Where and how to find data on safety: what do systematic reviews of complementary therapies tell us?

Background: Successfully identifying relevant data for systematic reviews with a focus on safety may require retrieving information from a wider range of sources than for ‘effectiveness’ systematic reviews. Searching for safety data continues to prove a major challenge. Objectives: To examine search methods used in systematic reviews of safety and to investigate indexing. Methods: Systematic reviews focusing on safety of complementary therapies and related interventions were retrieved from comprehensive searches of major databases. Data was extracted on search strategies, sources used and indexing in major databases. Safety related search terms were compared against index terms available on major databases. Data extraction by one researcher using a pre-prepared template was checked for accuracy by a second researcher. Results: Screening of 2563 records resulted in 88 systematic reviews being identified. Information sources used varied with the type of intervention being addressed. Comparison of search terms with available index terms revealed additional potentially relevant terms that could be used in constructing search strategies. Seventy-nine reviews were indexed on PubMed, 84 on EMBASE, 21 on CINAHL, 15 on AMED, 6 on PsycINFO, 2 on BNI and HMIC. The mean number of generic safety-related indexing terms on PubMed records was 2.6. For EMBASE the mean number was 4.8 with at least 61 unique terms being employed. Most frequently used indexing terms and subheadings were adverse effects, side effects, drug interactions and herb-drug interactions. Use of terms specifically referring to safety varied across databases. Conclusions: Investigation of search methods revealed the range of information sources used, a list of which may prove a valuable resource for those planning to conduct systematic reviews of safety. The findings also indicated that there is potential to improve safety-related search strategies. Finally, an insight is provided into indexing of and most effective terms for finding safety studies on major databases.

Interaction Rituals and Jumbled Emotions Among “Relative Strangers”: Simulated Patient Work on a Trainee Complementary Therapy Practitioner Program

Learning games such as role-play (which we refer to as “simulated interaction rituals”) are commonly used as social tools to develop trainee health practitioners. However, the effect of such rituals on individual and group participant emotions has not been carefully studied. Using a heuristic approach, we explore the experiences of complementary therapy practitioner trainees (and their trainers) participating in a personal development course. Ten trainees and two tutors were interviewed, observational notes taken, and a secondary qualitative analysis undertaken. Participants and tutors described a medley of disparate emotional and moral responses to group rituals, conceptualized in this article as “jumbled emotions.” Such emotions required disentangling, and both trainees and staff perceived participating in unfamiliar rituals “with relative strangers” as challenging. Front of stage effects are frequently processed “backstage,” as rituals threaten social embarrassment and confusion. Concerns around emotional triggers, authenticity, and outcomes of rituals arise at the time, yet trainees can find ways to work through these issues in time.