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Li J, Hui X, Yao L, Shi A, Yan P, Yao Y, Wang Q, Ma Y, Wei D, Lan L, Chen L, Yan L, Fang F, Li H, Feng X, Wu J, Qiao Y, Zhang W, Esill J, Qiao C, Yang K. The relationship of publication language, study population, risk of bias, and treatment effects in acupuncture related systematic reviews: a meta-epidemiologic study. BMC Med Res Methodol 2023; 23:96. [PMID: 37081403 PMCID: PMC10120256 DOI: 10.1186/s12874-023-01904-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There are debates in acupuncture related systematic reviews and meta-analyses on whether searching Chinese databases to get more Chinese-language studies may increase the risk of bias and overestimate the effect size, and whether the treatment effects of acupuncture differ between Chinese and non-Chinese populations. METHODS In this meta-epidemiological study, we searched the Cochrane library from its inception until December 2021, and identified systematic reviews and meta-analyses with acupuncture as one of the interventions. Paired reviewers independently screened the reviews and extracted the information. We repeated the meta-analysis of the selected outcomes to separately pool the results of Chinese- and non-Chinese-language acupuncture studies and presented the pooled estimates as odds ratios (OR) with 95% confidence interval (CI). We calculated the Ratio of ORs (ROR) by dividing the OR of the Chinese-language trials by the OR of the non-Chinese-language trials, and the ROR by dividing the OR of trials addressing Chinese population by the OR of trials addressing non-Chinese population. We explored whether the impact of a high risk of bias on the effect size differed between studies published in Chinese- and in non-Chinese-language, and whether the treatment effects of acupuncture differed between Chinese and non-Chinese population. RESULTS We identified 84 Cochrane acupuncture reviews involving 33 Cochrane groups, of which 31 reviews (37%) searched Chinese databases. Searching versus not searching Chinese databases significantly increased the contribution of Chinese-language literature both to the total number of included trials (54% vs. 15%) and the sample size (40% vs. 15%). When compared with non-Chinese-language trials, Chinese-language trials were associated with a larger effect size (pooled ROR 0.51, 95% CI 0.29 to 0.91). We also observed a higher risk of bias in Chinese-language trials in blinding of participants and personnel (97% vs. 51%) and blinding of outcome assessment (93% vs. 47%). The higher risk of bias was associated with a larger effect estimate in both Chinese-language (allocation concealment: high/unclear risk vs. low risk, ROR 0.43, 95% CI 0.21 to 0.87) and non-Chinese-language studies (blinding of participants and personnel: high/unclear risk vs. low risk, ROR 0.41, 95% CI 0.23 to 0.74). However, we found no evidence that the higher risk of bias would increase the effect size of acupuncture in Chinese-language studies more often than in non-Chinese-language studies (the confidence intervals of all ROR in the high-risk group included 1, Table 3). We further found acupuncture appeared to be more effective in Chinese than in non-Chinese population (Table 4). CONCLUSIONS The findings of this study suggest the higher risk of bias may lead to an overestimation of the treatment effects of acupuncture but would not increase the treatment effects in Chinese-language studies more often than in other language studies. The difference in treatment effects of acupuncture was probably associated with differences in population characteristics. TRIAL REGISTRATION We registered our protocol on the Open Science Framework (OSF) ( https://doi.org/10.17605/OSF.IO/PZ6XR ).
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Affiliation(s)
- Jing Li
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xu Hui
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Anya Shi
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Peijing Yan
- West China school of public health, Sichuan university, Chengdu, China
| | - Yuan Yao
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Qi Wang
- Health Research Methodology, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Health Policy PhD Program and McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China
- Chinese EQUATOR Centre, Hong Kong, China
| | - Dang Wei
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lei Lan
- School of Acupuncture, Moxibustion and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingxiao Chen
- Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Lijiao Yan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fang Fang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huijuan Li
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Center, Hong Kong Baptist University, Hong Kong, China
| | - Xiaowen Feng
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jingxi Wu
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yifan Qiao
- Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wenhao Zhang
- First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Janne Esill
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneva, Sweden
| | - Chengdong Qiao
- The First Hospital of Lanzhou University, Lanzhou, China.
| | - Kehu Yang
- Health technology Assessment Centre, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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Lokugamage AU, Robinson N, Pathberiya SDC, Wong S, Douglass C. Respectful maternity care in the UK using a decolonial lens. SN SOCIAL SCIENCES 2022; 2:267. [PMID: 36531139 PMCID: PMC9734803 DOI: 10.1007/s43545-022-00576-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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Affiliation(s)
| | - Nathan Robinson
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
| | | | - Sarah Wong
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
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Savona-Ventura C, Mahmood T. The role of traditional complementary physical interventions in obstetrics – A scientific review commissioned by the European board and college of obstetrics and gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2022; 279:84-87. [DOI: 10.1016/j.ejogrb.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Corbett GA, Dicker P, Daly S. Onset and outcomes of spontaneous labour in low risk nulliparous women. Eur J Obstet Gynecol Reprod Biol 2022; 274:142-147. [PMID: 35640443 DOI: 10.1016/j.ejogrb.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study was to: 1. Establish the median gestational age of spontaneous labour for low-risk nulliparas. 2. Examine the variation in mode of delivery and short-term neonatal outcomes with gestation at onset of spontaneous labour. STUDY DESIGN This is a retrospective observational cohort study conducted at a tertiary obstetric unit. The study population was 12, 323 low risk nulliparous women with singleton pregnancies who experienced spontaneous onset of labour. The study period was over seven years, from Jan 1st 2011 to 31st Dec 2017. Exclusion criteria were multiparity, multi-fetal pregnancy, booking after 14 weeks gestation, antepartum or intrapartum death, or any obstetric or fetal indication for delivery with the exception of post-maturity. Gestation of onset of spontaneous labour, demographic variables and maternal and neonatal outcomes were collected. The primary outcome was median gestational age at onset of spontaneous labour and its distribution at term. Secondary outcomes were mode of delivery and neonatal outcomes including low-apgar score and NICU admission. RESULTS 12, 323 patients were eligible for inclusion. Median gestation for onset of labour was 40.1 weeks gestation, with 80.5% of spontaneous labour occurs by 41 + 0 weeks gestation. The risk of assisted delivery (RR 1.32, 95% CI 1.23 - 1.42), caesarean section (RR 2.17, 95% CI 1.88-2.51) and low-apgar scores (RR 3.13 95% CI 1.50-6.55) increased significantly with spontaneous labour after 41 weeks' gestation. CONCLUSIONS Nulliparous women with low-risk pregnancies are most likely to experience spontaneous labour between 40 + 0 and 40 + 6. 80.5% of spontaneous labour occurred by 41 + 0 weeks gestation. Assisted vaginal delivery, caesarean section and low-apgar scores were significantly more likely with spontaneous labour after 41 weeks' gestation.
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Affiliation(s)
- Gillian A Corbett
- Department of Obstetrics and Gynaecology, The Coombe Women and Infants' University Hospital, Dublin, Ireland.
| | - Patrick Dicker
- Departments of Epidemiology and Public Health Medicine and Obstetrics and Gynaecology, Royal College of Surgeons, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, The Coombe Women and Infants' University Hospital, Dublin, Ireland
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5
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Graca S, Betts D, Roberts K, Smith CA, Armour M. The changing clinical landscape in acupuncture for women's health: a cross-sectional online survey in New Zealand and Australia. BMC Complement Med Ther 2022; 22:94. [PMID: 35361171 PMCID: PMC8973511 DOI: 10.1186/s12906-022-03576-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background Acupuncture is a popular treatment for women’s health. Several trials and meta-analysis have been published in recent years on key women’s health conditions but it is unclear if this has led to any changes in clinical practice or referrals from other health professionals. The aim of this survey was to explore if, how, and why, aspects of acupuncture practice have changed since our survey in 2013. Method An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women’s health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women’s health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners’ referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women’s health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion Acupuncture practitioners in Australia and New Zealand commonly treat women’s health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women’s health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03576-3.
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Affiliation(s)
| | - Debra Betts
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Kate Roberts
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia. .,Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand.
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Israel L, Rotter G, Förster-Ruhrmann U, Hummelsberger J, Nögel R, Michalsen A, Tissen-Diabaté T, Binting S, Reinhold T, Ortiz M, Brinkhaus B. Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial. Chin Med 2021; 16:137. [PMID: 34922567 PMCID: PMC8684198 DOI: 10.1186/s13020-021-00536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acupuncture has shown beneficial effects for seasonal allergic rhinitis (SAR); however, it is time and cost intensive. We investigated feasibility and effects of self-administered body acupressure as a self-care technique that stimulates acupuncture points with manual pressure in SAR patients. METHODS We conducted a two-armed randomized controlled exploratory trial to compare effects of self-administered acupressure over 4 weeks at five acupuncture points plus rescue medication (RM) with cetirizine compared to RM alone in SAR patients. Among other outcome parameters, we assessed disease-related quality of life (Rhinitis Quality of Life Questionnaire [RQLQ]), overall SAR symptoms by a visual analogue scale (VAS) and a rescue medication score (RMS) after 4 and 8 weeks. RESULTS Forty-one SAR patients (mean age 38.5 ± 10.0 years, n = 21, 51.2% women) were randomized. Compared to RM alone (n = 21), acupressure plus RM (n = 20) was associated with relevant improvements after 4 weeks, shown by the difference between groups in adjusted means of RQLQ: - 0.9 points (95% CI - 1.6 to - 0.2; p = 0.011) and VAS overall SAR symptoms: - 21.6 mm (95% CI - 36.3 to - 6.8; p = 0.005). The RMS was lower in the acupressure group than in the control group: 1.9 points (95% CI - 3.8 to - 0.1; p = 0.120). Group differences decreased slightly until week 8. The acupressure was feasible and safe. CONCLUSION Results of this exploratory study indicate that self-applied acupressure is feasible, may improve disease-specific quality of life and reduce disease-related symptoms as well as anti-allergic medication intake in SAR patients. High-quality confirmatory studies including a sham-control group are needed in the future. Trial registration DRKS-ID: DRKS00014310. Date of registration in DRKS: 2018/04/24. Investigator sponsored/initiated trial (IST/IIT): yes. Ethics approval/approval of the ethics committee: Approved (leading) Ethics Committee No. EA1/033/18, Ethik-Kommission der Charité -Universitätsmedizin Berlin. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014310.
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Affiliation(s)
- Lukas Israel
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Gabriele Rotter
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Ulrike Förster-Ruhrmann
- Department for Otolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Josef Hummelsberger
- Societas Medicinae Sinensis (SMS) e.V. - International Society for Chinese Medicine, Franz-Joseph-Straße 38, 80801, Munich, Germany
| | - Rainer Nögel
- Societas Medicinae Sinensis (SMS) e.V. - International Society for Chinese Medicine, Franz-Joseph-Straße 38, 80801, Munich, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Sylvia Binting
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Miriam Ortiz
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany.
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstr. 57, 10117, Berlin, Germany
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The Role of Research in Guiding Treatment for Women's Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020834. [PMID: 33478105 PMCID: PMC7835913 DOI: 10.3390/ijerph18020834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Background: Surveys of acupuncture practitioners worldwide have shown an increase in the use of acupuncture to treat women’s health conditions over the last ten years. Published studies have explored the effectiveness of acupuncture for various conditions such as period pain, fertility, and labor induction. However, it is unclear what role, if any, peer-reviewed research plays in guiding practice. Methods: Acupuncturists with a significant women’s health caseload were interviewed online in three small groups to explore factors that contribute to acupuncturists’ clinical decision made around treatment approaches and research. Results: Eleven practitioners participated in the focus groups. The overarching theme that emerged was one of ‘Not mainstream but a stream.’ This captured two themes relating to acupuncture as a distinct practice: ‘working with what you’ve got’ as well as ‘finding the right lens’, illustrating practitioners’ perception of research needing to be more relevant to clinical practice. Conclusions: Acupuncture practitioners treating women’s health conditions reported a disconnect between their clinical practice and the design of clinical trials, predominantly due to what they perceived as a lack of individualization of treatment. Case histories were popular as a learning tool and could be used to support increasing research literacy.
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Ji Z, Zhang J, Menniti-Ippolito F, Massari M, Fauci AJ, Li N, Yang F, Zhang M. The quality of Cochrane systematic reviews of acupuncture: an overview. BMC Complement Med Ther 2020; 20:307. [PMID: 33054785 PMCID: PMC7556594 DOI: 10.1186/s12906-020-03099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Many systematic reviews of clinical trials on acupuncture were performed within the Cochrane Collaboration, the evidence-based medicine (EBM) most recognized organization. Objective of the article was to systematically collect and identify systematic reviews of acupuncture published in the Cochrane Library and assess their quality from a methodological perspective. METHODS A comprehensive literature search was performed in the Cochrane Database of Systematic Reviews to identify the reviews of acupuncture conducted until June 2019. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist, an evaluation tool for systematic reviews. RESULTS Out of a total of 126 eligible reviews, 50 systematic reviews were included. According to the AMSTAR 2, 52% of Cochrane Systematic Reviews (CSRs) were of low quality, due to the presence of one or more weaknesses in at least one of the domains defined as critical for the methodological quality assessment. The less satisfied critical domain was inadequate investigation and discussion of publication bias. Declaration of potential sources of conflict of interest, and funding of the authors of the review and of the included studies were other important weaknesses. CONCLUSIONS The main methodological flaws in the included CSRs were related to topics of relatively new concern in the conduction of systematic reviews of the literature. However, both, lack of attention about retrieval of negative studies, and statements about conflict of interests are crucial point for the evaluation of therapeutic interventions according to EBM methodology.
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Affiliation(s)
- Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | | | | | | | - Na Li
- School of Social and Political Sciences, Institute of health and wellbeing, University of Glasgow, Glasgow, UK
| | - Fengwen Yang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingyan Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Abstract
The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for "Induction of Labor" retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each.
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Affiliation(s)
- Anna Maria Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milano, Milano, Italy
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10
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Betts D, Armour M, Robinson N. U.K. Support Network for Maternity Acupuncture: Survey of Acupuncturists on the Acupuncture (for Conception to) Childbirth Team. Med Acupunct 2019; 31:274-280. [PMID: 31624526 DOI: 10.1089/acu.2019.1386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: In the United Kingdom, a professional acupuncture network, the Acupuncture (for Conception to) Childbirth Team (ACT), provides education and support for practitioners using maternity acupuncture. However, the nature of treatments their members provide has been unknown. The aim of this survey was to explore how ACT members used acupuncture for maternity care within their women's health practices. Materials and Methods: An anonymous self-completion questionnaire, hosted by Survey Monkey, was completed by practitioners from 10 ACT branches. Questions covered demographic information, type and frequency of treatment provided in the previous year, and referral networks. Descriptive statistics were used to report the data. Results: Of 114 survey forms sent, 99 replies were received, a response rate of 86.8%. In addition to fertility and menstrual conditions, the majority of the practitioners (87 [87.8%]) had treated at least 1 pregnant woman each. The most-common maternity situations encountered were: birth preparation (84 [96.5%]); nausea & vomiting (82 [94.2%]); and inducing labor (79 [90.8%]). More than 50% of the practitioners were also treating lower-back and pelvic pain (77 [88.5%]), breech presentations (74 [85.0%]), threatened miscarriages (55 [63.2%]), and headaches/migraines (46 [52.8%]). Only a minority (8 [9.1%]) attended births. A greater number of referrals were received from medical health professionals for pregnancy (54 [65.8%]) than for fertility (16 [19.5%]) or menstrual conditions (8 [9.7%]). Conclusions: ACT practitioners were treating a wide range of maternity conditions. Referrals from Western medical practitioners were more common for maternity acupuncture than for fertility or menstrual health. It may be that this professional network approach would be beneficial in other countries to support practitioners interested in providing maternity acupuncture.
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Affiliation(s)
- Debra Betts
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Nicola Robinson
- Allied Health Sciences, School of Health and Social Care, London South Bank University, London.,Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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11
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Handayani S. Pre-Labor Acupuncture for Delivery Preparation in Multiparous Women Past Age 40. Med Acupunct 2019; 31:310-314. [PMID: 31624531 DOI: 10.1089/acu.2019.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pregnancies in women over age 40 have higher risk factors for both the mothers and their babies. Rates of cesarean sections are also increased. Acupuncture has been reported as a treatment that has beneficial effects on pregnancy and delivery. This article describes 2 patients older than age 40, who were pregnant and receiving pre-labor acupuncture treatment to prepare for childbirth at a primary health care clinic that provides basic medical services. Cases: The first case was a pregnant woman, age 43, who commenced acupuncture treatment at 36 weeks' gestation. The second case was a pregnant woman, age 42, who commenced acupuncture treatment at 39 weeks' gestation. Prior to labor commencing spontaneously, the first woman received acupuncture 6 times and the second woman received acupuncture 2 times. The acupuncture involved manually inserting needles at the LI 4, ST 36 ,and SP 6 acupoints. Results: Both patients commenced labor spontaneously and had natural vaginal births at term. The infants were in normal weight ranges and were healthy. Conclusions: Acupuncture treatment prior to labor was safe and resulted in spontaneous natural vaginal births for 2 women who were more than 40 years old. Further research is required to examine the potential of pre-labor acupuncture to help women achieve natural vaginal births when maternal age is considered a risk factor.
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Affiliation(s)
- Selfi Handayani
- Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
- Department of Acupuncture, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
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