T he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly inf... more T he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS. The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The HTA Programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public, service-users groups and professional bodies such as Royal Colleges and NHS Trusts. Research suggestions are carefully considered by panels of independent experts (including service users) whose advice results in a ranked list of recommended research priorities. The HTA Programme then commissions the research team best suited to undertake the work, in the manner most appropriate to find the relevant answers. Some projects may take only months, others need several years to answer the research questions adequately. They may involve synthesising existing evidence or conducting a trial to produce new evidence where none currently exists. Additionally, through its Technology Assessment Report (TAR) call-off contract, the HTA Programme is able to commission bespoke reports, principally for NICE, but also for other policy customers, such as a National Clinical Director. TARs bring together evidence on key aspects of the use of specific technologies and usually have to be completed within a short time period. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.
This paper examines some of the organizational and behavioural consequences of uncertainty throug... more This paper examines some of the organizational and behavioural consequences of uncertainty through consideration of a case study. An industrial firm and its problems are described and an attempt is made to understand the origins of the situation using a systems analysis which draws on constructs from the structural, the behavioural and the 'bureaucratic' traditions within organization theory. The analysis demonstrates: that the problems are interrelated and stem from the structural arrangements in the firm which are unable to cope with the prevailing uncertainties; that the behavioural difficulties may be seen as manifestations of the underlying structural/environmental mismatch; and, that the problems are exacerbated by apparently logical but paradoxically inappropriate managerial choices and responses. The implications of this study for theory, practice and method are discussed. 'We used the Aston data bank for comparative purposes. and found other firms in the technological category of 'Fabrication'. to have similar formal organization structures. (For a description of the Aston studies, see Pugh and Hickson, 1976).
Abstract: In the considerable literature on the use of information systems in organisations there... more Abstract: In the considerable literature on the use of information systems in organisations there are occasional discussions of issues broadly relevant to the area of job redesign. Hedberg, for example, has pointed to the potential of such systems for facilitating ...
Monoclonal antibodies generated by immunization with a plasma-membrane preparation from suspensio... more Monoclonal antibodies generated by immunization with a plasma-membrane preparation from suspension-cultured cells of Nicotiana glutinosa L. were used in combination with fluoresceinor rhodamine-labeled goat anti-mouse immunoglobulins to identify heterokaryons in protoplast fusion procedures. Antibody labeling did not inhibit callus formation nor plantlet regeneration. The antibodies are non-invasive and surface labeling provides clear optical discrimination of true heterokaryons from unfused aggregates as well as from parental protoplasts and homokaryons. Labeling is stable throughout fusion and hence by pre-labeling parental protoplast populations the strategy is both versatile and of general applicability.
Murine monoclonal antibodies to membrane antigens were generated by immunization with a crude cel... more Murine monoclonal antibodies to membrane antigens were generated by immunization with a crude cellular membrane preparation from suspension-cultured cells of Nicotiana glutinosa L. From a panel of thirteen monoclonal antibodies, seven were found to be directed against antigens present on the plasma-membrane by immunofluorescence visualization of antibody binding to the surface of isolated protoplasts. The corresponding set of plasma-membrane antigen(s) were present in root, shoot and leaf tissue and some but not all of these antigens were of wide species distribution, being found in Nicotiana tabacum L., N. plumbaginifolia L., Glycine max L., Phaseolus vulgaris L. and Triticum aesfivum L. Topologically specific labeling of intact protoplasts with a monoclonal antibody reactive with an epitope present on the plasma-membrane specifically labeled a membrane fraction which equilibrated at a density of 1.14 kg/1 following centrifugation in a sucrose gradient. In addition to use as biochemical markers for fractionation and molecular characterization of plasma-membranes, these monoclonal antibodies provide the basis for new selection tools in plant cell and gene manipulations.
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
The development of medical information systems which can be used in the consulting room has led t... more The development of medical information systems which can be used in the consulting room has led to independent solutions which are dedicated to specific tasks. Integrating users in the development process is a prerequisite to find the correct solutions to the medical problem and acceptance of the system. The PRECISE-CRS Project tested and enhanced the method of “User centered Design” to gather requirements for a medical workstation. This was done in specific European workshops with physicians from three countries for analysing and assessing human factors, requirements, and variations in scenarios and consultation simulations of different system prototypes.
Given the continuing emphasis on preventive medicine in general practice, there is considerable i... more Given the continuing emphasis on preventive medicine in general practice, there is considerable interest in the relative effectiveness of different ways of inviting patients to attend for screening. Recently, opportunistic methods have been advocated as being particularly useful but these methods often fail to reach a high proportion of the target population. Many patients do not consult and when they do they are not always invited to attend for screening. In this study a computer simulation model has been used to examine the effects of these variables in more detail. The notes of a random sample of 190 patients (97 women, 93 men) aged 30-50 years, registered with one general practitioner, were used to provide data for the model. The simulation model showed that increasing the number of screening appointments available each week has only a small effect on screening rates and that a ceiling is reached when 25 appointments per 1000 patients are available. In contrast, increasing the proportion of eligible consulting patients who are invited has a substantial effect such that it could take nearly 12 years to screen 90% of a target population if only one out of every four patients were invited compared with under four years if three out of every four patients were invited. The results suggest therefore that opportunistic screening methods are unlikely to achieve desired screening rates within acceptable time limits. It is argued that to achieve target levels of screening, practices will need to combine opportunistic methods with more formal methods of invitation.
Reporting on an experimental field study of computer use by general practitioners during consulta... more Reporting on an experimental field study of computer use by general practitioners during consultations, this paper focuses particularly on the experiences of the doctors in their efforts to communicate concurrently with a patient and a computer. Through the analysis of logs of computer use, video recordings of consultations and interviews with doctors, the authors report on the uptake of the computer facilities, the impact of such use on information handling during the consultation, the doctors' views about using the system, and finally the relationship between doctors' ;natural' consulting styles and their uptake and views of the system.
This paper reports an experimental study of general practitioners' use of an interactive computer... more This paper reports an experimental study of general practitioners' use of an interactive computerized protocol for the management of hypertension, focussing particularly on the protocol's effects on doctors' clinical behaviour. Prior to its computerization a paper-based version of the protocol was used enabling a comparison of the alternative forms. Doctors' delivery of care was assessed from video recordings of 89 consultations and from the records made during these consultations. Comparisons were made of consultations conducted under control and experimental conditions. Use of paper and computer protocols resulted in significant improvements in the doctors' delivery of care, in terms of the range of verbal and physical examinations conducted and recorded. The protocol's effects were most marked when the computerized version was used. However, use of the computer protocol resulted in the recording of information on the non-occurrence of certain events which had not been explicitly elicited during the verbal examination; features of the design which were intended to encourage adherence to the protocol may have been inappropriate to the realities of a general practice consultation. The findings provide some useful insights for the design of future computerized protocols for the management of chronic conditions.
www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a... more www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a system with an empirical basis that has been used in the treatment of pain for centuries. Its use for pain relief is supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects on pain must devolve from physiological and/or psychological mechanisms with biological foundations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous neurotransmitters including opioids, monoamines, oxytocin and other neuropeptides (SP, CGRP, GAL, CRF, NPY), important in the control of both sensory, affective and cognitive elements of pain. Over the past ten years there has been a growing awareness that pain is due not simply to the activation of peripheral nociceptors, as in nociceptive pain, but to multiple factors, and is therefore susceptible to various modes of acupuncture treatments. Depending on the aetiology, pain may be classified into several categories, such as nociceptive, neurogenic, chronic pain syndrome and psychogenic pain. Musculoskeletal and visceral pain states, both nociceptive, are characterised by hyperalgesia. However, despite belonging to a similar category, the pain is triggered by different mechanisms. Neurogenic pain is caused by injury or dysfunction in the nervous system and is often severe and intractable and may not respond to even powerful opioids. Recent studies suggest that there is a third pain category, distinct from the neurogenic and nociceptive, where pain is related to a sickness response that occurs with exposure to chemical compounds and infectious agents the associated central changes produce heightened pain sensitivity ('hurting all over'), termed chronic pain syndrome. In clinical trials acupuncture or low frequency electroacupuncture have shown to be effective in some nociceptive pain states, whereas high frequency stimulation is more effective in neurogenic pain. In chronic pain syndrome patients with high anxiety, acupuncture is generally inefficient. It is possible that part of the lack of effect in chronic pain syndromes can be attributed to high levels of the opioid-antagonist cholecystokinin in the brain. Acupuncture may be effective in some categories of pain but the mode of stimulation should be adjusted to the aetiology of pain. Also, patients are likely to respond better if they are not stressed and anxious.
These event rates are per consultation, and they do not give the risk per individual patient. Dem... more These event rates are per consultation, and they do not give the risk per individual patient. Demographic data suggest that the acupuncturist volunteers were reasonably representative of the members of the two societies, but over-reporting and underreporting are inherently possible in such studies. High individual rates may be due to a low personal threshold for reporting, or they may indicate the need for further training of the acupuncturist. Some avoidable adverse events occurred, and acupuncturists might consider modifying their practice to reduce the incidence of such events. We thank members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists for collecting data, Mike Fitter and Hugh MacPherson for advice in designing the questionnaire, and Val Hopwood for help in recruiting volunteers. Contributors: EE, SH, and AW planned the study, which was supervised by AW. The data were collected by members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. The results were collated by AW, and AH performed the statistical analysis. The final report was written by AW, SH, AH, and EE. AW and EE will act as guarantors.
www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a... more www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a system with an empirical basis that has been used in the treatment of pain for centuries. Its use for pain relief is supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects on pain must devolve from physiological and/or psychological mechanisms with biological foundations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous neurotransmitters including opioids, monoamines, oxytocin and other neuropeptides (SP, CGRP, GAL, CRF, NPY), important in the control of both sensory, affective and cognitive elements of pain. Over the past ten years there has been a growing awareness that pain is due not simply to the activation of peripheral nociceptors, as in nociceptive pain, but to multiple factors, and is therefore susceptible to various modes of acupuncture treatments. Depending on the aetiology, pain may be classified into several categories, such as nociceptive, neurogenic, chronic pain syndrome and psychogenic pain. Musculoskeletal and visceral pain states, both nociceptive, are characterised by hyperalgesia. However, despite belonging to a similar category, the pain is triggered by different mechanisms. Neurogenic pain is caused by injury or dysfunction in the nervous system and is often severe and intractable and may not respond to even powerful opioids. Recent studies suggest that there is a third pain category, distinct from the neurogenic and nociceptive, where pain is related to a sickness response that occurs with exposure to chemical compounds and infectious agents the associated central changes produce heightened pain sensitivity ('hurting all over'), termed chronic pain syndrome. In clinical trials acupuncture or low frequency electroacupuncture have shown to be effective in some nociceptive pain states, whereas high frequency stimulation is more effective in neurogenic pain. In chronic pain syndrome patients with high anxiety, acupuncture is generally inefficient. It is possible that part of the lack of effect in chronic pain syndromes can be attributed to high levels of the opioid-antagonist cholecystokinin in the brain. Acupuncture may be effective in some categories of pain but the mode of stimulation should be adjusted to the aetiology of pain. Also, patients are likely to respond better if they are not stressed and anxious.
T he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly inf... more T he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS. The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The HTA Programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public, service-users groups and professional bodies such as Royal Colleges and NHS Trusts. Research suggestions are carefully considered by panels of independent experts (including service users) whose advice results in a ranked list of recommended research priorities. The HTA Programme then commissions the research team best suited to undertake the work, in the manner most appropriate to find the relevant answers. Some projects may take only months, others need several years to answer the research questions adequately. They may involve synthesising existing evidence or conducting a trial to produce new evidence where none currently exists. Additionally, through its Technology Assessment Report (TAR) call-off contract, the HTA Programme is able to commission bespoke reports, principally for NICE, but also for other policy customers, such as a National Clinical Director. TARs bring together evidence on key aspects of the use of specific technologies and usually have to be completed within a short time period. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.
This paper examines some of the organizational and behavioural consequences of uncertainty throug... more This paper examines some of the organizational and behavioural consequences of uncertainty through consideration of a case study. An industrial firm and its problems are described and an attempt is made to understand the origins of the situation using a systems analysis which draws on constructs from the structural, the behavioural and the 'bureaucratic' traditions within organization theory. The analysis demonstrates: that the problems are interrelated and stem from the structural arrangements in the firm which are unable to cope with the prevailing uncertainties; that the behavioural difficulties may be seen as manifestations of the underlying structural/environmental mismatch; and, that the problems are exacerbated by apparently logical but paradoxically inappropriate managerial choices and responses. The implications of this study for theory, practice and method are discussed. 'We used the Aston data bank for comparative purposes. and found other firms in the technological category of 'Fabrication'. to have similar formal organization structures. (For a description of the Aston studies, see Pugh and Hickson, 1976).
Abstract: In the considerable literature on the use of information systems in organisations there... more Abstract: In the considerable literature on the use of information systems in organisations there are occasional discussions of issues broadly relevant to the area of job redesign. Hedberg, for example, has pointed to the potential of such systems for facilitating ...
Monoclonal antibodies generated by immunization with a plasma-membrane preparation from suspensio... more Monoclonal antibodies generated by immunization with a plasma-membrane preparation from suspension-cultured cells of Nicotiana glutinosa L. were used in combination with fluoresceinor rhodamine-labeled goat anti-mouse immunoglobulins to identify heterokaryons in protoplast fusion procedures. Antibody labeling did not inhibit callus formation nor plantlet regeneration. The antibodies are non-invasive and surface labeling provides clear optical discrimination of true heterokaryons from unfused aggregates as well as from parental protoplasts and homokaryons. Labeling is stable throughout fusion and hence by pre-labeling parental protoplast populations the strategy is both versatile and of general applicability.
Murine monoclonal antibodies to membrane antigens were generated by immunization with a crude cel... more Murine monoclonal antibodies to membrane antigens were generated by immunization with a crude cellular membrane preparation from suspension-cultured cells of Nicotiana glutinosa L. From a panel of thirteen monoclonal antibodies, seven were found to be directed against antigens present on the plasma-membrane by immunofluorescence visualization of antibody binding to the surface of isolated protoplasts. The corresponding set of plasma-membrane antigen(s) were present in root, shoot and leaf tissue and some but not all of these antigens were of wide species distribution, being found in Nicotiana tabacum L., N. plumbaginifolia L., Glycine max L., Phaseolus vulgaris L. and Triticum aesfivum L. Topologically specific labeling of intact protoplasts with a monoclonal antibody reactive with an epitope present on the plasma-membrane specifically labeled a membrane fraction which equilibrated at a density of 1.14 kg/1 following centrifugation in a sucrose gradient. In addition to use as biochemical markers for fractionation and molecular characterization of plasma-membranes, these monoclonal antibodies provide the basis for new selection tools in plant cell and gene manipulations.
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
The development of medical information systems which can be used in the consulting room has led t... more The development of medical information systems which can be used in the consulting room has led to independent solutions which are dedicated to specific tasks. Integrating users in the development process is a prerequisite to find the correct solutions to the medical problem and acceptance of the system. The PRECISE-CRS Project tested and enhanced the method of “User centered Design” to gather requirements for a medical workstation. This was done in specific European workshops with physicians from three countries for analysing and assessing human factors, requirements, and variations in scenarios and consultation simulations of different system prototypes.
Given the continuing emphasis on preventive medicine in general practice, there is considerable i... more Given the continuing emphasis on preventive medicine in general practice, there is considerable interest in the relative effectiveness of different ways of inviting patients to attend for screening. Recently, opportunistic methods have been advocated as being particularly useful but these methods often fail to reach a high proportion of the target population. Many patients do not consult and when they do they are not always invited to attend for screening. In this study a computer simulation model has been used to examine the effects of these variables in more detail. The notes of a random sample of 190 patients (97 women, 93 men) aged 30-50 years, registered with one general practitioner, were used to provide data for the model. The simulation model showed that increasing the number of screening appointments available each week has only a small effect on screening rates and that a ceiling is reached when 25 appointments per 1000 patients are available. In contrast, increasing the proportion of eligible consulting patients who are invited has a substantial effect such that it could take nearly 12 years to screen 90% of a target population if only one out of every four patients were invited compared with under four years if three out of every four patients were invited. The results suggest therefore that opportunistic screening methods are unlikely to achieve desired screening rates within acceptable time limits. It is argued that to achieve target levels of screening, practices will need to combine opportunistic methods with more formal methods of invitation.
Reporting on an experimental field study of computer use by general practitioners during consulta... more Reporting on an experimental field study of computer use by general practitioners during consultations, this paper focuses particularly on the experiences of the doctors in their efforts to communicate concurrently with a patient and a computer. Through the analysis of logs of computer use, video recordings of consultations and interviews with doctors, the authors report on the uptake of the computer facilities, the impact of such use on information handling during the consultation, the doctors' views about using the system, and finally the relationship between doctors' ;natural' consulting styles and their uptake and views of the system.
This paper reports an experimental study of general practitioners' use of an interactive computer... more This paper reports an experimental study of general practitioners' use of an interactive computerized protocol for the management of hypertension, focussing particularly on the protocol's effects on doctors' clinical behaviour. Prior to its computerization a paper-based version of the protocol was used enabling a comparison of the alternative forms. Doctors' delivery of care was assessed from video recordings of 89 consultations and from the records made during these consultations. Comparisons were made of consultations conducted under control and experimental conditions. Use of paper and computer protocols resulted in significant improvements in the doctors' delivery of care, in terms of the range of verbal and physical examinations conducted and recorded. The protocol's effects were most marked when the computerized version was used. However, use of the computer protocol resulted in the recording of information on the non-occurrence of certain events which had not been explicitly elicited during the verbal examination; features of the design which were intended to encourage adherence to the protocol may have been inappropriate to the realities of a general practice consultation. The findings provide some useful insights for the design of future computerized protocols for the management of chronic conditions.
www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a... more www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a system with an empirical basis that has been used in the treatment of pain for centuries. Its use for pain relief is supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects on pain must devolve from physiological and/or psychological mechanisms with biological foundations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous neurotransmitters including opioids, monoamines, oxytocin and other neuropeptides (SP, CGRP, GAL, CRF, NPY), important in the control of both sensory, affective and cognitive elements of pain. Over the past ten years there has been a growing awareness that pain is due not simply to the activation of peripheral nociceptors, as in nociceptive pain, but to multiple factors, and is therefore susceptible to various modes of acupuncture treatments. Depending on the aetiology, pain may be classified into several categories, such as nociceptive, neurogenic, chronic pain syndrome and psychogenic pain. Musculoskeletal and visceral pain states, both nociceptive, are characterised by hyperalgesia. However, despite belonging to a similar category, the pain is triggered by different mechanisms. Neurogenic pain is caused by injury or dysfunction in the nervous system and is often severe and intractable and may not respond to even powerful opioids. Recent studies suggest that there is a third pain category, distinct from the neurogenic and nociceptive, where pain is related to a sickness response that occurs with exposure to chemical compounds and infectious agents the associated central changes produce heightened pain sensitivity ('hurting all over'), termed chronic pain syndrome. In clinical trials acupuncture or low frequency electroacupuncture have shown to be effective in some nociceptive pain states, whereas high frequency stimulation is more effective in neurogenic pain. In chronic pain syndrome patients with high anxiety, acupuncture is generally inefficient. It is possible that part of the lack of effect in chronic pain syndromes can be attributed to high levels of the opioid-antagonist cholecystokinin in the brain. Acupuncture may be effective in some categories of pain but the mode of stimulation should be adjusted to the aetiology of pain. Also, patients are likely to respond better if they are not stressed and anxious.
These event rates are per consultation, and they do not give the risk per individual patient. Dem... more These event rates are per consultation, and they do not give the risk per individual patient. Demographic data suggest that the acupuncturist volunteers were reasonably representative of the members of the two societies, but over-reporting and underreporting are inherently possible in such studies. High individual rates may be due to a low personal threshold for reporting, or they may indicate the need for further training of the acupuncturist. Some avoidable adverse events occurred, and acupuncturists might consider modifying their practice to reduce the incidence of such events. We thank members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists for collecting data, Mike Fitter and Hugh MacPherson for advice in designing the questionnaire, and Val Hopwood for help in recruiting volunteers. Contributors: EE, SH, and AW planned the study, which was supervised by AW. The data were collected by members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. The results were collated by AW, and AH performed the statistical analysis. The final report was written by AW, SH, AH, and EE. AW and EE will act as guarantors.
www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a... more www.medical-acupuncture.co.uk/aimintro.htm Acupuncture is part of traditional Chinese medicine, a system with an empirical basis that has been used in the treatment of pain for centuries. Its use for pain relief is supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. Acupuncture effects on pain must devolve from physiological and/or psychological mechanisms with biological foundations. Acupuncture and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they bring about fundamental physiological changes. Acupuncture excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and acupuncture produce rhythmic discharges in nerve fibres, and cause the release of endogenous neurotransmitters including opioids, monoamines, oxytocin and other neuropeptides (SP, CGRP, GAL, CRF, NPY), important in the control of both sensory, affective and cognitive elements of pain. Over the past ten years there has been a growing awareness that pain is due not simply to the activation of peripheral nociceptors, as in nociceptive pain, but to multiple factors, and is therefore susceptible to various modes of acupuncture treatments. Depending on the aetiology, pain may be classified into several categories, such as nociceptive, neurogenic, chronic pain syndrome and psychogenic pain. Musculoskeletal and visceral pain states, both nociceptive, are characterised by hyperalgesia. However, despite belonging to a similar category, the pain is triggered by different mechanisms. Neurogenic pain is caused by injury or dysfunction in the nervous system and is often severe and intractable and may not respond to even powerful opioids. Recent studies suggest that there is a third pain category, distinct from the neurogenic and nociceptive, where pain is related to a sickness response that occurs with exposure to chemical compounds and infectious agents the associated central changes produce heightened pain sensitivity ('hurting all over'), termed chronic pain syndrome. In clinical trials acupuncture or low frequency electroacupuncture have shown to be effective in some nociceptive pain states, whereas high frequency stimulation is more effective in neurogenic pain. In chronic pain syndrome patients with high anxiety, acupuncture is generally inefficient. It is possible that part of the lack of effect in chronic pain syndromes can be attributed to high levels of the opioid-antagonist cholecystokinin in the brain. Acupuncture may be effective in some categories of pain but the mode of stimulation should be adjusted to the aetiology of pain. Also, patients are likely to respond better if they are not stressed and anxious.
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