Evaluating complementary medicine: methodological challenges of randomised controlled trials

Complementary medicine has a different philosophy from conventional medicine, presenting challenges to research methodology. Rigorous evaluation of complementary medicine could provide much needed evidence of its effectiveness. Good design of randomised controlled trials will avoid invalid results and misrepresentation of the holistic essence of complementary medicine. Practitioners need to be recognised as a component in or contributor to complementary treatment. Both specific and non-specific outcome measures with long follow up are needed to adequately encompass the essence of complementary medicine

Adventures in Time and Space: What Shapes Behavioural Decisions in Drosophila melanogaster?

Variation in behaviour can be observed both between individuals, based on their condition and experience as well as between populations due to sources of heterogeneity in the environment. These behavioural differences have evolved as a result of natural and sexual selection where different strategies may be favoured depending on the costs and benefits associated with those behaviours. In this thesis I examine two sources of heterogeneity within the environment and their behavioural consequences: how spatial complexity mediates sexual selection over time, and how inter and intraspecific signals and individual condition influence social oviposition behaviour. By increasing spatial complexity, we were able to manipulate male-female interaction rate which in turn influenced courtship behaviour and male-induced harm, the consequence of this was an increase in female fecundity especially in the later days of the assay and no change in offspring fitness. These results supported the idea that spatial complexity is able to mediate sexual selection through decreased harm to females. Oviposition decisions are of high consequence to an individual’s fitness and can be shaped by many environmental conditions. Instead of expending energy to evaluate all their different costs and benefits of the conditions of potential oviposition sites females can chose to rely on the signals left by others, in this case it would be beneficial for females to identify signals most like themselves. While we found females oviposited with individuals of the same species and diet, when given the option they showed more interest in and laid more eggs on media that previously held virgin males, bringing into question many assumptions of copying behaviour. In Drosophila melanogaster the only control females have over their offspring is who they mate with and where they oviposit their eggs, thus, these two factors can have a long-lasting impact on individual fitness for future generations. It is also important to consider how the standard lab environment may be shaping these behaviours, and the consequences this has for the evolutionary trajectory of lab populations

Quality of Life Following Massive Weight Loss and Body Contouring Surgery: an Exploratory Study.

Reconstructive surgery is a major growth intervention for body improvement, enhancing appearance and psychological well-being following massive weight loss. The psychosocial benefits include greater capacity for social networking, lower scores of body uneasiness, body image satisfaction, improved mental well-being and physical function. However little collective evidence exists regarding the impact of body contouring on patients Quality of Life (QoL) and there is a lack of systematic review and randomised controlled trials (RCTs) with a scarcity of high level evidence. The purpose of this exploratory study was to explore the QoL perceptions, experiences and outcomes of patients who have undergone body contouring following significant weight loss and to explore the relevance and potential utility of the Obesity Psychosocial State Questionnaire (OPSQ) as a valuable QoL outcomes measuring tool for use in clinical research. Data were collected in a community setting in the south of England via digitally recorded semi-structured interviews with twenty participants (18 women and 2 men), who also self-completed the Obesity Psychosocial State Questionnaire (OBSQ). Medical notes were reviewed retrospectively to gather data about body mass index (BMI), co-morbidities, eating profiles/lifestyle, uptake of bariatric surgery and type/number of body contouring procedures undergone. A thematic approach was adopted to analyse the interviews and medical record data, supported by Nvivo7 qualitative software, and a statistical approach to analyse the questionnaire data, supported by Statistical Analysis Software. The results provide unique glimpses of the body contouring interventions for empowering and facilitating a ‘transformation’, a ‘new identity’, a ‘new start’ in life, improved physical function, greater body image satisfaction, a stronger sense of well-being and an improved quality of life. A few of the participants who reported that their weight gain was powered by childhood traumas (abuse, neglect, abandonment) continued to struggle for ‘normality’, with fragile eating control and addictive traits. Eating disordered trauma survivors mentioned post traumatic flashbacks and underlying conflicts that triggered powerlessness and emotional eating. The emotional flooding with psychological and body related memories did not appear to be fully processed or released, despite counselling and binge eating programmes. The participants also confirmed the value of the OBSQ, whilst highlighting its limited set of three questions on feelings of self-efficacy towards eating habits. The study findings show that body contouring optimises quality of life with significant improvement in physical function, body image, mental health and psychosocial function. Further research is warranted to extent the scope of the findings within a sample drawn from multiple treatment centres. This would valuably: • Explore gender, ethnic and cultural variables, important to optimising quality of life. • Clarify distinguishing features between short and long-term QoL outcomes. • Lead to the development of national policy and guidelines on reconstructive ‘body contouring’ surgery following massive weight loss, in line with the call from the British Association for Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) A future multi-centre collaborative study could employ the OBSQ, supplemented by an additional tool to explore factors that influence eating habits such as the three factor eating questionnaire (such as the TFEQ-R1 21 Scale). Such research could enhance understanding of quality of life and long-term weight management

The Practitioners within the Cross-European Shiatsu Study. Their Characteristics and an Insight into Their Practice

This report presents the findings from the postal questionnaire survey of practitioners who participated in the three country, longitudinal, cohort study of the effects and experience of shiatsu (Long 2007). The purpose of the survey was to provide a context in which to situate the findings from the client-reported experiences and effects of shiatsu and to provide insight into possible practitioner variation in practice style as delivered and as part of usual practice. The report is divided into five sections. Section One outlines the methods. Section Two provides details on the characteristics of the participating practitioners, in relation to socio-demographic features, time in practice, training in other complementary and alternative medicine (CAM) modalities and working status. Section Three provides insight into the way that the practitioners give shiatsu and other advice or treatments they provide. Section Four details features of the environment in which the practitioners give shiatsu and the ways in which they make it a safe and supportive place. Section Five draws out the main conclusions from the survey

The MS Symptom and Impact Diary (MSSID): psychometric evaluation of a new instrument to measure the day to day impact of multiple sclerosis

OBJECTIVES: This study aimed to develop further a diary originally devised to measure the impact of multiple sclerosis (MS) as part of a cost utility study of beta interferon, and to evaluate its reliability, validity, and responsiveness in an outpatient sample of people with MS. METHODS: The original diary was further developed using qualitative and quantitative methods to ensure that it addressed the views of people with MS. The psychometric properties of the MS Symptom and Impact Diary (MSSID) were evaluated in a sample of 77 people who completed the MSSID daily for 12 weeks. Internal and test–retest reliability, discriminant and convergent validity, and responsiveness were assessed using traditional psychometric methods. RESULTS: The MSSID formed three, internally consistent scales that measured mobility, fatigue, and the overall impact of MS. The test–retest reliability of the mobility scale was adequate for individual comparisons (ICC.0.90) and the fatigue and overall impact scales were adequate for group comparisons (ICC.0.70). The MSSID was able to distinguish between clinical groups depending on clinical course, indoor ambulation status, and relapse status. It demonstrated associations with other single point instruments in the expected direction. Compared with single point instruments, its responsiveness was similar or better, especially in detecting short term improvements in functioning. CONCLUSIONS: The MSSID may provide a useful complement to currently available instruments to measure the outcomes of MS within clinical trials. Further research is needed to explore its feasibility in the context of a randomised controlled trial and its utility for clinicians

Exploring the evidence base for acupuncture in the treatment of Meniere’s Syndrome — A systematic review

Meniere’s syndrome is a long-term, progressive disease that damages the balance and hearing parts of the inner ear. To address the paucity of information on which evidence-based treatment decisions should be made, a systematic review of acupuncture for Meniere’s syndrome was undertaken. The method used was a systematic review of English and Chinese literature, from six databases for randomized, non-randomized and observational studies. All studies were critically appraised and a narrative approach to data synthesis was adopted. Twenty-seven studies were included in this review (9 in English and 18 in Chinese languages): three randomized controlled trials, three non-randomized controlled studies and four pre-test, post-test designs. All but one of the studies was conducted in China. The studies covered body acupuncture, ear acupuncture, scalp acupuncture, fluid acupuncture point injection and moxibustion. The studies were of varying quality. The weight of evidence, across all study types, is of beneficial effect from acupuncture, for those in an acute phase or those who have had Meniere’s syndrome for a number of years. The review reinforces the importance of searching for studies from English and Chinese literature. The transferability of the findings from China to a Western context needs confirmation. Further research is also needed to clarify questions around the appropriate frequency and number of treatment/courses of acupuncture. The weight of evidence suggests a potential benefit of acupuncture for persons with Meniere’s disease, including those in an acute phase and reinforces the importance of searching for published studies in the Chinese language