Investigation of international demand for Clinical Practice Guidelines of Acupuncture and moxibustion:A cross-sectional study

Objective:This study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies(WFAS)are located,including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion,and the demands of the content and evidence types of Clinical Practice Guidelines(CPGs)of acupuncture and moxibustion in accordance with WFAS standards,so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.Methods:The convenient sampling method was used to collect the questionnaires,and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020,July 2020,March 2021,and April 2021 respectively.They were then distributed to individual members of acupuncture-moxibustion societies by the contacts.The study content involved the basic information of respondents,including their nationality,occupation,educational background of acupuncture and moxibustion,their local clinical practice and medical management of acupuncture and moxibustion,as well as their demand for CPGs of acupuncture and moxibustion,etc.After the questionnaires were collected,the data were analyzed and described by quantitative research method.Results:In all,302 respondents from 37 countries of six continents responded.The 302 respondents were members of the WFAS society members.(1)Basic information of respondents.They all had acupuncture and moxibustion learning experience,among which,76.5%(231/302)had the education background of acupuncture and moxibustion professional college training,and 88.4%(267/302)had experience of acupuncture and moxibustion clinical practice.Acupuncturists or traditional Chinese medicine doctors accounted for 63.9%(193/302),western medicine doctors,nurses,and pharmacists accounted for 18.2%(55/302),and researchers and teachers accounted for 6.3%(19/302).(2)Local clinical practice and medical management of acupuncture and moxibustion.The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived.Among them,more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents(x^(2)=26.049,P<0.01),and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents(x^(2)=113.488,P<0.01).(3)Demand for CPGs of acupuncture and moxibustion.A total of 93.0%(281/302)respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice.The order of their demand and concern for WFAS CPGs was:acupuncture manipulation>latest progress of acupuncture treatment>choice of acupuncture therapies>safety of acupuncture and moxibustion>combination of acupuncture and other programs.A total of 87.4%(264/302)respondents believed that ancient classics could guide clinical practice,and the ancient literature should be used as evidence for the development of guidelines.Conclusion:The respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards.Commonly they have clinical practice experience and professional education background.They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion,hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on,and they believe that classical ancient books can guide their clinical practice.It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion.In view of the results of this study,it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region,as well as its legislation and management situation of acupuncture and moxibustion,so as to meet the needs of users as much as possible.

Kangfuxin(Periplaneta americana)Lotion for Adjunctive Treatment of Ulcerative Colitis:A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: The objective of the study is to investigate the effect of Kangfuxin lotion as adjunctive therapy for treating ulcerative colitis(UC) through a systematic review and meta?analysis of randomized controlled trials(RCTs). Materials and Methods: RCTs comparing Kangfuxin lotion with no treatment, placebo, western medications or combination therapy for treatment of UC were included in this study. Two English and three Chinese electronic databases were searched. All searches ended in December 2017. Data and quality assessment carried out respectively. Rev Man 5.2 software(Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) was used to analyze with effect estimate presented as mean difference(MD), risk ratio(RR) and 95% confidence interval(CI). Results: Fifteen trials with 1050 participants were included in this review. Overall, 13 trials were eligible for meta?analysis. Kangfuxin lotion combined with Mesalazine was better than Mesalazine on clinical cure rate(RR 1.45, 95% CI 1.24–1.70, 7 trials), recurrence rate of UC(RR 0.22, 95% CI 0.07–0.72, 2 trials), or endoscopic mucosal recovery(RR 8.05, 95% CI 2.64–24.57, 2 trials). And Kangfuxin lotion combined with triple live bacteria tablets(Bifidobacterium-Lactobacillus? Streptococcus thermophilus)was superior with regard to symptoms remission rate(RR 5.36, 95% CI 1.73–16.60, 3 trials), endoscopic disease activity score(MD-2.30, 95% CI-2.64–-1.96, 1 trial). There were no reports on the serious adverse events of Kangfuxin lotion. Conclusion: Kangfuxin lotion as adjunctive treatment appears more effective than medications alone on clinical cure rate, recurrence rate, endoscopic mucosal recovery and improvement rate of related symptoms.