bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoarthritis of the Knee – An Introduction
Authors: White Adrian 
Published: April 2009

Osteoarthritis of the knee is common, and a major cause of disability in older people that is likely to increase over time. Some patients progress rapidly to needing surgery, whereas others will have persistent pain for many years. The aims of conservative treatment are to reduce pain and disability. There is evidence that several non-pharmacological therapies such as exercise, education and weight loss can have an effect in patients with knee pain, though the effect is usually only modest. Ultrasound and short wave diathermy are widely available, but not supported by evidence. Particular preparations of topical treatments are effective, as too is oral paracetamol (acetaminophen). Glucosamine is popular but not all trials have found it to have any effect. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective, though their effect is modest and their longterm value is not established. They are associated with significant adverse events, particularly gastrointestinal haemorrhage, which has a substantial mortality. They are particularly dangerous in the elderly. Cyclooxygenase-2 (COX-2) inhibitors cause fewer gastrointestinal problems but increase the risk of vascular events including myocardial infarction and stroke. Herbal therapies have only sparse evidence in support. Intra-articular injections of steroids may be effective, at least for a short period, but hyaluronan has a longer duration of action. Patients prefer treatments that are safe, and are willing to forgo some effectiveness in favour of safety. In this context, acupuncture is a potentially valuable treatment for OA knee, and the evidence on effectiveness, safety and cost should be considered carefully.
Efficacy, Effectiveness, Safety and Costs of Acupuncture for Chronic Pain – Results of a Large Research Initiative
Authors: Witt Claudia M , Brinkhaus Benno , Reinhold Thomas , Willich Stefan N 
Published: April 2009

Background The aim of the ‘Acupuncture Model Project of the Techniker Krankenkasse’ was to determine efficacy, effectiveness, safety and cost effectiveness of acupuncture treatment in standard medical care. Methods We evaluated a total of 304 674 patients (34.5% men, aged 53.1?13.8 and 65.5% women, aged 49.5±14.2) who were in the care of over 10 000 physicians and received on average 10?3 acupuncture treatments for chronic pain (osteoarthritis of the hip or knee, low back pain, neck pain, headache) during a period of three months. Results and conclusions Our findings demonstrate that for the diagnoses examined, acupuncture in addition to usual care was an effective and safe treatment. Whether the effects of acupuncture can be attributed primarily to specific or nonspecific mechanisms appeared to depend on the diagnosis, and should be investigated in further studies. Using acupuncture as an adjunctive treatment was more expensive than usual care alone, but was cost-effective according to internationally accepted threshold values.
Acupuncture for Mild to Moderate Emotional Complaints in Pregnancy – a Prospective, Quasi-Randomised, Controlled Study
Authors: Guerreiro da Silva Joao Bosco 
Published: April 2009

Background The aim of this study was to describe the effects of acupuncture under real life conditions, in the treatment of emotional complaints during pregnancy. Methods A group of 51 conventionally treated pregnant women (with counselling by their physicians and nurses) was allocated by chance into two groups to be either treated or not by acupuncture. Both groups (28 in the study group and 23 in the control group) presented emotional complaints such as anxiety, depression and irritability. They reported the severity of symptoms using a Numerical Rating Scale (NRS) from 0 to 10; and they rated how much the symptoms disturbed five aspects of their lives: mood, sleep, relationships, social activities, sexual life and joy of living. Traditional acupuncture was used. In order to facilitate protocols we used pre-programmed points. Up to four points were permitted as optional points. Results Three women from the acupuncture group and four from the control group dropped out of the study. Over the study period, the NRS scores of intensity of emotional distress decreased by at least half in 15/25 (60%) of patients in the study group and in 5/19 (26%) of those in the control group (P=0.013). The impact of the distress on three out of the five aspects of life was significantly less in the acupuncture group when compared with the control group (P<0.05). Conclusion Emotional complaints are very common in pregnancy and medication is always a risk. In this study, acupuncture seems to be an efficacious means of reducing symptoms and improving the quality of life of women with emotional complaints during pregnancy. Large randomised studies are recommended to confirm these results.
Are Auricular Maps Reliable for Chronic Musculoskeletal Pain Disorders?: A Double-Blind Evaluation
Authors: Andersson Elisabeth , Persson Ann L , Carlsson Christer PO 
Published: April 2009

Aim To examine the proposed somatotopic relation between the regions in which patients report musculoskeletal pain and tender points located on the external ears according to a map based on commonly used auricular acupuncture maps. Methods Twenty-five patients (16 women) from a chronic pain clinic were included. Patients were asked, before examination of the external ears, if they had past or present musculoskeletal pain in any of 11 body regions. An ear map, collapsed into 11 zones representing the musculoskeletal system, was used. The ear examiner was blinded to the patients’ pain conditions, medical history and ongoing treatment. Patients communicated with the examiner only to express if tenderness was present in the external ear on palpation using a spring-loaded pressure stylus commonly used for auricular acupuncture. The degree of tenderness was registered on a 5-point scale and dichotomised (no tenderness or tenderness). Agreements between the patients’ painful body regions and tenderness in the external ear zones were presented as percentage, kappa values, sensitivity and specificity. Results The 25 patients reported 116 past or present musculoskeletal pain regions and had 110 tender ear zones. No statistically significant agreements were found between the painful body regions and the corresponding tender ear zones. Conclusions Our results did not show agreements between patients’ reported musculoskeletal pain regions and tender zones in the external ears assessed according to commonly used maps in auricular acupuncture using a pressure stylus. However, very tender points occur on the external ear in a population with chronic musculoskeletal pain.
Effect of Varying Frequency and Duration of Electroacupuncture Stimulation on Carrageenan-Induced Hyperalgesia
Authors: Taguchi Tatsuki , Taguchi Reina 
Published: April 2009

ObjectiveAlthough electroacupuncture (EA) therapy is used to relieve various kinds of pain, the optimal frequency and duration of EA remain unclear. We investigated the effect of varying frequency and duration of EA during hyperalgesia elicited by carrageenan-induced inflammation.MethodsCarrageenan was administered by subcutaneous intraplantar injection to induce inflammation. Nociceptive thresholds were measured using the paw pressure threshold (PPT) (Randall-Selitto Test). EA was applied at 3, 15, or 100Hz to the left anterior tibial muscles for 1, 15, or 60 minutes. Intensities used were chosen within the known tolerance of the animal, and increased up to 3mA for 3Hz, and up to 1.5mA for 15 and 100Hz. EA was started three hours after carrageenan injection.ResultsThree hours after carrageenan injection, a marked ipsilateral inflammatory response appeared and PPT decreased significantly. This decrease persisted for at least 24 hours after carrageenan injection. EA at 3Hz (60 minutes) resulted in significant increases of PPT which persisted for 24 hours after injection. EA at 3Hz (15 minutes) also induced PPT elevations immediately and for one hour after EA compared to the control group. However, no other variety of EA significantly increased PPT.ConclusionThese results show that EA produces electroacupuncture analgesia of carrageenan-induced hyperalgesia. These findings also suggest that, among the frequencies and durations tested, EA at 3Hz (60 minutes) is the most suitable frequency and duration for carrageenan-induced inflammation. It seems that EA has different analgesic effects and mechanisms according to the parameters of stimulation. For EA in the clinical induction of analgesia, it is especially important that an effective frequency and duration are selected.
Intramuscular and Periosteal Acupuncture for Anxiety and Sleep Quality in Patients with Chronic Musculoskeletal Pain – An Evaluator Blind, Controlled Study
Authors: Hansson Ylva , Carlsson Christer , Olsson Elisabeth 
Published: April 2009

Objectives Periosteal acupuncture seems clinically to have a stronger effect on pain than standard intramuscular acupuncture. The aim of the present study was to compare their relative effectiveness on promoting psychological functioning and quality of sleep. Methods Consecutive patients (n=144) referred to a physiotherapist for treatment of chronic nociceptive pain in the neck or low back for more than three months, aged 18–70, were alternately allocated to an intramuscular acupuncture group (n=59), to a periosteal acupuncture group (n=55), and, for the latter part of the study, to an information control group (n=30). Eight treatments were administered during a five week period with two optional treatments after one month. All patients were encouraged to stay active. Psychological functioning was estimated with the Hospital Anxiety and Depression Scale (HAD) and quality of sleep with a visual analogue scale. All estimations were performed prior to treatment, one week after the end of treatment, and one, three and six months after end of treatment. Non-parametric statistics were used. Results There were no significant differences between the acupuncture groups, nor between the acupuncture and control groups during the treatment period. One month after treatment, the level of anxiety was lower in both acupuncture groups compared with the control group. The proportions of non-cases (HAD score 0–7) increased in the intramuscular acupuncture group from 39 to 47 (not significant), in the periosteal acupuncture group from 37 to 49 (P<0.001), and in the control group from 15 to 16. Conclusion No differences between periosteal and intramuscular acupuncture were found. One month after treatment both acupuncture interventions reduced anxiety in patients suffering from chronic nociceptive musculoskeletal pain in the neck or low back when compared with a control intervention.
Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective
Authors: Lund Iréne , Lundeberg Thomas 
Published: April 2009

Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects.In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women.When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.
Acupuncture for Irritable Bowel Syndrome – An Exploratory Randomised Controlled Trial
Authors: Reynolds Julie A , Bland J Martin , MacPherson Hugh 
Published: April 2009

BackgroundThe evidence on the effectiveness of acupuncture for irritable bowel syndrome (IBS) is inconclusive. However, many patients with IBS are self referring for acupuncture, therefore it is of interest to know whether acupuncture is effective or not. The aim of this study was to establish variability in the primary outcome measure to enable a sample size to be calculated for a full scale trial, and to explore feasibility and design criteria.MethodsA pragmatic randomised controlled trial compared 10 sessions of acupuncture plus usual GP care with usual GP care alone. Thirty patients were recruited from four GP databases in Birmingham, UK, and randomised one-to-two to acupuncture or usual care alone. The primary outcome was the IBS Symptom Severity Score (SSS) at three months (maximum score 500). Analysis was by intention-to-treat, and multiple imputation was used for missing data.ResultsFrom the databases, 189 patients with IBS were identified, of whom 30 were eligible and consented to randomisation. At three months, a statistically and clinically significant difference between groups of 138 points (SD 90) in favour of acupuncture was observed on the IBS SSS (95% CI: 66 to 210; P=0.001) using multiple imputation. For a full scale trial, we estimate that a sample size of 108 patients per arm is required, based on a minimum clinically significant change of 50 points, drawn from a primary care population of 140 000.ConclusionsWe established the feasibility of a full scale trial, successfully recruiting patients and calculating the sample size required. The results of our pilot analysis suggest that more definitive research into acupuncture for IBS is merited. A pragmatic trial design will not be able to distinguish between acupuncture specific effects and placebo effects; however, it is the design of choice to determine cost effectiveness.
Magnets Applied to Acupuncture Points as Therapy – a Literature Review
Authors: Colbert Agatha P , Cleaver James , Brown Kimberly Ann , Harling Noelle , Hwang Yuting , Schiffke Heather C , Brons John , Qin Youping 
Published: April 2009

Objectives To summarise the acu-magnet therapy literature and determine if the evidence justifies further investigation of acu-magnet therapy for specific clinical indications. Methods Using various search strategies, a professional librarian searched six electronic databases (PubMed, AMED, Science Direct College Edition, China Academic Journals, Acubriefs, and the in-house Journal Article Index maintained by the Oregon College of Oriental Medicine Library). English and Chinese language human studies with all study designs and for all clinical indications were included. Excluded were experimental and animal studies, electroacupuncture and transcranial magnetic stimulation. Data were extracted on clinical indication, study design, number, age and gender of subjects, magnetic devices used, acu-magnet dosing regimens (acu-point site of magnet application and frequency and duration of treatment), control devices and control groups, outcomes, and adverse events. Results Three hundred and eight citations were retrieved and 50 studies met our inclusion criteria. We were able to obtain and translate (when necessary) 42 studies. The language of 31 studies was English and 11 studies were in Chinese. The 42 studies reported on 32 different clinical conditions in 6453 patients from 1986–2007. A variety of magnetic devices, dosing regimens and control devices were used. Thirty seven of 42 studies (88%) reported therapeutic benefit. The only adverse events reported were exacerbation of hot flushes and skin irritation from adhesives. Conclusions Based on this literature review we believe further investigation of acu-magnet therapy is warranted particularly for the management of diabetes and insomnia. The overall poor quality of the controlled trials precludes any evidence based treatment recommendations at this time.
Do General Practices Which Provide An Acupuncture Service Have Low Referral Rates and Prescription Costs? A Pilot Survey
Authors: Johnson Gina , White Adrian , Livingstone Ruth 
Published: April 2009

Background Studies by individual acupuncture practitioners have given an indication that offering acupuncture in primary care may reduce the need for referral to secondary care and reduce the costs of prescriptions. It would be informative to find out whether these findings can be supported by data from other practices. The aim of this study was to test the feasibility of surveying national data on referrals and prescribing. Methods Three primary care trusts (PCTs) were selected, and all practices within each trust were sent an email asking whether any member of the primary care team offered acupuncture, and if so how many appointments per week. Data on rates of referral to orthopaedic, physiotherapy, pain and rheumatology clinics were then sought from the PCT, both for the practices offering acupuncture and for the PCT as a whole. Similarly, data on costs of prescriptions for non-steroidal (NSAID) and non-opioid analgesic drugs were obtained from the Prescription Pricing Authority. Results Out of the 109 practices surveyed, a total of 14 (13%) offered acupuncture services to some extent. There was wide variation in provision between the different PCTs. The eight practices which offered at least one appointment per week for every 2000 registered patients were included in the analysis. The mean values (and SDs) for the three PCTs and for the eight acupuncture practices, respectively, were as follows: for referral to various clinics: orthopaedic 32.3 (16.2) and 27.4 (10.87); pain clinic 1.6 (1.3) and 2.8 (1.6); physiotherapy 13.4 (14.5) and 29.5 (10.0); and rheumatology 4.7 (2.3) and 6.4 (3.0). The mean values for costs of non-opioid analgesics were £1820 (£442) and £2008 (£762); and for NSAIDs were £4148 (£269) and £4476 (£1366), respectively. There were no trends towards a reduction of clinic referral or prescription costs. Conclusions We have conducted the first survey of the effects of provision of acupuncture in UK general practice, using data provided by the NHS, and uncovered a wide variation in the availability of the service in different areas. We have been unable to demonstrate any consistent differences in the prescribing or referral rates that could be due to the use of acupuncture in these practices. The wide variation in the data means that if such a trend exists, a very large survey would be needed to identify it. However, we discovered inaccuracies and variations in presentation of data by the PCTs which have made the numerical input, and hence our results, unreliable. Thus the practicalities of access to data and the problems with data accuracy would preclude a nationwide survey.
The Methodology of Controlled Trials of Acupuncture
Authors: Vincent C A 
Published: April 2009

The double-blind controlled trial methodology cannot be straightforwardly applied to trials of acupuncture. The double-blind condition, where the clinician is ignorant of the treatment allocation, cannot be sensibly maintained in trials of acupuncture or other physical treatments. The definition of an appropriate control group is also a difficult matter. The great majority of controlled trials of acupuncture so far conducted are seriously flawed by the use of a placebo control that itself has therapeutic effects. Recently more appropriate control groups have been developed, notably mock TENS, which is inert, and minimal acupuncture, which has only a very slight specific effect. As trials can only be single blind, if is especially important to monitor the adequacy of the control procedure, to ensure that it is perceived as being as effective as the true treatment. It is suggested that this can be achieved by assessing the: credibility of the two treatment procedures. Controlled trials of acupuncture should therefore be single blind, and employ a control condition that has no more than minimal specific effects, but is nevertheless seen as a credible, bona fide treatment by patients.
UTILITY INDIFFERENCE PRICING OF INTEREST-RATE GUARANTEES
Authors: BENTH FRED ESPEN , PROSKE FRANK 
Published: April 2009

We consider the problem of utility indifference pricing of a put option written on a non-tradeable asset, where we can hedge in a correlated asset. The dynamics are assumed to be a two-dimensional geometric Brownian motion, and we suppose that the issuer of the option have exponential risk preferences. We prove that the indifference price dynamics is a martingale with respect to an equivalent martingale measure (EMM) Q after discounting, implying that it is arbitrage-free. Moreover, we provide a representation of the residual risk remaining after using the optimal utility-based trading strategy as the hedge.Our motivation for this study comes from pricing interest-rate guarantees, which are products usually offered by companies managing pension funds. In certain market situations the life company cannot hedge perfectly the guarantee, and needs to resort to sub-optimal replication strategies. We argue that utility indifference pricing is a suitable method for analysing such cases.We provide some numerical examples giving insight into how the prices depend on the correlation between the tradeable and non-tradeable asset, and we demonstrate that negative correlation is advantageous, in the sense that the hedging costs become less than with positive correlation, and that the residual risk has lower volatility. Thus, if the insurance company can hedge in assets negatively correlated with the pension fund, they may offer cheaper prices with lower Value-at-Risk measures on the residual risk.