Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to become best practice guidelines for a future pragmatic randomised controlled trial with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London was analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, and the patterns of combined herb use and the correlations between these patterns and the presenting symptoms is analysed by means of factor analysis. Treating these use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice. We discuss the advantages and limitations of the methods – action based clinical study plus factor analysis – we employed to this end

Asymmetric syntheses involving keto-esters

The partial asymmetric syntheses performed by McKenzie involving Grignard reactions on optically active alpha-keto-esters. [diagram] are discussed, and a mechanism for the course of such syntheses is proposed. The reaction is probably influenced primarily by asymmetry in the electromagnetic field in the neighbourhood of the alpha-carbonyl group, induced by the asymmetric field in the optically active centre, and also by the differing free energies of intermediate diastereoisomeric Grignard complexes formed during the reaction. The resultant asymmetric synthesis is therefore directed by a combination of these effects, and not by any single force of "asymmetric induction" as originally postulated by McKenzie. This hypothesis is substantiated by reference to the two complementary syntheses of [diagrams] as the sign of rotation of the product and the degree of asymmetric synthesis are shown to depend on both the above factors. The effect of increasing the separation between the asymmetric and reaction centres in such syntheses has been studied by performing Grignard reactions on the homologous series of (-)-menthyl ketoesters, [diagram] Asymmetric synthesis takes place when n = 2 or 3, and the relationship between the hydroxy-acids and their corresponding lactones formed in these reactions has been investigated. Laevorotatory acids, giving dextrorotatory lactones of higher specific rotation than the parent compound were obtained, the degree of asymmetric synthesis being only slightly dependent on the conditions of reaction. No optical activity could be detected in the hydroxy-acids formed when n= 4 or 8, probably because the electromagnetic induction effect is dissipated along the methylene chain, and the difference in free energy between the diastereoisomeric Grignard complexes is too small to effect any observable asymmetric synthesis. <p

Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations

acceptedVersio

Evidence is in the Eye of the Beholder: The case of the 2016 draft NICE Guidelines for Low Back Pain [editorial]

As the paradigm of evidence-based medicine reaches its adolescence, it is appropriate to acknowledge how the systematic surveying of evidence on a particular clinical topic has constituted a positive advancement in healthcare decision makin. But for all the benefits rigorous review methods have to offer, we must remember that no matter how many controls we have in place to minimise bias from the process, ultimately the appraisal and synthesis of research remains a purely human endeavour and with that comes interpretation consistent with a particular, subjective world-view [2]. The recent publication of the UK’s National Institute for Health and Care Excellence (NICE) new draft guidelines for the management and treatment of low back pain and sciatica offers a prime example (https://www.nice.org.uk/). Unlike the 2009 guideline which recommended a course of acupuncture, the updated draft, published in March 2016, recommended against acupuncture [3]

Evidence is in the Eye of the Beholder: The case of the 2016 draft NICE Guidelines for Low Back Pain [editorial]

As the paradigm of evidence-based medicine reaches its adolescence, it is appropriate to acknowledge how the systematic surveying of evidence on a particular clinical topic has constituted a positive advancement in healthcare decision makin. But for all the benefits rigorous review methods have to offer, we must remember that no matter how many controls we have in place to minimise bias from the process, ultimately the appraisal and synthesis of research remains a purely human endeavour and with that comes interpretation consistent with a particular, subjective world-view [2]. The recent publication of the UK’s National Institute for Health and Care Excellence (NICE) new draft guidelines for the management and treatment of low back pain and sciatica offers a prime example (https://www.nice.org.uk/). Unlike the 2009 guideline which recommended a course of acupuncture, the updated draft, published in March 2016, recommended against acupuncture [3]

How do acupuncture practitioners use pattern identification – An international web-based survey?

© 2019 Elsevier GmbH Introduction: Training and practice of Traditional East Asian Medicine (TEAM) varies globally although similar diagnostic methods are used based on patients presenting signs and symptoms. These methods assist in determining disease patterns and treatment principles. The use of diagnostic principles and pattern identification (PI) was explored in this survey of TEAM practice across different countries. Methods: A web-based survey was disseminated to acupuncture professional membership organisations in UK, Australia, Italy, Korea and China using a Survey Monkey link between December 2015 and September 2017. Results: The 618 fully completed responses were available for comparison (UK 66, Australia 106, China 87, Italy 226, Korea 133). Demographic characteristics varied; UK practitioners were more likely to be female (71%) compared to the other countries (51-59%), Koreans tended to be under 40yrs (80%), compared to elsewhere (14-27%). Korean, UK and Australian respondents had fewer practitioners with biomedical training, 95% of the Italians had a biomedical qualification. TEAM diagnostic methods were more likely practised in the UK and Australian samples ( > 90%) but were lowest for the Italian sample (78%). TCM differential diagnosis was the predominant type of PI. PI was rated essential by 85% of Chinese practitioners, versus 32% Koreans, 45% Italians, 67% UK and 68% Australian respondents. Conclusion: This first international survey about acupuncturists use of PI demonstrated wide variation. The sample was limited to certain countries and relied on dissemination by specific professional bodies and participants completing an electronic questionnaire which may have affected responses but provides a platform for future studies