Use of Complementary & Alternative Medicine in HIV/AIDS Palliative Care
اسلاید 1: www.tabaye.ir
اسلاید 2: Use of Complementary & Alternative Medicine in HIV/AIDS Palliative Care
اسلاید 3: Learning objectivesDefine some of the different types of complementary and alternative careUnderstand why people use CAM and how culture plays a role in its useUnderstand some of the benefits and risks of CAM treatments in HIV/AIDS & palliative careLearn how to communicate with your patients about CAM
اسلاید 4: Consider a case34yoM, HIV+ x 7 years, reluctantly on ARVs for past 2 yrsHas used wide range of CAM therapies in the past, often not divulging to clinicianJust started acupuncture for n/v related to ARVsWants to start a garlic supp to boost immune system
اسلاید 5: What is Complementary & Alternative Medicine (CAM)?A group of diverse medical and health care systems, practices, and products not presently considered to be part of conventional medicine. (NCCAM)Two types:Healing practices used by general publicPractices used by specific ethnic or religious groupsKaptchuk; 2001, Ann Intern Med 135(3): 196-204
اسلاید 6: Five Domains of CAMAlternative Medical SystemsMind-Body Interventions Biologically-based treatments Manipulative therapiesEnergy TherapiesA full glossary of terms is available at http://nccam.nih.gov/health/whatiscam/
اسلاید 7: Who are CAM practitioners?Eisenberg DM et al, Ann Int Med (2002) 137:965-973.
اسلاید 8: Why learn about CAM?Use of CAM in US has increased by 47% in the past decadeMany insurers and managed care providers now cover some CAM therapiesPatients pay billions of dollars for CAM therapiesCAM therapies may interfere or interact with conventional treatmentWetzl, Ann Intern Med 2003; 138: 191-6
اسلاید 9: Why do people use CAM?Poor health statusA last resortRelief of symptoms Less adverse effects than conventional treatmentsConsistent with patients cultural or health beliefsOnly 4.4% of CAM users do not also use conventional medical care. Dissatisfaction with conventional care did not predict use. Astin; JAMA, 1998; 279:1548-1553Pan; J Pain & Symptom Mgmt 2000; 20: 374-897
اسلاید 10: CAM use in cancer and HIV patientsPatterson (2002) J Alt and Comp Med 8(4):477-485Risa (2002) Int J STD AIDS 13:706-713
اسلاید 11: Specific CAM therapies used in HIV/AIDS & palliative careHerbs & supplementsAcupunctureMassage therapyNaturopathic medicineChiropracticMind-Body therapy
اسلاید 12: Herbs and supplements Most common form of CAM used in US Benefits: Vitamins and nutritional supplements may improve well being Risks: Certain herbal treatments have been shown to interact with medications and in some cases are toxic Most herbs and supplements have not been carefully tested
اسلاید 13: Common uses of herbs & supplements in HIV/AIDS careOmega 3 oil as an anti-inflammatory--used to treat neuropathyHigh dose vitamin, mineral and antioxidant therapy to build immune system and slow disease progressionVitamin therapy--treats wasting, lack of appetite, malabsorption of nutrientsChinese herbs to treat diarrheaSt. John’s Wort as antidepressant, antiviral, anti-inflammatory agent.
اسلاید 14: Effect of a vitamin and mineral supplement on infection incidenceBarringer et al (2003) Ann Int Med 138:365n=130 patientsPercent with infection
اسلاید 15: Herbs and supplements: Recent problems and concernsEchinacea: Some believe it may stimulate the immune system and cause progression of HIV.Milk Thistle: May increase the levels of other drugs by slowing down liver enzymes that process these substancesSt. John’s Wort: May reduce the levels of HAART and interfere with chemotherapyKava: May cause liver dysfunction Garlic supplements: May lower levels of certain protease inhibitors
اسلاید 16: AcupunctureA component of Chinese medicine insertion of fine needles into well-defined specific sites to balance energy and promote healthSites of insertion correspond to different energy pathways that relate to symptoms and conditions
اسلاید 17: Common uses of acupuncture in HIV/AIDS & palliative careHelp with pain-related syndromes Reduction of nausea and vomiting Relief of dyspneaTreatment of addictionRisks:Rare cases of pneumothoraxBruising and bleeding may occur but are also rare
اسلاید 18: Capsicum plaster on acupuncture points for post-operative nausea and vomitingKim KS et al, Anesth Analg 2002;95:1103-1107 Percent of patients
اسلاید 19: Massage therapyManipulation of muscle and connective tissue to enhance function of those tissues and promote relaxation and well-beingMany different schools of massage therapy and body work
اسلاید 20: Common uses of massage therapy in HIV/AIDS & palliative careEnhance immune functionReduce musculoskeletal painIncrease lymph flowDecrease anxiety, increase self-esteem and positive body image.Provide human touchRisks: Few risks with licensed and trained practitioners An inexperienced or poorly trained practitioner may cause bruising or pain by the use of rough techniques
اسلاید 21: Naturopathic medicineNaturopathic physicians have extensive training. They rely on natural treatments, such as herbs and supplements, dietary and lifestyle modification, and mind-body medicine
اسلاید 22: Common uses of naturopathy in HIV/AIDS & palliative careUses:Treatment of nausea with gingerImmune enhancement agentsHyperthermia to increase immune functioningRisks:Most treatments have low toxicity; however, herbal remedies used may have not been adequately studied or may interact with medications
اسلاید 23: ChiropracticFocuses on the relationship between bodily structure (primarily that of the spine) and function, and how that relationship affects the preservation and restoration of healthChiropractors use spinal manipulative therapy as an integral treatment toolFrequently requested by patients with musculoskeletal pain
اسلاید 24: ChiropracticBenefits: Users claim relief from musculo-skeletal complaintsRisks: Cervical manipulation has been associated with vascular injury and strokeChiropractic spinal manipulation is NOT recommended for the treatment of pain secondary to cancer
اسلاید 25: Mind-body therapyA variety of techniques used to enhance the mind’s capacity to affect the bodyIncludes meditation, visualization, mental healing, prayer, and creative outlets such as music and artBenefits: Emotional support, peace of mind and reduced stress have been reported in studies
اسلاید 26: Common uses of mind-body therapy in HIV/AIDS & palliative careMeditation to alleviate emotional distressRelaxation techniques used to treat pain and dyspneaRisks: Virtually none unless the patient is coerced into treatments they do not want or if patient has unrealistic expectations of the benefit (i.e. cure)
اسلاید 27: Recommendations for CAMMay be useful for non-pharmacologic treatment of a number of concerns, including musculoskeletal pain, nausea and vomitingUse a licensed provider Re-evaluate the costs and the benefits after several weeksConsultation between the conventional care team and CAM provider is recommended to avoid contraindicated therapies
اسلاید 28: Other healing practicesEthno-medicineNative American traditional healersMexican American curanderismoHaitian vodunFolk medicineReligious healing
اسلاید 29: Why talk about CAM with patients? Information available to patient can be confusing or misinformedPatient may have misconceptions about conventional treatment availablePotential for adverse effects and drug interactions if provider does not know about CAM use by patient
اسلاید 30: Talking to a patient about CAMAsk the question:“Patients with HIV/AIDS often use other kinds of therapy for symptom relief or to help their immune system. For example, some patients use massage, acupuncture, herbs, etc. Have you used these or thought about using them for your illness?”Eisenberg; Ann Intern Med (1997); 127:61-9
اسلاید 31: Talking to patients about CAMUse pt. response to identify the issue of concernAsk for patient’s expectations or experience of the proposed treatmentReview issues of safety and efficacyRecommend that patient use a licensed providerConsult with the CAM provider Raise allopathic alternatives if relevantEisenberg (modified); Ann Intern Med (1997); 127:61-9
اسلاید 32: Reconsider a case34yoM, HIV+ x 7 years, B3, reluctantly on ARVs for past 2 yrs.Has used wide range of CAM therapies in the past, often not divulging to clinicianJust started acupuncture for n/v related to ARVsWants to start a garlic supp to boost immune system
اسلاید 33: Encourage:Responsible use of complementary and alternative therapiesGood communication with pt. and between all providersDiscourage:Treatment by unlicensed practitionersInjections of substances not approved by FDATreatments that have known adverse effects or drug interactionsSummary
اسلاید 34: ResourcesThe Body is a Web site for HIV related issues; There is a forum called “Ask The Experts” http://www.thebody.com/index.htmlBastyr Center for Natural Health is a comprehensive clinical service in Seattle staffed with a variety of trained CAM providers. Their telephone number is 206.834.4100
اسلاید 35: ContributorsThe primary author of this module is William Lafferty, MD, Assistant Professor, University of Washington, Department of Health ServicesAnthony Back, MDDirectorJ. Randall Curtis, MD, MPHCo-DirectorFrances Petracca, PhD EvaluatorLiz Stevens, MSW Project ManagerVisit our Website at uwpallcare.orgCopyright 2003, Center for Palliative Care Education, University of WashingtonThis project is funded by the Health Resources and Services Administration (HRSA) and the Robert Wood Johnson Foundation (RWJF).
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