The other side of the coin: safety of complementary and alternative medicine

Most consumers consider complementary and alternative medicine (CAM) products inherently safe. The growing simultaneous use of CAM products and pharmaceutical drugs by Australian consumers increases the risk of CAM-drug interactions. The Therapeutic Goods Administration (TGA) has a two-tier, risk-based regulatory system for therapeutic goods - CAM products are regulated as low risk products and are assessed for quality and safety; and sponsors of products must hold the evidence for any claim of efficacy made about them. Adverse reactions to CAM products can be classified as intrinsic (innate to the product), or extrinsic (where the risk is not related to the product itself, but results from the failure of good manufacturing practice). Adverse reactions to CAM practices can be classified as risks of commission (which includes removal of medical therapy) and risks of omission (which includes failure to refer when appropriate). While few systematic studies of adverse events with CAM exist, and under-reporting is likely, most CAM products and practices do not appear to present a high risk; their safety needs to be put into the perspective of wider safety issues. A priority for research is to rigorously define the risks associated with both CAM products and practices so that their potential impact on public health can be assessed

The comprehensive osteoarthritis test: a simple index for measurement of treatment effects in clinical trials

Objective. To assess the measurement properties of a simple index of symptom severity in osteoarthritis (OA) of the hips and knees. Methods. Both the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the proposed new Comprehensive Osteoarthritis Test (COAT) instrument were completed weekly by 125 subjects in the context of a randomized, 12-week, 3 parallel-arm clinical trial. The reliabilities of the various scales were assessed on a weekly basis by use of Cronbach's alpha coefficients. The validity of the COAT total scale was assessed by correlation with the WOMAC total scale on a weekly basis with correlation coefficients, and in terms of the correlations between subject-level intercepts and slopes over time. The relative responsiveness of the WOMAC and COAT total scales was assessed using a multilevel (longitudinal) multivariate (WOMAC, COAT) linear model. Results. The WOMAC and COAT total scales were highly reliable (mean over weeks: WOMAC alpha = 0.98; COAT alpha = 0.97). The correlations between the WOMAC and COAT scales were very high (mean over weeks = 0.92; subject-level intercepts = 0.91, slopes = 0.88). The COAT total scale was significantly more responsive than the WOMAC total scale in the active treatment (34.8% improvement vs 26.8%; p = 0.002). Conclusion. The COAT total scale is simple to administer, reliable, valid, and responsive to treatment effects

Breast Self Examination: To Do or Not To Do?

ABSTRAK Ini adalah satu kajian retrospektif untuk melihat presentasi kanser payudara dan cara ianya dikesan dikalangan pesakit di Hospital Kuala Lumpur. Sebanyak 366 rekod pesakit dari Klinik Endokrin dan Payudara dianalisa. Hasil kajian menunjukan kebanyakan pesakit adalah dalam lingkungan umur 40-49 tahun (39.6%). Sebanyak 81.4% pesakit menunjukkan ketulan pada payudara dan mengesan ketulan ini sendiri (97.3%). Diameter min tumor semasa presentasi adalah 4.7± 3 cm. Sebanyak 1.6% penyakit di kesan oleh kakitangan perubatan dan 1.1% lagi dikesan melalui mamogram. Kesimpulannya, kebanyakan pesakit mengesan ketulan pada payudara mereka sendiri. Ini mencadangkan bahawa kaedah pemeriksaan sendiri payudara boleh digunakan sebagai saringan untuk mengesan tanda-tanda awal kanser payudara, sekiranya kemudahan mamogram tidak ada. Pengesanan awal melalui pemeriksaan sendiri dapat menawarkan pilihan rawatan dan kualiti hidup yang lebih baik sungguhpun terdapat bukti yang menyatakan bahawa kaedah ini tidak dapat mengurangkan mortaliti kanser payudara. Kata kunci: Kanser payudara, peperiksaan sendiri payudara ABSTRACT This is a retrospective descriptive study done to look at common presentation and method of detection of breast cancer. A total of 366 case records of patients attending the Breast and Endocrine Clinic at Hospital Kuala Lumpur were reviewed. The peak age of breast cancer presentation was 40 to 49 years (39.6%). Most (81.4%) patients presented with a lump in the breast and the lump was mainly self-detected (97.3%). The mean tumour diameter on presentation was 4.7± 3 cm. Medical staff detected the disease in 1.6% cases and 1.1% of cases were detected by mammogram. Most women detected the lump themselves, suggesting that Breast Self Examination (BSE) can be used for detection of the disease in places where there is cost and availability constrains for mammogram. Early detection with BSE can possibly offer better treatment options and quality of life despite the evidence that it does not reduce the mortality due to breast cancer