Homoeopathy

Homoeopathy is a system of treating patients using very low dose preparations according to the principle: "like should be cured with like". This paper summarises the research evidence presented in a recent issue of Effective Health Care on the effectiveness of homoeopathy. Increasing numbers of patients are seeking information on complementary medicines from NHS health professionals. Results of a 1998 survey of use and expenditure on complementary medicine in England suggested that 28% of respondents had either visited a complementary therapist or had purchased an over the counter herbal or homoeopathic remedy in the past year. From this survey it was estimated that there could be over 470 000 recent users of homoeopathic remedies in England

Trial protocol and preliminary results for a cluster randomised trial of behavioural support versus brief advice for smoking cessation in adolescents

<p>Abstract</p> <p>Background</p> <p>Many young people report they want to stop smoking and have tried to do so, but most of their quit attempts fail. For adult smokers, there is strong evidence that group behavioural support enhances quit rates. However, it is uncertain whether group behavioural support enhances abstinence in young smokers trying to quit.</p> <p>Findings</p> <p>A cluster randomised trial for young people trying to stop smoking to compare the efficacy of a school-based 9 week intensive group behavioural support course versus a school-based 7 week brief advice only course. Participants were assessed for evidence of tobacco addiction and nicotine replacement therapy (NRT) was used if it was deemed appropriate by the therapist. Both types of course aimed to recruit approximately one hundred participants from approximately ten schools.</p> <p>The primary outcome was successful quitting at 4 weeks after quit day judged according to the Russell standard. Had the trial been completed, abstinence at 6 months after quit day and the relationships between successful quit attempts and 1) psychological assessments of dependence prior to quitting 2) salivary cotinine concentration prior to quitting and 3) sociodemographic characteristics would also have been assessed. The proportion of participants who stopped smoking in each arm of the trial were compared using Chi square tests.</p> <p>The trial was stopped shortly after it had started because funding to support the therapists running the stop smoking group behavioural support programme was withdrawn. Only three stop smoking courses were completed (two group support courses and one brief advice pharmacotherapy course). Seventeen participants in total entered the trial. At the end of the courses, one participant (10%) attending the group support programme had stopped smoking and no participant attending the brief advice programme had stopped smoking.</p> <p>Discussion</p> <p>The trial was stopped so we were unable to determine whether group support helped more young people to stop smoking than brief advice. Engagement and recruitment of participants proved much more difficult than had been anticipated. Fifteen of the seventeen participants reported that quitting smoking was either pretty important or very important to them. Thus, the stop smoking success rate could, nevertheless, be considered disappointing.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN25181936</p

LEG DOMINANCE EFFECTS ON KNEE KINEMATICS IN UNILATERAL AND BILATERAL SQUATS

Squatting movements are often used to assess known risk factors of injury such as knee valgus angle. This study aims to investigate the knee kinematics during unilateral and bilateral squats in relation to the dominant and non-dominant leg. Five uninjured participants completed three squats in three conditions; dominant unilateral, non-dominant unilateral and bilateral. Knee extension and valgus angles were calculated. Maximum knee valgus angle was higher in the nondominant unilateral trial than the same leg during the bilateral squat (unilateral = 10.6", bilateral = 8.4"; p < 0.05). Knee extension angles were significantly lower during bilateral squats (unilateral = 11 1 .go & 109.2", bilateral = 97.5" 8 98.2'; p < 0.05). Limb dominance effects knee valgus during squatting, and should therefore be taken into account during injury risk assessments

Effects of non-pharmacological interventions for insomnia in children with Autistic Spectrum Condition

Autism Spectrum Condition (ASC) is the name for a range of similar conditions that affect a person's social interaction, communication, interests and behaviour. In most cases many of the features of Autism can be recognised during early childhood. It is estimated that about 1 in every 160 children has an Autism Spectrum Condition (World Health Organisation). Further to this it is thought that between 40-80% of children with Autism have difficulties relating to sleep (Polimeni et al., 2005). Such sleep problems have been linked to a range of serious implications for the child's wellbeing. This review will explore the effects of non-pharmacological interventions for insomnia in children with autistic spectrum condition

Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD

ABSTRACT Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls ( pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD

Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: A systematic review and meta-analysis

Introduction: Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus. Method: Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus. Results: Nine trials met the inclusion criteria – one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD= -0.31, 95% CI -0.71–0.09, P=0.13, trail making test part A SMD= 0.28, 95% CI -0.20–0.77 P=0.25, trail making test part B SMD= -0.15, 95% CI -0.64–0.34 P=0.54, digit symbol SMD= 0.09, 95% CI -0.39–0.57 P=0.72), and memory (immediate memory SMD= 0.20, 95% CI -0.28–0.69, P=0.41 and delayed memory SMD= -0.06, 95% CI -0.55–0.42, P=0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials. Conclusions: Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results. Trial Registration: Protocol was registered (CRD42017058526) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO)

Force trace characteristics in anterior cruciate ligament deficient and uninjured knees during a maximal isometric task

Anterior cruciate ligament (ACL) deficiency has been shown to alter the muscle function of the leg. This study aimed to investigate differences in force trace characteristics of a maximal isometric task between ACL deficient and uninjured knees. Six ACL injured and uninjured participants completed maximal adduction, extension, and flexion isometric contractions. Peak, mean, standard deviation (SD), coefficient of variance (CV), frequency and signal regularity were calculated for all trials. Mean flexion force was larger in the ACL intact (0.91 N/kg) compared to their deficient (0.67 N/kg; p<0.05) knee. SD, CV and frequency composition of the extension trial differed between limbs in the uninjured (p<0.05). Analysis of variability, frequency and regularity of a signal may provide information on the function of the knee

Evaluating follow- up and complexity in cancer clinical trials (EFACCT): an eDelphi study of research professionals’ perspectives.

Objectives: To evaluate patient follow-up and complexity in cancer clinical trial delivery, using consensus methods to: (1) identify research professionals’ priorities, (2) understand localised challenges, (3) define study complexity and workloads supporting the development of a trial rating and complexity assessment tool (TRACAT). Design: A classic eDelphi completed in three rounds, conducted as the launch study to a multiphase national project (evaluating follow-up and complexity in cancer clinical trials). Setting: Multicentre online survey involving professionals at National Health Service secondary care hospital sites in Scotland and England varied in scale, geographical location and patient populations. Participants: Principal investigators at 13 hospitals across nine clinical research networks recruited 33 participants using pre-defined eligibility criteria to form a multidisciplinary panel. Main outcome measures: Statements achieving a consensus level of 70% on a 7-point Likert-type scale and ranked trial rating indicators (TRIs) developed by research professionals. Results: The panel developed 75 consensus statements illustrating factors contributing to complexity, follow-up intensity and operational performance in trial delivery, and specified 14 ranked TRIs. Seven open questions in the first qualitative round generated 531 individual statements. Iterative survey rounds returned rates of 82%, 82% and 93%. Conclusions: Clinical trials operate within a dynamic, complex healthcare and innovation system where rapid scientific advances present opportunities and challenges for delivery organisations and professionals. Panellists highlighted cultural and organisational factors limiting the profession’s potential to support growing trial complexity and patient follow-up. Enhanced communication, interoperability, funding and capacity have emerged as key priorities. Future operational models should test dialectic Singerian-based approaches respecting open dialogue and shared values. Research capacity building should prioritise innovative, collaborative approaches embedding validated review and evaluation models to understand changing operational needs and challenges. TRACAT provides a mechanism for continual knowledge assimilation to improve decision-making

A Protocol for an Evaluation Study of Patient Follow-Up and Cancer Clinical Trial Complexity: the EFACCT study.

Abstract Background Clinical research delivery is crucial in advancing treatment and care options for cancer. There is a burgeoning problem internationally in delivering cancer trials due to complex protocols, stratified treatments and increasing patient populations in follow-up with extended needs. The EFACCT study will evaluate the phenomena of cancer clinical trial delivery at NHS secondary care sites identifying burdens and implications for participants and organisations. Method This mixed-methods study adopting grounded theory will analyse operational processes and protocols at sites delivering Phase I-IV cancer trials for commercial and non-commercial studies. Research professionals and cancer patients who have participated in clinical trials will contribute to the development of an objective methodology defining and quantifying trial complexity, intensity and workload to enhance models of trial delivery. This in-depth study involving a two-arm e-Delphi, questionnaires, semi-structured interviews as well as trial documentation, database and systematic reviews will optimise clinical trial performance data in combination with qualitative evidence to form optimal models for cancer clinical trial delivery. Data from 12 geographically dispersed sites will be synthesised and continually compared until saturation is achieved. A total UK sample of 185 participants and documentation sample of 100 studies incorporates theoretical, purposive, quota and snowball sampling techniques leveraging the benefits of health informatics and rich participant contextual data. Results Data analysis will include descriptive statistics, thematic content analysis, theoretical, open, axial and selective coding and constant comparison methods. Statistical summaries will use measures of central tendency and levels of dispersion. Conclusion The study outcomes will involve the implementation of a trial rating and complexity assessment tool (TRACAT) and an evaluative theoretical model for cancer research operational management. These elements will create new knowledge supporting future research models, strategic planning, trial implementation and evaluation alongside the provision of a mechanism to optimise recruitment and enhance patient outcomes

Neurolinguistic programming: a systematic review of the effects on health outcomes

BACKGROUND: Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. AIM: To evaluate the effects of NLP on health-related outcomes. DESIGN AND SETTING: Systematic review of experimental studies. METHOD: The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. RESULTS: Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. CONCLUSION: There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes