Treating acute low back pain with acupuncture:A randomized controlled study protocol to compare the effectiveness between distal and local acupoints

Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.

Risk stratification in providing inter-facility transport： Experience from a specialized transport team

The role of Inter-facility transport （IFT） of patients is an emerging specialty requiring service reorganization, diversion of major trauma to trauma center. This study aimed to determine the patients who are more prone to en route adverse event during the period of 22：00 to 07：00, based on critical in-patient needs provided by the Emergency Department （ED） nursing staff at Alice Ho Miu Ling Nethersole Hospital （AHNH）. This study included all 22：00 to 07：00 IFTs accompanied by ED nurses at AHNH for a period of 28 months from August 2006 until December 2008. The transports were reviewed for： （1） age, （2） gender, （3） transport configuration, （4） clinical category, and （5） physiological instability before transport. A total of 79 patients were transported during the 22：00 to 07：00 timeframe within the study period. The types of patients were mainly neurosurgical emergencies （n=32; 40.5%）, surgical emergencies （n=28; 35.4%）, and upper gastrointestinal bleeding （UGIB） （n=11; 13.9%）. En route adverse events were encountered by the accompanying nurses in 16 transports （20.3%） with a higher incidence of adverse events during transport of surgical emergencies, UGIB and patients who were physiological unstable before transport （P〈 0.05）. A specialized transport team from the ED can assist other clinical departments by providing expert care during IFT. In spite of the high quality of care, adverse events do commonly occur.

How to secure the connection between thoracostomy tube and drainage system?

BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials(3M^(tm) Transpore^(tm) Medical tape, 3M^(tm) Micropore^(tm) Medical tape, 3M^(tm) Soft Cloth Tape on Liner) and three different methods(cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor.RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore^(tm), 31.29 lb for Micropore^(tm) and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore^(tm) is used(P<0.001). There was no statistical signifi cant difference between Micropore^(tm) and Soft Cloth Tape on Liner(P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method(P<0.0001 when compared with plastic band)(P=0.033 when compared with straight method).CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore^(tm) is not a recommended material for thoracostomy tube taping.

Survey on acupuncture treatment of neurogenic dysphagia and analysis of regularity of acupoint selection

Objective： To understand the general situation of clinical study on acupuncture for neurogenic dysphagia and the regularity of acupoint selection by literature analysis. Methods： By searching the relevant Chinese and English literature on acupuncture treatment of neurogenic dysphagia from 2999 to 2014 in China National Knowledge Infrastructure （CNKI）, Wanfang Database and Ovid Gateway, the data of the recruited literature, including average age of the patients, acupoint selection, course, therapeutic effects and follow-up information, were input into the data table of Microsoft Excel 2010. Results： Totally, 51 articles were input, involving 4 606 patients. The average course of acupuncture treatment for neurogenic dysphagia was 24.8 d. The average retaining time of the needles was 26.2 min. The average total effective rate was 91.2%. Lianquan （CV 23）, Fengchi （GB 20）, Fengfu （GV 16） and Yifeng （TE 17） were the most commonly used acupoints from the regular meridians, accounting for 63.4% of the totally-used acupoints. Jinjin （EX-HN 12） and Yuye （EX-HN 13） were the most commonly used acupoints from the extraordinary meridians, accounting for 45.9% of the totally-used extraordinary acupoints. The frequently-used meridians in turns were the Conception Vessel, Gallbladder Meridian of Foot Shaoyang and Stomach Meridian of Foot Yangming, accounting for 63.3% of the involved meridians. Conclusion： The therapeutic effect of acupuncture treatment for neurogenic dysphagia was satisfactory. The acupoints were Lianquan （CV 23）, Fengchi （GB 20） and Fengfu （GV 26） in predominance, and they were mostly selected from the Conception Vessel, Gallbladder Meridian and Stomach Meridian those are in close relationship with the throat and neck.

Effect of acupuncture treatment on smoking cessation in smokers from Hong Kong

OBJECTIVE: To analyze the characteristics of smokers treated with acupuncture for smoking cessation in Hong Kong.METHODS: A total of 2051 subjects were recruited in a clinical pilot research project "acupuncture for smoking cessation", which was conducted jointly by Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences and Hong Kong Pok Oi Hospital from January of 2011 to December of 2013. The characteristics of study subjects, including baseline information, smoking background, intention to quit and influencing factors were analyzed.RESULTS: The majority of subjects treated with acupuncture for smoking cessation in Hong Kong was male(66.7%), but the proportion of female smokers in this study(33.3%) was higher than that of female smokers in Hong Kong population(13.8%, P <0.05). Subjects were at the mean age of 43.83 years old, of which the percentage of females aged 31-40 years was the highest(38.8%, P < 0.05). The mean duration of smoking was 25.49 years. The number of cigarettes smoked per day was 17.57 cigarettes.Fagerstrom Test for Nicotine Dependence(FTND)was 5.29 points. Most of the subjects had attempted quitting smoking(81.42%). The confidence index(7.44 points) and the readiness to quit smoking(8.13 points) were high. Subjects quitting smoking were mostly due to health cause(81.91%). The majority of subjects were at the level of middle school(61.63%). The higher the educational level was, the lower the tobacco dependence was and the higher the confidence in successfully quitting smoking was. 50.27% of subjects chose acupuncture for smoking cessation mainly through friends, television and network publicity. Subjects who had received acupuncture had the highest confidence index, while those who wanted to try a new method had the lower confidence index.CONCLUSION: Acupuncture for smoking cessation was more popular in female smokers, especially those aged 31-40 years. The effectiveness of acupuncture-smoking cessation was most significant in the smokers over 60.