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The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial
Ji-Eun Park, Jae-Uk Sul, Kyungwon Kang, Byung-Cheul Shin, Kwon-Eui Hong, Sun-Mi Choi
BMC Complementary and Alternative Medicine , 2011, DOI: 10.1186/1472-6882-11-124
Abstract: Twenty-six participants (identified with either qi (vital energy) deficiency or qi excess syndrome) were randomly divided into either a moxibustion or sham group. Participants were treated with real or sham moxibustion at 4 acupuncture points, ST23 and ST27, bilaterally, 3 times per week for four weeks. The primary outcome was the frequency of defecations; secondary outcomes were the Bristol stool form scale (BSS) and the constipation assessment scale (CAS).Of the 26 participants that were randomized, 24 completed the study. Defecation frequency, BSS, and CAS showed no difference between the moxibustion and sham groups. The differences were -0.25 (95% CI: -2.08, 1.58, p = 0.78), -1.22 (95% CI: -2.7, 0.26, p = 0.1), 0.91 (95% CI: -1.46, 3.28, p = 0.44) in defecation frequency, BSS, CAS, respectively. The defecation frequency increased from an average of 3.3 to 4.6 times per week in the moxibustion group (1.5[-0.5, 2], p = 0.06) and from 2.7 to 3.7 stools per week in the sham group (1[-1, 2], p = 0.15) after four weeks of treatment. The difference between participants with a deficiency or an excess syndrome, determined based on assessment of sweat, facial features, pain, body energy, and pulse type, was significant in only defecation frequency. The difference was 3.3 (95% CI: 0.41, 6.19, p = 0.03).Moxibustion treatment appears safe, but showed no positive effect on constipation. The effectiveness of moxibustion treatment may depend on the syndrome pattern, and further long-term studies with a larger number of subjects are warranted.Clinical Research Information Service, KCT0000168Constipation is a common gastrointestinal complaint that is experienced by 27.2% of Canadians [1], 12%-19% of Americans [2], and 14% of Asians [3], with a prevalence of 11.6% in the elderly Asian [4]. In Korea, the prevalence is 16.5% for self-reported constipation, 9.2% for functional constipation and 3.9% for constipation-predominant irritable bowel syndrome [5].Constipation can cause abdom
Moxibustion and other acupuncture point stimulation methods to treat breech presentation: a systematic review of clinical trials
Xun Li, Jun Hu, Xiaoyi Wang, Huirui Zhang, Jianping Liu
Chinese Medicine , 2009, DOI: 10.1186/1749-8546-4-4
Abstract: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on moxibustion, acupuncture or any other acupoint stimulating methods for breech presentation in pregnant women. All searches in PubMed, the Cochrane Library (2008 Issue 2), China National Knowledge Information (CNKI), Chinese Scientific Journal Database (VIP) and WanFang Database ended in July 2008. Two authors extracted and analyzed the data independently.Ten RCTs involving 2090 participants and seven CCTs involving 1409 participants were included in the present study. Meta-analysis showed significant differences between moxibustion and no treatment (RR 1.35, 95% CI 1.20 to 1.51; 3 RCTs). Comparison between moxibustion and knee-chest position did not show significant differences (RR 1.30, 95% CI 0.95 to 1.79; 3 RCTs). Moxibustion plus other therapeutic methods showed significant beneficial effects (RR 1.36, 95% CI 1.21 to 1.54; 2 RCTs). Laser stimulation was more effective than assuming the knee-chest position plus pelvis rotating. Moxibustion was more effective than no treatment (RR 1.29, 95% CI 1.17 to 1.42; 2 CCTs) but was not more effective than the knee-chest position treatment (RR 1.22, 95% CI 1.11 to 1.34; 2 CCTs). Laser stimulation at Zhiyin (BL67) was more effective than the knee-chest position treatment (RR 1.30, 95% CI 1.10 to 1.54; 2 CCTs,).Moxibustion, acupuncture and laser acupoint stimulation tend to be effective in the correction of breech presentation.Breech presentation (opposite direction of the normal position of the foetus) is common in the mid-trimester of pregnancy, with the incidence of breech decreasing as the pregnancy approaches term. The incidence of breech presentation at term is reported to be 4% [1]. Women with breech presentation face serious problems if delivering vaginally. Breech presentation may arise from placenta praevia, multiple gestation, uterine abnormalities, poor uterine tone, pre-maturity or unknown causes, and is associated with primi
Systematic review of randomised controlled trials: Probiotics for functional constipation  [cached]
Anna Chmielewska, Hania Szajewska
World Journal of Gastroenterology , 2010,
Abstract: AIM: To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation.METHODS: The MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched in May 2009 for randomised controlled trials (RCTs) performed in paediatric or adult populations related to the study aim.RESULTS: We included five RCTs with a total of 377 subjects (194 in the experimental group and 183 in the control group). The participants were adults (three RCTs, n = 266) and children (two RCTs, n = 111) with constipation. In adults, data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010, Lactobacillus casei Shirota, and Escherichia coli Nissle 1917 on defecation frequency and stool consistency. In children, L. casei rhamnosus Lcr35, but not L. rhamnosus GG, showed a beneficial effect.CONCLUSION: Until more data are available, we believe the use of probiotics for the treatment of constipation condition should be considered investigational.
Moxibustion for hypertension: a systematic review
Jong-In Kim, Jun-Yong Choi, Hyangsook Lee, Myeong Soo Lee, Edzard Ernst
BMC Cardiovascular Disorders , 2010, DOI: 10.1186/1471-2261-10-33
Abstract: We searched 15 databases without language restrictions from their respective dates of inception until March 2010. We included randomized controlled trials (RCTs) comparing moxibustion to either antihypertensive drugs or no treatment. The risk of bias was assessed for each RCT.During the course of our search, we identified 519 relevant articles. A total of 4 RCTs met all the inclusion criteria, two of which failed to report favorable effects of moxibustion on blood pressure (BP) compared to the control (antihypertensive drug treatment alone). However, a third RCT showed significant effects of moxibustion as an adjunct treatment to antihypertensive drug therapy for lowering BP compared to antihypertensive drug therapy alone. The fourth RCT included in this review addressed the immediate BP-lowering effects of moxibustion compared to no treatment. None of the included RCTs reported the sequence generation, allocation concealment and evaluator blinding.There is insufficient evidence to suggest that moxibustion is an effective treatment for hypertension. Rigorously designed trials are warranted to answer the many remaining questions.By 2025, the number of adults with hypertension is predicted to be 1.56 billion worldwide [1]. Despite the efforts of conventional healthcare, more than 50% of the patients with high blood pressure (BP) fail to satisfactorily control this condition [2]. One reason is the adverse effects of many antihypertensive drugs, which result in patient noncompliance [3]. Therefore, a substantial proportion of hypertensive patients resort to complementary and alternative medicines to reduce their BP [4,5].Moxibustion is a traditional East Asian medical intervention that involves the burning of moxa (i.e., Artemisia vulgaris or mugwort) directly or indirectly at the acupuncture points. The indications of moxibustion include breech presentation, dysmenorrhea, knee osteoarthritis, diarrhea, asthma, stroke, cancer and hypertension, and so on [6,7]. Unlike th
Quality and validity of randomized controlled trials in China from the perspective of systematic reviews  [cached]
Hui Luo,Jian-ping Liu
Zhong Xi Yi Jie He Xue Bao , 2011,
Abstract: Abtract: A systematic review is based on randomized controlled trials (RCTs), and the reliability of its conclusion is closely related to the quality of original literature. The low quality of existing RCTs in China leads to the failure of conclusive findings in systematic reviews when evaluating the effectiveness of interventions. It is almost universal for systematic reviews to draw the conclusion that “further well-designed multicenter and large-scale RCTs are still required to confirm the beneficial effects of interventions”. This paper analyzed the current status of RCTs in China, discussed the influence of including trials of low quality in a systematic review and assessed how a systematic review should be carried out under such circumstances. Furthermore, the methods to evaluate the quality of RCTs were introduced and evaluated. Finally, several strategies were proposed to improve the quality of RCTs in China: foster an honest academic and social environment, enhance the training of doctors on clinical research methodology, promote the implementation of clinical registration systems and strengthen the quality control of clinical research and the medical journals regulations on the quality of submitted papers.
Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials  [PDF]
Stefan Müller-Lissner, Erika Richter, Marion Eberlin, Harald Weigmann, Tobias Mück, Michael A. Kamm
Open Journal of Gastroenterology (OJGas) , 2017, DOI: 10.4236/ojgas.2017.71005
Abstract: Background: Quality of life (QoL) is impaired in chronic constipation. Among nonprescription laxatives QoL data out of randomized controlled trials are available only for bisacodyl and sodium picosulfate (SPS). Methods: In two randomized, double-blind, placebo-controlled, parallel-group trials, the efficacy and safety of treatment with either bisacodyl or SPS, respectively, were assessed. After a 2-week baseline period patients with functional constipation were randomized to a 4-week treatment with either bisacodyl (2 tablets = 10 mg), SPS (18 drops = 10 mg), or matching placebo in a ratio of active drug to placebo of 2:1. Dose reduction as well as resuming the original dose was permitted. Patients who did not experience a bowel movement for more than 72 h were allowed to use a bisacodyl suppository. The primary endpoint was the mean number of Complete Spontaneous Bowel Movements (CSBMs) per week during the trial. QoL was assessed using the Patient Assessment of Constipation (PAC)-QoL questionnaire. Results: Active treatment led to a greater improvement of PAC-QoL scores for every domain. Active treatment was also superior to placebo for all individual questions of the questionnaire. Of note, SPS or bisacodyl not only improved satisfaction with stool patterns (quite a bit/extremely satisfied in 12.8% of patients on placebo and 50.3% on active treatment) but bloating was also considerably ameliorated (not at all feeling bloated in 24.5% on placebo and 41.4% on active treatment). Conclusion: Bisacodyl and SPS not only improve stool variables but also quality of life in patients with chronic functional constipation. (EudraCT Nos. 2007-001991-34 and 2007-002087-10).
Randomized Clinical Trials on Acupuncture in Korean Literature: A Systematic Review  [PDF]
Jae Cheol Kong,Myeong Soo Lee,Byung-Cheul Shin
Evidence-Based Complementary and Alternative Medicine , 2009, DOI: 10.1093/ecam/nem130
Abstract: The aim of this systematic review was to summarize randomized clinical trials (RCTs) assessing the effectiveness of acupuncture as published in Korean literature. Systematic searches were conducted on eight Korean medical databases. Manual searches were also conducted through eight major Korean medical journals. The methodological quality was assessed using a Jadad score. Studies evaluating needle acupuncture or auricular acupuncture (AA) with or without electrical stimulation were considered if they were sham or placebo-controlled or controlled against a comparative intervention. We also excluded acupuncture as an adjuvant to other treatments and other forms of acupuncture were excluded. Seven hundred and nine possibly relevant studies were identified and 10 RCTs were included. The methodological quality of the trials was generally poor. Manual acupuncture was compared to placebo acupuncture in four studies of patients with chronic low back pain, shoulder pain, premenstrual syndrome and allergic rhinitis. Three studies tested AA (two trials) and electroacupuncture (one trial) against no treatment, while three trials compared acupuncture with other active therapeutic controls. The methodological limitations of the included trials make their contribution to the current clinical evidence of acupuncture somewhat limited. The trial for premenstrual syndrome, shoulder pain and chronic low back pain added a limited contribution among those included RCTs. However, well-designed RCTs of acupuncture with a rigorous methodology are in progress or have been completed in Korea and will contribute to establish or contribute to the current progress of research in this field.
Drugs to Prevent Malaria in Travellers: A Systematic Review of Randomized Controlled Trials
Ashley M. Croft, Frédérique A. Jacquerioz and Katharine L. Jones
Human Parasitic Diseases , 2012, DOI: 10.4137/HPD.S4223
Abstract: Background: Malaria infects 10,000 to 30,000 international travellers each year. It can be prevented through anti-mosquito measures and drug prophylaxis. We did a systematic review to assess the effects of currently used antimalaria drugs, given as prophylaxis to non- immune adult and child travellers to regions with chloroquine-resistant Plasmodium falciparum malaria. Methods: We included randomized and quasi-randomized controlled trials of any antimalaria drug regimen currently used by inter- national travellers, compared against any other currently used regimen. In August 2009 we searched MEDLINE, EMBASE, LILACS, BIOSIS, mRCT, and the Cochrane Register of Controlled Trials (CENTRAL), without time restrictions. We searched reference lists, conference proceedings and one specialist journal, and contacted researchers and drug companies. We summarized the characteristics of the eligible trials, assessed their quality using standard criteria, and extracted relevant outcomes data. Where appropriate, we combined the results of different trials. Results: Eight trials (4240 participants) were included. One-quarter of trial participants were soldiers. Duration of exposure to malaria ranged from 15 days to 13 weeks. All trials reported common adverse events from antimalaria drugs. Atovaquone-proguanil users and doxycycline users had similar frequencies of reported adverse effects. Atovaquone-proguanil users had fewer reports of any adverse effect than mefloquine users (RR 0.72, 95% CI 0.6 to 0.85), also fewer gastrointestinal adverse effects (RR 0.54, 95% CI 0.42 to 0.7), and fewer neuropsychiatric adverse effects (RR 0.49, 95% CI 0.38 to 0.63). Chloroquine-proguanil users had more reports of any adverse effect than users of other drugs (RR 0.84, 95% CI 0.73 to 0.96), also more gastrointestinal adverse effects (RR 0.71, 95% CI 0.6 to 0.85). We found no evidence on primaquine in travellers. Conclusions: There is limited evidence on which currently available drug is most effective in preventing malaria. Atovaquone-proguanil and doxycycline are the best tolerated regimens. Doxycycline monohydrate appears exceptionally useful due to its good safety profile, low cost and protective efficacy against many travel-related infections, besides malaria. Mefloquine is associated with adverse neuropsy- chiatric outcomes. Chloroquine-proguanil is associated with adverse gastrointestinal outcomes. There is no evidence to support the use of primaquine as prophylaxis in travellers.
Acupoint Stimulation for Fibromyalgia: A Systematic Review of Randomized Controlled Trials  [PDF]
Huijuan Cao,Xun Li,Mei Han,Jianping Liu
Evidence-Based Complementary and Alternative Medicine , 2013, DOI: 10.1155/2013/362831
Abstract: Background. Acupoint stimulation is popular for treatment of fibromyalgia though there is lack of comprehensive evaluation of current clinical evidence for its effect and safety. Objective. To systematically review the beneficial effects and safety of acupoint stimulation for fibromyalgia. Methods. We searched six electronic databases for randomized trials on acupoint stimulation for treatment of fibromyalgia. Two authors extracted data and assessed the trial quality independently. RevMan 5.2 software was used for data analyses with effect estimate presented as (standard) mean difference and a 95% confidence interval. We defined minimum, medium, and large SMD effect sizes as 0.3, 0.5, and 0.75. Results. 16 RCTs with 1081 participants were involved in this review. Only two trials were evaluated as low risk of bias. Meta-analysis showed that acupuncture alone or combined with cupping therapy was superior to conventional medications on reducing pain scores and/or the number of tender points. However, acupuncture showed no better than sham acupuncture on pain reduction. There was no serious adverse event reported to be related to acupoint stimulation. Conclusions. Acupoint stimulation appears to be effective in treating fibromyalgia compared with medications. However, further large, rigorously designed trials are warranted due to insufficient methodological rigor in the included trials. 1. Background As nonspecific rheumatism, fibromyalgia (FM) is a disorder in which typical symptoms are chronic widespread muscular-skeletal pain and stiffness accompanying with fatigue, anxiety, sleep disorder, and/or irritable bowel syndrome [1]. The well known diagnostic criterion for this disease was developed by the American College of Rheumatology (ACR) in 1990 [2], and the latest version of this diagnostic criterion was updated in 2009 [3]. The main purpose of treatment for FM is to alleviate the pain and improve the quality of life for FM patients [4]. Without the curative medications for the entire scope of symptoms and disabilities associated with FM [4], complementary therapies are commonly used by FM patients, such as acupuncture, herbal medicine, and massage. Systematic reviews were also conducted to summarize the clinical evidence of therapeutic effect of those complementary therapies in treating FM. Mayhew and Ernst [5] collected results from five randomized controlled trials in 2007 and demonstrated that due to the small sample size and low methodological quality of included trials, acupuncture could not be recommended for FM. Three years later, other two
Efficacy of psychoeducation in bipolar patients: systematic review of randomized trials
Batista, Tarciso Aparecido;Baes, Cristiane Von Werne;Juruena, Mario Francisco;
Psychology & Neuroscience , 2011, DOI: 10.3922/j.psns.2011.3.014
Abstract: bipolar disorder is a recurrent and chronic disorder with significant morbidity and mortality. currently, pharmacological treatment is considered indispensable in bipolar disorder. however, despite advances in this area, treatment remains suboptimal. a large body of research has shown that innumerable psychosocial factors influence the emergence of mood disorders. therefore, in addition to pharmacological strategies, psychological interventions are increasingly recognized as an essential component in the treatment of bipolar patients. among the various approaches of psychosocial interventions, psychoeducation (pe) has been one of the most used. thus, the aim of this review was to evaluate the efficacy of pe in the clinical course, treatment adherence, and psychosocial functioning of bipolar patients by collecting data from controlled trials that used solely pe as a psychosocial approach. a systematic review of the literature was performed in the pubmed and scopus databases, without date limits, using the following keywords: psychoeducation and bipolar disorder. we found 13 randomized controlled trials. psychoeducation significantly improved the clinical course, treatment adherence, and psychosocial functioning of bipolar patients. it also reduced the number of relapses and recurrences per patient and increased the time to depressive, manic, hypomanic, and mixed recurrences. the number and length of hospitalizations per patient were also lower in patients who received pe. although we found a limited number of randomized controlled trials that evaluated the efficacy of pe in bipolar disorder, the studies showed positive results in reducing relapse rates and improving long-term treatment adherence. additionally, pe intervention improves the knowledge of the illness for both patients and caregivers to reduce their distress and improve overall social functioning.
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