Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine.

When people who advocate integrating conventional science-based medicine with complementary and alternative medicine (CAM) are confronted with the lack of evidence to support CAM they counter by calling for more research, diverting attention to the 'package of care' and its non-specific effects, and recommending unblinded 'pragmatic trials'. We explain why these responses cannot close the evidence gap, and focus on the risk of biased results from open (unblinded) pragmatic trials. These are clinical trials which compare a treatment with 'usual care' or no additional care. Their risk of bias has been overlooked because the components of outcome measurements have not been taken into account. The components of an outcome measure are the specific effect of the intervention and non-specific effects such as true placebo effects, cognitive measurement biases, and other effects (which tend to cancel out when similar groups are compared). Negative true placebo effects ('frustrebo effects') in the comparison group, and cognitive measurement biases in the comparison group and the experimental group make the non-specific effect look like a benefit for the intervention group. However, the clinical importance of these effects is often dismissed or ignored without justification. The bottom line is that, for results from open pragmatic trials to be trusted, research is required to measure the clinical importance of true placebo effects, cognitive bias effects, and specific effects of treatments

A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England

Background: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. Objectives: To identify and describe comprehensive care nurse led clinics in GUM services across England. Methods: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. Results: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. Conclusions: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention

A case study of how daily physical activity initiatives of occupational therapy were used to help physical movements for a child with dyspraxia

Background: Occupational therapy within the UK is used within schools to help develop children’s: fine motor; visual-perceptual; cognitive; and sensory-processing deficits as found in children with dyspraxia. The case study focuses on ‘Sue’ an 11 year old with dyspraxia, she presented with poor coordination, lack of focus and poor organisation skills. Within this paper, two daily physical activity interventions will be focused on: ‘resisted crawl’ and the ‘cat’. These are activities that are to help with difficulties linked to symmetric tonic neck reflex, and cause tension in the body when sitting on a chair or on the floor with arms and legs bent. It affects hand and eye coordination and causes problems with refocusing from far to near distance. Methods: The physical activity interventions were completed by a trained member of staff on a daily basis with ‘Sue’. Structured observations focusing biomechanically on the skills involved within the physical activities were completed. Also conversations with ‘Sue’ were recorded and semi-structured observations that took place once a week during (Friday) lunchtime to see how ‘Sue’ was applying her daily physical activities to a play context. Results and Conclusion: The data will show the progression of the successful as well as the unsuccessful parts of the physical activities throughout the 3 terms. It was found that when the interventions were completed on a daily basis ‘Sue’ was able to develop her coordination, by the end of the third term only the head and in particular the eyes were the unsuccessful part of the resisted crawl whilst the legs were the unsuccessful part of the cat, all other parts of the body were now being consistently successfully completed on a daily basis. The breaks for holidays impacted on ‘Sue’s’ movements and school have since recommended and developed a holiday plan to keep the progression of movements for ‘Sue’

John Ashbery: encuentro con los pintores

Este texto, basado en la ponencia presentada en el Seminario Permanente de Investigación de la Cátedra Félix Huarte dedicado a "Autorretrato en espejo convexo", propone un recorrido por el diálogo de Ashbery con la pintura: su primera etapa como crítico de arte en París y su relación con los pintores del expresionismo abstracto norteamericano

Understanding perceived determinants of nurses’ eating and physical activity behaviour : A theory-informed qualitative interview study

We thank Eilidh Duncan and Maria Prior for help with designing the interview topic guide. We would also like to thank all the nurses who gave their time to participate in the pilot study of the interview topic guide and the qualitative interviews. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The views expressed are those of the authors alone. Funding This work was funded through a Medical Research Council doctoral training award.Peer reviewedPublisher PD