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1.
J Altern Complement Med ; 25(6): 606-612, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31120303

RESUMO

Objectives: Complementary medicine (CM) has become increasingly available in hospital settings in several countries. Nonetheless, there are disparities in the provision and organization of CM between hospitals and even within a single hospital. This was the case at Lausanne University Hospital, where neither a registry of CM practices nor homogeneous guidelines for the provision of CM existed. The board of directors mandated the use of an internal consultant to assess practices, delineate the ward's needs, and draft proposals to structure the provision of CM services. Design: Lescarbeau et al.'s integrated model of consultation was used. Settings/Location: Academic medical center, Switzerland. Subjects: Heads of departments, medical and nurse directors, and CM practitioners. Interventions: Semi-structured interviews, online survey, and focus groups were used to focus on CM availability, needs, and practices; CM practitioner background, training, and position in the hospital; and the type of patients treated. Results: The assessment identified 15 types of CM in 51 wards, provided by CM practitioners who represented the profiles of 8 types of health care professionals. Three barriers to implementing CM were identified: heterogeneity in CM practitioners' training and project implementation, lack of CM information for patients and health care professionals, and variable access to CM among hospital wards and resulting lack in continuity of care. Three main needs regarding CM were delineated: to ensure CM quality, to provide structured interdepartmental CM clinical services, and to provide CM information to patients and health care professionals. Three action priorities were selected by the board of directors: to develop structured CM clinical services; to select CM provision based on the specific criteria of scientific evidence, therapies already available at hospital, and specific ward's needs; and to provide CM information to patients and health care professionals. Conclusions: This assessment permitted to structure CM provision according to internal consultation.


Assuntos
Centros Médicos Acadêmicos , Terapias Complementares , Assistência à Saúde , Serviços de Saúde , Hospitais , Grupos Focais , Pessoal de Saúde , Humanos , Inquéritos e Questionários , Suíça
2.
Rev Med Suisse ; 15(650): 958-964, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066527

RESUMO

Family medicine is now an integral part of the curriculum of medical schools in Switzerland. The current challenge is to convey information about the attractive aspects of family medicine to medical students to address the growing shortage of primary care physicians. This article describes the implementation of a research program to promote career choice in family medicine, which leads to the development of a conceptual framework as a theoretical basis for teaching and research. Innovations from three medical schools in French-speaking Switzerland are presented. The authors describe the implication for family physicians in private practice, who are key partners of academic family medicine.


Assuntos
Currículo , Medicina de Família e Comunidade , Universidades , Escolha da Profissão , Medicina de Família e Comunidade/educação , Faculdades de Medicina , Suíça
3.
Artigo em Inglês | MEDLINE | ID: mdl-31079290

RESUMO

Scarce data exist on the use of complementary and alternative medicine (CAM) by asylum seekers in Switzerland and their perception of discrimination. A cross-sectional study assessed the prevalence and type of CAM used by asylum seekers in one region of Switzerland and evaluated their self-perceived discrimination. Among the 61 asylum seekers who participated, lifetime prevalence of CAM use was 46%, with 28% reporting its use during the last year. Herbal medicine was the most frequently used CAM. Self-perceived discrimination was reported by 36% of asylum seekers, mainly related to their national origins. CAM users had a tendency to report more discrimination than non-users (44% vs. 30%). CAM use is prevalent among asylum seekers. Considering the importance of herbal medicine use and that only half of the respondents disclosed CAM use to their physician, clinicians should ask about it, notably because of potential risks of herb-drug interaction.

4.
Rev Med Suisse ; 15(648): 875-881, 2019 Apr 24.
Artigo em Francês | MEDLINE | ID: mdl-31021574

RESUMO

Respiratory tract infections such as bronchitis or sinusitis and urinary tract infections are common in the family doctor's office. Bronchitis and sinusitis are mostly of viral origin and antibiotics rarely hold a place in their management, while urinary tract infections most often require the prescription of antibiotics. In both situations, patients often seek complementary medicines to relieve symptoms or prevent recurrences. This article aims to synthesize available data on efficacy and safety of some treatments in complementary medicine used in these indications, such as South African geranium, the combination of thyme-primrose or thyme-ivy, Echinacea or cranberry.


Assuntos
Bronquite , Terapias Complementares , Infecções Respiratórias , Sinusite , Infecções Urinárias , Antibacterianos/uso terapêutico , Bronquite/terapia , Humanos , Infecções Respiratórias/terapia , Sinusite/terapia , Infecções Urinárias/terapia
5.
Sci Rep ; 9(1): 5078, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30911084

RESUMO

Complementary medicine (CM) is used by one third to one half of cancer patients throughout the world. The objective of this study was to describe the prevalence of CM use and the potential for interactions with cancer treatments in an academic oncology centre. A cross-sectional study was conducted among patients undergoing current cancer treatment. Among 132 included patients, 56% had used CM since their cancer diagnosis and 45% were using CM during cancer treatment at the time of the survey. The main CM used were green tea (35%), herbal tea (35%), homeopathy (27%), dietary supplements (27%), and herbal medicines (27%). A small majority of patients (58%) spontaneously mentioned the use of CM to their oncologist. Of 42 identified combinations of concomitant use of biologically based CM and anticancer agents among the study patients, the potential for pharmacokinetic interactions of clinical relevance was not expected in 17 combinations (40%), hypothetical and deemed unlikely in 23 (55%), and of probable low clinical relevance in 2 (5%). Considering the high prevalence of CM use, active enquiries should be made by healthcare professionals to detect symptoms that may relate to CM tolerance and effects or that suggest interactions between CM and cancer treatments.

7.
PLoS One ; 14(1): e0209851, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30605458

RESUMO

Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been absorbed, might favor analgesia in a clinical interaction model. Sixty-six healthy males participated in a study "to validate pupillometry as an objective measure of analgesia". Participants were unknowingly randomized double-blind to positive vs control information about side effects embedded in a video regarding the study drugs. Sequences of moderately painful heat stimuli applied before and after treatment with diclofenac and atropine served to evaluate analgesia. Atropine was deceptively presented as a co-analgesic, but used to induce side effects. Adverse events (AE) were collected with the General Assessment of Side Effects (GASE) questionnaire prior to the second induced pain sequence. Debriefing fully informed participants regarding the purpose of the study and showed them the two videos.The combination of medication led to significant analgesia, without a between-group difference. Positive information about side effects increased the attribution of AE to the treatment compared to the control information. The total GASE score was correlated with analgesia, i.e., the more AEs reported, the stronger the analgesia. Interestingly, there was a significant between-groups difference on this correlation: the GASE score and analgesia correlated only in the positive information group. This provides evidence for a selective link between AEs and pain relief in the group who received the suggestion that AEs could be taken as a sign "that help was on the way". During debriefing, 65% of participants said they would prefer to receive the positive message in a clinical context. Although the present results cannot be translated immediately to clinical pain conditions, they do indicate the importance of testing this type of modulation in a clinical context.

8.
PLoS One ; 13(9): e0204613, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30261029

RESUMO

OBJECTIVE: Recent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior. DESIGN: An exploratory cross-sectional study. SETTING AND PARTICIPANTS: Primary care physicians of the French-speaking part of Switzerland. MAIN OUTCOME MEASURES: Primary care physicians' perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths. RESULTS: 533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general. CONCLUSION: Our results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented.

9.
Rev Med Suisse ; 14(612): 1262-1266, 2018 Jun 20.
Artigo em Francês | MEDLINE | ID: mdl-29944292

RESUMO

In North America the massive increase in opioid prescriptions for chronic non-cancer pain has been a major health issue for several years. In Switzerland, the situation is less well known. This article aims to present the evolution of the Swiss consumption and replace it in a European and international context using the International Narcotics Control Board database. Between 1985 and 2015, the Swiss opioid consumption raised from 18 to 421 mg/person/year, making Switzerland the 7th largest opioid consumer per capita in the world. This increase could be due to more adequate pain management or liberalized opioid prescription for indications unsupported by the current evidence. Given these elements, further research is needed, yet increased caution is recommended when prescribing opioid drugs.

10.
PLoS One ; 12(9): e0184979, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28961256

RESUMO

BACKGROUND: Complementary medicine (CM) is utilized in a growing number of academic centers despite the debate concerning its value, risks and benefits. Healthcare professionals often feel uncomfortable discussing CM with patients, and little is known about their sources of knowledge in the field of CM. OBJECTIVE: To assess healthcare professionals' sources of knowledge and attitude toward CM in an academic hospital. DESIGN AND PARTICIPANTS: The cross-sectional web-based survey took place from October to December 2013. A total of 4,925 healthcare professionals working at Lausanne University Hospital, Switzerland, were invited to answer the questionnaire. MAIN MEASURES: Factors influencing healthcare professionals' opinion toward CM, knowledge and communication about CM. KEY RESULTS: The questionnaire was answered by 1,247 healthcare professionals. The three key factors influencing professionals' opinion toward CM were personal experience, clinical experience and evidence demonstrating the physiological mechanism of CM. Personal experience was more associated with nurses' and midwives' opinion compared to physicians' (80.8% vs 57.1%, OR = 3.08, [95% CI: 2.35-4.05], P<0.001 and 85.3% vs 57.1%, OR = 3.83, [95% CI: 1.95-7.53], P<0.001, respectively) as well as with professionals trained in CM compared to non-trained professionals (86.0% vs 73.2%, OR = 2.60, [95% CI: 1.92-3.53], P<0.001). Physicians relied more on randomized controlled clinical trials compared to nurses (81.3% vs 62.9%, OR = 0.43, [95% CI: 0.33-0.57], P<0.001). A majority of the respondents (82.5%) agreed that they lacked knowledge about CM and 65.0% noted that it was the patient who initially started the discussion about CM. CONCLUSIONS: Different professionals used different strategies to forge opinions regarding CM: physicians relied more on scientific evidence, while nurses and midwives were more influenced by personal experience. Regardless of preferred information source, most respondents did not feel prepared to address patient questions regarding CM. Enhancing interprofessional education opportunities is an important strategy to help providers become empowered to discuss CM with patients. This in turn will help patients making informed decisions in their healthcare.


Assuntos
Centros Médicos Acadêmicos , Terapias Complementares , Pessoal de Saúde , Conhecimento , Adulto , Estudos Transversais , Feminino , Humanos , Serviços de Informação , Masculino , Pessoa de Meia-Idade , Suíça
11.
Rev Med Suisse ; 13(568): 1300-1303, 2017 Jun 21.
Artigo em Francês | MEDLINE | ID: mdl-28643968

RESUMO

Complementary medicines are frequently used by chronic pain patients. It is a challenge for the primary care physician to provide objective information based on the scientific literature. Meta-analyses have shown favourable effects of acupuncture, therapeutic massage and osteopathy for patients with acute low back pain. Concerning chronic low back pain, meta-analyses have shown positive results with acupuncture, osteopathy, yoga and tai-chi. Other therapies have shown positive effects, but further trials are necessary to fully validate them. This article reviews the literature supporting the most studied complementary medicines.

12.
Int J Clin Pract ; 71(7)2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28524414

RESUMO

BACKGROUND: Complementary Medicine (CM) is frequently used by the general population, but data about prevalence among hospitalised patients are scarce. We evaluated the prevalence and determinants of CM use by inpatients, lifetime, 2 months before and during their hospitalisation in a general internal medicine ward. METHODS: Cross-sectional survey conducted in September 2014 among adult (≥18 years) patients hospitalised for at least 1 day in the general internal medicine ward of the Lausanne University Hospital, Switzerland. The association between the socio-demographic data and CM used were assessed using logistic regression model. RESULTS: Among the 289 eligible patients, 130 (45%, mean age 68.9±16.4 years, 59.2% male) were included. The lifetime prevalence of CM use was 74.6%. One-third (31.5%) and one-tenth of patients reported CM use 2 months prior or during hospitalisation, respectively. The four most reported CM used during lifetime were homeopathy (54.6%), herbal medicine (49.5%), therapeutic massage (47.4%), and osteopathy (44.3%). Herbal medicine, homeopathy, meditation and therapeutic massage were the four main CM used during hospitalisation. On bivariate analysis, lifetime use of CM was significantly associated with higher level of education (apprenticeship: OR 3.2, 95% CI [1.20-8.51], high school/university: OR 7.67, 95% CI [2.59-22.70]; P=.004) and healthcare coverage for CM (OR 3.53, 95% CI [1.32-9.46]; P=.014), but not with age and gender. During hospitalisation only 3.8% of patients were asked about CM use by physicians. CONCLUSION: One-third of hospitalised patients used CM 2 months before hospitalisation and one-tenth during hospital stay. CM use is seldom queried by hospital staff; better assessment of CM use among hospitalised patients could prevent potential adverse events or interactions.


Assuntos
Terapias Complementares/estatística & dados numéricos , Hospitalização , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares , Hospitais Universitários , Humanos , Medicina Interna , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Suíça , Adulto Jovem
13.
BMC Complement Altern Med ; 17(1): 193, 2017 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-28376851

RESUMO

BACKGROUND: Chronic pain patients often use complementary medicine (CM) to alleviate their pain; however, little is known about the use of CM by chronic low back pain (cLBP) patients. We investigated the frequency of use of CM by cLBP patients, the perceived effects of these therapies, patients' knowledge regarding CM, and patient-physician communication regarding CM. METHOD: A cross-sectional survey was conducted from November 2014 to February 2015. A questionnaire was distributed by physicians to 238 consecutive patients consulting for cLBP at the Pain Center of Lausanne University Hospital, Switzerland. Poisson regression model was used to analyze patients' level of knowledge regarding various CMs, and the logistic regression model was used to assess CM use for cLBP. RESULTS: The questionnaire was returned by 168 cLBP patients (response rate: 70.6%). Lifetime prevalence of CM use for cLBP was 77.3%. The most commonly used therapies were osteopathy (48.8%), massage (45.2%) and acupuncture (31.6%), rated for their usefulness on a 0-10 scale as a mean ± SD of 5.4 ± 2.7, 5.9 ± 2.5 and 3.8 ± 3.2, respectively. The CM treatment best known by patients was osteopathy, followed by massage and acupuncture. If their doctors proposed CM as a treatment for cLBP, 78% of participants reported being very or somewhat likely to try CM. Respondents with CM health insurance were more likely to use CM (OR = 2.26; 95%CI: 1.07-4.78; p = 0.031) for cLBP. Respondents having experienced cLBP for more than five years were more likely to use CM to treat their cLBP than respondents having experienced cLBP for one year or less (OR = 2.84; 95%CI: 1.02-7.88; p = 0.044). CONCLUSIONS: More than three-quarters of cLBP patients in our sample did use CM to treat their cLBP. The results showed that the most commonly used therapies were not necessarily the highest rated in terms of perceived usefulness. These results highlight the importance of developing integrative pain centers in which patients may obtain advice regarding CM treatments.


Assuntos
Terapias Complementares , Dor Lombar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/terapia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Clínicas de Dor , Inquéritos e Questionários , Suíça , Adulto Jovem
14.
Health Commun ; 32(6): 714-720, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27408954

RESUMO

At the beginning of the medical encounter, clinicians should elicit patients' agendas several times using open-ended questions. Little is known, however, about how many times physicians really solicit a patient's agenda during follow-up encounters. The objective was to analyze the number of agenda solicitations by physicians, of agendas initiated by physicians, and of patients' spontaneous agendas during the beginning and the entire encounter. We analyzed 68 videotaped follow-up encounters at a university primary care outpatient clinic. The number of different types of agenda setting was searched for and analyzed using negative binomial regression or logistic regression models. Physicians solicited agendas a mean ± SD of 0.8 ± 0.7 times/patient during the first 5 minutes and 1.7 ± 1.2 times/patient during the entire encounter. Physicians in 32.4% of encounters did not solicit the patient agenda, and there were never more than two physician's solicitations during the first 5 minutes. The mean number of physician's solicitations of the patients' agenda was 42% lower among female physicians during the first 5 minutes and 34% lower during the entire encounter. The number of agendas initiated by physicians was 1.2 ± 1.2/patient during the beginning and 3.2 ± 2.3/patient during the entire encounter. In 58.8% of the encounters, patients communicated their agendas spontaneously. There were twice as many patient spontaneous agendas (IRR = 2.12, p = .002) with female physicians than with males. This study showed that agenda solicitation with open-ended questions in follow-up encounters does not occur as often as recommended. There is thus a risk of missing new agendas or agendas that are important to the patient.


Assuntos
Comunicação , Visita a Consultório Médico , Relações Médico-Paciente , Médicos , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Inquéritos e Questionários , Universidades , Gravação de Videoteipe
15.
Explore (NY) ; 12(5): 341-6, 2016 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27450407

RESUMO

OBJECTIVE: To assess the attitudes of physicians, nurses, physical therapists, and midwives toward complementary medicine (CM) at a Swiss academic hospital and toward its use for treating chronic pain. DESIGN: The cross-sectional survey took place from October to December 2013. SETTING: An e-mail sent to 4925 healthcare professionals (1969 physicians, 2372 nurses, 145 physical therapists, and 111 midwives) working at Lausanne University Hospital, Switzerland, invited them to answer a web-based questionnaire. RESULTS: The questionnaire was answered by 1247 healthcare professionals (response rate: 25.3%). Of these, 96.1% strongly agreed or agreed that CM could be useful for the treatment of chronic pain, with more nurses (96.7%) and midwives (100%) than physicians (93.8%) agreeing that CM could be useful (P < .001 for both comparisons). Women had more positive attitude toward CM than men (97.8% versus 91.2%; P < .001). Of the respondents, 96.9% were strongly in favor or in favor of offering CM, especially hypnosis (89.8%), osteopathy (85.5%), and acupuncture (83.4%), at the hospital for treating chronic pain. Respondents listed migraine (74.7%), tension headaches (70.6%), and low back pain (70.1%) as three main conditions for which they would refer patients for acupuncture. The three therapies with which respondents were the most unfamiliar were neuraltherapy (57.2%), mindfulness-based stress reduction (MBSR) (54.1%), and biofeedback (51.9%). Over half of respondents, 58.3%, had never referred a patient to a CM practitioner. A total of 84.3% of the respondents felt that they lacked the knowledge to inform their patients about CM.


Assuntos
Atitude do Pessoal de Saúde , Dor Crônica/terapia , Terapias Complementares , Enfermeiras e Enfermeiros , Manejo da Dor/métodos , Fisioterapeutas , Médicos , Terapia por Acupuntura , Adulto , Feminino , Cefaleia , Hospitais de Ensino , Humanos , Hipnose , Dor Lombar , Masculino , Pessoa de Meia-Idade , Enfermeiras Obstétricas , Medicina Osteopática , Inquéritos e Questionários , Suíça , Universidades
16.
Rev Med Suisse ; 12(508): 451-3, 2016 Mar 02.
Artigo em Francês | MEDLINE | ID: mdl-27089602

RESUMO

Patients often use dietary supplements for cardiovascular prevention. An US study showed that 75% of patients with cardiovascular disease used dietary supplements. Red yeast rice, phytosterols and fibers can significantly decrease LDL. The level of monacolin in red yeast rice can vary between products and toxins can sometimes be found. Prospective studies showed that fibers could decrease cardiovascular risk. Others substances, like guggul, soy and artichoke leaf extracts, did not show a clear benefit for cardiovascular prevention. Measurements of cholesterol levels can help the physician to discuss with his patient about the effects of some dietary supplements.


Assuntos
Doenças Cardiovasculares , LDL-Colesterol , Fibras na Dieta/administração & dosagem , Suplementos Nutricionais , Hipercolesterolemia , Produtos Biológicos/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/efeitos dos fármacos , Frutas , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipercolesterolemia/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Gomas Vegetais/administração & dosagem , Falha de Tratamento , Verduras , Grãos Integrais
17.
J Adolesc ; 45: 307-16, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26530332

RESUMO

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.


Assuntos
Adaptação Psicológica , Pais , Transtornos Somatoformes , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Suíça , Avaliação de Sintomas , Adulto Jovem
18.
Swiss Med Wkly ; 143: w13756, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24018633

RESUMO

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.


Assuntos
Terapias Complementares/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Terapia por Acupuntura/estatística & dados numéricos , Aromaterapia/estatística & dados numéricos , Atitude do Pessoal de Saúde , Estudos Transversais , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Humanos , Manipulação Osteopática/estatística & dados numéricos , Manipulações Musculoesqueléticas/estatística & dados numéricos , Inquéritos e Questionários , Suíça
19.
Swiss Med Wkly ; 143: w13807, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24018734

RESUMO

INTRODUCTION: Dietary supplement (DS) use increased rapidly in recent years. However, evidence of benefits of many DSs for healthy users is scarce and may not equate with known risks of overdose, drug interaction and recently discovered negative long-term effects. This exploratory study aimed to investigate the perceptions and motivations of DS users in Lausanne, Switzerland. METHOD: A convenience sample (n = 147) was recruited at the entrances of local sales points. Data were collected in on-site semistructured interviews that assessed dietary supplementation habits. RESULTS: The majority of DSs were all-in-one products, containing a mixture of minerals and vitamins, or products containing only minerals. Among the 147 users, 72 (49%) used one all-in-one product and 3 (2%) used two all-in-one products. Thirty-one (21%) consumers did not know for at least one product what the purpose of their DS use was. Seventy-five percent of participants thought that DS use presents no risk or nearly no risk. Only 49% of participants stated that their physicians were informed about their consumption. Although men searched more often for potential risks (p <0.001), they turned less frequently to health professionals to get this information (p = 0.007). DISCUSSION: As in other surveys performed elsewhere, our study shows that, in Lausanne (Switzerland), DSs are commonly used as mixed products. Risk perception seems generally low among DS users. Physicians should be trained to evaluate patients' perceived needs and DS consumption in order to provide good evidence-based information or to propose alternatives to DS use.


Assuntos
Suplementos Nutricionais , Conhecimentos, Atitudes e Prática em Saúde , Risco , Adolescente , Adulto , Feminino , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Minerais , Suíça , Vitaminas , Adulto Jovem
20.
J Gen Intern Med ; 24(6): 739-41, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19390902

RESUMO

BACKGROUND/OBJECTIVE: "By-the-way" syndrome, a new problem raised by the patient at an encounter's closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response. DESIGN/PARTICIPANTS: Cross-sectional study of 92 videotaped encounters in an academic primary care clinic. RESULTS: The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient's question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient's agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient's question, particularly (38.5%) if it was of psychosocial content. CONCLUSIONS: "By-the-way" syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient's agenda twice or more during the office visit might decrease the appearance of this syndrome.


Assuntos
Papel do Médico/psicologia , Relações Médico-Paciente , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Síndrome , Adulto Jovem
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