NB. This project is (as of March 2008) now complete - for the executive summary of the final project report, click here. The CAMEOL website - the result of the project - can be viewed by by clicking here.

Aims

• To carry out a detailed review and critical appraisal of the published research in specific complementary therapies, focussing on key areas of NHS priority.

• To make this information available to health care professionals, researchers and the public via the Internet.

• To maintain an evidence-based information resource that reflects current research evidence and to establish an ongoing process for updating this information.

Background
It has been estimated that over 31 million visits were made to practitioners of eight established complementary therapies in 1998 in the UK (Thomas et al 2001). The House of Lords Select Committee on Science and Technology report on Complementary and Alternative Medicine (HL Paper 123, 2000) acknowledged the increasing public and professional interest in complementary therapies. It also pointed to the need for research evidence, as well as wider access to research-based information. Over 2 million articles are published annually in over 20,000 biomedical journals (Mulrow 1995). Medline, for example, is a database produced by the United States National Library of Medicine (NLM). It contains 3,700 journals from over 70 countries, from 1966 onwards. There are a number of databases that cover specialist subjects and include complementary therapies (Richardson 2001). The Research Council for Complementary Medicine (RCCM) has produced a comprehensive guide to searching for published information in complementary medicine (Rees 1995, Rees 2001, Richardson 2001). The RCCM has also developed a specialist complementary therapy database (CISCOM) and search service that is available through the RCCM web-site. CISCOM (followed by Medline) was found to be the most effective database for searching for controlled clinical trials in complementary therapy (White et al 1995). Other sources, such as the Cochrane clinical trials registry provide a specialist source of information regarding clinical trials in complementary medicine.

A source of information recently developed by the National Centre for Complementary and Alternative Medicine (NCCAM) in the USA and the National Library of Medicine (NLM) is CAM (Complementary and Alternative Medicine) on PubMed. This is a subset of the NLM bibliographic citations including Medline citations and offers computer links to more that 1,700 journals. CAMonPubMed 'features more than 230,000 references to CAM-related articles and reports' (NCCAM Newsletter, 2001). However a search on this subset may produce irrelevant articles that will need to be filtered out on the basis of the titles or abstracts. The School of Integrated Health together with the RCCM is working towards addressing the anomalies in searching for research in complementary medicine.

In order to advise and support patients who choose complementary therapy approaches practitioners require a readily accessible, user-friendly database that includes details of safety issues as well as evidence for effectiveness (and ineffectiveness). They also need to be able to access simple and straightforward information that provides details of study types as well as a synopsis of the research and its relevance to clinical practice.

Searching and critical appraisal
The reviews and critical appraisals will focus on complementary therapy research in NHS priority areas (cancer, mental health, coronary heart disease and stroke, and chronic illness). Each review will follow a comprehensive search strategy specifically designed for broad coverage of the area and one that includes all relevant databases.
The complementary therapies to be included in the search will be based on those therapies included in House of Lords Select Committee report that patients frequently request (Thomas et al 2001). Additional therapies that have the potential to provide an important component of self-management programmes will be included: Acupuncture, Osteopathy and Chiropractic, Homoeopathy, Medical Herbalism, Hypnotherapy, Reflexology, Massage and Aromatherapy, Meditation, Yoga, Alexander Technique.

All the citations that meet the inclusion criteria will be classified according to their research methodology. The full text / paper will be retrieved for all clinical studies that include measures of outcome, effectiveness and adverse events. A critical appraisal template will be applied to these studies in order to assess their methodological quality. Clinicians who are experienced in the diseases and therapeutic interventions will be invited to assess these citations and appraisals for their 'clinical relevance'.

Outcomes
The outcome of this project will be a database of complementary medicine in NHS priority areas.

Benefits
Once this information is available electronically it will make searching the complementary medicine literature in the NHS priority areas much more efficient. The availability of this information, collated under disease groups, classified according to research methodology and including both a research methods appraisal and an assessment of clinical relevance (for effectiveness studies), will make a major contribution to promoting evidence-based patient choice.

The intended target audience for this information is primarily health professionals and researchers, however the NHS Health Priorities Complementary Therapies Database will be accessible also by the general public. We recognise that some further work may be required to provide an evidence-based information product with a more 'public' face.

Time-scale: The project started in March 2003 and it is anticipated that the first set of reviews will be available by September 2004.
Project Director: Dr Janet Richardson
Project Manager: Karen Pilkington
Funding: Funded by the Department of Health (£297,800)

References
HL Paper 123. House of Lords Select Committee on Science and Technology. Session 1999-2000, 6th Report, Complementary and Alternative Medicine. Her Majesty's Stationary Office, London.

Mulrow C.D. (1995) Rationale for systematic reviews. In: Chalmers I. & Altman D. (eds) Systematic Reviews. BMJ Publishing Group.

National Centre for Complementary Medicine. Complementary & Alternative Medicine at the NIH. Spring 2001: Vol V111, Number 2. email: nccam@altmedinfo.org

Rees R.W. (1995) CISCOM, the Centralised Information Service for Complementary Medicine. Complementary Therapies in Medicine. 3: 183-186.

Rees R.W. (2001) Researching complementary therapies in cancer care. In: Barraclough J. Integrated Cancer Care: Holistic, complementary and creative approaches. Oxford: Oxford University Press.

Richardson J. (2001) Complementary therapies: what is the evidence for their use? Professional Nurse. 17(2): 96-99.

Thomas K. J., Nicholl J.P., Coleman P. (2001) Use and expenditure on complementary medicine in England: a population based survey. Complementary Therapies in Medicine 9: 2-11.

White A., Resch K.L., Ernst E. (1995) Searching for Acupuncture Trials: Which Database? Acupuncture in Medicine 13: 2, 97-99.