Applying latent tree analysis to classify Traditional Chinese Medicine syndromes (Zheng) in patients with psoriasis vulgari

OBJECTIVE To treat patients with psoriasis vulgaris using Traditional Chinese Medicine (TCM), one must stratify patients into subtypes (known as TCM syndromes or Zheng) and apply appropriate TCM treatments to different subtypes. However, no unified symptom-based classification scheme of subtypes (Zheng) exists for psoriasis vulgaris. The present paper aims to classify patients with psoriasis vulgaris into different subtypes via the analysis of clinical TCM symptom and sign data. METHODS A cross-sectional survey was carried out in Beijing from 2005-2008, collecting clinical TCM symptom and sign data from 2764 patients with psoriasis vulgaris. Roughly 108 symptoms and signs were initially analyzed using latent tree analysis, with a selection of the resulting latent variables then used as features to cluster patients into subtypes. RESULTS The initial latent tree analysis yielded a model with 43 latent variables. The second phase of the analysis divided patients into three subtype groups with clear TCM Zheng connotations: 'blood deficiency and wind dryness'; 'blood heat'; and 'blood stasis'. CONCLUSIONS Via two-phase analysis of clinic symptom and sign data, three different Zheng subtypes were identified for psoriasis vulgaris. Statistical characteristics of the three subtypes are presented. This constitutes an evidence-based solution to the syndromedifferentiation problem that exists with psoriasis vulgaris

A mixed methods sequential explanatory study of the utilisation and practice of traditional Chinese medicine by Chinese people in Hong Kong and Guangzhou

Little is known about why traditional Chinese (TCM) continues to be used and practised by Chinese people despite the existence of evidence-based Western medicine (WM). This study aims to explore Chinese patients and TCM practitioners’ attitudes and beliefs towards the utilisation and practice of TCM and to determine if there are any differences in the way in which Chinese people use and practice TCM in different regions of China, in this study, Hong Kong and Guangzhou. A mixed-method, sequential explanatory study was undertaken that involved two phases. In the first phase, a structured questionnaire translated into Chinese was used to collect data from a convenience sample of Chinese patients attending outpatient clinics in Hong Kong and Guangzhou. A Chinese research assistant who could speak Cantonese and Mandarin distributed the questionnaires to patients attending the TCM outpatient clinics in Hong Kong and Guangzhou. Also, a random sample of Chinese medicine practitioners in Hong Kong was sent a questionnaire by post, as a list of Chinese medicine practitioners names, and clinic addresses in Hong Kong are available on the Chinese Medical Council’s Internet website. For TCM practitioners in Guangzhou, a Chinese research assistant distributed the questionnaire in-person to a random sample of TCM doctors working at the Guangzhou University of Traditional Chinese medicine in Guangzhou. In the second phase of the study, semi-structured interviews were conducted with patients and Chinese medicine practitioners in Hong Kong and patients and TCM practitioners in Guangzhou. Patients and TCM practitioners who took part in an interview were randomly selected from a list of patients and TCM practitioners who had previously filled out a questionnaire in the first phase of the study. A total of 1,200 patients and 400 TCM practitioners took part in the study, which comprised of 600 patients attending an out-patient TCM clinic in Hong Kong and 600 attending an out-patient TCM clinic in Guangzhou. The response rate for patients who took part was 81.4% (n= 505) and for Guangzhou 91.6% (n=550). For TCM practitioners, the response rate was 55% (n=110) for practitioners in Hong Kong and 61.5% (n= 123) for practitioners in Guangzhou. Patients’ mean age was 44.6 years, and the sample consisted of 41.2% males and 58.8% females. For TCM practitioners, the mean age was 45.4 years and the sample consisting of 66.1% males and 33.9% females. In the second phase of the study, semi-structured interviews were conducted with 16 patients and 16 TCM practitioners in Hong Kong and Guangzhou, respectively. The results showed that for patients in Hong Kong and Guangzhou the most common use of TCM was for the treatment of acute medical conditions, such as colds and flu and also for chronic medical conditions, such as rheumatism and diabetes. Also, patients in Guangzhou were found to use TCM to “recuperate” the body after taking Western medicines prescribed by WM doctors, or after suffering a chronic illness. Concurrent use of TCM and WM was found to be more common in patients in Guangzhou, than in patients in Hong Kong. The integration of TCM services in hospitals in Hong Kong is notably different from that of China. Unlike China, where TCM practitioners are permitted to treat in-patients inside state-run hospitals, in Hong Kong, TCM practitioners are only permitted to treat patients on an outpatient basis and not as in-patients. The results of this study contribute to the existing body of literature about the utilisation and practice of TCM by Chinese people in Hong Kong and Guangzhou. The study also provides unique information about the practice of TCM in Hong Kong since the implementation of the Chinese medicine Ordinance and the establishment of the Chinese Medicine Council of Hong Kong. Although the study contributes to the existing body of literature concerning the utilisation and practice of TCM by Chinese people and TCM practitioners ‘respectively, it does have several inherent limitations. Among the significant limitations is the fact that, as a cross-sectional survey design was used, therefore no “cause and effect” relationships can be drawn from the results. Furthermore, because statistical tests, in general, require a large sample size to ensure a representative distribution of the population being studied, the total number of patients and TCM practitioners who participated in the study is relatively small

Health Biotechnology Innovation for Social Sustainability -A Perspective from China

China is not only becoming a significant player in the production of high-tech products, but also an increasingly important contributor of ideas and influence in the global knowledge economy. This paper identifies the promises and the pathologies of the biotech innovation system from the perspective of social sustainability in China, looking at the governance of the system and beyond. Based on The STEPS Centre’s ‘Innovation, Sustainability, Development: A New Manifesto’, a ‘3D’ approach has been adopted, bringing together social, technological and policy dynamics, and focusing on the directions of biotechnological innovation, the distribution of its benefits, costs and risks and the diversity of innovations evolving within it and alongside it

Factors affecting physicians’ attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVE: Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians’ attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design. DESIGN: A cross-sectional survey. SETTING: Twelve hospitals in Beijing, China. PARTICIPANTS: 1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research. METHODS: This research used a survey containing a previously validated 6-point Likert scale called ‘Chinese-revised Patient-Practitioner Orientation Scale’ (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants’ attitudes and to identify the sociodemographic predictors of Chinese physicians’ attitudes towards patient-centred care. RESULTS: Gender, professional title (ie, seniority) and hospital type influence Chinese physicians’ attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor–patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales. CONCLUSIONS: This research identified sociodemographic predictors of Chinese physicians’ attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician–patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability

Spectrum-effect relationships between high performance liquid chromatography fingerprints and bioactivities of charred areca nut

Purpose: To investigate the spectrum-effect relationships between high performance liquid chromatography (HPLC) fingerprints and duodenum contractility of charred areca nut (CAN) on rats.Methods: An HPLC method was used to establish the fingerprint of charred areca nut (CAN). The promoting effect on contractility of intestinal smooth was carried out to evaluate the duodenum contractility of CAN in vitro. In addition, the spectrum-effect relationships between HPLC fingerprints and bioactivities of CAN were investigated using multiple linear regression analysis (backward method).Results: Fourteen common peaks were detected and peak 3 (5-Hydroxymethyl-2-furfural, 5-HMF) was selected as the reference peak to calculate the relative retention time of 13 other common peaks. In addition, the equation of spectrum-effect relationships {Y = 3.818 - 1.126X1 + 0.817X2 - 0.045X4 - 0.504X5 + 0.728X6 - 0.056X8 + 1.122X9 - 0.247X13 - 0.978X14 (p < 0.05, R2 = 1)} was established in the present study by the multiple linear regression analysis (backward method). According to the equation, the absolute value of the coefficient before X1, X2, X4, X5, X6, X8, X9, X13, X14 was the coefficient between the component and the parameter.Conclusion: The model presented in this study successfully unraveled the spectrum-effect relationship of CAN, which provides a promising strategy for screening effective constituents of areca nut.Keywords: Charred areca nut, Spectrum-effect relationships, HPLC fingerprints, Duodenum contractilit

Cultural constructions of illness : the client and practitioner perspectives of traditional Chinese medicine. Perth Western Australia

An increased use of Complementary and alternate health care practices (CAM) and under which TCM is found assumed, is found in overseas countries and has become increasingly popular among Australian consumer. There has been a considerably increase in the consumer use of TCM over the past decade, but little is understood on the practice of the clinical encounter in TCM explained from the context within a clinic in western society.Investigation was made on how social and cultural processes have shaped people’s acceptance of TCM as a form of complementary health. Drawing from an ethnographic focus, the study explores the practice of TCM in several clinic settings in Perth. Attention is paid to the ways in which notions of health and illness are constructed by clients and practitioners. This study examined the interactions found in the process of ‘Kanbing’ from a TCM practice in Perth, Western Australia in order to understand how health practices are shaped by cultural and social processes. From an anthropological perspective, the ethnography of this study was guided an extended contact with the everyday clinical context of TCM, facilitated through participant observation, interviews with clients and practitioners and case study analysis. Interviews revealed perspectives from clients of non-Asian backgrounds to record the lived experiences of the encounters between the practitioner and client of TCM in the clinic. Participant observation took place over a two year period from February 2002 to March 2003 with further follow up work in the field conducted at intervals throughout 2004 and 2006 to gain additional data.The client centred interrelationships between practitioners of TCM, clients, and their perceptions, formed part of the interpretative process that informed the understanding of the cultural context from how an illness is described and explained through the process of Kanbing. My research was drawn from the reality of the encounter within the clinical context through participant observation within two western clinics of TCM. Thus the study makes a contribution to anthropology on the understanding of the structure and meaning found within the practice of traditional Chinese medicine in Australia

Chinese Medicine Student Clubs in Taipei, Taiwan

This thesis focuses on a communal form of transmission of Chinese medicine in contemporary Taiwan: Chinese medicine university student clubs. Offering fundamental Chinese medicine curricula to students and the interested public, the student clubs used to serve as a direct educational steppingstone towards licensed practice. Recent changes in medical education policy, however, made a university degree in Chinese medicine a requirement, thereby pushing informal ways of knowledge transmission into the realm of lay activity. Nevertheless, the clubs remain active and still serve as a community for people interested in Chinese medicine, including those wanting to pursue it professionally. Based on field research conducted in two such university clubs in Taipei in early 2018, this thesis first outlines the challenges and tensions faced and negotiated by those club members with professional ambitions. Not (yet) enrolled in “official” Chinese medicine programs at university but already deeply engaged in learning, they constitute a group of people rarely represented in academic literature, namely those just orienting themselves towards becoming Chinese medicine physicians. These processes of orientation and becoming are shaped by organizational, economic, and epistemological pressures and embedded in transnational movements, imaginaries, and regulatory regimes. Secondly, the thesis examines the function and position of the clubs in the changing landscape of Chinese medical education in Taiwan, as well as in the wider field of transmission of Chinese medicine. I argue that they foster continued interest in Chinese medicine in an environment that has favored biomedicine since the Japanese colonial era and that they, although through paths more winded than before, still contribute to the reproduction of professional Chinese medical expertise. In addition, they provide space for communal forms of healthcare. Lastly, they contribute to the maintenance of everyday healthcare competence in the wider public, or what Arthur Kleinman (1980) has called the “popular sector of healthcare.

Patents and Traditional Medicine: Digital Capture, Creative Legal Interventions and the Dialectics of Knowledge Transformation

This article examines the debate over the exclusion of indigenous or local knowledge forms from the global intellectual property system, and some of the current attempts to solve this problem. Using the lens of cultural cosmopolitanism, the article highlights important trends in the dialectics of developing countries\u27 engagement with intellectual property and other collateral knowledge protection systems. The three sites at which this significant development is unfolding are: (1) the digitization of traditional medicinal knowledge through India\u27s traditional knowledge digital library (TKDL) project; (2) a recent attempt at incorporating innovations in Chinese Herbal Medicine (CHM) in Taiwanese patent law; and (3) efforts to enshrine disclosure of origin requirements (DRs) in patent applications, and developments around geographical indications (Gls)

Caring for a child with severe intellectual disability in China: The example of Rett syndrome

Purpose: Rett syndrome is one of several genetic disorders known to cause severe intellectual and physical disability, mostly in girls. Girls affected by Rett syndrome appear to develop normally in the first 6 months of life, after which the usual clinical presentation comprises regression of communication and hand skills, the appearance of hand stereotypies and impaired gait. Intellectual disability affects more than 1.5% of the population of children in developing countries yet we know little about the daily lives and support services available for them and their caregivers. Method: This qualitative study explored the daily experiences of 14 mothers and one grandmother caring for a child with Rett syndrome in China via telephone interviews. Results: Participants reported a lack of education, rehabilitation and support services available to them. Limited access to information reduced families’ capacity to adequately meet the needs of their child. These gaps were further exacerbated by discrimination and perceived stigma from some members of the community. Conclusions: Additional support services and educational programs at the governmental level can improve the quality of life of persons with an intellectual disability and their families and programs involving community participation in the care of people with disabilities may help to address discrimination

Efficacy and safety of acupuncture for the treatment of non-specific acute low back pain: a randomised controlled multicentre trial protocol [ISRCTN65814467]

BACKGROUND: Low back pain and its associated incapacitating effects constitute an important healthcare and socioeconomic problem, as well as being one of the main causes of disability among adults of working age. The prevalence of non-specific low back pain is very high among the general population, and 60–70% of adults are believed to have suffered this problem at some time. Nevertheless, few randomised clinical trials have been made of the efficacy and efficiency of acupuncture with respect to acute low back pain. The present study is intended to assess the efficacy of acupuncture for acute low back pain in terms of the improvement reported on the Roland Morris Questionnaire (RMQ) on low back pain incapacity, to estimate the specific and non-specific effects produced by the technique, and to carry out a cost-effectiveness analysis. METHODS/DESIGN: Randomised four-branch controlled multicentre prospective study made to compare semi-standardised real acupuncture, sham acupuncture (acupuncture at non-specific points), placebo acupuncture and conventional treatment. The patients are blinded to the real, sham and placebo acupuncture treatments. Patients in the sample present symptoms of non specific acute low back pain, with a case history of 2 weeks or less, and will be selected from working-age patients, whether in paid employment or not, referred by General Practitioners from Primary Healthcare Clinics to the four clinics participating in this study. In order to assess the primary and secondary result measures, the patients will be requested to fill in a questionnaire before the randomisation and again at 3, 12 and 48 weeks after starting the treatment. The primary result measure will be the clinical relevant improvement (CRI) at 3 weeks after randomisation. We define CRI as a reduction of 35% or more in the RMQ results. DISCUSSION: This study is intended to obtain further evidence on the effectiveness of acupuncture on acute low back pain and to isolate the specific and non-specific effects of the treatment