Views of pediatric health care providers on the use of herbs and dietary supplements in children.

Herbs and dietary supplements (HDS) are widely used by adults for treating illnesses and/or preserving good health, and many parents use HDS for their children as well. Previous reports suggest parents will not divulge HDS use to health care providers for fear of their skepticism or disapproval. Yet the views of pediatric health care providers on HDS use in children are not well known. This study investigated the attitudes and practices of pediatric nurses and physicians regarding HDS use in children, in order to identify those characteristics associated with a high degree of confidence in initiating a dialogue on the topic of HDS with families in their practice. A written survey on attitudes and practices toward HDS was developed, piloted, revised, and then administered to a convenience sample of practitioners attending a regional postgraduate course in general pediatrics. Only 42% of 204 pediatric health care providers sampled felt confident in initiating discussions about the therapeutic use of herbs and dietary supplements with families in their practice. Confidence in discussing HDS with families correlated with both personal use of an HDS (OR 3.22; p=0.033) and length of time in practice less than 10 years (OR 8.26; p=0.007). Less than 18% felt that HDS were safe for children under 6 months of age; and only 35% felt they were safe for use in children < 24 months old. Only 7% felt that parents should be allowed to give their hospitalized child an herb or dietary supplement they had brought with them from home, although this increased to 35% if the herb or dietary supplement had been prescribed by a physician. Ninety-two percent of practitioners thought that HDS should be more closely regulated by the FDA. Only a minority of pediatric community practitioners felt confident in discussing HDS with families of children in their practice. Those who had been in practice for a shorter time and who had used HDS themselves were more likely to report confidence in initiating such discussions. The provision of more postgraduate educational opportunities to learn about herbs and dietary supplements may alleviate some practitioners' concerns about their own competency in discussing HDS with families in their practice.

Randomized trial of an internet curriculum on herbs and other dietary supplements for health care professionals.

PURPOSE: Herbs and dietary supplements are widely used, and there is an urgent need to educate health professionals about their risks and benefits. The Internet provides an innovative way of educating busy health professionals. This study assessed the impact of an Internet-based curriculum on health professionals' knowledge, confidence, and clinical practices related to herbs and dietary supplements. METHOD: The study was a randomized crossover trial involving physicians, pharmacists, advanced practice nurses, and dietitians. Participants were invited by e-mail and randomly assigned to immediate intervention versus waiting-list groups (n = 537). The curriculum lasted ten weeks and consisted of 20 case-based modules, each involving one multiple-choice or true-or-false question and its answer, links to reliable Internet sources of additional information, and a moderated listserv discussion group. Participants were surveyed about their knowledge, confidence, and communication related to herbs and dietary supplements on enrollment, after the immediate intervention group had completed the curriculum, and after the waiting-list group completed the curriculum. RESULTS: Baseline scores for knowledge, confidence, and communication were similar in the two groups. At the first follow-up, there was greater improvement in scores for all three areas in the immediate intervention group than in the waiting-list group (improvement for knowledge, 3.0 versus 1.4; confidence, 2.6 versus 0.6; communication, 0.21 versus -0.1, p <.01 for all comparisons). After all participants had received the curriculum, scores for both groups were significantly better than at baseline and similar to one another. CONCLUSION: Internet-based education about herbs and dietary supplements for diverse health professionals is feasible and results in significant and sustained improvements in knowledge, confidence, and communication practices.

Pediatric faculty development in integrative medicine.

As more patients use complementary and alternative medical (CAM) therapies, faculty may be asked to teach trainees about topics requiring faculty development training. Our purpose in this study was to evaluate qualitatively and quantitatively a new faculty development program covering 4 key areas of CAM: herbs and dietary supplements, mind-body therapies, massage, and acupuncture. Faculty members (N = 6) volunteered for the program and were included in the study if they completed at least 3 of the 6 scheduled sessions. For each session, participants completed a pretest evaluating their knowledge and confidence about the topic, then they received background reading and focused discussion questions. Each session was a case-based, experiential seminar led by an expert in the content area. Participants completed post-session questionnaires measuring knowledge, confidence, and communication practices at the end of each session and at the end of the series of seminars. They also were asked for feedback and suggestions for the following year. All participants strongly agreed that they gained important knowledge; scores on tests about herbs increased from 62% at baseline to 84% at completion, and scores on knowledge of acupuncture increased from 60% before the session to 98% after. All participants strongly agreed that their confidence in talking with patients, colleagues, and trainees improved; on average, confidence scores improved an average of 1.8 out of a total of 5 possible points for all topics. Participants more frequently asked patients about their use of herbs (from 50% at baseline to 75% at the end) and increased the percentage of training encounters in which they discussed CAM with trainees or colleagues from 10% to 25%. We concluded that faculty development in integrative medicine is feasible and results in qualitative and quantitative improvements in knowledge, confidence, and clinical and teaching behaviors.

Herbs and other dietary supplements: healthcare professionals' knowledge, attitudes, and practices.

CONTEXT: Herbs and other dietary supplements (H/DS) are frequently used by the public. They have significant health implications, yet little is known about health professionals' knowledge, attitudes, or clinical practices related to H/DS. DESIGN: Cross-sectional survey of clinicians prior to participation in an Internet-based educational program on herbs and dietary supplements. PARTICIPANTS: The 537 participants included 111 physicians (MD), 30 advanced practice nurses (RN), 46 pharmacists (PharmD), and 350 dietitians (RD). In addition to demographic information, participants were asked about their knowledge, attitudes, and practices related to H/DS. RESULTS: Most participants were involved in direct patient care (85%), in practice or on faculty (84%), and from outside our local institutions (76%); 66% reported receiving professional education about H/DS in the past year. There were statistically significant differences between professional groups, with RDs scoring better than others, but even their average scores were less than 60% of possible. The average score on knowledge questions was 10/20; the average confidence score was 4 out of 10 possible, and the average communication score was 1.4 out of 4 possible. Most respondents knew the most common clinical uses of echinacea and St. John's wort, and felt confident that they knew more than their colleagues about H/DS. Key deficits were in knowledge about adverse effects, confidence in reporting side effects, routinely communicating with patients about H/DS, and recording H/DS information in the medical record. CONCLUSIONS: Despite significant interest and previous training in H/DS, these clinicians had substantial room for improvement in knowledge, attitudes, and clinical practices about H/DS. Educational interventions and institutional policies are needed to improve the quality of patient care regarding H/DS, and such interventions should be rigorously evaluated to ensure that continuous improvements occur.

Supplement use growing among children and adolescents.

Many pediatric patients, especially those with chronic or recurrent conditions, use dietary supplements. It is critical that physicians open a dialogue with their patients and their families about the use of dietary supplements and herbal remedies. It is important for parents to research what is known about the efficacy and safety of a supplement when considering giving it to their children. Physicians must become familiar with evidenced-based resources, as well as federal and professional guidelines.

Promoting medication adherence in children.

The problem of getting children to follow a treatment regimen is widespread and is frustrating for physicians. The extent to which any patient adheres to a medical regimen is an essential determinant of clinical success. Strategies to improve adherence in children include using simplified drug regimens (e.g., once-daily dosing), pleasant-tasting medicines, liquid or other nonpill formulations, regular phone contact between parents and physicians, reminders, information counseling, self-management plans, and other forms of individualized supervision or attention. Physicians also can encourage adherence by providing a dearly written explanation or patient information sheets that list generic and brand names, dosage, schedule, duration, and common side effects and practical ways of coping with them. Physicians, children, and parents should develop a mutually agreed-upon treatment plan. Having the child participate in devising the plan improves adherence.

HolisticKids.org--evolution of information resources in pediatric complementary and alternative medicine projects: from monographs to Web learning.

Use of complementary and alternative medicine (CAM) is growing in the United States. Children are a part of this trend, with adolescent self-care exceeding adult use. As a result, the necessity of educating pediatricians on CAM practices has become clear. This paper describes the Pediatric Integrative Medicine Education (PIME) project with a focus on the creation of HolisticKids.org, a Website designed to educate pediatric residents. HolisticKids.org also addresses the needs and interests of medical students, fellows, faculty, and community-based care providers who work with children and CAM. An outstanding aspect of this effort is its interdisciplinary nature, involving physicians, pharmacists, dieticians, nurses, medical librarians, and Web specialists. Collaboration is mirrored on an institutional level, where the participating institutions include Children's Hospital Boston, Harvard Medical School, Boston Medical Center, the Massachusetts College of Pharmacy and Health Sciences, and Dana Farber Cancer Institute. Now in the third year of development, this Web-based education project demonstrates how integrative medical education can contribute to pediatric care for diverse families and complement cultural competency efforts. Ongoing efforts focus on adding content, developing evaluation techniques, and disseminating this resource to the health sciences community.

Herbs for benign prostatic hyperplasia.

OBJECTIVE: To review and evaluate the literature relative to the use of herbal therapies in the treatment of benign prostatic hyperplasia. DATA SOURCES: Literature was identified by MEDLINE, Embase, International Pharmaceutical Abstracts, and the International Bibliographic Information on Dietary Supplements searches and through cross-referencing of selected articles. STUDY SELECTION/DATA EXTRACTION: All articles identified from the data sources were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS: A large percentage of men >50 years old begin to experience signs and symptoms of benign prostatic hyperplasia (BPH). Herbs hold promise in the treatment of BPH. Serenoa repens, Pygeum africanum, Urtica dioica radix, and Cucurbita peponis semen are some of the botanical therapies used in the treatment of BPH. CONCLUSIONS: There are many European studies examining efficacy, dose, and adverse effects of these plants in the treatment of BPH. However, numerous questions remain. These include issues concerning long-term beneficial and adverse effects of herbal therapy, prevention of complications, standardization of extracts, and concomitant use with "mainstream" medications. Based on the information available today, these botanical therapies can be used for treatment of a number of objective and subjective symptoms in patients with BPH, stages I and II.

Herbal medicine course within pharmacy curriculum.

Due to the growing use of herbs and dietary supplements by consumers, pharmacists now need a basic knowledge of this topic for their professional practices. To meet this need, an elective course on herbs and dietary supplements is being taught at the Massachusetts College of Pharmacy and Health Science. The objective of the course is to teach students basic phytopharmacology, counseling skills on herbal medicine, evidence- based resources, manufacturing practices, and dietary regulations. A review of over 50 herbs touches on clinical use, efficacy, safety, and drug interactions. This paper reviews the course curriculum, resources and exercises used throughout the course.