[Attitudes, knowledge and use of complementary and alternative medicine among perioperative healthcare professionals]. / Komplementer terápiás gyógymódok megítélése a perioperatív ellátásban dolgozó egészségügyi szakdolgozók között.

INTRODUCTION: Perioperative healthcare professionals' attitudes towards non-conventional treatments have not been explored in Hungary yet. AIM: Our goal was to survey healthcare professionals' attitude and knowledge towards naturopathy in six clinics of the Semmelweis University that provide perioperative care. METHOD: An anonymous, paper-based questionnaire was used. With an 82% response rate, the data was gained from 119 questionnaires and was processed using statistical analysis and chi-squared test. RESULTS: Only 25.2% of those surveyed considered themselves to be well-informed in this field. 68.1% of the participants had an interest in naturopathy and 60.5% would have liked to learn about naturopathy. 70.6% would be willing to use non-conventional treatments in their daily work, predominantly those who have used these methods in the case of their own illness, p = 0.0027. The most popular treatment methods included homeopathy, alternative massage and movement therapy, acupuncture and manual therapy. CONCLUSION: As anticipated based on international literature in this field, those Hungarian healthcare professionals who took part in our survey showed openness and interest towards naturopathy. Orv. Hetil., 2017, 158(10), 368-375.

Complementary and alternative medicine: attitudes, knowledge and use among surgeons and anaesthesiologists in Hungary.

BACKGROUND: Despite their worldwide popularity the question of using non-conventional treatments is a source of controversy among medical professionals. Although these methods may have potential benefits it presents a problem when patients use non-conventional treatments in the perioperative period without informing their attending physician about it and this may cause adverse events and complications. To prevent this, physicians need to have a profound knowledge about non-conventional treatments. METHODS: An anonymous questionnaire was distributed among surgeons and anaesthesiologists working in Hungarian university clinics and in selected city or county hospitals. Questionnaires were distributed by post, online or in person. Altogether 258 questionnaires were received from 22 clinical and hospital departments. RESULTS: Anaesthesiologists and surgeons use reflexology, Traditional Chinese Medicine, herbal medicine and manual therapy most frequently in their clinical practice. Traditional Chinese Medicine was considered to be the most scientifically sound method, while homeopathy was perceived as the least well-grounded method. Neural therapy was the least well-known method among our subjects. Among the subjects of our survey only 3.1 % of perioperative care physicians had some qualifications in non-conventional medicine, 12.4 % considered themselves to be well-informed in this topic and 48.4 % would like to study some complementary method. Women were significantly more interested in alternative treatments than men, p = 0.001427; OR: 2.2765. Anaesthesiologists would be significantly more willing to learn non-conventional methods than surgeons. 86.4 % of the participants thought that non-conventional treatments should be evaluated from the point of view of evidence. Both surgeons and anaesthesiologists accept the application of integrative medicine and they also approve of the idea of teaching these methods at universities. CONCLUSIONS: According to perioperative care physicians, non-conventional methods should be evaluated based on evidence. They also expressed a willingness to learn about those treatments that meet the criteria of evidence and apply these in their clinical practice.

[Complementary and alternative medicine use in surgical patients]. / Nem konvencionális gyógymódok használata sebészeti betegek között.

INTRODUCTION: Due to the rise in use of non-conventional therapies, we may consider the application of those in perioperative setting. AIM: The aims of the authors were to measure the attitude of patients waiting for elective surgery towards naturopathic methods, to determine their use and factors influencing their usage. METHOD: A questionnaire was applied that patients filled in individually and anonymously at the First Department of Surgery of Semmelweis University, between July 1, 2014 and April 30, 2016. RESULTS: 63.6% of the 519 participants (response rate = 21%) were interested in non-conventional therapies, and 26.8% of them applied naturopathy. In this group there were significantly more females (p = 0.022; OR: 1.066-2.3635), patients with university degree (p = 0.000315; OR: 1.3915-3.1132), aged 40-49 (p = 0.012419; OR: 1.1451-3.2405), and patients with hormonal disease (p = 0.039482; OR: 1.0186-5.7242). In terms of lifetime prevalence the most popular methods were traditional Chinese medicine (8.9%), alternative movement and massage therapy (7.5%) and homeopathy (7.3%). Only 12.9% of the patients reported the application of these methods to the physician. CONCLUSION: Surgical patients are interested in naturopathic methods, and one-fourth of them actually use them even in the perioperative period. Orv. Hetil., 2016, 157(37), 1483-1488.

Herbal medicine use by surgery patients in Hungary: a descriptive study.

BACKGROUND: The popularity of non-conventional treatments, especially the consumption of herbs is showing an increasing tendency all over the world. The consumption of herbal medicines might cause several complications during perioperative care. METHODS: The survey was conducted at the First Department of Surgery of Semmelweis University and focused on the demographics of patients consuming herbal medicines who had undergone elective surgery between July 1(st) 2014 and February 28(th) 2015. A one-page questionnaire, that the patients filled in individually and anonymously, was used. The response rate was 17.3 %. RESULTS: Out of the 390 patients who filled in the questionnaire, 7.2 % (28 patients) used herbal medicines, 3.6 % (14 patients) of them two weeks prior to their hospitalization. The other 3.6 % (14 patients) took herbal medicines sometime in the past. The majority of those who have ever consumed herbs are women (18/28), have completed secondary or tertiary education (23/28), more than half of them suffer from tumorous diseases and only a quarter of them (7/28) informed their physician about their use of herbal medication of their own accord. CONCLUSIONS: Attention must be paid to the exploration of herb consumption habits of surgery patients during the preoperative examinations in order to avoid potential side effects, complications or drug interactions.

[Alternative and complementary medicine from the primary care physician's viewpoint]. / Nem-konvencionális gyógymódok a háziorvos szemszögébol.

INTRODUCTION: The patients initiate the use of complementary and alternative medicine and this often remains hidden from their primary care physician. AIM: To explore general practitioners' knowledge and attitude towards complementary and alternative medicine, and study the need and appropriate forms of education, as well as ask their opinion on integration of alternative medicine into mainstream medicine. METHOD: A voluntary anonymous questionnaire was used on two conferences for general practitioners organized by the Family Medicine Department of Semmelweis University. Complementary and alternative medicine was defined by the definition of the Hungarian Academy of Sciences and certified modalities were all listed. RESULTS: 194 general practitioners answered the questionnaire (39.8% response rate). 14% of the responders had licence in at least one of the complementary and alternative therapies, 45% used complementary and alternative therapy in their family in case of illness. It was the opinion of the majority (91.8%) that it was necessary to be familiar with every method used by their patients, however, 82.5% claimed not to have enough knowledge in complementary medicine. Graduate and postgraduate education in the field was thought to be necessary by 86% of the responders; increased odds for commitment in personal education was found among female general practitioners, less than 20 years professional experience and personal experience of alternative medicine. CONCLUSIONS: These data suggest that general practitioners would like to know more about complementary and alternative medicine modalities used by their patients. They consider education of medical professionals necessary and a special group is willing to undergo further education in the field.

A preoperative ultrasound-based protocol for optimisation of fluid therapy to prevent early intraoperative hypotension: a randomised controlled study.

BACKGROUND: Intraoperative hypotension is a risk factor for postoperative complications. Preoperative dehydration is a major contributor, although it is difficult to estimate its severity. Point-of-care ultrasound offers several potential methods, including measurements of the inferior vena cava. The addition of lung ultrasound may offer a safety limit. We aimed to evaluate whether the implication of an ultrasound-based preoperative fluid therapy protocol can decrease the incidence of early intraoperative hypotension. METHODS: Randomised controlled study in a tertiary university department involves elective surgical patients of ASA 2-3 class, scheduled for elective major abdominal surgery under general anaesthesia with intubation. We randomised 40-40 patients; 38-38 were available for analysis. Conventional fluid therapy was ordered on routine preoperative visits. Ultrasound-based protocol evaluated the collapsibility index of inferior vena cava and lung ultrasound profiles. Scans were performed twice: 2 h and 30 min before surgery. A high collapsibility index (≥ 40%) indicated a standardised fluid bolus, while the anterior B-profile of the lung ultrasound contraindicated further fluid. The primary outcome was the incidence of postinduction and early intraoperative (0-10 min) hypotension (MAP < 65 mmHg and/or ≥ 30% of decrease from baseline). Secondary endpoints were postoperative lactate level, urine output and lung ultrasound score at 24 h. RESULTS: The absolute criterion of postinduction hypotension was fulfilled in 12 patients in the conventional group (31.6%) and 3 in the ultrasound-based group (7.9%) (p = 0.0246). Based on composite criteria of absolute and/or relative hypotension, we observed 17 (44.7%) and 7 (18.4%) cases, respectively (p = 0.0136). The incidence of early intraoperative hypotension was also lower: HR for absolute hypotension was 2.10 (95% CI 1.00-4.42) in the conventional group (p = 0.0387). Secondary outcome measures were similar in the study groups. CONCLUSION: We implemented a safe and effective point-of-care ultrasound-based preoperative fluid replacement protocol into perioperative care. TRIAL REGISTRATION: The study was registered to ClinicalTrials.gov on 10/12/2021, registration number: NCT05171608 (registered prospectively on 10/12/2021).

Relationship between the coronavirus epidemic and the use of complementary and alternative medicine prior to elective surgical procedures / A koronavírus-járvány hatása a komplementer terápiás gyógymódok igénybevételére elektív sebészeti mutétek elott.

Összefoglaló. Bevezetés: A 2019 végén Vuhanból kiinduló, SARS-CoV-2 okozta koronavírus-járvány jelentos hatást gyakorolt életünkre. Specifikus terápia hiányában az emberek egy része alternatív gyógymódokhoz fordult. Célkituzés: Vizsgálatunk célja annak feltárása volt, milyen hatást gyakorolt a koronavírus-járvány a betegek komplementer gyógymódokhoz való viszonyulására elektív sebészeti mutétek elott. Módszer: Egy magyarországi klinika és egy városi kórház elektív sebészeti mutétre váró betegei körében végeztünk anonim kérdoíves felmérést 2020. augusztus 3. és december 18. között. 279 kérdoívet dolgoztunk fel, a válaszadási arány 69,7% volt. Eredmények: A koronavírus-járvány hatására a válaszadók 91,4%-ának nem változott meg a véleménye a nem konvencionális kezelésekrol, 8,2%-a bizakodóbban tekintett ezekre. A komplementer terápia betegségmegelozo hatása iránt a kitöltok 16,8%-a volt bizakodó, 25,4%-a elutasító, 57,7%-a nem formált véleményt. A válaszadók 24,7%-a vett igénybe élete során alternatív módszereket, a koronavírus-fertozés megelozésére csak a nyilatkozók 10%-a alkalmazna ilyen gyógymódokat. Kizárólag a pandémia hatására senki nem kezdett el komplementer gyógymódokat használni. A kérdoívet kitöltok 55,6%-a használt gyógynövénykészítményt élete során. A járvány ideje alatt a válaszadók 27,5%-a vett igénybe gyógynövénykészítményeket; a gyógymód alkalmazása és a vizsgált szociodemográfiai tényezok között nem találtunk összefüggést. A gyógynövények alkalmazása alacsonyabb mértéku volt a daganatos és a thromboemboliás betegek között. Következtetés: Vizsgálatunk alapján a komplementer gyógymódok használata feltehetoen a járvány miatt elrendelt korlátozásokból adódóan csökkent, a gyógynövények alkalmazása azonban nem változott lényegesen. A válaszadók tizede használt komplementer gyógymódot a koronavírus-fertozés megelozésére. Orv Hetil. 2021; 162(42): 1678-1686. INTRODUCTION: The coronavirus epidemic caused by SARS-CoV-2 from Wuhan at the end of 2019 had considerable impact on our lives. In the absence of specific therapy, some people have resorted to alternative therapies. OBJECTIVE: The aim of our study was to explore the effect of the coronavirus epidemic on the patients' attitudes toward complementary and alternative medicine. METHOD: We have performed anonymous questionnaire survey among patients of a Hungarian university hospital and a city hospital waiting for elective surgery between August 3, 2020 and December 18, 2020. We received 279 questionnaires, the response rate was 69.7%. RESULTS: As a result of the coronavirus epidemic, 91.4% of the respondents did not change their opinion about complementary and alternative treatments, 8.2% were more optimistic about them. 16.8% of respondents were optimistic, 25.4% rejected, and 57.7% did not form an opinion about the disease-preventing effect of complementary therapy. A quarter of respondents (24.7%) had used complementary therapies in their lifetime, with only 10% of respondents using such therapies to prevent coronavirus infection. As a result of the pandemic, no one started using complementary therapies. 55.6% of the respondents used a herbal preparation during their lifetime. In the course of the epidemic, a high proportion of respondents (27.5%) used herbal preparations; no correlation was found between the use of the treatment and the socio-demographic factors examined. The use of herbs was lower among cancer and thromboembolic patients. CONCLUSION: Based on our study, the use of complementary therapies presumably decreased due to the restrictions imposed in the epidemic, however, the use of herbs did not change significantly. One-tenth of the respondents used naturopathic cure to prevent coronavirus infection. Orv Hetil. 2021; 162(42): 1678-1686.

[The use of herbal remedies prior to elective surgical procedures at an urban hospital and a university clinic in Hungary. Descriptive study]. / Gyógynövények használata elektív mutéti beavatkozás elott. Kérdoíves felmérés egy egyetemi klinika és egy városi kórház betegei körében.

Introduction: Herbal medicine use has become widespread in recent years. This is the first study in Hungary evaluating the use of nutraceutical agents in patients undergoing elective surgery. Aim: The aim of this study was to assess the types, frequency of use and predisposing factors of the most commonly used herbs among patients of an urban hospital and a university clinic. Method: We conducted an anonymous survey questionnaire at the Jávorszky Ödön Hospital and at the 1st Department of Surgery of Semmelweis University. A total of 1000 questionnaires were distributed. Results: In total, 612 questionnaires were returned. 34.3% of patients used herbal remedies, 19.6% of them two weeks prior to surgery. The most commonly used herbs were garlic, chamomile and lemongrass, while in the two-week period before surgery were garlic, ginger and rosehips. 58.5% of the patients had some type of co-morbidity; in this group, the use of herbal remedies was significantly more frequent. 64.4% of patients were expected to undergo general surgical intervention; in this group, the use of herbs was more popular. Analyzing the sociodemographic factors, women, people with a higher level of education, the ones that live in the capital and are over 60 years of age are more likely to use these compounds. Conclusion: One third of patients waiting for surgery used herbal remedies, one fifth of them two weeks prior to surgery. Only one fifth of the patients reported the use of these compounds to their doctors. Orv Hetil. 2020; 161(1): 17-25.