Universities of Exeter and Plymouth

Exeter, United Kingdom

Universities of Exeter and Plymouth

Exeter, United Kingdom

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Cohen P.A.,Harvard University | Ernst E.,Universities of Exeter and Plymouth
Cardiovascular Therapeutics | Year: 2010

Many patients use herbal supplements to treat chronic cardiovascular conditions and often combine herbal ingredients with cardiovascular medications. However, physicians do not reliably elicit a history of herbal use from their patients and may overlook herbal supplements' adverse effects. Although often considered harmless by patients, herbal supplements may cause adverse cardiovascular effects from an herbal ingredient, a contaminant, or an herb-drug interaction. Herbal stimulants, including bitter orange, ephedra, caffeine, guarana, maté, kola, areca, lobelia, khat, and others are the most common category of herbal therapies to cause cardiovascular effects. However, dozens of other herbal ingredients have also been linked to adverse cardiovascular events. In addition to listed ingredients, herbal supplements may become contaminated at a number of stages during production. Pesticides, heavy metals, bacteria, and pharmaceutical agents have been detected in herbal supplements. Supposedly "herbal" products that are adulterated with prescription anorectics, antidepressants, diuretics, phosphodiesterase-5 inhibitors along with other medications have been identified throughout Europe, North America, and Asia. All of these adulterants have potential cardiovascular effects. Herbal interactions with a variety of cardiovascular medications may also lead to adverse events. Herbal ingredients may cause pharmacokinetic as well as pharmacodynamic herb-drug interactions. We review clinically relevant patterns of adverse cardiovascular reactions to herbal supplements, and we provide resources and recommendations for practicing cardiologists evaluating patients with suspected herbal adverse effects. © 2010 Blackwell Publishing Ltd.


Ernst E.,Universities of Exeter and Plymouth
Evidence-based Complementary and Alternative Medicine | Year: 2011

The aim of this article is to provide a preliminary estimate of how much CAM is evidence-based. For this purpose, I calculated the percentage of 685 treatment/condition pairings evaluated in the "Desktop Guide to Complementary and Alternative Medicine" which are supported by sound data. The resulting figure was 7.4.% For a range of reasons, it might be a gross over-estimate. Further investigations into this subject are required to arrive at more representative figures. Copyright © 2011 Edzard Ernst.


Hunt K.,Universities of Exeter and Plymouth | Ernst E.,Universities of Exeter and Plymouth
Archives of Disease in Childhood | Year: 2011

Background: The use of complementary and alternative medicine (CAM) in paediatric populations is common yet, to date, there has been no synthesis of the evidence of its effectiveness in that population. This overview of systematic review evaluates the evidence for or against the effectiveness of CAM for any childhood condition. Methods: Medline, AMED and Cochrane were searched from inception until September 2009. Reference lists of retrieved articles were hand-searched. Experts in the field of CAM were contacted. No language restrictions were applied. Results: 17 systematic reviews were included in this overview, covering acupuncture, chiropractic, herbal medicine, homeopathy, hypnotherapy, massage and yoga. Results were unconvincing for most conditions although there is some evidence to suggest that acupuncture may be effective for postoperative nausea and vomiting, and that hypnotherapy may be effective in reducing procedure-related pain. Most of the reviews failed to mention the incidence of adverse effects of CAMs. Conclusions: Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions. Many of the systematic reviews included in this overview were of low quality, as were the randomised clinical trials within those reviews, further reducing the weight of that evidence. Future research in CAM for children should conform to the reporting standards outlined in the CONSORT and PRISMA guidelines.


Bachmann B.,Friedrich - Alexander - University, Erlangen - Nuremberg | Taylor R.S.,Universities of Exeter and Plymouth | Cursiefen C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Ophthalmology | Year: 2010

Topic: Preoperative corneal neovascularization (CNV) is thought to be associated with an increased rate of corneal graft failure and potentially also graft rejection. Clinical Relevance: New therapeutic options that offer differential influence on the ingrowths or regression of either corneal blood or lymphatic vessels force us to re-evaluate the known data about the role of CNV in keratoplasty. Methods: Electronic databases and corneal registries were searched (up through September 2008). Results were reported both descriptively for each study and using random effects meta-analysis. Potential moderating factors for the association between vascularization and graft failure and rejection were examined using metaregression analysis. Results: Nineteen studies reporting on a total of 24 944 grafts undergoing keratoplasty were included. An increase in the risk of graft failure and rejection in the presence of pathologic CNV was seen in studies with a pooled risk ratio of 1.32 (95% confidence interval [CI], 1.151.49) for graft failure and 2.07 (95% CI, 0.983.15) for graft rejection. There was evidence of incremental increase of risk for graft failure and rejection as more corneal quadrants were affected by neovascularization. The 2 factors predictive of increased risk of neovascularization and graft failure were increased recipient age (P =0.003) and male gender (P = 0.046). Conclusions: Graft failure and rejection risk increase with an increasing number of corneal quadrants affected by neovascularization before keratoplasty. These data support the study of novel topical antiangiogenic therapies at the cornea to precondition such a cornea for future corneal grafting. © 2010 by the American Academy of Ophthalmology.


Bleakley A.,Universities of Exeter and Plymouth | Marshall R.,Universities of Exeter and Plymouth
Medical Education | Year: 2013

CONTEXT There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education. DISCUSSION Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work. The medical humanities may play a critical role in educating for democracy in medical culture generally, and in improving communication in medical students specifically, as both demand high levels of empathy. Studies in the science of communication can provide a valuable evidence base justifying the inclusion of the medical humanities in the core curriculum. A case is made for the potential of the medical humanities - as a form of 'adult play'- to educate for collaboration and tolerance of ambiguity or uncertainty, providing a key element of the longer-term democratising force necessary to change medical culture and promote safer practice. CONCLUSION The arts and humanities can provide important contextual media through which the lessons learned from the science of communication in medicine can be translated and promoted as forms of medical education. Discuss ideas arising from this article at 'discuss' © Blackwell Publishing Ltd 2013.


Ernst E.,Universities of Exeter and Plymouth
Journal of Ginseng Research | Year: 2010

This overview is focused on Panax ginseng, one of the most commonly used herbal remedies. The currently available data regarding its clinical efficacy is somewhat confusing, despite the fact that many clinical trials and systematic reviews have been published. The risks of Panax ginseng seem to be only minor. Numerous mechanisms of action have been described. Future studies of this fascinating herbal remedy seem warranted but they should overcome the methodological limitations of the previous research. © The Korean Society of Ginseng.


Ernst E.,Universities of Exeter and Plymouth
The New Zealand medical journal | Year: 2012

To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation. Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition. The selection of studies, data extraction, and validation were performed independently by two reviewers. Sixty RCTs had been published. Twenty-nine RCTs did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred. Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors. Adverse effects are poorly reported in recent RCTs of chiropractic manipulations.


Perry R.,Universities of Exeter and Plymouth | Hunt K.,Universities of Exeter and Plymouth | Ernst E.,Universities of Exeter and Plymouth
Pediatrics | Year: 2011

BACKGROUND: Complementary and alternative medicines often are advocated for infantile colic, yet there has been no synthesis of the evidence to inform current practice about their use. OBJECTIVE: To critically evaluate all randomized clinical trials of nutritional supplements and other complementary and alternative medicines as a treatment for infantile colic. METHODS: Five electronic databases were searched from their inception to February 2010 to identify all relevant randomized clinical trials of complementary and alternative medicines and supplements for infantile colic. Reference lists of retrieved articles were hand searched. Data were extracted by two independent reviewers, and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias. RESULTS: Fifteen randomized clinical trials met the inclusion criteria and were included. Thirteen studies were placebo controlled. Eight were of good methodological quality. Eleven trials indicated a significant result in favor of complementary and alternative medicines. However, none of these randomized clinical trials were without flaws. Independent replications were missing for most modalities. CONCLUSIONS: Some encouraging results exist for fennel extract, mixed herbal tea, and sugar solutions, although it has to be stressed that all trials have major limitations. Thus, the notion that any form of complementary and alternative medicine is effective for infantile colic currently is not supported from the evidence from the included randomized clinical trials. Additional replications are needed before firm conclusions can be drawn. Copyright © 2011 by the American Academy of Pediatrics.


Ernst E.,Universities of Exeter and Plymouth
International Journal of Clinical Practice | Year: 2010

Complementary and alternative medicine (CAM) has been defined as 'diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine' (1). Today, CAM is used by large proportions of the general population (2,3). The popularity of CAM is patient-driven; most orthodox healthcare professionals have little interest in (4) or knowledge of (5) this area, and many remain sceptical about CAM's therapeutic value (6). © 2010 Blackwell Publishing Ltd.


Borrelli F.,University of Naples Federico II | Ernst E.,Universities of Exeter and Plymouth
Maturitas | Year: 2010

The use of complementary and alternative medicine (CAM) among menopausal women has increased in the last years. This review examines the evidence from systematic reviews, RCTs and epidemiological studies of CAM in the treatment of menopausal symptoms. Some evidence exists in favour of phytosterols and phytostanols for diminishing LDL and total cholesterol in postmenopausal women. Similarly, regular fiber intake is effective in reducing serum total cholesterol in hypercholesterolemic postmenopausal women. Clinical evidence also exists on the effectiveness of vitamin K, a combination of calcium and vitamin D or a combination of walking with other weight-bearing exercise in reducing bone mineral density loss and the incidence of fractures in postmenopausal women. Black cohosh appears to be effective therapy for relieving menopausal symptoms, primarily hot flashes, in early menopause. Phytoestrogen extracts, including isoflavones and lignans, appear to have only minimal effect on hot flashes but have other positive health effects, e.g. on plasma lipid levels and bone loss. For other commonly used CAMs, e.g. probiotics, prebiotics, acupuncture, homeopathy and DHEA-S, randomized, placebo-controlled trials are scarce and the evidence is unconvincing. More and better RCTs testing the effectiveness of these treatments are needed. © 2010 Elsevier Ireland Ltd.

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