Peppermint Essential Oil for Nausea and Vomiting in Hospitalized Patients: Incorporating Holistic Patient Decision Making Into the Research Design.

AIMS: This study examined nausea and vomiting (N/V) in hospitalized patients following the use of inhaled peppermint essential oil (aromatherapy) compared to combined aromatherapy/antiemetics or antiemetics alone. METHOD AND MATERIALS: A total of 103 hospitalized patients were offered one of three options to control N/V. Patient choice was considered in the holistic trial design so that patients were not denied either the essential oil or antiemetics. Patients rated nausea 0 to 10 on the Edmonton Symptom Assessment Scale at symptom onset and within 60 minutes of the intervention. RESULTS: Only three subjects enrolled in the antiemetic arm; thus this arm was eliminated from analysis, resulting in 100 evaluable patients. Mean nausea score improved significantly for the entire sample following the aromatherapy or aromatherapy/antiemetic intervention (p < .0001). Patients in the aromatherapy arm had significant improvement in nausea compared to the combined aromatherapy/antiemetic arm (p < .0001). Patient perception that peppermint oil relieves N/V significantly improved for the entire sample. Notable is that 65% of patients used peppermint essential oil alone. CONCLUSIONS: Peppermint essential oil is an effective independent or complementary modality for relief of N/V in hospitalized patients. Research designs that incorporate patient decision making should be considered for studies in which placebos do not contribute to holistic care.

The effect of inhalation aromatherapy with damask rose essence on pain intensity and anxiety in burned patients: A single-blind randomized clinical trial.

INTRODUCTION: Pain and anxiety are a major problem of burn patients. Despite the use of different medications, patients still suffer from these two problems. Aromatherapy along with medication may help in alleviating these symptoms. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients. METHODS: This three group clinical trial was conducted on 120 patients with burns less than 30% TBSA. The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no intervention. RESULTS: Baseline state-trait anxiety and pain intensity were similar in these three groups (p > 0.05). We found a significant reduction in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups (p < 0.001). However, we found no significant difference between the placebo and control groups in terms of these variables at these times (p > 0.05). Also, we found no significant difference among three groups in frequency of analgesics drugs and trait anxiety after intervention (p > 0.05). CONCLUSION: Inhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.

Effects of sweet orange aromatherapy on pain and anxiety during needle insertion among patients undergoing hemodialysis: A quasi-experimental study.

PURPOSE: Patients undergoing hemodialysis experience pain and anxiety during needle insertion, and the scientific interest in aromatherapy in reducing pain and anxiety is increasing. Thus, this study aimed to determine the effects of sweet orange aromatherapy on pain and anxiety during needle insertion in hemodialysis. DESIGN: Quasi-experimental, pretest, and posttest. METHODS: This study was carried out among 50 patients with chronic kidney disease who were non-randomly assigned to either sweet orange aromatherapy or calm breathing in three outpatient hemodialysis centers in the Philippines between July and August 2015. The numeric rating scale and adapted state-trait anxiety inventory were utilized to measure pain and anxiety. RESULTS: After the intervention, both the pain and anxiety scores were significantly lower for patients who received sweet orange aromatherapy than those who received calm breathing. The results obtained modest effect sizes that imply high practical significance. CONCLUSION: The sweet orange aromatherapy can be effective in reducing pain and anxiety. Thus, this can be used by nurses as an alternative and complementary approach to reduce both pain and anxiety in painful procedures like needle insertion.

Establishing a Comprehensive Aromatherapy Program in Patient Care Settings.

Since the profession began, nurses have sought to comfort through their healing presence and interventions. Clinical aromatherapy is an ancient practice finding new attention in modern-day health care to contribute to relief of symptoms of pain, anxiety and nausea. The use of complementary and integrative therapies is on the rise as clinicians and consumers seek to reduce the use of medications and the evidence-base for integrative therapies continues to expand. This article describes the development and introduction of a clinical aromatherapy program into a hospital system using a train-the-trainer model. Lessons learned from the process and future considerations are also discussed.

Essential Oils to Reduce Postoperative Nausea and Vomiting.

PURPOSE: The purpose of this study was to determine if using essential oil products for adult patients reduced the need for antiemetics for postoperative nausea and vomiting (PONV). DESIGN: A prospective and retrospective cross-sectional design using a convenience sample. METHODS: Double blinded to the type of essential oil, subjects randomly selected a nasal inhaler containing peppermint, ginger, or a combination of both. A prophylactic dose was given preoperatively, and during the postoperative period nausea was assessed using verbal descriptive scale. FINDINGS: Overall 322 same day surgical patients were analyzed (control group [n = 179] and intervention group [n = 143]). The intervention group had a greater history of PONV but received fewer doses of antiemetics postoperatively compared with the control group. There was no significant difference in the effectiveness of the three types of inhalers. CONCLUSIONS: Aromatherapy demonstrated a statistically significant (P < .05) reduction in the need for antiemetics to treat PONV.

Clinical Effectiveness of Traditional and Complementary Medicine Interventions in Combination with Nicotine Replacement Therapy on Smoking Cessation: A Randomized Controlled Pilot Trial.

Background: Smoking is associated with many preventable diseases and deaths. Globally, more than 6 million deaths per year are related to smoking. This study aimed to evaluate the pragmatic effectiveness of traditional and complementary medicine (T&CM) interventions for the smoking cessation treatment and to calculate the incremental cost-effectiveness ratio (ICER) of these interventions. Methods: The study design was a pragmatic, open-label randomized trial. The hypothesis of this trial was that the smoking cessation success rate increases with the addition of T&CM methods. The intervention group was provided T&CM interventions in addition to nicotine replacement therapy (NRT) and counseling, whereas the control group was treated with only NRT and counseling. Individuals received treatment for 4 weeks, then follow-up care for 20 weeks. Results: Forty-one participants were enrolled and assigned to either an intervention group or a control group at a ratio of 1:1. The odds ratio values at 4 weeks were 1.96 (0.51-8.51) in intention-to-treat analysis and 3.27 (0.75-17.75) in per-protocol analysis. The amount of smoking (cigarettes) decreased in both groups: from 17.2 ± 10.31 (baseline) to 1.7 ± 3.02 (4 weeks) in the intervention group and from 12.9 ± 5.47 (baseline) to 3.3 ± 5.96 (4 weeks) in the control group. The total medical costs per patient were $212.20 USD in the intervention group and $170.80 in the control group. The adjusted ICER of T&CM interventions was $13,355. Conclusions: This pilot study evaluated the clinical feasibility of T&CM used in conjunction with NRT and counseling for the smoking cessation treatment. However, there was no statistically significant effectiveness of T&CM interventions to raise cessation success rate. This study demonstrates the necessity for further studies based on large-scale randomized controlled trials.

[Aromatherapy - From Traditional and Scientific Evidence into Clinical Practice]. / Aromatherapie: wann können ätherische Öle medizinisch eingesetzt werden?

Essential oils (EOs), also known as volatile oils, are concentrated natural plant products which contain volatile aroma compounds. Most EOs are derived by steam distillation, a tradition which can be traced back as many as 5000 years. They possess unique properties which result in various possibilities for application, also in modern medical contexts. Areas for medical aromatherapy include respiratory diseases, pain management or stress alleviation, amongst many others. Different modes of application exist: The rich ingredients can be absorbed by the body by anointment, gentle massage, inhalation, or oral intake of capsules. Also the risks of EO application in medical contexts should be considered, such as rare allergic reactions, overdosing, poor substance quality or overestimation of the effectiveness.

A bibliometric analysis of two decades of aromatherapy research.

BACKGROUND: Quantitative data are lacking on the profile of published research in aromatherapy. The objective of the study was to investigate the profile of original and review articles under the topic aromatherapy using bibliometric analysis. METHODS: Articles on aromatherapy, published between 1995 and 2014, were retrieved from the Science Citation Index-Expanded database from the Web of Science. The records extracted were analyzed for citation characteristics, including the distribution of publication years, languages, countries or regions, journals, articles, and authors using HistCite 12.03.17. VOSviewer v.1.61 was used to construct bibliometric diagrams. RESULTS: A total of 549 original and review articles, published in 287 different peer-reviewed journals by 1888 authors, were identified. There was a steady increase in the number of published articles from 1995 to 2014. The majority of the articles was written in English (95.8%) and the United States was the leading country in the total number of published articles (n = 107, 19.5%) Journal of Alternative and Complementary Medicine published the greatest number of articles on the topic (n = 31, 5.6%). The article that received the greatest number of citations was published in Complementary Therapies in Medicine. Visualization analysis based on co-occurrences of words in the title and abstract revealed three clusters of research topics, including essential oil, intervention, and complementary medicine. CONCLUSIONS: This study provided a systematic overview of productivity and visibility of research work in aromatherapy and the findings could be used for organizing and prioritizing future research efforts in aromatherapy research.

[A French survey on the resort of oral alternative complementary medicines used in children with cancer]. / Évaluation du recours aux médecines alternatives et complémentaires orales dans un service d'onco-hématologie pédiatrique.

INTRODUCTION: The use of oral complementary and alternative medicine (CAM) is widespread among cancer patients, but considerably less known in pediatric cancer patients. Our survey was conducted in a pediatric onco-hematology unit to study the frequency and the circumstances of CAM use. METHODS: This study included 50 children treated for malignant diseases. A questionnaire was used to collect support general data on the child as well as information on the CAM use. One of the child's parents was interviewed. RESULTS: Most of parents (48%) used one or more CAM for their child in the context of cancer. The most used type of CAM was homeopathy, dietary supplements and aromatherapy. The most frequent goal for CAM use was to limit the side effects of conventional treatment (75% of parents). For 87.5% of users, the CAM was effective. Physicians were not aware of this use for 33.3% of users, in spite of the fact that the family physician was the main source of information for this use. Most of parents (48%) needed more information about the CAM and they bought CAM in a pharmacy. CONCLUSIONS: The use of oral CAM in this survey was common. For most parents, this use was effective and appreciated because they generated fewer side effects than conventional treatments. However, doctors were not systematically informed of this use. This is problematic because some CAM such as herbal supplements could potentially cause interactions with cancer treatments. More information about CAM is necessary in pediatric onco-hematology.

A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties.

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta-analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients.

Use of complementary and alternative medicines during the third trimester.

OBJECTIVE: To estimate the prevalence, indications, and associated factors for complementary and alternative medicine use during the last trimester of pregnancy. METHODS: A questionnaire survey was conducted of women with a live birth (N=700) admitted to the postnatal unit at the Royal Aberdeen Maternity Hospital, northeast Scotland. Outcome measures included: complementary and alternative medicine used; vitamins and minerals used; reasons for complementary and alternative medicine use; independent associated factors for use; views; and experiences. Descriptive and inferential statistical analysis was performed. RESULTS: The response rate was 79.6% of eligible women. Two thirds of respondents (61.4%) reported using complementary and alternative medicine, excluding vitamins and minerals, during the third trimester. Respondents reported using a total of 30 different complementary and alternative medicine modalities, of which oral herbal products were the most common (38% of respondents, 40 different products). The independent associated factors for complementary and alternative medicine use identified were: complementary and alternative medicine use before pregnancy (odds ratio [OR] 4.36, 95% confidence interval [CI] 2.39-7.95, P<.001); a university education (OR 2.41, 95% CI 1.46-4.0, P=.001), and complementary and alternative medicine use by family or friends (OR 2.36, 95% CI 1.61-3.47, P<.001). There was no association with health care professional recommendations. Users were significantly more likely than nonusers to agree that complementary and alternative medicines were safer than prescribed medicines (P=.006), less likely to be associated with side effects (P≤.001), and could interfere with conventional medicines (P≤.001). CONCLUSION: Despite the majority of respondents, and notably users, being uncertain about their safety and effectiveness, complementary and alternative medicine modalities and complementary and alternative medicine products are widely used during the third trimester of pregnancy in this study population. Although prior use was the most significant independent associated factor, the role of family and friends, rather than health professionals, in the decision to use complementary and alternative medicine may be of concern. LEVEL OF EVIDENCE: III.

Complementary/alternative and conventional medicine use amongst menopausal women: results from the Australian Longitudinal Study on Women's Health.

Large population-based studies of complementary and alternative medicine (CAM) and conventional medicine use amongst menopausal women are lacking. This study helps address this gap by analysing data from a nationally representative sample of 10011 Australian women aged 59-64 years. Overall, 39% of menopausal women consulted CAM practitioners, 75% used self-prescribed CAM, 95% consulted general practitioners (GP) and 50% consulted specialists during the previous year, and 12% were current hormone replacement therapy (HRT) users. Our findings suggest that CAM is a significant healthcare option utilized by women to treat menopausal symptoms, and so requires attention from GPs and specialists.

Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland.

BACKGROUND: In 2004, complementary and alternative medicine (CAM) was offered by physicians in one-third of Swiss hospitals. Since then, CAM health policy has changed considerably. This study aimed to describe the present supply and use of CAM in hospitals in the French-speaking part of Switzerland, and to explore qualitatively the characteristics of this offer. METHODS: Between June 2011 and March 2012, a short questionnaire was sent to the medical directors of hospitals (n = 46), asking them whether CAM was offered, where and by whom. Then, a semi-directive interview was conducted with ten CAM therapists. RESULTS: Among 37 responses (return rate 80%), 19 medical directors indicated that their hospital offered at least one CAM and 18 reported that they did not. Acupuncture was the most frequently available CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology and obstetrics, palliative care, psychiatry, and anaesthetics. In eight out of ten interviews, it appeared that the procedures for introducing a CAM in the hospital were not tightly supervised by the hospital and were mainly based on the goodwill of the therapists, rather than clinical/scientific evidence. CONCLUSION: The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have risen since 2004. The selection of a CAM to be offered in a hospital should be based on the same procedure of evaluation and validation as conventional therapy, and if the safety and efficiency of the CAM is evidence-based, it should receive the same resources as a conventional therapy.

Prevalence of complementary and alternative medicine (CAM)-use in UK paediatric patients: a systematic review of surveys.

AIM: This systematic review is aimed at estimating the prevalence of complementary and alternative medicine (CAM)-use by paediatric populations in the United Kingdom (UK). METHOD: AMED, CINAHL, COCHRANE, EMBASE and MEDLINE were searched for English language peer-reviewed surveys published between 01 January 2000 and September 2011. Additionally, relevant book chapters and our own departmental files were searched manually. RESULTS: Eleven surveys were included with a total of 17,631 paediatric patients. The majority were of poor methodological quality. Due to significant heterogeneity of the data, a formal meta-analysis was deemed inappropriate. Ten surveys related to CAM in general, while one was specifically on homeopathy. Across all surveys on CAM in general, the average one-year prevalence rate was 34% and the average lifetime prevalence was 42%. In surveys with a sample size of more than 500, the prevalence rates were considerably lower than in surveys with the sample size of lower than 500. Herbal medicine was the most popular CAM modality, followed by homeopathy and aromatherapy. CONCLUSIONS: Many paediatric patients in the UK seem to use CAM. Paediatricians should therefore have sufficient knowledge about CAM to issue responsible advice.

Use of complementary and alternative medicine in departments of obstetrics in croatia and a comparison to Germany.

BACKGROUND: This nationwide study assessed the use of complementary and alternative medicine (CAM) methods in departments of obstetrics in Croatia and compared it with an identical assessment carried out in Germany. METHODS: All Croatian obstetrics departments were sent a questionnaire already tested in Germany which assessed the use of CAM methods: whether any were used during childbirth and if so how frequently, and the reasons behind their application. RESULTS: Questionnaires were returned by 100% (36/36) of departments identified. The only used CAM therapy was acupuncture, which was available in 5.6% (2/36) of the departments. All other methods (homeopathy, aromatherapy, massage etc.) were not used at all. Furthermore, acupuncture was only administered by physicians. These findings were found to strongly contrast with the findings from Germany. CONCLUSIONS: Among the main CAM methods only acupuncture is used to a small extent in the field of obstetrics in Croatia. Thus, the impression from the literature that shows a considerable use of CAM in this area definitely does not apply for all parts of the world. Future studies should seek to identify the reasons behind the intensive use of CAM in Germany and its virtual non-use in Croatia. This also means that analyses of CAM use are required with respect to perinatal outcome, the results of which could finally help decide about the reasonability of CAM.

Clinical indications and perceived effectiveness of complementary and alternative medicine in departments of obstetrics in Germany: a questionnaire study.

OBJECTIVE: Our earlier study on complementary and alternative medicine (CAM) methods showed that acupuncture, homeopathy, and aromatherapy are available in most obstetrics departments in Germany but it did not evaluate the clinical indications for using CAM. The present study aimed to explore further the effectiveness of CAM use in obstetrics. STUDY DESIGN: We sent all departments of obstetrics in North Rhine-Westphalia a questionnaire designed to delineate their use of acupuncture, homeopathy, and aromatherapy during childbirth. It sought details on who provided the CAM therapy (midwife or physician). We asked respondents to indicate on a five-point scale how reasonable or otherwise they would consider the provision of CAM in each of six common problem situations and to estimate for each the proportion of patients given the CAM treatment. Respondents were also asked about the rationale for offering CAM, quality assurance and side effects. Spearman's bivariate correlation, cross-tabulation and Pearson's chi(2) test were used for statistical analysis. RESULTS: About 73.4% (138/187) of the departments responded. Acupuncture and homoeopathy were most widely used. Although obstetricians are responsible for patient care, decisions to provide CAM were largely taken by midwives, and the midwives' belief in the methods' effectiveness and patient demand were the principle motivating factors. Rates of CAM use in the six problem scenarios evaluated were directly related to practitioners' perceptions of the methods' therapeutic effectiveness. CONCLUSIONS: CAM methods were widely offered despite the lack of evidence of effectiveness or information on adverse consequences. In Germany, including CAM in the mandatory national quality assurance measures and perinatal surveys would provide valuable information; CAM use elsewhere merits further study.

Use of complementary and alternative medicine in departments of obstetrics in Germany.

BACKGROUND: This nationwide study aimed to assess the use of complementary and alternative medicine (CAM) methods in German departments of obstetrics. METHODS: All German departments of obstetrics were identified and were sent a questionnaire designed to assess which CAM methods, if any, they used during childbirth, how frequently, and why. SPSS software was used for statistical analyses (Spearman's bivariate correlation, cross-tabulation, and Pearson's chi-square test). RESULTS: The questionnaires were returned by 40.3% (381/946) of the identified departments. The most commonly used CAM therapy was acupuncture (available in 97.3% (366/376) of departments) followed by homeopathy (offered in 93.4%) and aromatherapy (available in 76.6%). Most decisions regarding CAM use were made by midwives; only decisions on acupuncture were taken by obstetricians and midwives. Reasons given for using CAM were patient demand and perceived efficacy of CAM, particularly by midwives. Obstetricians were only partly convinced of the efficacy of CAM methods and their conviction varied with the type of unit they worked in. CONCLUSIONS: CAM methods are widely used in German departments of obstetrics despite lacking evidence of effectiveness. Efficacy, side effects and consequences of CAM use should be assessed using the mandatory German quality assurance measures and birth surveys. CAM use elsewhere also merits further study.

Evaluation of aromatherapy in treating postoperative pain: pilot study.

This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001).

Audit of an aromatherapy service in a maternity unit.

This paper reports the results of the audit of a maternity aromatherapy service at a small Midlands maternity unit. The service was introduced in May 2000 and the principal aims of the audit, conducted in October 2002 were to investigate clinical effectiveness, maternal satisfaction and staff training needs. The service has been shown to be effective in normalising childbirth and increasing satisfaction of mothers in respect of their labour experiences. A concurrent audit of staff demonstrated interest and enthusiasm of the service and identified areas for further development. The service was short listed for the Prince of Wales Foundation for Integrated Health Awards for Good Practice in 2003 and awarded a certificate of achievement.