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  • Subject Name : Nursing

Making Decisions: Evidence Around Complementary Medicines

  1. What are complementary medicines? Do complementary medicines differ from regular pharmaceutical products? How? (consult the relevant literature).

Complementary medicine is often associated with nature and considered ‘natural’ and these are not associated with the traditional medical treatments (Reid, et al 2016). It gives people the feeling of returning to nature and our traditional roots. The products within complementary medicine tend to be derived from plants and natural sources. People hold the belief that if it’s natural, it must be good for you. Pharmaceuticals medicine tends to have one active ingredient whilst CAM medicines can have up to 30 active ingredients and claim too assist with a variety of conditions because of this complexity in CAM it can be difficult to perform randomised trials

The testing for pharmaceuticals is rigorous and must be registered with Australian Register of Therapeutic Goods (ARTG) Pharmaceuticals are focused on treating an illness and moving people from sickness to average health whereas Complementary medicine is focused on helping people achieve optimal health (complementary Medicines Australia, 2017). This means pharmaceuticals tend to focus on and separate the body into parts whereas CAM looks at the body as system working together.

  1. Briefly introduce the hierarchy of evidence and discuss the relevance and challenges of this method of ranking sources of evidence for CMs.

The hierarchy of evidence is a way of being able to rank different forms of the best available evidence. The top of the pyramid is considered the best, whilst the bottom is considered the weakest form of evidence. It is relevant to CM as to be taken seriously CM needs to expand its levels of evidence. There is some debate as to whether it is possible for it to get to the level of evidence Pharmaceuticals has. There are two important factors to consider when evaluating CM efficacy, what is in it, which can be tricky as many herbal mixtures have lots of different active compounds at low concentrations, the other factor is how well it works in the body (Arentz, et al 2014). It can be difficult to create randomised control trials, being as herbal practitioners may use different herbal mixtures for different patients with the same ailment or adjust dosage or change treatment as they progress. Trials are normally just one treatment and then a placebo without a high level of flexibility that would be required for CM (Arentz, et al 2014). People argue that if there is any benefit it cannot be linked to one herbal as it’s a concoction and therefor you need to test each individual ingredient (CMA, 2017). There is also the problem that herbal remedies can vary so often from batch to batch it can be hard to test their efficiency accurately because of this inconsistency it can be difficult to predict if it will work in the same way every time for every person (Walters, 2014). For these reasons it makes it difficult for CM to rise to the high levels the Hierarchy of Evidence requires.

  1. Use the PubMed database in the UTas library to locate two published research articles from academic journals that focus on the product/medicine you have chosen. Both articles should focus on the use of the chosen substance for treating or addressing the same issue (for example depression, hypertension, muscle cramps etc). One of the articles should be of the highest level of evidence that you can find according to the evidence hierarchy, and the other should be an article that you consider is relevant and useful (but which is not level one evidence). Briefly discuss the key findings of the two articles and explain how you chose the lower ranked article.

The selected substance is Vitamin D which has been used as a complimentary medicine. The issue for which this complimentary medicine has been used is the muscular strengths. The two studies have been selected from the Pubmed and these are detailing the impact of vitamin D as complimentary medicine in the post-menopausal women. One randomized controlled trial conducted by Apaydin, et al (2018) has been selected. The other is a case report which is written by De Santis, et al (2018).

Apaydin, et al (2018), in their study found that the levels of D3 increased with the daily low dose and single high dose in the two groups during the 12th and 4th week. The skeletal muscles of humans have vitamin D receptors and the genotypic variations in this receptor have been found to decrease the muscle strength. The Vitamin D as a complimentary medicine as a significant role in muscle function and strength. This is more pronounced in the proximal muscles present in the lower extremity. Therefore, the researchers in this study have focused on the quadriceps and the hamstrings. The administration of this vitamin led to improvement in these muscle groups particularly the groups which was on daily dose of this vitamin in small doses.

The second paper is De Santis, et al (2018) and they found that the vitamin D deficiency in the older women (79 years) is often missed during diagnosis. She had fractures and also had muscular pain for many years. The patients who had low trauma fractures or there is suspicion of osteoporosis must be screened for this vitamin’s deficiency. This will allow for proper treatment for replenishing the vitamin D level in the older women.

The lower ranked article is of the case report. This is placed at lower value in terms of evidence quality as it is only focussing on one patient. This has been selected by placing filters on the Pubmed database.

  1. Discuss the strength of the evidence base for the chosen substance based on the research you have conducted. Reflect on the impact that completing thisexercise has on your personal decision-making about using CMs. What, in your opinion, counts as legitimate evidence for you?

The chosen substance was Vitamin D and with the strength of the two evidence it is understood that this has significant role in enhancing muscle strength. The lower ranked paper showed the link between the poor muscular strength and ongoing muscle pain with this vitamins’ deficiency. However, the RCT established that daily low dose and single high dose have significant impact on the muscle strength and functioning of the post-menopausal women.

In completing this assignment, I have understood the importance of ascertaining the quality of evidence before selecting any complimentary medicine. evidence-based studies guide the clinical decision-making effectively (Frost, 2020). The complimentary medicines have to be used when there is high quality evidence supporting its use in the selected population for the given disease. According to me, an evidence is legitimate in CMs case, if it is done on a large population with multiple centres and have been randomly controlled. As in RCT there are two groups which are used for judging the effectiveness of a drug or a treatment (Bradley, November 16, 2012). Thus, with the RCT there is a clinical base for ascertaining effectiveness of a complimentary medicine.

References for The Science of Complementary Medicines

Apaydin, M., Can, A. G., Kizilgul, M., Beysel, S., Kan, S., Caliskan, M., ... & Cakal, E. (2018). The effects of single high-dose or daily low-dosage oral colecalciferol treatment on vitamin D levels and muscle strength in postmenopausal women. BMC endocrine disorders18(1), 48.

Arentz, S., Smith, C. A., Abbott, J. A., & Bensoussan, A. (2014). A survey of the use of complementary medicine by a self-selected community group of Australian women with polycystic ovary syndrome. BMC complementary and alternative medicine14(1), 472.

Bradley, J. (November 16, 2012). From ‘trust us, we’re doctors’ to the rise of evidence-based medicine. Available at https://theconversation.com/from-trust-us-were-doctors-to-the-rise-of-evidence-based-medicine-10608

Complementary Medicines Australia, (CMA). (2017). The Science of Complementary Medicines. Retrieved from http://www.cmaustralia.org.au/resources/Documents/FINAL%20The%20Science%20of%20Complementary%20Medicines.pdf

De Santis, R., Fitzgerald, J., Adamis, D., Molloy, D. W., Timmons, S., Meagher, D., & O’Regan, N. (2018). CGS 38th Annual Scientific Meeting Advances in Care: From the Individual to the Technology.

Frost, G. (2020). Why I’m at odds with evidence-based practice in 2020? Available at https://yourwellnessnerd.com/evidence-based-practice/

Reid, R., Steel, A., Wardle, J., Trubody, A., & Adams, J. (2016). Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC complementary and alternative medicine16(1), 176.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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