review will be disseminated through peer-reviewed publications and conference presentations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016042838.

Florais de Bach em paciente com histórico de abuso sexual: um relato de caso / Flower remedies in patient with a history of sexual abuse: case report

Introduction: According to the World Health Organization (WHO), child sexual abuse is regarded as one of the greatest public health problems. Psychological and emotional effects of sexual abuse can be devastating to the survivors and social and relationship problems arising from this abuse can persist well into adulthood4. Objective: This case study reports on the treatment effects of Bach's flower remedies on a 21 years old, female patient with a history of sexual abuse living in Brazil. Methods: Treatment consisted of remedies comprised of six flower essences that were selected each month over a four-month time period. Data were collected using two open-ended questions that explored the effect of the remedies on the patient's physical, cognitive, emotional and spiritual health as well as her perceptions about the positive and negative aspects of using Bach's flower remedies. Qualitative content analysis was conducted. Results: Over the course of the intervention, the patient reported a significant improvement in her emotional well-being, being able to have a "good laugh" and no longer feeling ashamed of being happy. Also she started pursuing dating relationships throughout the period of treatment. Conclusion: Bach's flower remedies may be a promising intervention for individuals who have experienced childhood sexual abuse and have experienced difficulties in developing relationships. In this case study, a female sexual abuse survivor reported Bach's flower remedies as having beneficial effects with regards to her willingness to engage in dating behaviour and pursue the possible establishment of intimate relationships.(AU)

Introdução: Segundo a Organização Mundial da Saúde (OMS), o abuso sexual infantil é considerado como um dos maiores problemas de saúde pública. Os efeitos psicológicos e emocionais do abuso sexual podem ser devastadores e os problemas sociais e de relacionamento decorrentes podem persistir até a vida adulta. Objetivo: Este estudo de caso relata os efeitos do tratamento com os remedios florais de Bach em uma paciente de 21 anos, do sexo feminino, de nacionalidade Brasileira com um histórico de abuso sexual. Métodos: O tratamento consistiu em remédios compostos por seis essências florais que foram selecionados a cada mês, durante um período de quatro meses. Os dados foram coletados por meio de duas perguntas abertas que exploraram o efeito dos remédios na saúde física, cognitiva, emocional e espiritual da paciente, bem como suas pecepções sobre os aspectos positivos e negativos do uso de remédios florais de Bach. Foi realizada uma análise quantitativa. Resultados: Ao longo da intervenção, o paciente relatou uma melhora significativa no seu bem-esstar emocional, onde se sentiu capaz de dar uma "boa risada" e não sentir mais vergonha de ser feliz. Além disso, ela se permitiu iniciar um namoro durante o período de tratamento. Considerações: Os remédios florais de Bach podem ser uma intervenção promissora para indivíduos que sofreram abuso sexual na infância. Nesse estudo de caso, uma vítima de abuso sexual relatou resultados positivos com o tratamento com os florais de Bach, principalmente no que diz repeito a á criação de relacionamentos íntimos.(AU)