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Hypertensive patients' preferences for complementary and alternative medicine and the influence of these preferences on the adherence to prescribed medication

Lee K, Mokhtar HH, Krauss SE, Ong BK

Complement Ther Clin Pract, 2014 May;20(2):99-105.
PMID: 24767954 DOI: 10.1016/j.ctcp.2014.03.001

PURPOSE: This study aimed to understand hypertensive patients' perceptions of and adherence to prescribed medication.
METHODS: A qualitative research study based on 23 purposely selected participants from a community health clinic in Malaysia. The participants underwent in-depth semi-structured interviews, and the data were analyzed using qualitative content analysis method.
RESULTS: The participants were presented with six types of perceptions of medication. The majority of the participants had negative perceptions of Western medicine (WM), self-adjusted their prescribed medication with complementary and alternative medicine (CAM) and concealed their self-adjusting habits from their doctors. Participants who thought positively of WM took their prescribed medication regularly. Most of the participants perceived the nature of WM as not being curative because of its side effects. Patients have the right to choose their preferred medication when they understand their illness.
CONCLUSION: Local health care systems should provide patients with alternative health services that suit their requests.
KEYWORDS: Adherence; Complementary and alternative medicine; Hypertension; Qualitative research
Study site: Klinik kesihatan, Selangor, Malaysia
Complementary and Alternative Medicine (CAM) use by Malaysian oncology patients

Farooqui M, Hassali MA, Abdul Shatar AK, Shafie AA, Seang TB, Farooqui MA

Complement Ther Clin Pract, 2012 May;18(2):114-20.
PMID: 22500849 DOI: 10.1016/j.ctcp.2011.09.003

The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments.
Assessment of general public perceptions toward traditional medicines used for aphrodisiac purpose in state of Penang, Malaysia

Hassali MA, Saleem F, Shafie AA, Al-Qazaz HK, Farooqui M, Aljadhey H, et al.

Complement Ther Clin Pract, 2012 Nov;18(4):257-60.
PMID: 23059442 DOI: 10.1016/j.ctcp.2012.06.001

The study aims to evaluate general public perceptions regarding the use of Traditional and Complementary Medicines (TCM) for aphrodisiac purposes. A questionnaire based, cross-sectional study was undertaken. Respondents were selected in the state of Penang, Malaysia. A total of 392 respondents were included in the study. Descriptive statistics were used for data analysis. Chi Square/Fischer Exact tests were used where appropriate. Out of 392 respondents, 150 (38.26%) reported using specific Traditional medicines for aphrodisiac purposes. Most respondents (46.94%) agreed that aphrodisiac medicines were easily available t. Moreover, 40.31% of the respondents reported that traditional aphrodisiac medicines were cheaper than modern (prescription) medicines. This study highlights limited public knowledge regarding the use of traditional aphrodisiac medicine. Healthcare professionals should be aware of informal TCM usage when prescribing allopathic medicines.
Complementary and alternative medicines (CAM) disclosure to the health care providers: a qualitative insight from Malaysian cancer patients

Farooqui M, Hassali MA, Abdul Shatar AK, Shafie AA, Farooqui MA, Saleem F, et al.

Complement Ther Clin Pract, 2012 Nov;18(4):252-6.
PMID: 23059441 DOI: 10.1016/j.ctcp.2012.06.005

This study sought to evaluate Malaysian oncology patients CAM disclosure to the health care providers. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified three themes: reasons of CAM disclosure, reasons of CAM non-disclosure and preference of CAM discussion to health care providers. Patients agreed that CAM disclosure is important to avoid any interaction with the conventional medicines. Perceived lack of physicians' knowledge & interest in CAM, fear of termination of therapy by the physicians upon CAM disclosure, and perceived simplicity of some of the CAM therapies were among the reasons of non-disclosure. Given the option of oncologists, pharmacists or nurses, patients described oncologists as the most suitable person to discuss or disclose CAM use due to confidence in their clinical skills. Understanding the underlying beliefs of patients' reluctance to disclose CAM to health care providers is important especially when they are on an ongoing treatment for cancer.
Potential drug-herb interaction with antiplatelet/anticoagulant drugs

Saw JT, Bahari MB, Ang HH, Lim YH

Complement Ther Clin Pract, 2006 Nov;12(4):236-41.
PMID: 17030294

This is a cross-sectional survey evaluating the use of herbal medicines in medical wards patients that may interfere with the effect of antiplatelet or anticoagulant therapy. Among the 250 patients participated, 42.4% (n=106) were taking herbs with 76 patients (71.7%) using herbs for the past 12 months. Overall, almost 31% (n=23, N=76) of patients were taking one or more of the specified herbal medicines [ginseng (Panax ginseng), garlic (Allium sativum), ginkgo (Gingko biloba) thought to interact with antiplatelet or anticoagulant therapy. The study showed that 21% (n=16, N=76) of patients co-ingested specified herbs with antiplatelet or anticoagulant therapy, of which half of them were at risk of potential drug-herb interactions. A large proportion of respondents involved in potential drug-herb interaction were elderly people (62.5%, n=5). However, more than 90% of herbal users did not disclose the use of herbal medicine to their health professionals. It is thus prudent for all care givers to be aware of the possibility of drug-herb interaction and inquire about herbal use from patients.
Fulltext Survival of patients with advanced and recurrent ovarian cancer treated using integrative medicine in Malaysia: A case series

Linus-Lojikip S, Subramaniam V, Lim WY, Hss AS

Complement Ther Clin Pract, 2019 Sep 06;37:73-85.
PMID: 31521007 DOI: 10.1016/j.ctcp.2019.09.001

BACKGROUND: This case series describes the survival outcomes of patients who underwent integrative medicine (IM) protocol for ovarian cancer, a treatment protocol, that integrated a carefully selected set of complementary and alternative medicine (CAM) into the conventional treatment for ovarian cancers.
MATERIALS AND METHODS: Retrospective review of patients' medical records was conducted at a private medical centre that delivered the IM protocol for patients with advanced and recurrent ovarian cancers. We explored and analysed the overall survival and disease progressions of those who received the IM treatment for at least 2 months.
RESULTS: Forty patients with advanced ovarian cancers fulfilled the inclusion criteria for this case series. An overall of 75% of the cases achieved remission with initial IM treatment, 17.5% had a partial response and 7.5% showed progressive disease. The overall 5-year survival for all 40 cases is 53.1%. When explored further, the 5-year survival for cases who received CAM only is 75%, and cases who received combined limited chemotherapy with CAM had a 5-year survival of 55%. At study endpoint, 11 cases died due to ovarian cancer.
CONCLUSION: These findings suggest that CAM may be a valuable addition to conventional therapy to treat and improve the survival of patients with ovarian cancers. A formal randomized control trial is required to evaluate the efficacy and long-term outcomes of using IM to treat advanced and recurrent ovarian cancers.
Pattern of complementary and alternative medicine (CAM) use among patients with chronic kidney disease

Shamsuddin N, Karuppannan M, Hafiz Wan Md Adnan WA, Farooqui M, Gnanasan S

Complement Ther Clin Pract, 2019 11;37:86-92.
PMID: 31539806 DOI: 10.1016/j.ctcp.2019.09.003
Self-preference music for gagging patient: Effect on physiology and oral health-related quality of life during dental impression

Mustafa NWNA, Ishak NH, Mohd Rosli NA, Nik Zulkifeli NR, Rajali A

Complement Ther Clin Pract, 2021 May;43:101392.
PMID: 33862351 DOI: 10.1016/j.ctcp.2021.101392

BACKGROUND: Gagging condition is among factors contributing to avoidance behavior to seek the dental treatment, and rigorous management is still under investigation. This study aims to explore the effect of listening to the self-preference music in reducing the gagging condition during dental impression procedure towards gagging patient. Physiology and psychological impact to the procedure with and without musical intervention are investigated.
METHOD AND MATERIAL: A group of twenty-five patients that will undergo impression procedure was randomly selected. Self-reported Gagging Problem Assessment (GPA-pa-SF) questionnaires was then administered to determine the severity of gagging. Maxillary impression was taken twice within the same patient in two different time intervals (1st without any intervention and 2nd with musical intervention). During both procedures, the pulse rate/minutes (BPM) and arterial oxygen saturation of haemoglobin (SpO2%) were recorded and psychometric assessment was evaluated through the Oral Health Impact Profile (OHIP-14).
RESULT: Mean value of BPM was significantly reduced with music (p
Effects of Muslims praying (Salat) on EEG gamma activity

Doufesh H, Ibrahim F, Safari M

Complement Ther Clin Pract, 2016 Aug;24:6-10.
PMID: 27502795 DOI: 10.1016/j.ctcp.2016.04.004

This study investigates the difference of mean gamma EEG power between actual and mimic Salat practices in twenty healthy Muslim subjects. In the actual Salat practice, the participants were asked to recite and performing the physical steps in all four stages of Salat; whereas in the mimic Salat practice, they were instructed to perform only the physical steps without recitation. The gamma power during actual Salat was statistically higher than during mimic Salat in the frontal and parietal regions in all stages. In the actual Salat practice, the left hemisphere exhibited significantly higher mean gamma power in all cerebral regions and all stages, except the central-parietal region in the sitting position, and the frontal area in the bowing position. Increased gamma power during Salat, possibly related to an increase in cognitive and attentional processing, supports the concept of Salat as a focus attention meditation.
Use and toxicity of traditional and complementary medicine among patients seeking care at an emergency department of a teaching hospital in Malaysia

Jatau AI, Aung MMT, Kamauzaman THT, Ab Rahman AF

Complement Ther Clin Pract, 2018 May;31:53-56.
PMID: 29705480 DOI: 10.1016/j.ctcp.2018.01.016

OBJECTIVE: Traditional and Complementary Medicines (TCM) are widely used worldwide, and many of them have the potential to cause toxicity, interaction with conventional medications and non-adherence to prescribed medications due to patients' preference for the TCM use. However, information regarding their use among patients seeking care at emergency departments (ED) of a healthcare facility is limited. The study aimed to evaluate the TCM use among patients attending the ED of a teaching hospital in Malaysia.
STUDY DESIGN: A sub-analysis of data from a prevalence study of medication-related visits among patients at the ED of Hospital Universiti Sains Malaysia was conducted. The study took place over a period of six weeks from December 2014 to January 2015 involving 434 eligible patients. Data on demography, conventional medication, and TCM uses were collected from patient interview and the medical folders.
RESULTS: Among this cohort, 66 patients (15.2%, 95%CI 12.0, 19.0) reported concurrent TCM use. Sixteen (24.2%) of the TCM users were using more than one (1) type of TCM, and 17 (25.8%) came to the ED for medication-related reasons. Traditional Malay Medicine (TMM) was the most frequently used TCM by the patients. Five patients (7.6%) sought treatment at the ED for medical problems related to use of TCM.
CONCLUSION: Patients seeking medical care at the ED may be currently using TCM. ED-physicians should be aware of these therapies and should always ask patients about the TCM use.
Use of complementary and alternative medicine in pregnancy and its impact on obstetric outcome

Yusof J, Mahdy ZA, Noor RM

Complement Ther Clin Pract, 2016 Nov;25:155-163.
PMID: 27863606 DOI: 10.1016/j.ctcp.2016.09.005

OBJECTIVE: To evaluate the prevalence of use of complementary and alternative medicine (CAM) in a Malaysian antenatal population and its impact on obstetric outcome.

DESIGN: Cross sectional study.

SETTING: Obstetric Unit, Hospital Sultanah Bahiyah, Alor Setar, Kedah.

MATERIAL AND METHOD: Women attending antenatal clinic and Patient Admission Centre (PAC) above 30 weeks gestation were given structured questionnaires to fill. Pregnancy outcome measures were documented and analyzed in relation to the information gathered through the questionnaire. SPSS Version 21 was used to analyze all data obtained.

RESULTS: Out of 447 women, the overall prevalence of CAM usage in pregnancy was 85.2%. It was popular among pregnant mothers aged between 26 and 35 years old and most commonly used in the third trimester (p = 0.0.010) to facilitate labour. Other sociodemographic factors such as race, parity, education, occupation and residence were not significantly important. Traditional herbs was the commonest type of CAM used in pregnancy (58.3%) followed by selusuh (24.3%). About 78.5% of the CAM users delivered vaginally (p = 0.020) but a significant proportion (14.3%) had fetal distress (p = 0.035) compared to non CAM users. The most common type of herbs used was akar kayu bunga Fatimah (37.7%) and gamat (13.4%). In our study, usage of selusuh product and akar kayu bunga Fatimah had a significant impact in achieving vaginal delivery and shortened the duration of labour particularly in multiparae. The usage of Kacip Fatimah and Salindah was associated with preterm labour (p = 0.04)Tongkat Ali herbal coffee had a significant association with hypertensive disorders in pregnancy (p = 0.011) and fetal distress (p = 0.04) Meanwhile, the usage of Jamu Mustika Ratu was significantly associated with low birth weight in grandmultiparae (p = 0.026)and spirulina was significantly associated with oligohydramnios (p = 0.04).

CONCLUSION: Usage of CAM in pregnancy in the Malaysian population is of high prevalence CAM in pregnancy has beneficial and adverse obstetric outcomes. More research is needed to establish the safety of usage of various forms of CAM in pregnancy.

Study site: Obstetric Unit, Hospital Sultanah Bahiyah, Alor Setar, Kedah.
The effects of Momordica charantia (bitter melon) supplementation in patients with primary knee osteoarthritis: A single-blinded, randomized controlled trial

Soo May L, Sanip Z, Ahmed Shokri A, Abdul Kadir A, Md Lazin MR

Complement Ther Clin Pract, 2018 Aug;32:181-186.
PMID: 30057048 DOI: 10.1016/j.ctcp.2018.06.012

BACKGROUND: Osteoarthritis is a common problem affecting the joints in the elderly, caused disability and consequently decrease the quality of life. The conservative treatment includes the usage of analgesia, but the use of herbal medicine is growing. Momordica charantia or bitter melon has been widely described to have anti-diabetic and anti-inflammatory effects. However, its effect on reducing pain in primary knee osteoarthritis is not well studied. We aim to determine the effects of Momordica charantia in reducing pain among primary knee osteoarthritis patients.
MATERIALS AND METHODS: Thirty-eight and thirty-seven primary knee osteoarthritis patients underwent 3 months of Momordica charantia and placebo supplementation respectively. Three 500 mg per capsule of Momordica charantia were taken thrice daily. Rescue analgesia was allowed as needed. Pain and symptoms throughout the Momordica charantia supplementation period were assessed using Knee Injury and Osteoarthritis Outcome Score and EQ-5D-3L Health questionnaire, while rescue analgesia intake throughout the period of supplementation was measured using analgesic score.
RESULTS: After 3 months supplementation period, body weight, body mass index, and fasting blood glucose reduced significantly in the Momordica charantia group. There were also significant improvements in Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, and reduction in analgesic score. The placebo group had also shown significant improvements in certain Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, but with increased of the analgesic score.
CONCLUSION: Momordica charantia supplementation offers a safe alternative to reducing pain and improving symptoms among the primary knee osteoarthritis patients while reducing the need for analgesia consumption. These beneficial effects can be seen as early as 3 months of supplementation.
Study site: Orthopaedic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Complementary and alternative medicine (CAM) disclosure to health care providers: A qualitative insight from Malaysian thalassemia patients

Ismail WI, Ahmad Hassali MA, Farooqui M, Saleem F, Roslan MNF

Complement Ther Clin Pract, 2018 Nov;33:71-76.
PMID: 30396630 DOI: 10.1016/j.ctcp.2018.06.004

BACKGROUND AND PURPOSE: This study investigated the disclosure of complementary and alternative medicine (CAM) use to health care providers by Malaysian thalassemia patients.
METHODS: The semi-structured interviews were audio taped, transcribed verbatim, and translated into English.
RESULTS: Thematic analysis identified four themes: 1) reason for CAM disclosure, 2) attempt to disclose CAM, 3) withdrawal from CAM disclosure, and 4) non-disclosure of CAM use. The reason for patients' disclosure of CAM use to healthcare providers is because they wanted to find information about CAM and were afraid of the interaction between the conventional medicine and CAM. Patients also disclosed the use of CAM because they were not satisfied with the conventional medicine that had caused them harm.
CONCLUSION: Effective communication between patients and health care providers is important, especially for patients who are undergoing conventional thalassemia treatment, for fear that there is an interaction between conventional treatment and CAM use.
Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics

Hasan SS, Ahmed SI, Bukhari NI, Loon WC

Complement Ther Clin Pract, 2009 Aug;15(3):152-7.
PMID: 19595416 DOI: 10.1016/j.ctcp.2009.02.003

OBJECTIVE: The primary objective of this study was to evaluate the use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Another aim was to identify demographic and socio-economic factors that are associated with CAM use.
RESEARCH DESIGN AND METHODS: Face-to-face interviews of conveniently selected patients with chronic diseases were conducted in outpatient clinics of a general hospital. A validated data collection form was used to gather the information regarding pattern, perception, reasons, and perceived effect of CAM on the disease state. The other relevant information including demographics, diagnosis, indication, and treatment were collected from the patients' medical records.
RESULTS: Out of 321 patients interviewed in this study, 205 patients were using some form of CAM, and thus the utilisation rate was 63.9%. A significant number of patients (35.5%) were using CAM for diabetes mellitus. Thirteen types of CAM were identified in the study with the most common being vitamins supplements (48.2%), herbal medicines (26.4%), ginseng (4.7%) and traditional Chinese medicine (4.0%). The patients with higher education level, higher income, and aged more than 50 years were independently associated with CAM use. Majority of the patients (77.6%) reported that their condition had improved by using CAM.
CONCLUSION: The present study confirms the high frequency of CAM use among patients with chronic diseases in a Malaysian public hospital. The popularity of CAM indicated the patients' preference towards holistic approach to health care.
Study site: Outpatient clinics, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
A systematic review on Chinese herbal treatment for radiotherapy-induced xerostomia in head and neck cancer patients

Nik Nabil WN, Lim RJ, Chan SY, Lai NM, Liew AC

Complement Ther Clin Pract, 2018 Feb;30:6-13.
PMID: 29389481 DOI: 10.1016/j.ctcp.2017.10.004

BACKGROUND: Over 80% of head and neck cancer patients suffer from radiotherapy-induced xerostomia (dry mouth). Xerostomia affects cancer patients' quality of life, and xerostomia sometimes persists throughout the patients' lifetime. This review aimed to evaluate the effectiveness and safety of Chinese herbs in relieving radiotherapy induced xerostomia.
METHODS: Systematic searches were conducted on 6 databases (English and Chinese). Studies published up till May 2017 were considered for inclusion.
RESULTS: A final 14 RCTs (total 994 head and neck cancer patients undergoing radiotherapy) compared Chinese herbs with no herbs, were included in analysis. Very low to moderate quality of evidence found Chinese herbal treatment may relief radiotherapy-induced xerostomia and other related complications (such as oral mucositis and loss of appetite) in head and neck cancer patients.
CONCLUSION: There is limited evidence that Chinese herbal treatment may relief radiotherapy-induced xerostomia and other related complications in head and neck cancer patients.
Women's perspectives towards traditional and complementary medicine used to conceive, during pregnancy and the postpartum period

Shaukat Ali R, Gnanasan S, Farooqui M

Complement Ther Clin Pract, 2018 Feb;30:109-115.
PMID: 29389469 DOI: 10.1016/j.ctcp.2017.12.009

OBJECTIVES: This study aims to explore pregnant and postpartum women's understanding of the meaning of traditional and complementary medicine (T&CM) and how that may affect their T&CM use.
METHODS: A cross-sectional study was conducted using self-administered questionnaires. Data collected from 374 women were analysed and represented via descriptive statistics.
RESULTS: Out of the 374 participants, 285 (76.2%) reported using at least one type of T&CM to conceive, during pregnancy or in the postpartum period. The majority of the participants identified that T&CM is all about plants or natural products without chemicals or drugs (n = 267, 71.4%, p

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