This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

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Context Cultural competency is a cornerstone of patient-centered health care. Religious doctrines may define appropriate consumption or use of certain animals and forbid use of others. Many medications contain ingredients that are animal-derived; these medications may be unacceptable to individual patients within the context of their religious beliefs and lifestyle choices. Knowledge of animal-derived medications as a component of cultural competency can facilitate a dialogue that shifts focus from the group to the individual, away from cultural competency toward cultural humility, and away from a paternalistic provider/patient dynamic toward one of partnership. Objectives To explore how animal-derived drug components may impact medication selection and acceptability from the perspective of patients, physicians, and religious leaders as evidenced by studies that explore the question via survey or questionnaire. A secondary objective is to use the context of animal-derived drug products as a component of cultural competency to build a framework supporting the development of cultural humility. Methods A systematic search was performed in the PubMed, CINAHL, Cochrane, and ProQuest databases using combinations of the following terms: “medication selection,” “medication,” “adherence,” “pharmaceutical preparations,” “religion and medicine,” “religion,” “animal,” “dietary,” “porcine,” and “bovine.” Studies that reported using surveys or questionnaires to examine patient, physician, or religious leader perspective on animal-derived medications published in English between 1990 and 2020 were included. Review articles, opinion pieces, case reports, surveys of persons other than patients, religious leaders, or physicians, and studies published in languages other than English were excluded. Three authors independently reviewed articles to extract information pertaining to perspectives on animal-based medication ingredients. Results Eight studies meeting the described criteria were found that queried beliefs or knowledge of patients, religious leaders, or physicians regarding medications and medical products of biologic origin. Those studies are described in full in this review. Conclusions Knowledge of animal-derived ingredients may help open conversations with patients around spiritual history and cultural competency, particularly for those patients belonging to religious sects with doctrines that define appropriate use of human- or animal-derived products. Further formal study is needed to explore more fully the extent to which religious beliefs may impact selection of animal- or human-derived medications. Guidelines developed from this knowledge may aid in identifying individual patients with whom the discussion may be particularly relevant. More studies are needed to quantify and qualify beliefs regarding animal-derived medication constituents.

In response to the COVID‐19 pandemic, Lincoln Memorial University's DeBusk College of Osteopathic Medicine, like many other institutions, transitioned to providing virtual lectures rather than face‐to‐face class sessions. Although there are important advantages to this format, students have difficulty staying attentive to hours of video presentations each day. Virtual sessions also present additional challenges for interactive discussion and group activities. In addition, the COVID‐19 pandemic contributed to increased feelings of isolation and anxiety. To foster student engagement and provide a sense of community, we decided to deliver some lectures as a co‐hosted talk show. To accomplish this, the lead presenter prepared materials including learning objectives, major content points and supplemental information, while the co‐host prepared questions and comments based on high yield topics and common misconceptions. During the lecture, the primary presenter delivered most of the content with interjections, questions and comments from the co‐host to emphasize key points and clarify concepts. Following the presentations, students were asked to provide feedback on the effectiveness of this delivery style. Results were mixed; although many students appreciated the dynamic and colloquial nature, others found the format distracting. We concluded that benefits of the format included: easily scalable, can be synchronous or asynchronous, doesn't rely on audience to produce questions, facilitates complementary teaching styles and provides a dynamic, casual atmosphere. Some potential drawbacks of this approach were that some students found it too casual, and that comments from the co‐host were distracting. As a result of student feedback, we have begun to use this format occasionally – for review sessions for example – with greater success.

Introduction Obesity and diabetes are ongoing public health concerns in the United States, especially in rural communities. Obesity is a leading cause of many conditions such as cardiovascular diseases and diabetes. Diabetes, specifically Type 2 Diabetes Mellitus (T2DM), is a leading cause of many conditions such as heart disease and vision problems. Commercially available green tea (Camellia sinensis) products may promote weight loss and insulin sensitivity as indicated by change in Body Mass Index (BMI) and insulin‐resistance markers, which could provide potential benefit in the adjunctive management of obesity and diabetes. We conducted a meta‐analysis on recent randomized controlled trials (RCTs) to test the hypothesis that consumption of green tea (GT) or green tea extract (GTE) for over four weeks can lead to a decrease in BMI and/or Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR) index. Our study results will provide updated guidance on dietary recommendations and offer insight into effect sizes translatable to the general population. Methods Electronic databases including PubMed were searched for parallel‐designed and double‐blinded RCTs published between 2010 and 2020 that examined the effect of GT and GTE on BMI and/or HOMA‐IR Index. Two authors independently reviewed articles for inclusion with differences resolved by consensus. Three authors independently assessed studies to assign risk of bias scores. Heterogeneity of studies was evaluated through use of forest plots and the I2 statistic using RevMan5 software. When necessary, data of varying measurement units were synthesized by meta‐analysis. Results Eleven studies involving over 800 subjects were included. Daily doses of green tea ranged from 379 mg standardized extract to 20 mg green tea solids. Duration of interventions ranged from 4 to 48 weeks. Preliminary analysis indicates a statistically significant (p<0.05) percentage change in BMI and HOMA‐IR index with mean effect sizes of –2.29% (95% CI –4.45%, ‐0.13%, p=0.04) and –19.75% (95% CI ‐35.11%, ‐4.39%, p=0.01), respectively. Most included studies had unknown or high risk of bias. Conclusions Included studies were widely varied in patient selection, dosing, dosing strategy, and outcome measurements. However, these differences suggest broader applicability of the results. Adding green tea may be an accessible, inexpensive and well‐tolerated dietary change that may reduce the risk of chronic diseases associated with obesity and diabetes. Future research opportunities include conducting large RCTs to address the public health concern of obesity, diabetes and preventive medicine.