Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach

BACKGROUND: Despite the increasing demand for acupuncture and homoeopathy in Germany, little is known about the effects of these treatments in routine care. We set up a pragmatic documentation study in general practice funded within the scope of project launched by a German health insurer. Patients were followed-up for up to four years. METHODS: The aim of the project was to study the effects and benefits of acupuncture and/or homoeopathy, and to assess patient satisfaction within a prospective documentation of over 5000 acupuncture and over 900 homoeopathy patients. As data sources, we used the documentation made available by therapists on every individual visit and a standardised quality-of-life questionnaire (MOS SF-36); these were complemented by questions concerning the patient's medical history and by questions on patient satisfaction. The health insurer provided us with data on work absenteeism. RESULTS: Descriptive analyses of the main outcomes showed benefit of treatment with middle to large-sized effects for the quality of life questionnaire SF-36 and about 1 point improvement on a rating scale of effects, given by doctors. Data on the treatment and the patients' and physicians' background suggests chronically ill patients treated by fairly regular schemes. CONCLUSION: Since the results showed evidence of a subjective benefit for patients from acupuncture and homoeopathy, this may account for the increase in demand for these treatments especially when patients are chronically ill and unsatisfied with the conventional treatment given previously

Super Dual Auroral Radar Network Expansion and its Influence on the Derived Ionospheric Convection Pattern

The Super Dual Auroral Radar Network (SuperDARN) was built to study ionospheric convection and has in recent years been expanded geographically. Alongside software developments, this has resulted in many different versions of the convection maps data set being available. Using data from 2012 to 2018, we produce five different versions of the widely used convection maps, using limited backscatter ranges, background models and the exclusion/inclusion of data from specific radar groups such as the StormDARN radars. This enables us to simulate how much information was missing from older SuperDARN research. We study changes in the Heppner-Maynard boundary (HMB), the cross polar cap potential (CPCP), the number of backscatter echoes (n) and the χ2/n statistic which is a measure of the global agreement between the measured and fitted velocities. We find that the CPCP is reduced when the PolarDARN radars are introduced, but then increases again when the StormDARN radars are added. When the background model is changed from the RG96 model, to the most recent TS18 model, the CPCP tends to decrease for lower values, but tends to increase for higher values. When comparing to geomagnetic indices, we find that there is on average a linear relationship between the HMB and the geomagnetic indices, as well as n, which breaks when the HMB is located at latitudes below ∼50° due to the low observational density. Whilst n is important in constraining the maps (maps with n > 400 data points are unlikely to differ), it is insufficient as the sole measure of quality

Dusk-Dawn Asymmetries in SuperDARN Convection Maps

The Super Dual Auroral Radar Network (SuperDARN) is a collection of radars built to study ionospheric convection. We use a 7-year archive of SuperDARN convection maps, processed in 3 different ways, to build a statistical understanding of dusk-dawn asymmetries in the convection patterns. We find that the data set processing alone can introduce a bias which manifests itself in dusk-dawn asymmetries. We find that the solar wind clock angle affects the balance in the strength of the convection cells. We further find that the location of the positive potential foci is most likely observed at latitudes of 78° for long periods (>300 min) of southward interplanetary magnetic field (IMF), as opposed to 74° for short periods

Influences of the equatorward SuperDARN expansion on data coverage and measured parameters

The Super Dual Auroral Radar Network (SuperDARN) was built to study ionospheric convection at Earth and has in recent years been expanded equatorward to observe ionospheric flows over a larger latitude range. The SuperDARN expansion to midlatitudes started in 2005 with the building of the Wallops Island Radar at 37.93 degrees geographic latitude, and a geographic longitude of -75.47 degrees. Since then, nine more mid-latitude radars have been added to the network, allowing us to measure ionospheric convection on a larger scale than ever before. Using data from the years 2012 to 2018, we perform a statistical analysis on processed SuperDARN convection maps for the entire dataset.  We process a number of versions of the maps, using different background models both with and without the inclusion of data from midlatitude radars. This enables us to explore the difference the addition these radars make to the dataset, as well as simulate how much information was missing from the previous decades of SuperDARN research. To show the importance of growing the radar network to include measurements at mid-latitudes we study a variety of parameters, such as changes in the equatorward boundary of the ionospheric electric field, changes in the cross polar cap potential, changes in the locations of the minimum and maximum potentials, and the width of the return flow region. We show that there is a clear difference between the datasets, especially when comparing the measured parameters to geomagnetic indices, such as AL

Generalized Quantum Theory: Overview and Latest Developments

The main formal structures of Generalized Quantum Theory are summarized. Recent progress has sharpened some of the concepts, in particular the notion of an observable, the action of an observable on states (putting more emphasis on the role of proposition observables), and the concept of generalized entanglement. Furthermore, the active role of the observer in the structure of observables and the partitioning of systems is emphasized.Comment: 14 pages, update in reference

Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals

We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS).<p></p> <b>Aims</b> (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and complexity of complaints most frequently treated nationally; (3) to present a cross section of outcome scores by appointment number, including that for the most frequently treated medical complaints; (4) to explore approaches to standard setting for homeopathic practice outcome in patients treated at the homeopathic hospitals.<p></p> <b>Methods</b> A total of 51 medical practitioners took part in data collection over a 4-week period. Consecutive patient appointments were recorded under the headings: (1) date of first appointment in the current series; (2) appointment number; (3) age of patient; (4) sex of patient; (5) main medical complaint being treated; (6) whether other main medical complaint(s); (7) patient-reported change in health, using Outcome Related to Impact on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, –4 to +4, where a score ≤−2 or ≥+2 indicates an effect on the quality of a patient's daily life); (8) receipt of other complementary medicine for their main medical complaint.<p></p> <b>Results</b> The distribution of patient age was bimodal: main peak, 49 years; secondary peak, 6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service and proportion of patients who attended more than six visits varied between hospitals. A total of 235 different medical complaints were reported. The 30 most commonly treated complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome (CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis; allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis; headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia; ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with important co-morbidity was higher in those seen after visit 6 (56.9%) compared with those seen up to and including that point (40.7%; P < 0.001). The proportion of FU patients reporting ORIDL-PS ≥ +2 (improvement affecting daily living) increased overall with appointment number: 34.5% of patients at visit 2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently treated complaints, the proportion of patients that reported ORIDL-PS ≥ +2 at visit numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder).<p></p> <b>Conclusions</b> We have successfully piloted a process of national clinical data collection using patient-reported outcome in homeopathic hospital outpatients, identifying a wide range and complexity of medical complaints treated in that setting. After a series of homeopathy appointments, a high proportion of patients, often representing “effectiveness gaps” for conventional medical treatment, reported improvement in health affecting their daily living. These pilot findings are informing our developing programme of standard setting for homeopathic care in the hospital outpatient context

Considering the case for an antidepressant drug trial involving temporary deception: a qualitative enquiry of potential participants

<p>Abstract</p> <p>Background</p> <p>Systematic reviews of randomised placebo controlled trials of antidepressant medication show small and decreasing differences between pharmacological and placebo arms. In part this finding may relate to methodological problems with conventional trial designs, including their assumption of additivity between drug and placebo trial arms. Balanced placebo designs, which include elements of deception, may address the additivity question, but pose substantial ethical and pragmatic problems. This study aimed to ascertain views of potential study participants of the ethics and pragmatics of various balanced placebo designs, in order to inform the design of future antidepressant drug trials.</p> <p>Methods</p> <p>A qualitative approach was employed to explore the perspectives of general practitioners, psychiatrists, and patients with experience of depression. The doctors were chosen via purposive sampling, while patients were recruited through participating general practitioners. Three focus groups and 12 in-depth interviews were conducted. A vignette-based topic guide invited views on three deceptive strategies: post hoc, authorised and minimised deception. The focus groups and interviews were tape-recorded and transcribed. Transcripts were analysed thematically using Framework.</p> <p>Results</p> <p>Deception in non-research situations was typically perceived as acceptable within specific parameters. All participants could see the potential utility of introducing deception into trial designs, however views on the acceptability of deception within antidepressant drug trials varied substantially. Authorized deception was the most commonly accepted strategy, though some thought this would reduce the effectiveness of the design because participants would correctly guess the deceptive element. The major issues that affected views about the acceptability of deception studies were the welfare and capacity of patients, practicalities of trial design, and the question of trust.</p> <p>Conclusion</p> <p>There is a trade-off between pragmatic and ethical responses to the question of whether, and under what circumstances, elements of deception could be introduced into antidepressant drug trials. Ensuring adequate ethical safeguards within balanced placebo designs is likely to diminish their ability to address the crucial issue of additivity. The balanced placebo designs considered in this study are unlikely to be feasible in future trials of antidepressant medication. However there remains an urgent need to improve the quality of antidepressant drug trials.</p

The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services.</p> <p>Methods</p> <p>We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations).</p> <p>Results</p> <p>Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources.</p> <p>Conclusion</p> <p>To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.</p