[The analysis on the funding of Natural Science Foundation of China for acupuncture projects from 2005 to 2015].

The funding of Natural Science Foundation of China (NSFC) for acupuncture projects from 2005 to 2015 was summarized and analyzed. The results indicated during past 11 years, 711 projects regarding acupuncture were funded by NSFC, with a total of 281 million RMB, accounting for 12.39% in TCM projects. It was concluded the funding for acupuncture projects was increased year by year, but was still relatively weak; in addition, the funding was unbalanced in different areas and organizations, mainly in Beijing, Shanghai, Sichuan, Guangdong, Tianjin, and the continuity and variability both existed in research content and direction.

An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS).

OBJECTIVES: To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. METHODS: An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure-the Northwick Park Neck Pain Questionnaire (NPQ). RESULTS: In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. CONCLUSIONS: In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions.

[Educational philosophy of acupuncture and moxibustion of Chengjiang school successor professor HUANG Zongxu].

Based on the historical documents regarding professor HUANG Zongxu, his educational philosophy of acupuncture and moxibustion was summarized. As a result, the following characteristics were found. He focused on the education of acupuncture and moxibustion, which combined the classroom teaching with apprentice teaching; he compiled teaching materials and committed himself to education reform; he started the first acupuncture undergraduate majors in Fujian province; he valued the academic inheritance and practice of acupuncture; he authored publications and proposed arguments to inherit experience. In addition, he valued medical ethics and focused on patients.

[Problems and solutions on transformation of scientific research achievements of acupuncture].

With more and more attention and investment on acupuncture scientific researches, considerable outcomes and achievements has been acquired, but the shortcoming of low transformation rate of acupuncture research achievements is gradually exposed. Nowadays there is no related report on this problem, so based on achievement translational research in other areas and practical situation of acupuncture, the existing problems and solutions are analyzed. As a result, the existing problems include (1) the research content is mainly basic research and clinical research but less acupuncture device research, leading to limited transformation efficiency; (2) the evaluation system and transformation pattern are still needed to be perfect. The solutions are (1) to properly evaluate the research achievements of acupuncture, (2) to advocate the concept and method of translational medicine, (3) to reform the policy and system, and (4) to establish valid platforms covering research, outcomes and transformation.

[The present situation and development of acupuncture and moxibustion in Portugal].

The development courses of acupuncture and moxibustion as well as the present situation, education and legislation in Portugal were reviewed in this article. Acupuncture and Moxibustion has been developed in Portugal since 1980's. The first acupuncture school appeared in the year of 1992. Until now, courses on Chinese medicine and acupuncture has already been set up in about six universities. Acupuncture legislation started in the year 2003. At present, professional levels of acupuncture practitioners vary a lot. There are over 50 indications currently. And acupuncture treatment is basically at one's own expense.

[Acupuncture and moxibustion in Tunisia].

The development status of acupuncture and moxibustion in Tunisia is introduced in this article. Although acupuncture and moxibustion only has a history of more than 30 years in Tunisia, it is very popular among the local people. Until now, there is one acupuncture and moxibustion center aided and built with the help of the Chinese government. Acupuncture and moxibustion clinical department has been set in some of the hospitals, and acupuncture and moxibustion clinical practice is also carried out in some private clinics. Cost of acupuncture and moxibustion in public hospitals has already been covered by medical insurance. As for education of acupuncture and moxibustion, training courses were set up in medical colleges of Tunisia by Tunisian government which is lectured by Chinese acupuncture experts. Acupuncture and moxibustion has been used to treat many diseases in Tunisia and is warmly welcomed by Tunisian.

[An analysis of national projects of scientific research in Japanese acupuncture-moxibustion academia during recent 40 years].

Adopting bibliometrics research methods to categorize and analyze the acupuncture scientific research findings which has been published by the KAKEN Database of Grants-In-Aid for Scientific Research, and moreover compared results from some of the winning national research projects published by the Internet-based Science Information System of China in 2011. Upon evaluation, it is found that the applied logic of Japanese acupuncture academia is clearer and the fixed position is more accurate. The achivments and academic thought of Japan acup-mox cirde will in some way inspire the acupuncture researchers in China regarding project selection and help them to avoid invalid or duplicate research. Furthermore, it is concluded that Chinese acupuncture academia is focusing on basic research and is showing the spirit for the scientific research as the cradle of acupuncture and moxibustion. In comparison, Japanese acupuncture academia is re nowned for their focus on the subtle interplay of basic and clinical research, as well as attention to detail, serves as a testament to their straightforward, absence of pretense as a country of practical scientific research.

[Analysis on research projects for acupuncture and moxibustion supported by NSFC during the 11th 5-year-plan].

In the present paper, the authors introduce the approved and finished research projects for acupuncture and moxibustion therapies supported by the National Natural Science Foundation of China (NSFC) during the 11th 5-year-plan. A total of 194 research projects were subsidized by NSFC from 2006 to 2010. These projects include 6 aspects: meridian-collaterals, acupoint theory, acupuncture analgesia, mechanisms underlying improvement of different clinical problems, clinical trials, and moxibustion therapy. The research on acupoints has been becoming a new hotspot in recent years. Majority of the research projects focus on the mechanism of acu-moxibustion underlying improvement of different clinical problems, while fewer projects on clinical trials. During the 11th 5-year-plan, 119 projects were completed; most of them involved meridian-collateral theory, acupoint theory, mechanism of acu-moxibustion underlying improvement of clinical problems and acupuncture manipulations. Following analysis of the finished research projects, we find that 1) many neurobiological methods and techniques are commonly used in the research on meridian-collateral theory; 2) the research on acupoint theory is changing from observing the local morphological structure to identifying characteristics of the regional activated receptors, particularly under the circumstances of visceral pathological conditions and efficacies of acupoints; 3) researches on the underlying mechanism of acu-moxibusiton for improving clinical disorders mainly focused on its cerebral protective effects against cerebral ischemia, in addition, researches about other diseases on clinical conditions have been also carried out, but the related mechanisms are far from understanding; 4) In many research projects, various new methods and techniques, such as fMRI, position emission tomography, genomics, proteomics, molecular biology, nerve stem cell, etc. were widely used; 5) Randomized controlled multi-center clinical trials are definitely insufficient. Only two clinical projects were finished during the 11th 5-year-plan. Moreover, it should be noted that in the subject of acu-moxibustion, independent innovation researches are fewer; the foundation of competitive ability is relatively weaker; the supporting conditions for finishing the research projects are poorer in some institutes or districts; and the interrelations among the theoretical, experimental and clinical researches are not intimately close, leading to relative lag in the subject development.

Management of frozen shoulder: a systematic review and cost-effectiveness analysis.

BACKGROUND: Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence. DATA SOURCES: A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment. REVIEW METHODS: Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta-analysis. A mixed-treatment comparison (MTC) was also undertaken. An economic decision model was intended, but was found to be implausible because of a lack of available evidence. Resource use was estimated from clinical advisors and combined with quality-adjusted life-years obtained through mapping to present tentative cost-effectiveness results. RESULTS: Thirty-one clinical effectiveness studies and one economic evaluation were included. The clinical effectiveness studies evaluated steroid injection, sodium hyaluronate, supervised neglect, physical therapy (mainly physiotherapy), acupuncture, MUA, distension and capsular release. Many of the studies identified were at high risk of bias. Because of variation in the interventions and comparators few studies could be pooled in a meta-analysis. Based on single RCTs, and for some outcomes only, short-wave diathermy may be more effective than home exercise. High-grade mobilisation may be more effective than low-grade mobilisation in a population in which most patients have already had treatment. Data from two RCTs showed that there may be benefit from adding a single intra-articular steroid injection to home exercise in patients with frozen shoulder of < 6 months' duration. The same two trials showed that there may be benefit from adding physiotherapy (including mobilisation) to a single steroid injection. Based on a network of nine studies the MTC found that steroid combined with physiotherapy was the only treatment showing a statistically and clinically significant beneficial treatment effect compared with placebo for short-term pain (standardised mean difference -1.58, 95% credible interval -2.96 to -0.42). This analysis was based on only a subset of the evidence, which may explain why the findings are only partly supportive of the main analysis. No studies of patients' views about the treatments were identified. Average costs ranged from £36.16 for unguided steroid injections to £2204 for capsular release. The findings of the mapping suggest a positive relationship between outcome and European Quality of Life-5 Dimensions (EQ-5D) score: a decreasing visual analogue scale score (less pain) was accompanied by an increasing (better) EQ-5D score. The one published economic evaluation suggested that low-grade mobilisation may be more cost-effective than high-grade mobilisation. Our tentative cost-effectiveness analysis suggested that steroid alone may be more cost-effective than steroid plus physiotherapy or physiotherapy alone. These results are very uncertain. LIMITATIONS: The key limitation was the lack of data available. It was not possible to undertake the planned synthesis exploring the influence of stage of frozen shoulder or the presence of diabetes on treatment effect. As a result of study diversity and poor reporting of outcome data there were few instances where the planned quantitative synthesis was possible or appropriate. Most of the included studies had a small number of participants and may have been underpowered. The lack of available data made the development of a decision-analytic model implausible. We found little evidence on treatment related to stage of condition, treatment pathways, the impact on quality of life, associated resource use and no information on utilities. Without making a number of questionable assumptions modelling was not possible. CONCLUSIONS: There was limited clinical evidence on the effectiveness of treatments for primary frozen shoulder. The economic evidence was so limited that no conclusions can be made about the cost-effectiveness of the different treatments. High-quality primary research is required.

Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK.

BACKGROUND: The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences. METHODS: Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. RESULTS: Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. CONCLUSIONS: Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the other sector. Future research should evaluate whether the differences we identified in patients' experiences across private and public healthcare are common, whether they translate into significant differences in clinical outcomes, and whether similar faces of consumerism characterise patients' experiences of other interventions in the private and public sectors.

Incorporating acupuncture in a university-based family medicine center: lessons learned.

OBJECTIVES: To evaluate the utilization, financial costs, and benefits of incorporating acupuncture into a university-based family medicine center. DESIGN: Retrospective billing records review. SETTING: An academic family medicine center located within a university-based medical center. SUBJECTS: The entire population of consecutive patients seen in an acupuncture clinic from April, 2002 through October, 2006. OUTCOME MEASURES: Patient characteristics, number and types of visits, and charges and collections. METHODS: Analysis of de-identified, electronic billing records. RESULTS: During the 4(1/2)-year study period, 788 unique patients were seen, accounting for a total of 4953 visits. The most common clinical conditions treated were back pain, headache, and neck pain. Mean charge and collection per visit was $82 and $53, respectively. Mean annual clinic revenues and expenses were $58,653 and $74,223, respectively. CONCLUSIONS: The authors' experience with an acupuncture clinic within an academic medical center has been generally positive, but we have not been able to turn a profit within the first 4(1/2) years of operation. Advantages of including physician-acupuncturists include improved patient access to third-party payers for clinical services, and possibly better acceptance by physician colleagues and the larger medical center system. Physician-acupuncturists, however, tend to have higher salary and liability costs associated with their services. Incorporating licensed acupuncturists allows for improved access to patients as well as lower operating expenses. We postulate that patients are generally more willing to pay cash for acupuncture services provided by a licensed acupuncturist compared to a physician, whose services are generally expected to be covered by medical insurance. Our findings suggest that incorporating acupuncture into existing medical practices may benefit patients, providers, the clinic as a whole, and the larger community, but the profit margin associated with providing acupuncture in these settings is likely to be negative or slim.

Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care.

To assess quality of life and cost-effectiveness of additional acupuncture treatment for allergic rhinitis, patients were randomly allocated to 2 groups; both received usual care, but one group received an additional 10 acupuncture sessions. Quality of life (according to the SF-36 Health Survey), and direct and indirect costs, were assessed at baseline and after 3 months, and the incremental cost-effectiveness ratio of acupuncture treatment was calculated. This German study (December 2000-June 2004) involved 981 patients (64% women, mean age 40.9 years (standard deviation, 11.2); 36% men, mean age 43.2 years (standard deviation, 13.0)). At 3 months, quality of life was higher in the acupuncture group than in the control group (mean Physical Component Score 51.99 (standard error (SE), 0.33) vs. 48.25 (SE, 0.33), P < 0.001; mean Mental Component Score 48.55 (SE, 0.42) vs. 45.35 (SE, 0.42), respectively, P < 0.001). Overall costs in the acupuncture group were significantly higher than those in the control group (Euro (euro; 1 euro = US $1.27) 763, 95% confidence interval: 683, 844 vs. 332 euro, 95% confidence interval: 252, 412; mean difference 432 euro, 95% confidence interval: 318, 545). The incremental cost-effectiveness ratio was 17,377 euro per quality-adjusted life year (women, 10,155 euro; men, 44,871 euro) and was robust in sensitivity analyses. Acupuncture, supplementary to routine care, was beneficial and, according to international benchmarks, cost-effective. However, because of the study design, it remains unclear whether the effects are acupuncture specific.

Acupuncture: a useful tool for health care in an operational medicine environment.

Acupuncture is a form of medical care that originated in China; it has evolved and progressed over thousands of years to become one of the most commonly used forms of health care throughout the world. Allopathic (Western) medicine has begun to seriously investigate and to use this system only in the past three decades. Although acupuncture's mechanisms for healing are not fully understood, it helps many conditions. Using acupuncture reduces or eliminates the need for expensive medications and the potential risk of adverse events resulting from medications, with cost savings and health benefits to patients. During a deployment of naval combat engineers to Iraq in support of Operation Iraqi Freedom, acupuncture was used in the health care of sailors, Marines, and soldiers. It objectively and subjectively improved the health of troops in the field. Troops were able to function while being treated, reducing or avoiding sick in quarters or light limited duty status and saving operational man-days. Acupuncture in the right hands can serve as a health force multiplier (amplifying a provider's clinical impact) and can be integrated into routine health care, whether in garrison or in the field.

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial.

BACKGROUND: Venous leg ulcers constitute a chronic recurring complaint that affects 1.0-1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles - which has been demonstrated both experimentally and in clinical practice - probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture. METHODS/DESIGN: Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2). DISCUSSION: The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made. This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26438275.

Increasing research capacity at the New England School of Acupuncture through faculty and student research training initiatives.

Few complementary and alternative medicine (CAM) institutions require their students to undergo substantive training in research literacy and conduct, and well-developed programs to train CAM institution faculty in research are virtually non-existent. As part of a National Center for Complementary and Alternative Medicine (NCCAM) initiative to increase research capacity at CAM institutions, the New England School of Acupuncture (NESA), in collaboration with the Harvard Medical School (HMS) Osher Institute, was awarded a Developmental Center for Research on Complementary and Alternative Medicine (DCRC) grant. This article discusses a number of initiatives that we designed and implemented to train NESA students, faculty members, and alumni in the foundations of clinical research and to stimulate interest in both participating in research and receiving additional research training. Specific initiatives included a 30-hour faculty "Foundations of Research" course; a year-long course entitled, "How to Write a Publishable Case Report"; institution of a monthly research seminar series; revision of an already required student research course; and the addition of 2 new student-mentored independent research electives. We discuss successes and challenges encountered in developing and administering these initiatives and the overall impact they have had on research culture and productivity at NESA.

Increasing research capacity at the New England School of Acupuncture: building grants management infrastructure.

A significant practical, yet perhaps under-appreciated, barrier to a more active role of complementary and alternative medicine (CAM) institutions in research is the organizational infrastructure required for submitting and managing research grants. In this article, we discuss how the New England School of Acupuncture, in collaboration with the Harvard Medical School Osher Institute and with the support of a Developmental Center for Research on Complementary and Alternative Medicine grant awarded by the National Center for Complementary and Alternative Medicine of the National Institutes of Health, developed its grants management infrastructure and increased its research capacity. We highlight initiatives that have been successful, challenges we have encountered, and lessons we learned that may be relevant to other CAM institutions that may wish to develop a research program.

Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain.

To assess quality of life (QoL), costs, and cost-effectiveness of acupuncture treatment plus routine care versus routine care alone in osteoarthritis patients, a randomised, controlled trial was conducted in 255 general practices in Germany. Four hundred and eighty-nine patients with chronic pain due to osteoarthritis of the knee or hip were included to evaluated QoL and costs at baseline and after 3 months using health insurance funds data and standardized questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to routine care alone (mean cost-difference: 469.50 euros [95%CI 135.80-803.19 euros]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was 17,845 euros per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.

Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.

In a randomized controlled trial plus a nonrandomized cohort, the authors investigated the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic low back pain and assessed whether the effects of acupuncture differed in randomized and nonrandomized patients. In 2001, German patients with chronic low back pain were allocated to an acupuncture group or a no-acupuncture control group. Persons who did not consent to randomization were included in a nonrandomized acupuncture group. All patients were allowed to receive routine medical care in addition to study treatment. Back function (Hannover Functional Ability Questionnaire), pain, and quality of life were assessed at baseline and after 3 and 6 months, and cost-effectiveness was analyzed. Of 11,630 patients (mean age=52.9 years (standard deviation, 13.7); 59% female), 1,549 were randomized to the acupuncture group and 1,544 to the control group; 8,537 were included in the nonrandomized acupuncture group. At 3 months, back function improved by 12.1 (standard error (SE), 0.4) to 74.5 (SE, 0.4) points in the acupuncture group and by 2.7 (SE, 0.4) to 65.1 (SE, 0.4) points among controls (difference=9.4 points (95% confidence interval 8.3, 10.5); p<0.001). Nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients. The incremental cost-effectiveness ratio was euro10,526 (euros) per quality-adjusted life year. Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective.