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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.
Randomized Clinical Trials of Constitutional Acupuncture: A Systematic Review  [PDF]
Myeong Soo Lee,Byung-Cheul Shin,Sun-Mi Choi,Jong Yeol Kim
Evidence-Based Complementary and Alternative Medicine , 2009, DOI: 10.1093/ecam/nep085
Abstract: The aim of this systematic review is to compile and critically evaluate the evidence from randomized clinical trials (RCTs) for the effectiveness of acupuncture using constitutional medicine compared to standard acupuncture. Ten databases were searched through to December 2008 without language restrictions. We also hand-searched nine Korean journals of oriental medicine. We included prospective RCTs of any form of acupuncture with or without electrical stimulation. The included trials had to investigate constitutional medicine. There were no restrictions on population characteristics. Forty-one relevant studies were identified, and three RCTs were included. The methodological quality of the trials was variable. One RCT found Sasang constitutional acupuncture to be superior to standard acupuncture in terms of the Unified PD Rating Scale and freezing gate in Parkinson's disease (PD). Another two RCTs reported favorable effects of eight constitutional acupuncture on pain reduction in patients with herniated nucleus pulposi and knee osteoarthritis. Meta-analysis demonstrated positive results for eight constitutional acupuncture compared to standard acupuncture on pain reduction (weighted mean difference: 10 cm VAS, 1.69, 95% CI 0.85–2.54, P < 0.0001; heterogeneity: τ2 = 0.00, Χ2 = 0.00, P = 0.96, I2 = 0%). Our results provide suggestive evidence for the effectiveness of constitutional acupuncture in treating pain conditions compared to standard acupuncture. However, the total number of RCTs and the total sample size included in our analysis were too small to draw definite conclusions. Future RCTs should assess larger patient samples with longer treatment periods and appropriate controls.
Impact of Including Korean Randomized Controlled Trials in Cochrane Reviews of Acupuncture  [PDF]
Kun Hyung Kim,Jae Cheol Kong,Jun-Yong Choi,Tae-Young Choi,Byung-Cheul Shin,Steve McDonald,Myeong Soo Lee
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0047619
Abstract: Acupuncture is commonly practiced in Korea and is regularly evaluated in clinical trials. Although many Cochrane reviews of acupuncture include searches of both English and Chinese databases, there is no information on the value of searching Korean databases. This study aimed to investigate the impact of searching Korean databasesand journals for trials eligible for inclusion in existing Cochrane acupuncture reviews.
Herbal Medicines for Parkinson's Disease: A Systematic Review of Randomized Controlled Trials  [PDF]
Tae-Hun Kim, Ki-Ho Cho, Woo-Sang Jung, Myeong Soo Lee
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035695
Abstract: Objective We conducted systematic review to evaluate current evidence of herbal medicines (HMs) for Parkinson's disease (PD). Methods Along with hand searches, relevant literatures were located from the electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycInfo, CNKI, 7 Korean Medical Databases and J-East until August, 2010 without language and publication status. Randomized controlled trials (RCTs), quasi-randomized controlled trials and randomized crossover trials, which evaluate HMs for idiopathic PD were selected for this review. Two independent authors extracted data from the relevant literatures and any disagreement was solved by discussion. Results From the 3432 of relevant literatures, 64 were included. We failed to suggest overall estimates of treatment effects on PD because of the wide heterogeneity of used herbal recipes and study designs in the included studies. When compared with placebo, specific effects were not observed in favor of HMs definitely. Direct comparison with conventional drugs suggested that there was no evidence of better effect for HMs. Many studies compared combination therapy with single active drugs and combination therapy showed significant improvement in PD related outcomes and decrease in the dose of anti-Parkinson's drugs with low adverse events rate. Conclusion Currently, there is no conclusive evidence about the effectiveness and efficacy of HMs on PD. For establishing clinical evidence of HMs on PD, rigorous RCTs with sufficient statistical power should be promoted in future.
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.
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.
Efficacy of psychoeducation in bipolar patients: systematic review of randomized trials  [cached]
Tarciso Aparecido Batista,Cristiane Von Werne Baes,Mario Francisco Juruena
Psychology & Neuroscience , 2011,
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.
A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes
Adam L Gordon, Phillipa A Logan, Rob G Jones, Calum Forrester-Paton, Jonathan P Mamo, John RF Gladman
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-31
Abstract: A systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for “Nursing Home”, “Residential Facilities” and “Homes for the Aged”; CINAHL for “nursing homes”, “residential facilities” and “skilled nursing facilities”; AMED for “Nursing homes”, “Long term care”, “Residential facilities” and “Randomized controlled trial”; and BNI for “Nursing Homes”, “Residential Care” and “Long-term care”. Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results.3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6?years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health.This study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.
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