Quality assurance of the university medical education, hospital services and traditional pharmaceutical products of the Bhutanese So-wa-rig-pa health care system.

BACKGROUND: The Bhutanese So-wa-rig-pa medicine (BSM) was integrated with the allopathic (modern) health care system in 1967. Ever since the health care integration policy was implemented, the BSM has gone through many phases of quality improvement and changes including the establishment of one university-based institute, 58 hospitals and Basic Health Units (BHU)-based health care services, and one traditional medicine factory. The BSM provides primary health care services to more than 20-30 % of patients who visit hospitals and BHU on a daily basis. However, there has been no study covering the quality assurance system of BSM. Our paper addresses this information gap. METHODS: This study was an observational ethnographic study supported by phenomenological understanding and content analysis of the data. The information was triangulated through consultation with the BSM practitioners (discussion (N = 8)) and personalized in-depth question-answer sessions using electronic protocols (N = 5). These participants comprised BSM educationists, clinical physicians, researchers, production and the quality assurance staff who were selected using convenience and purposive sampling method. The relevant So-wa-rig-pa information and literature were obtained from the government policy documents, official websites, scientific papers and the traditional medical texts. This study is enhanced by our practical observations and first-hand experience with BSM while working as the researchers at the Ministry of Health in Bhutan. In addition, the information in this paper is crosschecked and authenticated by five So-wa-rig-pa practitioners of Bhutan. RESULTS: The study highlights the following: a) The BSM receives both the government and people's support, b) The quality assurance system have been developed by integrating the traditional empirical knowledge and modern scientific protocols, c) There exist three administrative and functional organizations responsible for providing the quality BSM health care services in Bhutan, d) Extensive standard treatment guidelines and Quality documentation system exist for BSM as required by the regulatory bodies in Bhutan. The paper also recommends appropriate future directions for BSM. CONCLUSIONS: The BSM plays significant role in the primary health care system of the country. Consequently, the quality, safety and efficacy of BSM has been given priority by the Bhutan government. Many scientific protocols were integrated with the traditional quality approaches and further scientific studies are still required to improve its quality.

Reliability of Manual Pulse Diagnosis Methods in Traditional East Asian Medicine: A Systematic Narrative Literature Review.

BACKGROUND/OBJECTIVE: Little evidence shows the reliability of Chinese medicine pulse diagnosis. Regularly used in modern practice, it is believed to gather important diagnostic information. However, in the current evidence-based healthcare system, basing clinical decisions on unproven methods is problematic and obviously questions the relevancy of the procedure. Therefore, the literature on reliability of practitioners implementing the method was reviewed. METHODS: Major medical databases and reference lists of identified articles were searched. All studies published in English that investigated manual pulse diagnosis applied to the radial artery by human testers were considered. RESULTS: Twelve eligible studies were included; three evaluated intra- and inter-rater pulse diagnosis reliability, and nine assessed inter-rater reliability. Acceptable levels of intra- and inter-rater reliability were achieved with operationally defined methods. Poor reliability was related to unclear definitions and terminology existing within the classical definitions, and with standardized systems to persisting imprecise descriptions that can be interpreted differently. Reliability of pulse qualities was influenced by sensation complexity and the amount of sensory input provided to the testers' fingers by the impulse. Consistent study limitations included small sample sizes; the possibility that testers' prior knowledge confounded the data; and, most notably, the fact that many studies did not consider intra-rater reliability. Assessing the effectiveness of interventions in clinical practice is guided by comparisons of markers to baseline. The absence of intra-rater results may therefore raise methodologic concerns for these types of studies. CONCLUSION: Strategies for future studies include using pulse methods with concrete operational definitions; investigating intra- and inter-rater reliability for extrapolation to clinical practice; similar training and experience in the method to control for tester variance; maintaining independence of the data by ensuring testers have no prior knowledge of the participants' pulses; and for more rigorous testing, consideration of the number of pulse variables, participants, and testers.

How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

OBJECTIVES: The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. METHODS: We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. RESULTS: Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. CONCLUSIONS: The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Quality evaluation of Panax ginseng roots using a rapid resolution LC-QTOF/MS-based metabolomics approach.

Korean ginseng (Panax ginseng C.A. Meyer) contains several types of ginsenosides, which are considered the major active medicinal components of ginseng. The types and quantities of ginsenosides found in ginseng may differ, depending on the location of cultivation, making it necessary to establish a reliable method for distinguishing cultivation locations of ginseng roots. P. ginseng roots produced in different regions of Korea, China, and Japan have been unintentionally confused in herbal markets owing to their complicated plant sources. PCA and PLS-DA using RRLC-QTOF/MS data was able to differentiate between ginsengs cultivated in Korea, China, and Japan. The chemical markers accountable for such variations were identified through a PCA loadings plot, tentatively identified by RRLC-QTOF/MS and partially verified by available reference standards. The classification result can be used to identify P. ginseng origin.

Onsen (hot springs) in Japan--transforming terrain into healing landscapes.

Japan is situated on the Pacific fire rim and has a large number of hot springs (onsens). There are over 27,000 sources of such springs and the country has a well regulated system of onsens. Within this geographical and cultural peculiarities certain unique traditional health practices have evolved, prominent among which is Touji or onsen therapy. The article highlights various healing practices surrounding onsens, institutionalization of these practices, current policy regulations, standards and their contemporary challenges. This research used publicly available information from literature sources and data through expert interviews. It draws attention to the fact that touji has been marginalized in the recent health policies. The study highlights that onsen as a therapeutic landscape has an important role in maintaining health and wellbeing in the country and holds immense value in building social cohesion in local communities. The study points to the need for appropriate studies on the social and symbolic healing elements related to onsen landscapes, as well as the need for developing a comprehensive strategy for strengthening their culturally specific health management roles.

Strategies for quality control of Chinese medicines.

Chinese medicines (CM) have been attracting interest and acceptance in many countries. Quality control is vital for ensuring the safety and efficacy of CM. Usually, CM are used as whole plant and/or combination of several herbs, and multiple constituents are responsible for the therapeutic effects. Therefore, quality control of CM is very difficult. To date, the valid method for quantitatively evaluating the quality of CM is poor. In this article, the strategies for quantification, related to the markers, reference compounds and approaches, in quality control of CM were reviewed and discussed.

Medical Education and Medical Practice in Korea

No abstract available.