Wednesday, February 22, 2017

Highlights of Meridians Winter 2017 issue

The Winter 2017 issue Meridians:  Journal of Acupuncture and Oriental Medicine, (Meridians:  JAOM 2017 4(1)) arrived this month and I had the opportunity to read several of the articles.  Here are my notes on those I enjoyed reading most.

How to access Meridians:
If you are an NCCAOM Diplomate, the electronic edition is a free benefit, just go to the Diplomate Benefits page.  
Not an NCCAOM Diplomate?  You can buy a copy of the issue you want through the Meridians website.
Meridians  is also indexed on CINAHL and EBSCO.

Research Literacy
Jennifer Stone has a succinct, 1 page article about how to prepare a scientific paper for poster presentation, p. 18.
The review of Richard Hammerschlag's lectures [p.27] was interesting and I am looking forward to looking at the presentation conference slide link [referenced on p.28].  Dr. Hammerschlag's advice, as reported here, on double-blinded acupuncture studies, was, basically, don't do it. See the article for the explanation.
The sham vs. verum acupuncture problem.   NIH has not marked any type of study with sham acupuncture as a control as "low priority".  To learn more about why, there are a couple good explanations in this issue.  One from Dr. Hammerschlag on p. 27 and another in a full article by Ryan Davenport, "Acupuncture and RCTs:  A Critique of Sham and Verum Methodologies", p. 29-31, 44.  

30% equals clinical efficacy revised 7.3.2017
I hear this phrase quoted often in my volunteer work with systems change. I see it is quoted on p. 28,  “The classic self-assessment tool for pain evaluation has to do with measurement of pain reduction. A 30% reduction was considered successful.”
Where does this 30% number come from?  
It is a standard that originated with a well-cited article from The New England Journal of Medicine published in 1988 by Laupacis et al, "An assessment of clinically useful measures of the consequences of treatment".  30% or more change in patient-reported scores (using a validated measurement tool) is considered clinically meaningful change.
That is often interpreted as any clinical outcome that is less than 30% is not considered meaningful (as a metric--I am sure 29% improvement meant much to a patient).  And 30% or more improvement in function is considered meaningful.  So far I see this quoted in RCTs (randomized controlled trials), clinical effectiveness trials, and literature reviews.  Literature reviews that can show a minimum of 30% change (usually an improvement in symptoms or function) is useful when providing evidence of clinical effectiveness when making a change in policy whether it is facility-level, state-level, or national level policy. 

Tai Chi, a modality to improve health, balance
And, apparently, Tai Chi decreases fear of falling in the elderly.  The article starts on p. 28.
Tai Chi is a great modality to teach patients.  Are you able to offer it (class or one-on-one practice) at least weekly to patients?  Maybe your clinic or facility has a wellness center that offers ongoing classes where people can practice? Tai chi can be specific for a condition or general for wellness.

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