National Institutes of Health's Clinical Center sets new policy on use of herbal and other alternative supplements by patients enrolled in clinical trials.

The nationwide concern over the escalating use of herbal and other alternative dietary supplements is prompting a call for action in health care organizations. Not only is there mounting evidence to support a strong concern for patient safety, but the use of these products by people participating in biomedical research protocols has an added impact on the integrity of the research design and data gathering. These issues are of increasing concern to the National Institutes of Health's hospital for biomedical research, the Warren Grant Magnuson Clinical Center. Surveys completed in 2000 showed that 25-45% of Clinical Center patients reported taking herbal and other alternative dietary supplements. In 2001, the Clinical Center moved forward to develop and implement a policy to guide hospital staff in the management of patient use of herbal and alternative supplements. The policy established the requirement for all patients to be screened for supplement use upon admission or outpatient visit. Continued use of supplement products during hospitalization and/or outpatient enrollment on protocol require a physician's authorizing order. The implementation of this policy has increased awareness and provided an important step forward in protecting patient safety and preserving the scientific integrity of the research at the NIH's Clinical Center.

Complementary therapy in critical care settings: a review of surveys and implications for nurses.

Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.

A systematic review of the quality of research on hands-on and distance healing: clinical and laboratory studies.

PURPOSE: To systematically review the quality of published experimental clinical and laboratory research involving hands-on healing and distance healing between 1955 and 2001. DATA SOURCES: Studies were identified through comprehensive literature searches on spiritual healing in MEDLINE, PSYCH LIT, EMBASE, CISCOM, and the Cochrane Library from their inceptions to December 2001. STUDY SELECTION: We selected published randomized, controlled trials of spiritual healing (hands-on healing and distance healing) done in clinical and laboratory settings, all of which had been peer reviewed. DATA EXTRACTION: Independent quality assessment of internal validity was conducted on all identified studies using the comprehensive Likelihood of Validity Evaluation scale. Clinical and laboratory studies were analyzed separately and then subdivided into hands-on healing or distance healing interventions. RESULTS: A total of 45 laboratory and 45 clinical studies published between 1956 and 2001 met the inclusion criteria. Of the clinical studies, 31 (70.5%) reported positive outcomes as did 28 (62%) of the laboratory studies; 4 (9%) of the clinical studies reported negative outcomes as did 15 (33%) of the laboratory studies. The mean percent overall internal validity for clinical studies was 69% (65% for hands-on healing and 75% for distance healing) and for laboratory studies 82% (82% for hands-on healing and 81% for distance healing). Major methodological problems of these studies included adequacy of blinding, dropped data in laboratory studies, reliability of outcome measures, rare use of power estimations and confidence intervals, and lack of independent replication. CONCLUSIONS: When laboratory studies were compared to clinical studies in the areas of hands-on healing and distance healing across the quality criteria for internal validity, distance healing studies scored better than hands-on healing studies, and laboratory studies fared better than clinical studies. Many studies of healing contained major problems that must be addressed in any future research.

Surveys of complementary and alternative medicine: Part V. Use of alternative and complementary therapies for psychiatric and neurologic diseases.

Surveys of general complementary and alternative medicine (CAM) use have suggested an association with high levels of depression and anxiety. This raises the question of whether anxious or depressed people seek CAM, or whether there are underlying factors associated with long-term chronic illness. There is no clear indication from four surveys of psychiatric patients. These are summarized and presented. A separate table summarizes three studies of patients with neurologic diseases, two of patients with multiple sclerosis, and one of a mixed patient population. More studies are amassing in specific disease areas, although it is difficult to detect clear trends because of methodological and terminological incompatibilities.