The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists.
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Acupuncture Therapy↗
Biomedical subjects
M Fitter
Publications and source records attributed to M Fitter.
A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists.
The paper describes the type and frequency of adverse events and transicnt reactions following consultations with professional acupuncturists. In a postal survey, involving 1,848 professional acupuncturists, all of whom were members of the British Acupuncture Council and practising in the UK, details of adverse events and transient reactions following treatment were recorded on standardised self-report forms. A sample size of 30,000 treatments was sought, and piloting indicated that a four-week period was required. Practitioners also provided information on themselves, including age, sex, length of training and years of practice. A total of 574 practitioners responded. 31% of the total population. These practitioners reported on adverse events and transient reactions associated with 34,407 treatments. No serious adverse events were reported, where these were defined as requiring hospital admission, prolonging hospital stays, permanently disabling, or resulting in death (95% CI: 0 to 1.1 per 10,000 treatments). A total of 43 significant minor adverse events were reported, a rate of 1.3 per 1,000 treatments (95% CI: 0.9 to 1.7). These included severe nausea and actual fainting (12), unexpected, severe and prolonged aggravation of symptoms (7), prolonged and unacceptable pain and bruising (5) and psychological and emotional reactions (4). There were three avoidable events: two patients had needles left in by mistake, and one patient had moxa burns to the skin, also caused by practitioner error. The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments. 15% (95% CI: 14.6 to 15.3) of the 34,407 total. In terms of local reactions, there were reports of mild bruising (1.7%), pain (1.2%) and bleeding (0.4%). Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8% of treatments. The most common mild transient reactions to treatment were feeling relaxed (11.9%) and feeling energised (6.6%). In this prospective survey of 34,407 treatments, practitioners reported no serious adverse events. This conclusion was based on data collected from one in three members of the British Acupuncture Council. Given that the whole membership delivers between one and a half and two million treatments a year, this is important evidence on public health and safety. When compared with medication routinely prescribed in primary care, the results suggest that acupuncture is a relatively safe treatment modality.
Acupuncture Therapy↗
Acupuncture for low back pain: results of a pilot study for a randomized controlled trial.
OBJECTIVES: To pilot procedures to be used in a randomized controlled trial of acupuncture for low back pain. DESIGN: Uncontrolled clinical trial. SETTING: Primary care and acupuncture clinics in York, England. SUBJECTS: 20 patients with low back pain lasting 1 month or more. INTERVENTIONS: 10 sessions of individualized acupuncture from a traditional acupuncturist. MAIN OUTCOME MEASURES: Change in Oswestry low back pain disability questionnaire; present pain intensity scale; effect on daily living scale, and SF-36 general health questionnaire at post-treatment and 6 months after the end of treatment. RESULTS: 14 patients completed follow-up. Patients had similar severity scores at baseline to those referred to an NHS outpatient clinic. Post-treatment, there were statistically significant improvements in Oswestry, present pain intensity, effect on daily living and the physical functioning, social functioning, bodily pain, vitality and mental health sub-scales of the SF36. Similar results were found at the six month follow-up. Oswestry scores showed reduced levels of pain at 6 months compared to than at post-treatment, falling approximately 40% from baseline. CONCLUSIONS: Though the improvements in pain and quality in life may be due to the natural course of back pain, the promising responses justify further research. The procedures used in the study are appropriate for a randomized controlled trial. Drop-out could be reduced by more careful patient monitoring.
Activities of Daily Living↗
Longer-term clinical and economic benefits of offering acupuncture to patients with chronic low back pain assessed as suitable for primary care management.
This paper presents the research protocol for a pragmatic study of the benefits of providing an acupuncture service to patients in primary care with chronic low back pain. The proposal was written in response to a call for bids from the NHS Executive's centrally funded research programme for Health Technology Assessment (HTA). The research question posed was 'Does acupuncture have long-term effectiveness in the management of pain in primary care?' The present study was designed as a collaboration between an interdisciplinary team drawn from health services researchers at the University of Sheffield, acupuncture researchers from the Foundation for Traditional Chinese Medicine in York, and practitioners from general practice and acupuncture in York. The proposal presented here was submitted in response to an invitation from the Commissioning Board following a successful outline bid. It is reproduced here, largely as submitted in January 1998, using the headings under which information was requested. We also present an appendix describing methodological alterations made to the design in response the Commissioning Board's comments on the proposal. We present it in this format to give an idea of the evolution of the design and the process by which the research proposal was shaped. The final working protocol comprises a combination of these two elements.
Acupuncture Therapy↗
Opportunistic screening.
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Computer Simulation↗
General practitioners' subjective experience of surgery workload.
General practitioners (GPs) in the U.K. frequently cite heavy workload as a major source of work-related stress. However, there is little direct evidence either to support this claim or to suggest whether the source of this stress lies in the amount, or rather the type, of work undertaken. The present paper uses a within-subjects design to address these issues in the surgery context. Over a two-week period three GPs gave ratings of subjective workload following each of their surgeries (N = 20-23). Correlational analysis showed a wide range of surgery characteristics to predict the GPs' reactions, including the length of surgeries, the number of consultations, the number of re-presentations, and the number of follow-ups and investigations requested. The GPs' perceptions of their patients (e.g. in terms of their health status and the appropriateness of the consultation), in contrast, did not emerge as significant predictors. The results of multiple regression analyses, however, revealed that most of the first-order effects could be accounted for by surgery length. Thus while the study supported the hypothesised link between the overall level of surgery work demands and the subjective experience of workload, it failed to confirm any consistent additional effects of the type of work involved. It was also found that as the length of surgeries increased, the GPs were more likely to arrange follow-up appointments. The implications of the present findings are therefore two-fold.(ABSTRACT TRUNCATED AT 250 WORDS)
Adaptation, Psychological↗
Patients' views on health screening in general practice.
This paper describes the reactions of 159 patients to the way in which they were invited to participate in a health screening programme and their views on the screening appointment itself. It was found that those invited by letter, rather than opportunistically during a routine consultation, thought their appointment time harder to keep. A group of patients identified as relatively infrequent consulters were less likely to believe that the invite showed the practice to be interested in their health. However, overall the patients' perceptions of both the way in which they were invited and the screening appointment itself were found to be very positive and their satisfaction ratings high.
Adult↗
The potential and limitations of opportunistic screening: data from a computer simulation of a general practice screening programme.
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.
Computer Simulation↗
An interactive computerized protocol for the management of hypertension: effects on the general practitioner's clinical behaviour.
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.
Behavior↗
Consultation use of a computer by general practitioners.
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.
Computers↗