Utilization of traditional medicine in primary health care in low- and middle-income countries: a systematic review.

This paper reports the findings from the first systematic review of the utilization of traditional medicine (TM) in primary health care (PHC) in low- and middle-income countries (LMICs). PHC is an important component of health care and essential for achieving universal health coverage (UHC). For countries where there is a gap in PHC, TM plays a vital role. It is widely used and has the potential to increase the coverage of PHC and UHC. Hence in situations where TM is recognized in a considerable magnitude, there are scarce evidence and minimal regulation on it and TM practitioners (TMPs). This study aims to identify the current situation in the utilization of TM in PHC or UHC in LMICs. A systematic review and thematic synthesis of qualitative and quantitative studies have been conducted. A total of 56 articles met the criteria and were included in the review. In all, 14 analytic themes have been developed including the current use of TM in PHC, higher accessibility of TM, medical pluralism, national health system, national health policy and national health insurance to include TM, including TMPs in the referral system, utilizing TMPs as community health workers, the needs of scientific research on TM and the need for training both TMPs and conventional medical staffs for better collaboration. The study concluded that it is necessary to further focus on TM in the macro level on strengthening the referral system by including TM to establish a comprehensive service delivery network under UHC and in the micro level to focus on training the TMPs and conventional medicine health workers on both areas to attain more in-depth understanding of each other, which can lead to better collaboration and quality patient care.

Effectiveness and safety of fluoroscopy-guided acupuncture for subacromial impingement syndrome: A protocol for a randomized, patient-assessor blind, parallel clinical trial.

INTRODUCTION: Subacromial impingement syndrome (SIS) is one of the most common diseases inducing shoulder pain. Acupuncture is a source of pain relief that has been used for SIS; however, there is no clinical study about image-guided acupuncture for SIS. The aim of this study is to evaluate the effectiveness and safety of fluoroscopy-guided acupuncture in patients with SIS. METHODS: This is the protocol for a randomized, patient-assessor blind, parallel clinical trial comparing fluoroscopy-guided acupuncture to acupuncture without fluoroscopy. There will be a 1-week run-in period before random allocation to 2 groups. The total duration of the clinical trial will be 3 weeks including 2 weeks for the follow-up period. A total of 57 participants will be enrolled for the clinical trial. Acupuncture will be conducted in 2 sessions for each group, once at baseline and once at the 1-week mark. The primary outcome will be 100 mm pain visual analogue scale. Secondary outcomes will include the Neer and Hawkins test, the Modified Constant Murley Score scale, the Shoulder Pain And Disability Index, the patient satisfaction degree, and the accuracy rate of acupuncture. For the evaluation of safety, adverse events will be monitored. DISCUSSION: We designed the clinical trial using image-guided acupuncture. This will be the first trial to study the effectiveness of image-guided acupuncture for SIS compared with acupuncture using the proportional measurements. TRIAL REGISTRATION: Clinical Research Information Service Registration Number is KCT0002751. Registered on March 23, 2018.

Validity and reliability of POM-Checker in measuring shoulder range of motion: Protocol for a single center comparative study.

INTRODUCTION: Assessments of the range of motion (ROM) in human joints have been widely used to evaluate the joint condition. Although maker based motion capture system is the most popular and practical method in the clinical field, there have been limitations such as the relatively long time required in procedure or influence of attached markers on natural movement. Recently, markerless motion capture systems have been actively developed due to their relatively lower cost and convenience for installation. The POM-Checker (Team Elysium Inc., Seoul, Rep of Korea), a markerless motion capture system, was developed with new algorithms to assess the ROM in human joints. However, the measure of the POM-Checker has not been compared with a golden-standard device in evaluating the ROM in the human joints. So we developed a protocol to evaluate the validation and reliability of the POM-Checker in measuring the shoulder ROM. This study will also provide a standard procedure to measure the shoulder ROM with the POM-Checker and 3D motion analysis system simultaneously. METHODS/DESIGN: This protocol is for a single institution comparative study to evaluate the validity and reliability of POM-Checker. Six participants will be recruited. We will measure the angles of shoulder abduction and flexion with POM-Checker and 3D motion analysis system simultaneously. The primary outcome is the angles of shoulder abduction and flexion. DISCUSSION: This will be the first study to analyze the validity and reliability of POM-Checker in measuring shoulder ROM. Although the sample size of this study is small, it may not influence on the results conclusively, because the measures are very precise numerical angles. Furthermore, the angles of shoulder movements will be measured with both devices simultaneously. CONCLUSION: The results of the study will be helpful to find out the validity and reliability of a new developed ROM measure device, POM-Checker, by comparison with a golden standard system, 3D motion capture system, in measuring the shoulder ROM. It will also contribute to use of the POM-Checker in measuring the ROMs in many human joints.

Mecasin treatment in patients with amyotrophic lateral sclerosis: study protocol for a randomized controlled trial.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes paralysis of limb, swallowing, and breathing muscles. Riluzole, the Food and Drug Administration-approved drug for ALS, provides minimal benefit, prolonging patient life by only 2-3 months. Previous studies have found a neuro-protective and anti-neuroinflammatory effect of Mecasin, with retrospective studies providing suggestive evidence for a beneficial effect of Mecasin. The aim of this study was to develop a protocol to determine the proper dosage of Mecasin. METHODS: This is a phase II-A, multi-center, randomized study with three arms. Thirty-six patients with ALS will be randomly assigned to one of three groups, each receiving the standard treatment with 100 mg of riluzole in addition to one of 1.6 g of Mecasin, 2.4 g of Mecasin, or a placebo. The Primary outcome is the Korean version of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised result after 12 weeks of treatment. Secondary outcomes include results of the Short Form Health Survey-8, Medical Research Council Scale, Visual Analogue Scale for Pain, Hamilton Rating Scale for Depression, Fatigue Severity Scale, Patient Global Impression of Change, pulmonary function test, forced expiratory volume in 1 s and its ratio to forced vital capacity, creatine kinase, and body weight. The frequencies of total adverse events and serious adverse events will be described and documented. The trial protocol has been approved by the Institutional Review Board of the Wonkwang University Gwangju and Sanbon Hospital (2016-5-4 and 2016-34-01, respectively). An Investigational New Drug status (30731) was granted by the Korea Food and Drug Administration. DISCUSSION: This trial will aim to identify the optimal dosage of Mecasin. Additionally, it will test the efficacy and safety of Mecasin in conjunction with standard treatment, riluzole, for alleviating the functional decline in patients with ALS. TRIAL REGISTRATION: Korean National Clinical Trial Registry CRIS; KCT0001984 . Registered on 28 July 2016.

Change in radial artery pulse wave in stroke hemiplegic patients: Protocol for a case-control study.

INTRODUCTION: About 55% to 75% of stroke survivors have motor disorders and problems that affect their quality of life. The prevention of secondary neurological damages through relapse prevention and the rehabilitation of stroke patients suffering from morbidities are crucial to improve the prognosis of patients with stroke. Pulse examinations can be used to determine the stroke progression. This study will investigate the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke. METHODS/DESIGN: This study protocol is for a prospective matched case-control study. A total of 84 participants will be recruited, 56 patients with hemiplia caused by stroke, and 28 control patients matched by age, gender, and body mass index. The primary outcome of this study will be the differences and changes in the radial augmentation index. DISCUSSION: The results of the study will help to determine the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke. The findings will provide information about the physiological and hemodynamic mechanisms. CONCLUSION: This will be the first study to analyze the pulse wave of the radial artery (PWRA) on the affected side and on the normal side in stroke patients with hemiplegia. This study will clarify whether the radial artery pressure pulse wave can be used to evaluate the result of stroke treatment objectively. The results of the study will be available in February 2019. The version of the protocol is v1.6 written in March 7, 2016. ETHICS AND DISSEMINATION: Written informed consent will be obtained from all participants. This study has been approved by the Institutional Review Board (IRB) of Wonkwang University Gwangju Hospital, Gwangju, Republic of Korea (WKIRB-2016/8). The study findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: This trial was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002147).

The status on non-communicable disease prevention and control in the Philippines: A systematic review

OBJECTIVE: This paper aims to provide concise background information regarding the state of noncommunicable diseases (NCDs) and their risk factors as well as the existing efforts to address them in the Philippines in the last 25 years. METHODS: A desk review of documents and literature review as well as analyses of available statistical data and several consultations with involved government agencies have been made to come up with summary figures and tables.RESULTS: NCDs as well as metabolic conditions that can potentially lead to NCDs are on the rise in the last score of years. The Philippines, through the Department of Health, has been visionary in leading various projects and activities to fight NCDs over the last two decades, and its efforts are slowly paying off: the prevalence of tobacco use and that of hypertension have decreased over the last 5 years. NCD mortality (including premature deaths) and prevalence of behavioral risk factors, however, generally remain high, and the Philippines needs to accelerate whole-of-society and whole-of-government actions to sustain the gains and attain its NCD targets in the next 10 years or so. CONCLUSION: The need to strengthen health system interventions and promote accountability of various sectors in addressing NCDs and its risk factors in the country arises. The development of a multisectoral action plan on NCD prevention and control is needed to halt the rise of NCDs in the country.

Acupuncture and spontaneous regression of a radiculopathic cervical herniated disc.

The spontaneous regression of herniated cervical discs is not a well-established phenomenon. However, we encountered a case of a spontaneous regression of a severe radiculopathic herniated cervical disc that was treated with acupuncture, pharmacopuncture, and herb medicine. The symptoms were improved within 12 months of treatment. Magnetic resonance imaging (MRI) conducted at that time revealed marked regression of the herniated disc. This case provides an additional example of spontaneous regression of a herniated cervical disc documented by MRI following non-surgical treatment.