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Taylor-Swanson L, Levett K. Leveraging Interprofessional Collaboration to Collect Agreed Common Outcomes in Everyday Clinical Practice. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:911-915. [PMID: 36269344 DOI: 10.1089/jicm.2022.0733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lisa Taylor-Swanson
- College of Nursing, University of Utah, Salt Lake City, UT, USA.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kate Levett
- National School of Medicine, The University of Notre Dame Australia, Darlinghurst, Australia, USA.,NICM Health Research Institute, THRI, University of Western Sydney, Sydney, Australia.,Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, Australia
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Taylor G, Addie YO, Burchett J, Durkin C, Crawford P, Ledford CJW. "Miracle" or "Medicine": A Turning-Point Analysis of Patients' and Physicians' Shifting Views on Acupuncture. Med Acupunct 2020; 32:263-271. [PMID: 33101570 DOI: 10.1089/acu.2020.1428] [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: 11/13/2022] Open
Abstract
Objective: Acupuncture is one of the most widely used treatments of complementary and alternative medicine (CAM) within the military's health system. The success of CAM integration is partially dependent on both providers' and patients' perceptions that acupuncture is health-promoting. The aim of this research was to identify turning points, or changes, across treatments that enhanced or inhibited physicians' and patients' perception of acupuncture as health-promoting. Materials and Methods: Using a retrospective-interview approach, interviews were conducted with 15 family medicine physicians practicing medical acupuncture in a family medicine setting and with 17 patients (N = 32). Turning points were separated into 2 groups (health-promoting or health-inhibiting). Similarities and differences between perspectives were noted. Results: Patients and physicians identified two changes that enhanced their perspective of acupuncture as health-promoting: (1) observed health changes and (2) pain-medicine/narcotic reduction/elimination. Patients identified their ability to fulfill personal or professional roles, whereas physicians identified (1) training experiences and (2) enhanced relationships with patients. Health-inhibiting changes in perspective were identified as logistical constraints/barriers by both parties, although their perspectives differed to some degree. Turning points that were viewed as health-inhibiting treatment were identified as clinical challenges by physicians and as a lack of consistency in care by patients. Conclusions: The insight from these findings can help identify areas where medical acupuncture can be improved to promote successful integration in conventional medicine settings, as well as how providers can tailor communication with patients about acupuncture.
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Affiliation(s)
- Greenberry Taylor
- Department of Journalism, University of Florida, Gainesville, FL, USA
| | - Yewande O Addie
- Department of Journalism, University of Florida, Gainesville, FL, USA
| | - Jason Burchett
- Nellis Family Medicine Residency Program, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
| | - Christopher Durkin
- Nellis Family Medicine Residency Program, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
| | - Paul Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA.,Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christy J W Ledford
- Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020; 2:CD009232. [PMID: 32032444 PMCID: PMC7007200 DOI: 10.1002/14651858.cd009232.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011. OBJECTIVES To examine the effects of acupuncture and acupressure for pain management in labour. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) -4.42, 95% confidence interval (CI) -12.94 to 4.09, 2 trials, 325 women, low-certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate-certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate-certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low-certainty evidence), and probably little to no effect on caesarean section (low-certainty evidence). Acupuncture compared to usual care We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) -1.31, 95% CI -2.14 to -0.49, 4 trials, 495 women, I2 = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low-certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I2 = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low-certainty evidence) or caesarean section (low-certainty evidence). Acupuncture compared to no treatment One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD -1.16, 95% CI -1.51 to -0.81, 163 women, very low-certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control We are uncertain if acupressure reduces pain intensity in labour (MD -1.93, 95% CI -3.31 to -0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low-certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate-certainty evidence). Acupressure compared to usual care We are uncertain if acupressure reduces pain intensity in labour (SMD -1.07, 95% CI -1.45 to -0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low-certainty evidence). Acupressure compared to a combined control Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD -0.42, 95% CI -0.65 to -0.18, 2 trials, 322 women, moderate-certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience. AUTHORS' CONCLUSIONS Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high-quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteWomen and Kids72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Kate M Levett
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
- University of Notre DameSchool of MedicineSydneyAustralia
| | - Mike Armour
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Aidan L Tan
- National University HospitalDepartment of Preventive MedicineSingaporeSingapore
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD)Cochrane Iran Associate CentreTehranIran
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Ijaz N. Research-related attitudes among Chinese medicine students at a Canadian college: a mixed-methods study. Integr Med Res 2019; 8:264-270. [PMID: 31799116 PMCID: PMC6881630 DOI: 10.1016/j.imr.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies have suggested that American Chinese medicine students' research interest declines as their training progresses. Many students further express low confidence in the congruence ('model validity') of bioscientific research methods in relation to the Chinese medicine paradigm. However, prior research has not assessed the impacts of research-related coursework on student perspectives in this regard. METHODS First-, second- and third-year Chinese medicine students were surveyed regarding their research-related views. Final year students were re-surveyed after completing the research course. Qualitative analyses of the participating students' coursework were also undertaken. RESULTS Over 80% of all participants showed high research interest and engagement, and viewed research as both relevant to clinical practice and important for the profession's socioeconomic legitimation. Male students were significantly more likely to view scientific evidence as improving the quality of Chinese medicine care (p = 0.021). A view that conventional research methods have low model validity for Chinese medicine interventions was higher among third year students than those in their first or second years of study (p = 0.001). Research coursework appeared to increase self-assessed research interest and skill. Concern regarding model validity was strongly evident in student coursework. CONCLUSION Research-related curricular interventions in the Chinese medicine field should directly address model validity, as it is of significant interest to a majority of students.
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Affiliation(s)
- Nadine Ijaz
- Humber College, Faculty of Health Sciences and Wellness, Toronto, Canada
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Sánchez-Araujo M, Luckert-Barela AJ, Sánchez N, Torres J, Conde JE. On Dermatomes, Meridians and Points: Results of a Quasiexperimental Study. Acupunct Med 2018; 32:62-9. [DOI: 10.1136/acupmed-2013-010352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Traditional Chinese medicine (TCM) meridians and points run vertically, reflecting their function in the Zhang-Fu system (meridian pattern). However, the trunk's spinal nerves show a traverse orientation, or a ‘horizontal pattern’. Objective The aim of the present work was to evaluate, via a cognitive quasiexperiment, whether the clinical indications of the points on the trunk are associated with their meridian function or with their innervation and visceral–somatic connection. Methods The points in each dermatome of the trunk were considered crosswise, regardless of their meridians. The clinical indications for each point were differentiated into two mutually exclusive categories: (a) vertical distribution effect (VDE) or ‘meridian pattern’, when indications were quite different regarding the indications for the other points on the dermatome; and (b) transverse distribution effects (TDE) or ‘horizontal pattern’, represented by mainly local or segmental indications except for Shu-Mu points. After observing that the proportions between both categories often exceeded 60% in pilot samples, 60% was adopted as the reference value. Results A total of 22 dermatomes accommodated 148 points with 809 indications, of which 189 indications (23.4%) exhibited VDE features, whereas 620 (76.6%) exhibited TDE features. Conclusions A TDE/VDE ratio of 3 : 1 implies that the clinical indications for the points of any dermatome on the torso are similar, regardless of their meridians, and suggests that most of the indications for trunk points involve a ‘horizontal pattern’ due to their neurobiological nature. These findings may help in understanding acupuncture's neurobiology and clarify some confusing results of clinical research, for example, excluding sham acupuncture as an inert intervention for future clinical trials.
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Affiliation(s)
- Max Sánchez-Araujo
- Complementary Therapy Research Unit, Francisco de Miranda University, Coro, Venezuela
- Instituto de Investigación de Salud y Terapéutica, INSYT, Caracas, Venezuela
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Guo ZL, Fu LW, Su HF, Tjen-A-Looi SC. Reply to "Letter to the Editor: Acupuncture is not a unique explanation for reflex excitatory cardiovascular responses". Am J Physiol Regul Integr Comp Physiol 2018; 315:R984-R985. [PMID: 30362827 DOI: 10.1152/ajpregu.00237.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Zhi-Ling Guo
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, California
| | - Liang-Wu Fu
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, California
| | - Hou-Fen Su
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, California
| | - Stephanie C Tjen-A-Looi
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, California
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Fisher CL, Ledford CJW, Moss DA, Crawford P. Physician Communication to Enhance Patient Acupuncture Engagement in Family Medicine. JOURNAL OF HEALTH COMMUNICATION 2018; 23:422-429. [PMID: 29630471 DOI: 10.1080/10810730.2018.1458924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.
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Affiliation(s)
- Carla L Fisher
- a College of Journalism & Communications, STEM Translational Communication Center, UF Health Cancer Center; UF Health Center for Arts in Medicine , University of Florida , Gainesville , FL , USA
| | - Christy J W Ledford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - David A Moss
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
| | - Paul Crawford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
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International patient registry on acupuncture therapy for premature ovarian insufficiency: Challenges and opportunities. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2018. [DOI: 10.1016/j.wjam.2018.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Soliday E, Betts D. Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand. J Acupunct Meridian Stud 2018; 11:25-30. [PMID: 29482798 DOI: 10.1016/j.jams.2017.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/18/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand. METHODS Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included. RESULTS Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild. DISCUSSION Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study's unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians.
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Affiliation(s)
- Elizabeth Soliday
- Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA.
| | - Debra Betts
- National Institute of Complementary Medicine at University of Western Sydney, Sydney, Australia; Postgraduate Programmes, New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington, New Zealand
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Shim JM, Lee YS. The association between the use of biomedical services and the holistic use of traditional East Asian medicine: a national survey of outpatients in South Korea. BMJ Open 2017; 7:e018414. [PMID: 29217726 PMCID: PMC5728304 DOI: 10.1136/bmjopen-2017-018414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The holistic use of a system of complementary and alternative medicine (CAM) is potentially linked to its treatment outcomes. This paper examines how the use of biomedicine is associated with the holistic use of CAM, focusing on traditional East Asian medicine (EM) that is uniquely integrated in the medical system in South Korea. DESIGN/SETTINGS A representative national sample of EM outpatients in South Korea. PARTICIPANTS 3861 survey respondents. METHODS By using the 2011 Korean National Survey of EM patients, ordered logistic regression models specify the relationship between EM outpatients' use of biomedicine and their holistic use of EM modalities. RESULTS Among EM outpatients who used at least one EM modality in the past 3 months, people who used two (33.3%) or three (29.4%) modalities together are the two highest proportions, followed by users of four (18.1%), five (7.2%), six (2.1%) and seven (0.6%) modalities. The odds for EM users to use EM holistically are 17% greater among EM users who used biomedicine as well, compared with EM users who did not use biomedicine. CONCLUSIONS The healthcare community should recognise that CAM use likely becomes holistic as people use biomedicine concomitantly, when the practice rights over a CAM system are comprehensively and exclusively entitled to a group of CAM professionals who are independent from practitioners of biomedicine.
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Affiliation(s)
- Jae-Mahn Shim
- Department of Sociology, Korea University, Seoul, Republic of Korea
| | - Yun-Suk Lee
- Department of Sociology, University of Seoul, Seoul, Republic of Korea
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Measuring patient reported outcomes of acupuncture treatment on pain patients' health status. Complement Ther Clin Pract 2017; 28:192-199. [PMID: 28779929 DOI: 10.1016/j.ctcp.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/04/2017] [Accepted: 06/26/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The primary aim of this observational multicenter case series study was to assess patient reported outcome measures of health status following routine acupuncture treatment. DESIGN Via the patient reported 'MYMOP2-online' questionnaire 110 pain patients reported three times (baseline, after four weeks, after sixteen weeks) whether changes in health status occurred following un-standardized routine acupuncture treatment. RESULTS ANOVA for repeated measures showed that primary pain (-38.8%), secondary pain (-38.4%), limitation to daily functioning (-33.2%), subjective well-being (24.2%), and health status (34.0%) significantly improved between zero and four weeks (p < 0.001). The achieved health benefits persisted over the long term (sixteen weeks). Pain medication usage decreased by 44.5% in four weeks. The changes in health status could not be related to specific aspects of acupuncture treatment. CONCLUSION In this observational study pain patients self-reported a statistically significant and clinically relevant long-term improvement in health status following acupuncture treatments in routine practice.
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Shim JM, Kim J. Cross-national differences in the holistic use of traditional East Asian medicine in East Asia. Health Promot Int 2016; 33:536-544. [DOI: 10.1093/heapro/daw089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Betts D, Smith CA, Dahlen HG. Does acupuncture have a role in the treatment of threatened miscarriage? Findings from a feasibility randomised trial and semi-structured participant interviews. BMC Pregnancy Childbirth 2016; 16:298. [PMID: 27717319 PMCID: PMC5055689 DOI: 10.1186/s12884-016-1092-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/04/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Threatened miscarriage is a common complication of early pregnancy increasing the risk of miscarriage or premature labour. Currently there is limited evidence to recommend any biomedical pharmacological or self-care management, resulting in a 'watchful waiting' approach. The objective of this study was to examine the feasibility of offering acupuncture as a therapeutic treatment for women presenting with threatened miscarriage. METHODS A mixed methods study involving a randomised controlled trial and semi structured interviews. A pragmatic acupuncture protocol including medical self-care advice was compared to an active control receiving touch intervention and medical self-care advice. Descriptive statistics were used to examine the demographic and baseline characteristics. Endpoints were analysed between groups using a mean t-test and chi-square tests with P < 0.05 considered statistically significant. Dichotomous data was expressed as Risk Ratio with 95 % confidence intervals. Eleven participants were purposively interviewed about their experiences on exiting the trial with interviews analysed using thematic analysis. RESULTS Forty women were successfully randomised. For women receiving acupuncture there was a statically significant reduction with threatened miscarriage symptoms including bleeding, cramping and back pain compared with the control (p = 0.04). Thematic analysis revealed women were dissatisfied with the medical support and advice received. An overarching theme emerged from the data of 'finding something you can do.' This encompassed the themes: 'they said there was nothing they could do,' 'feeling the benefits' and 'managing while marking time.' CONCLUSION Acupuncture was a feasible intervention and reduced threatened miscarriage symptoms when compared to a touch intervention. Further research is required to further explore acupuncture use for this common complication and whether it can reduce the incidence of miscarriage. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12610000850077 . Date of registration 12/10/2010. Retrospectively registered, with first participant enrolled 11/10/2012.
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Affiliation(s)
- Debra Betts
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- New Zealand School Acupuncture and Traditional Chinese Medicine, P.O. Box 11076, Wellington, 6142 New Zealand
| | - Caroline A. Smith
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Ning Z, Lao L. Acupuncture for Pain Management in Evidence-based Medicine. J Acupunct Meridian Stud 2015; 8:270-3. [DOI: 10.1016/j.jams.2015.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022] Open
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Luo J, Xu H, Liu B. Real world research: a complementary method to establish the effectiveness of acupuncture. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:153. [PMID: 25997850 PMCID: PMC4440554 DOI: 10.1186/s12906-015-0676-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/13/2015] [Indexed: 01/22/2023]
Abstract
Background Acupuncture has been widely used in the management of a variety of diseases for thousands of years, and many relevant randomized controlled trials have been published. In recent years, many randomized controlled trials have provided controversial or less-than-convincing evidence that supports the efficacy of acupuncture. The clinical effectiveness of acupuncture in Western countries remains controversial. Discussion Acupuncture is a complex intervention involving needling components, specific non-needling components, and generic components. Common problems that have contributed to the equivocal findings in acupuncture randomized controlled trials were imperfections regarding acupuncture treatment and inappropriate placebo/sham controls. In addition, some inherent limitations were also present in the design and implementation of current acupuncture randomized controlled trials such as weak external validity. The current designs of randomized controlled trials of acupuncture need to be further developed. In contrast to examining efficacy and adverse reaction in a “sterilized” environment in a narrowly defined population, real world research assesses the effectiveness and safety of an intervention in a much wider population in real world practice. For this reason, real world research might be a feasible and meaningful method for acupuncture assessment. Summary Randomized controlled trials are important in verifying the efficacy of acupuncture treatment, but the authors believe that real world research, if designed and conducted appropriately, can complement randomized controlled trials to establish the effectiveness of acupuncture. Furthermore, the integrative model that can incorporate randomized controlled trial and real world research which can complement each other and potentially provide more objective and persuasive evidence.
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Shim JM. The influence of social context on the treatment outcomes of complementary and alternative medicine: the case of acupuncture and herbal medicine in Japan and the U.S. Global Health 2015; 11:17. [PMID: 25907272 PMCID: PMC4415294 DOI: 10.1186/s12992-015-0103-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/01/2015] [Indexed: 11/23/2022] Open
Abstract
Background Complementary and alternative medicine (CAM), such as acupuncture and herbal medicine, is popular in many countries. Yet, treatment outcomes of CAM are found to vary significantly between medical trials in different social environments. This paper addresses how the social organization of medicine affects medical treatment outcomes. In particular, it examines the extent to which two popular complementary and alternative medicine (CAM) interventions (acupuncture and herbal medicine) are coordinated with biomedicine and how coordination characteristics are related to the treatment outcomes of the two CAM interventions. Methods This paper conducts an archival analysis of the institutional settings of the CAM interventions in Japan and the U.S. It also conducts a systematic content analysis of the treatment outcomes in 246 acupuncture reports and 528 herbal medicine reports that are conducted in Japan or the U.S. and registered in the Cochrane Library’s Central Register of Controlled Trials (CENTRAL), and 716 acupuncture reports and 3,485 herbal medicine reports that are from Japan or the U.S. and listed in MEDLINE. It examines the association between the treatment outcomes of the two interventions and the geographical location of the reports; it also explores how the institutional settings of the interventions are related to the treatment outcomes. Results Japanese herbal medicine is integrated into the national medical system the most and American herbal medicine the least; American acupuncture and Japanese acupuncture fall in the middle. Treatment outcomes are the most favorable for Japanese herbal medicine and the least favorable for American herbal medicine. The outcomes of American acupuncture and Japanese acupuncture fall in the middle. Conclusions The co-utilization of CAM with biomedicine can produce difficulties due to tensions between CAM and biomedicine. These difficulties and subsequent CAM treatment outcomes vary, depending on how CAM is institutionalized in relation to biomedicine in the national medical system. Coordinated CAM interventions are more likely to be effective and synergic with biomedicine, when compared to uncoordinated ones.
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Affiliation(s)
- Jae-Mahn Shim
- Department of Sociology, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 130-743, Korea.
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Levett KM, Smith CA, Dahlen HG, Bensoussan A. Acupuncture and acupressure for pain management in labour and birth: a critical narrative review of current systematic review evidence. Complement Ther Med 2014; 22:523-40. [PMID: 24906592 DOI: 10.1016/j.ctim.2014.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/27/2014] [Accepted: 03/30/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reviews of maternity services highlight the need for a reduction of medical interventions for women with low risk pregnancies and births to prevent the potential cascade of interventions and their associated risks. Complementary medicines (CM) such as acupuncture and acupressure have claimed to be effective in reducing interventions in labour; however, systematic reviews of evidence to date are conflicting. AIMS To examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. METHODS A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords 'CAM', 'alternative medicine', 'complementary medicine', 'complementary therapies', 'traditional medicine', 'Chinese Medicine', 'Traditional Chinese Medicine', 'acupuncture', 'acupressure', cross-referenced with 'childbirth', 'birth', labo*r', and 'delivery'. The quality of the evidence is also evaluated in the context of study design. RESULTS The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required. CONCLUSION The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked. The use of pragmatic trials designs with woman-centred outcomes may be appropriate for evaluating the effectiveness of these therapies.
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Affiliation(s)
- K M Levett
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
| | - C A Smith
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
| | - H G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia.
| | - A Bensoussan
- National Institute for Complementary Medicine, University of Western Sydney, Penrith, New South Wales, Australia.
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Appleyard I, Lundeberg T, Robinson N. Should systematic reviews assess the risk of bias from sham–placebo acupuncture control procedures? Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Effects of pretreatment with a combination of melatonin and electroacupuncture in a rat model of transient focal cerebral ischemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:953162. [PMID: 24348730 PMCID: PMC3853035 DOI: 10.1155/2013/953162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/01/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Both melatonin and electroacupuncture (EA) have been suggested to be effective treatments against stroke. However, it is unknown whether a combination of these two therapies could be beneficial against transient focal cerebral ischemia. The present study investigated the effects of pretreatment of a combination of melatonin and EA in a rat model of transient middle cerebral artery occlusion (MCAO). After pretreatment of melatonin plus EA (MEA), transient MCAO was induced for 90 minutes in male Sprague-Dawley (SD) rats. The neurological deficit score, brain infarct volume, cerebral edema ratio, neuronal inflammation, and apoptosis were evaluated 24 hours after transient MCAO. The expression of related inflammatory and apoptotic mediators in the brain was also investigated. The results showed that MEA improved neurological outcome, reduced brain infarct volume, and inhibited neuronal inflammation as well as apoptosis 24 hours after transient MCAO. The beneficial effects may derive from downregulation of proinflammatory and proapoptotic mediators and upregulation of antiapoptotic mediators. Thus, these results suggest a preventive effect of pretreatment of MEA on transient focal cerebral ischemia.
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Anders EF, Findeisen A, Nowak A, Rüdiger M, Usichenko TI. Acupuncture for treatment of hospital-induced constipation in children: a retrospective case series study. Acupunct Med 2012; 30:258-60. [PMID: 22914304 DOI: 10.1136/acupmed-2012-010192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Acupuncture is a promising option in the treatment of functional bowel disorders. The aim of this study was to evaluate the feasibility and acceptance of acupuncture for the treatment of hospital-induced constipation (HIC) in children. METHODS Bilateral stimulation of acupuncture point LI11 was applied in 10 children with HIC using fixed indwelling acupuncture needles (0.9 mm long) before considering starting conventional local constipation therapy with laxative suppositories. The clinical records were studied retrospectively for feasibility, acceptance and effectiveness of acupuncture. RESULTS Acupuncture was feasible in all children and application of the indwelling needles was tolerated without fear. Side effects were not observed. After a median of 3 days of HIC, all children defaecated within 2 h after LI11 stimulation. No patient required conventional local constipation therapy. CONCLUSIONS Acupuncture for the treatment of HIC is feasible and acceptable. Its effect should be verified in a randomised controlled trial.
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Affiliation(s)
- Eric Falk Anders
- Department of Paediatrics, Carl Gustav Carus-TU Dresden, Fetscher Str. 74, 01307, Dresden, Germany.
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Betts D, Smith CA, Hannah DG. Acupuncture as a therapeutic treatment option for threatened miscarriage. Altern Ther Health Med 2012; 12:20. [PMID: 22439880 PMCID: PMC3342918 DOI: 10.1186/1472-6882-12-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/22/2012] [Indexed: 11/10/2022]
Abstract
Background Threatened miscarriage involves vaginal bleeding in a pregnancy that remains viable. This is a common early pregnancy complication with increased risk factors for early pregnancy loss, preterm premature rupture of membranes (PPROM), preterm delivery, low birth weight babies and maternal antepartum haemorrhage. Currently there are no recommended medical treatment options, rather women receive advice that centres on a 'wait and see' approach. For women with a history of unexplained recurrent miscarriage providing supportive care in a subsequent pregnancy improves live birthing outcomes, but the provision of supportive care to women experiencing threatened miscarriage has to date not been examined. Discussion While it is known that 50-70% of miscarriages occur due to chromosomal abnormalities, the potential for therapeutic intervention amongst the remaining percentage of women remains unknown. Complementary and alternative medicine (CAM) therapies have the potential to provide supportive care for women presenting with threatened miscarriage. Within fertility research, acupuncture demonstrates beneficial hormonal responses with decreased miscarriage rates, raising the possibility acupuncture may promote specific beneficial effects in early pregnancy. With the lack of current medical options for women presenting with threatened miscarriage it is timely to examine the possible treatment benefits of providing CAM therapies such as acupuncture. Summary Despite vaginal bleeding being a common complication of early pregnancy there is often reluctance from practitioners to discuss with women and medical personal how and why CAM may be beneficial. In this debate article, the physiological processes of early pregnancy together with the concept of providing supportive care and acupuncture are examined. The aim is to raise awareness and promote discussion as to the beneficial role CAM may have for women presenting with threatened miscarriage.
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Usichenko TI, Lietz P, Pavlovic D, Schmidt R, Wendt M, Mustea A. Acupuncture does not influence brainstem auditory evoked potentials: a volunteer crossover study. Acupunct Med 2011; 29:215-20. [PMID: 21521742 DOI: 10.1136/aim.2010.003327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although acupuncture is effective for treating several conditions, its site specificity is questionable. OBJECTIVE To investigate whether acupuncture influences the brainstem auditory evoked potentials (BAEP). METHODS 10 healthy volunteers were enrolled according to inclusion criteria. One of four acupuncture points-TE3, GB43 (both auditory system-specific, according to traditional Chinese medicine) and non-specific acupuncture points HT7 and ST44-was needled during each session. Each volunteer received four sessions of acupuncture, with a 1-week interval between the sessions. RESULTS Peak latencies and amplitudes of the BAEP were registered before and during each session of acupuncture. Pain intensity and the incidence of paraesthesia (Qi sensation) during acupuncture were also registered. The peak latencies and amplitudes of the BAEP registered during acupuncture had not changed from the baseline levels. Needling of acupoint HT7 was most painful and induced the maximal incidence of Qi sensation. CONCLUSIONS Findings suggest that monitoring the BAEP is not a suitable technique for studying the immediate effects of acupuncture.
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Affiliation(s)
- Taras I Usichenko
- Department of Anaesthesiology and Intensive Care Medicine, Ernst Moritz Arndt University of Greifswald, Friedrich Loeffler Strasse 23b, 17487 Greifswald, Germany.
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Paradoxes in acupuncture research: strategies for moving forward. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 2011:180805. [PMID: 20976074 PMCID: PMC2957136 DOI: 10.1155/2011/180805] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 07/19/2010] [Accepted: 08/31/2010] [Indexed: 11/17/2022]
Abstract
In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) “top down” as multi-component “whole-system” interventions and (2) “bottom up” as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.
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Wayne PM, Hammerschlag R, Langevin HM, Napadow V, Park JJ, Schnyer RN. Resolving paradoxes in acupuncture research: a roundtable discussion. J Altern Complement Med 2009; 15:1039-44. [PMID: 19757981 DOI: 10.1089/acm.2009.0466] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter M Wayne
- Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, USA
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Cooperman OB. Creating the Next Level of Healing: Western Medicine, Complementary and Alternative Medicine, and the Rapidly Changing Roles of Physician and Patient. Med Acupunct 2009. [DOI: 10.1089/acu.2009.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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