This systematic review identified 9 studies that assessed or manipulated patient expectancies regarding acupuncture treatment and related expectancies to health outcomes. The studies used heterogeneous methodologies, preventing meta-analysis. A descriptive review found that 5 studies reported statistically significant effects of expectancy on at least one outcome, with 3 also finding evidence suggestive of an interaction between expectancy and whether real or placebo acupuncture was received. While some trends were observed, conclusions are limited by the heterogeneity of study designs. Future research should further consider how best to assess or manipulate expectancies in this area.
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
This document discusses the ethics of placebo treatment in clinical settings. The author argues that while placebos are often thought to be deceptive, this view misunderstands why placebos are considered deceptive. The goal of the paper is to develop a precise definition of what constitutes a placebo in order to clarify the ethics around placebo treatment. The central question addressed is whether there is something inherent in the nature of placebo treatment that always makes it against a patient's best interests and therefore always impermissible.
Physical activity and the prevention of depressionGiliano Campos
The document summarizes a systematic review examining whether physical activity (PA) can prevent the onset of depression. The review analyzed 30 prospective studies that assessed the relationship between baseline PA and subsequent depression. Twenty-five studies found that higher baseline PA was associated with a lower risk of developing depression later, providing evidence that PA may have a protective effect against future depression. Most of these studies were considered high quality. The review also found that as little as 10-29 minutes of daily PA or 150 minutes per week may help prevent depression. Greater amounts of PA provided even more protection. The majority of the evidence suggests PA can serve as a useful strategy for reducing depression risk from a public health perspective.
This document discusses hypotheses in research. It defines a hypothesis as a tentative statement about the relationship between two or more variables. Good hypotheses are conceptual, empirical, objective, specific, relevant, testable, consistent, simple, and verifiable. Hypotheses guide research by linking theory to practice and determining appropriate methods. Characteristics of strong hypotheses and different types (e.g. research, null, directional) are explained. The document also covers formulating hypotheses through background knowledge, intellectual versatility, analogy, and deductive reasoning from theories.
a small and well descriptive presentation on hypothesis topic. it has all the information you need to know about the topic covering the types, characteristics and contributions you want to know about hypothesis.
This document provides an overview of key concepts in statistics, including hypothesis testing, null and alternative hypotheses, regression analysis, correlation, the exponential distribution, types of errors in hypothesis testing, central tendency, Bayes' theorem, Chebyshev's theorem, and simple random sampling. It defines these terms and provides examples to illustrate statistical concepts.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
1. A hypothesis is a tentative assumption made to explain a phenomenon or guide an investigation. It can be a conjectural statement about the relationship between two or more variables that can be tested.
2. The main functions of a hypothesis are to provide focus for a study by specifying what aspects to investigate and what data to collect. Developing a hypothesis enhances objectivity.
3. For a hypothesis to be testable and useful for a study, it should be simple, specific, conceptually clear, capable of being verified, and related to existing knowledge. The outcome of testing a hypothesis may prove it right, partially right, or wrong.
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
This document discusses the ethics of placebo treatment in clinical settings. The author argues that while placebos are often thought to be deceptive, this view misunderstands why placebos are considered deceptive. The goal of the paper is to develop a precise definition of what constitutes a placebo in order to clarify the ethics around placebo treatment. The central question addressed is whether there is something inherent in the nature of placebo treatment that always makes it against a patient's best interests and therefore always impermissible.
Physical activity and the prevention of depressionGiliano Campos
The document summarizes a systematic review examining whether physical activity (PA) can prevent the onset of depression. The review analyzed 30 prospective studies that assessed the relationship between baseline PA and subsequent depression. Twenty-five studies found that higher baseline PA was associated with a lower risk of developing depression later, providing evidence that PA may have a protective effect against future depression. Most of these studies were considered high quality. The review also found that as little as 10-29 minutes of daily PA or 150 minutes per week may help prevent depression. Greater amounts of PA provided even more protection. The majority of the evidence suggests PA can serve as a useful strategy for reducing depression risk from a public health perspective.
This document discusses hypotheses in research. It defines a hypothesis as a tentative statement about the relationship between two or more variables. Good hypotheses are conceptual, empirical, objective, specific, relevant, testable, consistent, simple, and verifiable. Hypotheses guide research by linking theory to practice and determining appropriate methods. Characteristics of strong hypotheses and different types (e.g. research, null, directional) are explained. The document also covers formulating hypotheses through background knowledge, intellectual versatility, analogy, and deductive reasoning from theories.
a small and well descriptive presentation on hypothesis topic. it has all the information you need to know about the topic covering the types, characteristics and contributions you want to know about hypothesis.
This document provides an overview of key concepts in statistics, including hypothesis testing, null and alternative hypotheses, regression analysis, correlation, the exponential distribution, types of errors in hypothesis testing, central tendency, Bayes' theorem, Chebyshev's theorem, and simple random sampling. It defines these terms and provides examples to illustrate statistical concepts.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
1. A hypothesis is a tentative assumption made to explain a phenomenon or guide an investigation. It can be a conjectural statement about the relationship between two or more variables that can be tested.
2. The main functions of a hypothesis are to provide focus for a study by specifying what aspects to investigate and what data to collect. Developing a hypothesis enhances objectivity.
3. For a hypothesis to be testable and useful for a study, it should be simple, specific, conceptually clear, capable of being verified, and related to existing knowledge. The outcome of testing a hypothesis may prove it right, partially right, or wrong.
This document summarizes a meta-analysis of 206 studies on adventure therapy outcomes published between 1967 and 2012. The meta-analysis found that adventure therapy has a moderate positive effect on psychosocial outcomes, with an overall effect size of 0.50 for pre-post outcomes. Larger effects were found for outcomes related to self-concept, social development, and clinical measures. Moderator analyses found slightly larger effects for older participants and programs with an open group structure. The meta-analysis provides benchmarking data to evaluate adventure therapy program outcomes.
PROPOSAL: Memory Self Efficacy and Treatment Outcomes in Transient Ischemic A...KyleDishman
Research Proposal:
THESIS: “Does memory self-efficacy (as monitored and diagnosed by a professional) play a positive role in effects of cognitive behavioral therapy in stroke patients.”
This document discusses different types of research hypotheses and how to formulate a hypothesis. It defines associative, causal, complex, directional, and non-directional hypotheses. A research hypothesis must be testable and specify the independent and dependent variables. The null hypothesis predicts results are due to chance, while the alternative hypothesis predicts something other than chance influenced results. A directional alternative hypothesis predicts the direction of an effect, while a non-directional hypothesis does not specify a direction. Formulating a good hypothesis is the starting point for research design and testing hypotheses is how results are analyzed.
This document discusses hypotheses in research. A hypothesis is a testable statement about the relationship between two or more variables. Good hypotheses are specific, empirically testable, and manageable. Researchers develop hypotheses to give direction to their research and focus their study. There are different types of hypotheses, including simple, complex, working, null, and alternative hypotheses. Once a hypothesis is developed, researchers select a research design to collect data, such as descriptive or experimental methods, to test their hypothesis.
This document discusses different types of hypotheses used in quantitative research studies. It defines what a hypothesis is and lists characteristics of a good hypothesis. The document then describes different types of hypotheses including simple vs complex, associative vs causal, directional vs non-directional, and null vs research hypotheses. It provides examples of each type of hypothesis. The document also discusses formulation, components, evaluation criteria for research hypotheses and provides an example research question and hypotheses related to anemia in pregnancy and low birth weight.
The document defines and discusses hypotheses in research contexts. It provides that a hypothesis is a formal, testable statement of the expected relationship between independent and dependent variables. The document outlines several definitions of a hypothesis provided by authors and discusses the key characteristics of a good hypothesis. It also differentiates between different types of hypotheses such as universal, existential, null, alternate, non-directional, directional, and research hypotheses. The purpose, components, and process of hypothesis making and testing are described.
Interpretation of ayurvedic_terminology_in_research_and_biostatistic_perspect...Dnyanesh Kharat
The Statistical methods which were used by the ancient Indian Acharyas are in practice for long time and now a days also and just need to find out and explore them with present terminologies of contemporary science.
The document discusses different types of hypotheses:
- Directional hypotheses specify the expected direction of relationships between variables, while non-directional hypotheses do not.
- Hypotheses can take declarative, null, question, or predictive forms. Declarative hypotheses state expected relationships, while null hypotheses state no relationship exists. Question hypotheses are research questions. Predictive hypotheses allow researchers to state expected principles.
- Examples are provided for each type to illustrate their meanings.
This document defines and discusses hypotheses. It begins by explaining that a hypothesis is a tentative statement about the relationship between two variables. It then defines a hypothesis as a provisional statement showing a relationship between variables. The document outlines the main types of hypotheses as the null hypothesis, which predicts no relationship, and the alternative hypothesis, which predicts a relationship. It also lists the steps for formulating a hypothesis and characteristics of a good hypothesis such as conceptual clarity and verifiability. Finally, it discusses the functions of a hypothesis such as providing a basis for research and preventing blind searches.
1) A hypothesis is a tentative statement proposed for testing through scientific investigation. It predicts the relationship between two or more variables.
2) Hypotheses guide research design and analysis by specifying the variables to be studied and their expected relationships.
3) The main types of hypotheses are simple, complex, directional, non-directional, null, and alternative. Hypotheses can also be classified as associative, causal, statistical, or research hypotheses.
Research involves systematically studying a topic to establish facts and reach new conclusions. A hypothesis is an educated guess about how things work that can be tested through research. It relates an independent variable to a dependent variable. The null hypothesis states there is no relationship between variables, while the alternative hypothesis suggests a potential outcome. Alternative hypotheses can be directional, specifying the expected relationship, or non-directional, without a specified direction. Hypotheses guide research by providing a framework for data collection and interpretation.
Increasing apple consumption in over-60s has no effect on frequency of doctor's visits.
Does social media use affect
teenagers' mental health?
Teenagers who spend more than 2 hours per day on
social media will report higher levels of anxiety and
depression than those who spend less time.
Teenagers' time spent on social media has no effect on reported levels of anxiety and depression.
Does exercise improve cognitive
function in older adults?
Older adults who engage in regular exercise will
perform better on cognitive tests than those who do
not exercise regularly.
Regular exercise has no effect on cognitive test performance in older adults.
This meta-analysis examined 15 clinical trials involving 916 participants to test the hypothesis that eicosapentaenoic acid (EPA) is the effective component in omega-3 polyunsaturated fatty acid (PUFA) supplementation for treating major depressive episodes. The analysis found that supplements containing at least 60% EPA were effective at reducing depression symptoms, while supplements containing less than 60% EPA were ineffective. Exploratory analyses suggested EPA was effective in a dose-dependent manner when the EPA dose exceeded the docosahexaenoic acid (DHA) dose between 200-2200 mg of EPA. The findings provide evidence that EPA, rather than DHA, is likely the active component in PUFA supplementation for treating depression.
The document defines a hypothesis as a tentative generalization that requires empirical testing. It discusses different types of hypotheses including those that affirm characteristics, associate variables, or establish causal relationships. Hypotheses can originate from general culture, scientific theories, analogies, or personal experience. For a hypothesis to be workable, it should be specific, conceptually clear, testable with available techniques, relate to existing theory, simple, and capable of empirical testing. Formulating hypotheses provides a point of inquiry, direction for research, and allows selection of relevant facts and conclusions. The document also introduces the null hypothesis as a negative formulation of the actual research hypothesis.
This document defines and discusses hypotheses in research. It begins by defining a hypothesis as a tentative statement about the relationship between two or more variables. It then discusses the importance of hypotheses in providing direction, goals, and a framework for research. The document outlines characteristics of good hypotheses and different types of hypotheses, including simple vs. complex, associative vs. causal, directional vs. non-directional, and null vs. research hypotheses. Sources of hypotheses and their role in linking theories to practice are also mentioned.
For a detailed explanation Watch the Youtube video:
https://youtu.be/6g4tD162yhI
Hypothesis, Characteristics of a good hypothesis, contribution to research study, Types of hypothesis, Source, level of significance, two-tailed one-tailed test, types of errors
Title:
Adventure Therapy: Treatment Effectiveness and Applications with Australian Youth
Abstract:
This final seminar reviews the original contribution of Bowen’s (2016) PhD thesis to the field of adventure therapy. This thesis advances understanding of the therapeutic uses and treatment effectiveness of adventure therapy by systematically reviewing the efficacy of adventure therapy programs internationally (Study 1), providing an up-to-date profile of Australian outdoor adventure intervention programs for youth (Study 2), examining the efficacy of the Wilderness Adventure Therapy® model of clinical treatment for Australian youth (Study 3), and examining the efficacy of the PCYC Bornhoffen Catalyst program for Australian youth-at-risk (Study 4). Findings from this thesis strongly support the assertion that adventure therapy should be in the suite of therapeutic interventions that operate in diverse service settings across Australia. For more information, see http://www.danielbowen.com.au/research/PhD
Primary supervisor: Assistant Professor James Neill
Supervisory panel member: Professor Anita Mak
Artigo - Acupuncture on oxygen consumptionRenato Almeida
1) Auricular acupuncture had a significant effect on improving the oxygen consumption and recovery ability of boxing athletes.
2) The study found that VO2max, a key indicator of cardiovascular endurance, was significantly higher after auricular acupuncture stimulation compared to a control group.
3) Auricular acupuncture stimulation may enhance athletic performance by improving aerobic ability as shown by increased VO2max and VEmax, and faster recovery of heart rate and body temperature after exercise.
O documento descreve os principais ossos da região escapular, membro superior e mão. Detalha as partes anatômicas da escápula, clavícula, úmero, rádio, ulna, carpo, metacarpos e falanges, incluindo faces, margens, ângulos e processos. Fornece vistas anterior, posterior e medial destes ossos para melhor entendimento de sua localização e articulações.
O documento discute a importância da saúde baseada em evidências para a tomada de decisão clínica. Apresenta os níveis hierárquicos da evidência científica, com ensaios clínicos randomizados no nível mais alto. Também explica as etapas de uma revisão sistemática, que sintetiza de forma rigorosa as pesquisas sobre um tema, fornecendo a melhor evidência para guiar a prática.
This document summarizes a meta-analysis of 206 studies on adventure therapy outcomes published between 1967 and 2012. The meta-analysis found that adventure therapy has a moderate positive effect on psychosocial outcomes, with an overall effect size of 0.50 for pre-post outcomes. Larger effects were found for outcomes related to self-concept, social development, and clinical measures. Moderator analyses found slightly larger effects for older participants and programs with an open group structure. The meta-analysis provides benchmarking data to evaluate adventure therapy program outcomes.
PROPOSAL: Memory Self Efficacy and Treatment Outcomes in Transient Ischemic A...KyleDishman
Research Proposal:
THESIS: “Does memory self-efficacy (as monitored and diagnosed by a professional) play a positive role in effects of cognitive behavioral therapy in stroke patients.”
This document discusses different types of research hypotheses and how to formulate a hypothesis. It defines associative, causal, complex, directional, and non-directional hypotheses. A research hypothesis must be testable and specify the independent and dependent variables. The null hypothesis predicts results are due to chance, while the alternative hypothesis predicts something other than chance influenced results. A directional alternative hypothesis predicts the direction of an effect, while a non-directional hypothesis does not specify a direction. Formulating a good hypothesis is the starting point for research design and testing hypotheses is how results are analyzed.
This document discusses hypotheses in research. A hypothesis is a testable statement about the relationship between two or more variables. Good hypotheses are specific, empirically testable, and manageable. Researchers develop hypotheses to give direction to their research and focus their study. There are different types of hypotheses, including simple, complex, working, null, and alternative hypotheses. Once a hypothesis is developed, researchers select a research design to collect data, such as descriptive or experimental methods, to test their hypothesis.
This document discusses different types of hypotheses used in quantitative research studies. It defines what a hypothesis is and lists characteristics of a good hypothesis. The document then describes different types of hypotheses including simple vs complex, associative vs causal, directional vs non-directional, and null vs research hypotheses. It provides examples of each type of hypothesis. The document also discusses formulation, components, evaluation criteria for research hypotheses and provides an example research question and hypotheses related to anemia in pregnancy and low birth weight.
The document defines and discusses hypotheses in research contexts. It provides that a hypothesis is a formal, testable statement of the expected relationship between independent and dependent variables. The document outlines several definitions of a hypothesis provided by authors and discusses the key characteristics of a good hypothesis. It also differentiates between different types of hypotheses such as universal, existential, null, alternate, non-directional, directional, and research hypotheses. The purpose, components, and process of hypothesis making and testing are described.
Interpretation of ayurvedic_terminology_in_research_and_biostatistic_perspect...Dnyanesh Kharat
The Statistical methods which were used by the ancient Indian Acharyas are in practice for long time and now a days also and just need to find out and explore them with present terminologies of contemporary science.
The document discusses different types of hypotheses:
- Directional hypotheses specify the expected direction of relationships between variables, while non-directional hypotheses do not.
- Hypotheses can take declarative, null, question, or predictive forms. Declarative hypotheses state expected relationships, while null hypotheses state no relationship exists. Question hypotheses are research questions. Predictive hypotheses allow researchers to state expected principles.
- Examples are provided for each type to illustrate their meanings.
This document defines and discusses hypotheses. It begins by explaining that a hypothesis is a tentative statement about the relationship between two variables. It then defines a hypothesis as a provisional statement showing a relationship between variables. The document outlines the main types of hypotheses as the null hypothesis, which predicts no relationship, and the alternative hypothesis, which predicts a relationship. It also lists the steps for formulating a hypothesis and characteristics of a good hypothesis such as conceptual clarity and verifiability. Finally, it discusses the functions of a hypothesis such as providing a basis for research and preventing blind searches.
1) A hypothesis is a tentative statement proposed for testing through scientific investigation. It predicts the relationship between two or more variables.
2) Hypotheses guide research design and analysis by specifying the variables to be studied and their expected relationships.
3) The main types of hypotheses are simple, complex, directional, non-directional, null, and alternative. Hypotheses can also be classified as associative, causal, statistical, or research hypotheses.
Research involves systematically studying a topic to establish facts and reach new conclusions. A hypothesis is an educated guess about how things work that can be tested through research. It relates an independent variable to a dependent variable. The null hypothesis states there is no relationship between variables, while the alternative hypothesis suggests a potential outcome. Alternative hypotheses can be directional, specifying the expected relationship, or non-directional, without a specified direction. Hypotheses guide research by providing a framework for data collection and interpretation.
Increasing apple consumption in over-60s has no effect on frequency of doctor's visits.
Does social media use affect
teenagers' mental health?
Teenagers who spend more than 2 hours per day on
social media will report higher levels of anxiety and
depression than those who spend less time.
Teenagers' time spent on social media has no effect on reported levels of anxiety and depression.
Does exercise improve cognitive
function in older adults?
Older adults who engage in regular exercise will
perform better on cognitive tests than those who do
not exercise regularly.
Regular exercise has no effect on cognitive test performance in older adults.
This meta-analysis examined 15 clinical trials involving 916 participants to test the hypothesis that eicosapentaenoic acid (EPA) is the effective component in omega-3 polyunsaturated fatty acid (PUFA) supplementation for treating major depressive episodes. The analysis found that supplements containing at least 60% EPA were effective at reducing depression symptoms, while supplements containing less than 60% EPA were ineffective. Exploratory analyses suggested EPA was effective in a dose-dependent manner when the EPA dose exceeded the docosahexaenoic acid (DHA) dose between 200-2200 mg of EPA. The findings provide evidence that EPA, rather than DHA, is likely the active component in PUFA supplementation for treating depression.
The document defines a hypothesis as a tentative generalization that requires empirical testing. It discusses different types of hypotheses including those that affirm characteristics, associate variables, or establish causal relationships. Hypotheses can originate from general culture, scientific theories, analogies, or personal experience. For a hypothesis to be workable, it should be specific, conceptually clear, testable with available techniques, relate to existing theory, simple, and capable of empirical testing. Formulating hypotheses provides a point of inquiry, direction for research, and allows selection of relevant facts and conclusions. The document also introduces the null hypothesis as a negative formulation of the actual research hypothesis.
This document defines and discusses hypotheses in research. It begins by defining a hypothesis as a tentative statement about the relationship between two or more variables. It then discusses the importance of hypotheses in providing direction, goals, and a framework for research. The document outlines characteristics of good hypotheses and different types of hypotheses, including simple vs. complex, associative vs. causal, directional vs. non-directional, and null vs. research hypotheses. Sources of hypotheses and their role in linking theories to practice are also mentioned.
For a detailed explanation Watch the Youtube video:
https://youtu.be/6g4tD162yhI
Hypothesis, Characteristics of a good hypothesis, contribution to research study, Types of hypothesis, Source, level of significance, two-tailed one-tailed test, types of errors
Title:
Adventure Therapy: Treatment Effectiveness and Applications with Australian Youth
Abstract:
This final seminar reviews the original contribution of Bowen’s (2016) PhD thesis to the field of adventure therapy. This thesis advances understanding of the therapeutic uses and treatment effectiveness of adventure therapy by systematically reviewing the efficacy of adventure therapy programs internationally (Study 1), providing an up-to-date profile of Australian outdoor adventure intervention programs for youth (Study 2), examining the efficacy of the Wilderness Adventure Therapy® model of clinical treatment for Australian youth (Study 3), and examining the efficacy of the PCYC Bornhoffen Catalyst program for Australian youth-at-risk (Study 4). Findings from this thesis strongly support the assertion that adventure therapy should be in the suite of therapeutic interventions that operate in diverse service settings across Australia. For more information, see http://www.danielbowen.com.au/research/PhD
Primary supervisor: Assistant Professor James Neill
Supervisory panel member: Professor Anita Mak
Artigo - Acupuncture on oxygen consumptionRenato Almeida
1) Auricular acupuncture had a significant effect on improving the oxygen consumption and recovery ability of boxing athletes.
2) The study found that VO2max, a key indicator of cardiovascular endurance, was significantly higher after auricular acupuncture stimulation compared to a control group.
3) Auricular acupuncture stimulation may enhance athletic performance by improving aerobic ability as shown by increased VO2max and VEmax, and faster recovery of heart rate and body temperature after exercise.
O documento descreve os principais ossos da região escapular, membro superior e mão. Detalha as partes anatômicas da escápula, clavícula, úmero, rádio, ulna, carpo, metacarpos e falanges, incluindo faces, margens, ângulos e processos. Fornece vistas anterior, posterior e medial destes ossos para melhor entendimento de sua localização e articulações.
O documento discute a importância da saúde baseada em evidências para a tomada de decisão clínica. Apresenta os níveis hierárquicos da evidência científica, com ensaios clínicos randomizados no nível mais alto. Também explica as etapas de uma revisão sistemática, que sintetiza de forma rigorosa as pesquisas sobre um tema, fornecendo a melhor evidência para guiar a prática.
A tomografia computadorizada diferencia tecidos e melhora a avaliação de fraturas da coluna vertebral. A ressonância magnética mostra nitidamente a relação entre discos, vértebras e ligamentos, sendo o exame de escolha para avaliar hérnias discais. A radiografia da coluna é geralmente realizada em incidências anteroposterior e perfil para visualizar estruturas com alto contraste.
O documento descreve as principais partes anatômicas da pélvis feminina, fêmur, tíbia, fíbula e pé, listando os principais ossos e características de cada estrutura.
O documento descreve a anatomia do tóraxe e abdome, incluindo a posição e funções do diafragma, nervos intercostais, coração, aorta e veias, e os músculos que formam as paredes do abdome.
O documento descreve as estruturas do crânio e cérebro e os principais exames de imagem utilizados para avaliá-los, incluindo radiografia, tomografia computadorizada, ressonância magnética e angiografia. Esses exames permitem visualizar fraturas, tumores, inflamações, hemorragias e outras alterações.
A radiologia estuda o uso da energia radiante no diagnóstico e tratamento de doenças, utilizando técnicas como raio-X, tomografia computadorizada, ultra-sonografia, ressonância magnética e medicina nuclear. Esses exames permitem identificar estruturas normais e anormais do corpo para reconhecer alterações causadas por doenças e lesões.
1) O traumatismo cranioencefálico é uma das principais causas de morbidade e mortalidade em acidentes, sendo superado apenas pelo acidente vascular cerebral. 2) Exames como TC e RNM são importantes para diagnosticar lesões cerebrais como fraturas, hematomas e edema. 3) As lesões podem ser difusas, como concussão e lesão axonal difusa, ou focais, como contusões e hematomas subdurais e epidurais.
This document discusses the ethics of placebo treatment in clinical settings. The author argues that while placebos are commonly seen as deceptive, this view stems from a misunderstanding of what makes something a placebo and how placebos work. The central question addressed is whether there is something about the nature of placebo treatment that always makes it against a patient's best interests and thus impermissible. The author aims to provide a precise definition of placebos and the placebo effect to clarify this debate.
Hyland2007 dispositional predictors of placebo respondingbenwhalley
This study aimed to test a motivational interpretation of placebo effects using two different placebo therapies: flower essences and gratitude therapy. The motivational interpretation is that rituals consistent with self-actualizing goals have a nonspecific therapeutic benefit beyond expectations. Study 1 found that trait spirituality predicted perceived improvement from flower essences, independently of optimism and expectations. Study 2 found that trait gratitude predicted perceived sleep improvement from gratitude therapy, independently of expectations. These findings suggest that engagement with positive, therapeutic rituals, beyond expectations, determines the extent of the placebo response.
Assignment BriefExcelsior College PBH 321 .docxssuser562afc1
Assignment Brief
Excelsior College PBH 321
Page 1
PRO MISING NEW D RUG FOR ARTH RITIS P AIN – OR SAME OLD STORY?
Use this commentary as an example for how you are expected to respond to questions critiquing the article.
Side notes from the instructor to you, which are simply informational, are in [* ].
Q: What were the study’s rationale/hypothesis and objectives?
This study aimed to test the safety, efficacy, and possible side effects of a new drug for treatment of
osteoarthritis of the knee. Given the limited existing treatment options for the condition, and a small Phase 1
trial which suggested possible benefits of tanezumab, the investigators aimed to compare treatment of
arthritis pain with different injected doses of the drug to treatment with a placebo injection.
Q: What were the assigned treatment and control groups, and how were they defined?
Individuals were randomly allocated to treatment with either 10, 25, 50, 100 or 200 ug of tanezumab
via injection, or a placebo (control group), also injected.
Q: Was there any way that the blinding of treatment status could have been compromised (in other words,
if the investigator somehow figures out treatment status)? If so, what might have been its potential impact?
The pharmacist preparing the dosage (either the drug or placebo) was aware of the subject’s
randomization to treatment or placebo. It is unlikely the pharmacist would have (accidentally or purposefully)
changed someone’s treatment from their randomly assigned one, and since the pharmacist presumably played
no part in the analysis of study data, their awareness of treatment status did not likely affect the study’s
findings. Similarly, the statistician’s knowledge would not be expected to have an impact, barring unethical
research practices from this individual. An opportunity for un-blinding may have been presented if individuals
assigned to placebo experienced significantly more knee pain, or if individuals assigned to tanezumab
experienced many side effects – but this is really only likely to occur when the investigator ascertains the
outcome directly (such as by interviewing or examining the patient). Because participants self-reported all of
their outcome information (i.e., instead of being directly assessed by a physician) throughout the study, and
this information was summarized later by the investigators, compromise of the investigator’s blinding to
subject treatment status was unlikely and probably did not constitute a major source of bias in this study.
Excelsior College PBH 321
Page 2
Q: What was the outcome of interest for this study? How was it measured? Do you see any problems with
the way the outcome of interest was measured? If so, suggest some alternatives.
Pain while walking and overall knee pain was recorded by the patient in a daily diary. The patient’s
overall assessment of their pain during the trial (called “global ass ...
Available online at www.sciencedirect.comN u r s O u t l o o.docxcelenarouzie
Available online at www.sciencedirect.com
N u r s O u t l o o k 6 0 ( 2 0 1 2 ) 1 8 2 e 1 9 0
www.nursingoutlook.org
Using meta-analyses for comparative effectiveness
research
Vicki S. Conn, PhD, RN, FAAN*, Todd M. Ruppar, PhD, RN, GCNS-BC,
Lorraine J. Phillips, PhD, RN, Jo-Ana D. Chase, MN, APRN-BC
Meta-Analysis Research Center, School of Nursing, University of Missouri, Columbia, MO
a r t i c l e i n f o
Article history:
Received 30 December 2011
Revised 16 April 2012
Accepted 22 April 2012
Keywords:
Comparative effectiveness
research
Meta-analysis
* Corresponding author: Dr. Vicki S. Conn, A
Center, S317 School of Nursing, University o
E-mail address: [email protected] (V.S.
0029-6554/$ - see front matter � 2012 Elsevi
doi:10.1016/j.outlook.2012.04.004
a b s t r a c t
Comparative effectiveness research seeks to identify the most effective inter-
ventions for particular patient populations. Meta-analysis is an especially
valuable form of comparative effectiveness research because it emphasizes the
magnitude of intervention effects rather than relying on tests of statistical
significance among primary studies. Overall effects can be calculated for diverse
clinical and patient-centered variables to determine the outcome patterns.
Moderator analyses compare intervention characteristics among primary
studies by determining whether effect sizes vary among studies with different
intervention characteristics. Intervention effectiveness can be linked to patient
characteristics to provide evidence for patient-centered care. Moderator anal-
yses often answer questions never posed by primary studies because neither
multiple intervention characteristics nor populations are compared in single
primary studies. Thus, meta-analyses provide unique contributions to knowl-
edge. Although meta-analysis is a powerful comparative effectiveness strategy,
methodological challenges and limitations in primary research must be
acknowledged to interpret findings.
Cite this article: Conn, V. S., Ruppar, T. M., Phillips, L. J., & Chase, J.-A. D. (2012, AUGUST). Using meta-
analyses for comparative effectiveness research. Nursing Outlook, 60(4), 182-190. doi:10.1016/
j.outlook.2012.04.004.
Despite remarkable scientific advances over recent
decades, the effectiveness of many health interven-
tions remains unclear. The Institute of Medicine noted
that evidence of effectiveness exists for less than half of
the interventions in use today.1 Scant evidence exists
comparing multiple possible interventions for the same
health problem.2 Newer or more costly interventions
may not be linked with better outcomes, and variations
in health care expenditure may be unrelated to changes
in health outcomes.3-5 The troubling lack of information
about interventions’ relative effectiveness led to
comparative effectiveness research (CER) initiatives.
ssociate Dean & Potter-B
f Missouri, Columbia, MO
Conn).
er Inc. All rights reserved
CER can be defined as research designed to discov.
This document discusses the history and use of placebos in clinical research and medicine. It provides background on the origins of the term placebo and how placebos have been used historically in fields like homeopathy. The document then discusses how placebos are currently accepted as having clinically important effects, though the mechanisms are not fully understood. It notes placebos can produce effects in many medical conditions and even surgery. Placebos are seen as particularly relevant in psychiatry given uncertainties about disease origins and drug mechanisms of action. Examples are given of placebo response rates in depression and variability between individuals and cultures.
Brough et al perspectives on the effects and mechanisms of CST a qualitative ...Nicola Brough
This document summarizes a qualitative study on the effects and mechanisms of craniosacral therapy according to users' views. 29 participants were interviewed about their experiences with craniosacral therapy. Most participants reported improvements in at least two dimensions of holistic wellbeing: body, mind and spirit. Experiences during therapy included altered perceptual states and specific sensations and emotions. Participants emphasized the importance of the therapeutic relationship. The emerging theory from the study suggests that the trusting relationship in craniosacral therapy allows clients to experience altered states of awareness, which facilitates a new understanding of the interrelatedness of body, mind and spirit and an enhanced ability to care for oneself and manage health problems.
A protocol for a trial of homeopathic treatment for irritable bowel syndromehome
Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek
complementary and alternative medicine including homeopathic treatment. However there is much controversy as
to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of
individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and
usual care alone, for patients with irritable bowel syndrome.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
This document summarizes a study that evaluated the effectiveness of a placebo therapy program designed for a clinical trial on convergence insufficiency. The study developed a placebo therapy program intended to simulate real vision therapy/orthoptics without actually stimulating accommodation or vergence. At the end of the 12-week treatment period, subjects were asked which treatment they thought they received and how sure they were of their answer. Ninety-five percent of subjects receiving real therapy and 83% receiving placebo therapy thought they received real therapy. The majority of subjects in both groups were somewhat, pretty, or very sure of their answer. The study concluded that the placebo therapy program was effective in maintaining subject masking in this clinical trial.
This document summarizes a study that evaluated the effectiveness of a placebo therapy program designed by the Convergence Insufficiency Treatment Trial (CITT) Investigator Group. The study involved 95 subjects between ages 9-30 with convergence insufficiency who were randomly assigned to receive either real vision therapy/orthoptics or a placebo version designed to simulate real therapy. At the end of the 12-week treatment period, subjects were asked if they thought they received real or placebo therapy and how sure they were. Ninety-five percent of subjects receiving real therapy and 83% receiving placebo therapy thought they got real therapy. Of those thinking they got real therapy, 90% of real therapy subjects and 89% of placebo subjects were somewhat to
This document discusses effective physical treatments for chronic low back pain. It finds that exercise is one of the few clearly effective treatments, with systematic reviews finding exercise reduces pain and disability. While exercise is effective, the optimal implementation is unclear. Two example programs discussed are group general exercise and individually supervised specific spinal stabilization exercise. The document also discusses laser therapy for chronic back pain, but notes no systematic review has evaluated its efficacy.
The document discusses the role of placebos in clinical trials. It defines placebos as inert substances with no therapeutic value used as dummy medicines. Placebos are used in clinical trials to compare effects to active drugs and exclude placebo responders. The placebo effect is psychological and based on expectations. Mechanisms involve neurobiological and psychological factors. Guidelines state placebos can only be used when no alternative exists and risks are justified, with informed consent and risk monitoring. A placebo washout period terminates prior drug effects to observe the trial drug's effects. Problems include imperfect placebos, impure placebos, selection bias, and overestimating placebo effects.
“Limiting the placebo effect in periodontal clinical trials- current concepts and future directions”- A keynote lecture as a part of 41st Indian Society of Periodontology National Conference at Nagpur, India on 23/10/2016.
“Limiting the placebo effect in periodontal clinical trials”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at SVS Institute of Dental Sciences, Mahabubnagar, India on 13/8/2013 and in Narayana Dental College, Nellore, India on 17/6/2014.
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi1TatianaMajor22
Int. J. Environ. Res. Public Health 2013, 10, 2214-2240; doi:10.3390/ijerph10062214
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Review
Burnout in Relation to Specific Contributing Factors and Health
Outcomes among Nurses: A Systematic Review
Natasha Khamisa
1,2,
*, Karl Peltzer
3,4,5
and Brian Oldenburg
2,6
1
School of Health Sciences, Department of Public Health, Monash South Africa, 144 Peter Road,
Roodepoort, Johannesburg 1725, South Africa
2
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne 3800,
Australia; E-Mail: [email protected]
3
Human Science Research Council, 134 Pretorius Street, Pretoria 0002, South Africa;
E-Mail: [email protected]
4
University of Limpopo, University Street, Turfloop, Sovenga, Polokwane 0727, South Africa
5
ASEAN Institute for Health Development, Mahidol University, Salaya 73170, Thailand
6
Monash Alfred Hospital Campus, Level 3 Burnet Tower, 89 Commercial Road, Melbourne 3004,
Australia
* Author to whom correspondence should be addressed; E-Mail: [email protected];
Tel.: +27-11-950-4450.
Received: 1 March 2013; in revised form: 16 May 2013 / Accepted: 24 May 2013 /
Published: 31 May 2013
Abstract: Nurses have been found to experience higher levels of stress-related burnout
compared to other health care professionals. Despite studies showing that both job
satisfaction and burnout are effects of exposure to stressful working environments, leading
to poor health among nurses, little is known about the causal nature and direction of these
relationships. The aim of this systematic review is to identify published research that has
formally investigated relationships between these variables. Six databases (including
CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were
searched for combinations of keywords, a manual search was conducted and an
independent reviewer was asked to cross validate all the electronically identified articles.
Of the eighty five articles that were identified from these databases, twenty one articles
were excluded based on exclusion criteria; hence, a total of seventy articles were included
in the study sample. The majority of identified studies exploring two and three way
relationships (n = 63) were conducted in developed countries. Existing research includes
OPEN ACCESS
Int. J. Environ. Res. Public Health 2013, 10 2215
predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2);
hence, the evidence base for causality is still very limited. Despite minimal availability of
research concerning the small number of studies to investigate the relationships between
work-related stress, burnout, job satisfaction and the general health of nurses, this review
has identified some contradictory evidence for the role of job satisfaction. This emphasizes
the nee ...
Clinical study designs can be categorized as either experimental (treatment) studies or observational studies. Experimental studies have more validity due to randomization and control groups. Common study designs include randomized controlled trials (RCTs), which are considered the gold standard; cohort studies, which follow groups over time; and case-control studies, which identify exposures in individuals with and without an outcome. Parallel and crossover studies differ in that parallel studies assign subjects to separate treatment groups throughout, while crossover studies switch subjects between treatments with washout periods between.
This 2 page article, which appeared in The Iowa Psychologist, provides an ultra brief summary of what makes therapy effective (the common factors) and how we can get better at what do: namely, add PCOMS, harvest client existing resources, and rely on that neglected old friend, the therapeutic alliance.
Dose response and efficacy of spinal manipulation for care of chronic low bac...Younis I Munshi
This randomized controlled trial studied the dose-response relationship between spinal manipulation therapy (SMT) sessions and chronic low back pain outcomes. 400 participants with chronic low back pain were randomized to receive 0, 6, 12, or 18 SMT sessions over 6 weeks from a chiropractor, with additional non-SMT light massage sessions to control for provider attention. The primary outcomes of pain and disability were evaluated at 12 and 24 weeks. Results showed modest linear dose-response effects, with 12 SMT sessions producing the greatest reduction in pain and disability at 12 weeks and 18 sessions producing the greatest effects at 52 weeks. Overall, SMT produced clinically meaningful improvements in pain and disability that were sustained to 52 weeks, with 12 visits appearing
A Systematic Review On The Effectiveness Of Complementary And Alternative Med...Martha Brown
This systematic review assessed the effects of spinal manipulative therapy (SMT), acupuncture, and herbal medicine for chronic non-specific low back pain (LBP) based on 35 randomized controlled trials including over 8,000 patients. The review found that SMT, acupuncture, and herbal medicine provided only short-term relief or improvement for chronic LBP based on low to very low quality evidence. Specifically, SMT was not found to be more clinically beneficial than sham treatments, passive modalities, or other interventions. Acupuncture provided short-term benefit compared to waiting list controls or when added to other interventions. Herbal medicines showed some positive short-term individual trial results but overall effects could not be determined due to
Trends in management of rheumatoid arthritis Dr.Neena Mehan
Rheumatoid Arthritis (RA) is an auto-immune disease in which body mistakenly considers some parts of its own system as pathogens and attacks them.
Similar to Artigo (acupuntura) - Uma revisão sistemática sobre a expectativa ao tratamento por acupuntura (20)
Acupuncture has become more widely used in sports medicine to treat pain and hasten recovery from injuries. Modern acupuncture uses sterile, disposable needles inserted at specific points along "meridians" to balance the flow of life energy in the body. Treatment sessions typically involve 6-12 needles placed for 10-30 minutes. While generally safe, serious risks include infection and organ puncture. Research shows acupuncture effective for osteoarthritis knee pain and some studies find it can improve immune function after exercise. The largest trial to date found acupuncture helped reduce knee pain more than education or sham acupuncture.
This case report describes how goal-directed acupuncture improved the performance of a top modern pentathlete over 7 years. The acupuncture points were chosen based on symptoms that were limiting performance in each event, and verified using thermography. Stimulation of points relieved symptoms and improved the athlete's ranking from 10th to top positions. While training effects and placebo cannot be ruled out, the report reviews literature supporting specific physiological effects of acupuncture for enhanced endurance, recovery, and oxygen intake in athletes. However, the potential for acupuncture to be considered doping is discussed.
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
Artigo - Acupuncture and human performanceRenato Almeida
This summary provides an overview of a journal article that discusses the potential for acupuncture to enhance human performance as an ergogenic aid.
1) The article introduces acupuncture as an ancient Chinese medical practice that is being investigated for its potential to improve strength, aerobic conditioning, flexibility, and sport performance. However, little is known about its effects on healthy athletes.
2) It provides background on the historical and theoretical foundations of acupuncture in Chinese medicine, including the concepts of qi, yin-yang balance, and meridian pathways.
3) The article acknowledges that while side effects are usually mild, risks like dizziness could endanger athletes and recommends guidelines to prevent misuse as a competitive
Artigo (acupuntura) - Mecanismos neuroendócrinos no tratamento da hipertensão...Renato Almeida
This document reviews the neuroendocrine mechanisms of acupuncture in treating hypertension. It discusses how acupuncture activates the arcuate nucleus, ventrolateral gray, and nucleus raphe to inhibit neural activity in the rostral ventrolateral medulla, which plays a critical role in blood pressure regulation. Experimental studies in animal models show that low-frequency electroacupuncture stimulation at specific acupoints over somatic nerves reduces sympathetic nervous system activity and lowers blood pressure. The effects of acupuncture are mediated by opioids, GABA, and serotonin released in the brain regions involved in cardiovascular control.
Artigo (acupuntura) - Efeito placebo da acupunturaRenato Almeida
This pilot study aimed to validate the Streitberger placebo needle as a credible placebo for use in acupuncture trials. 37 patients with chronic knee or hip pain were randomized to receive either real acupuncture or placebo needle treatment over two 2-week periods, with a crossover between treatments. Outcomes were measured by questionnaires assessing sensations from the needles and ability to distinguish real from placebo treatment. While most patients could not detect needle penetration, nearly 40% were able to detect a difference between real and placebo treatments. The study was unable to demonstrate clear differences between real and placebo needling. However, the inability of some patients to distinguish treatments raises concerns about using this needle as a standard placebo control. Further research is needed on consistency of technique before
Artigo (acupuntura) - Acupuntura no pós-operatório de artroscopia do joelhoRenato Almeida
O documento descreve um estudo que avaliou a eficácia da acupuntura no pós-operatório de cirurgias artroscópicas no joelho, comparando-a com fisioterapia e medicação. Trinta e seis pacientes foram divididos em dois grupos, onde um grupo recebeu 20 sessões de acupuntura e outro recebeu 20 sessões de fisioterapia associada a anti-inflamatórios. Os resultados mostraram que tanto a acupuntura quanto a fisioterapia melhoraram a dor, at
Artigo (acupuntura) - Acupuntura e seus riscosRenato Almeida
This review analyzed 57 systematic reviews and 95 case reports regarding acupuncture for pain. The systematic reviews showed inconsistent and contradictory results, with only neck pain having unanimously positive conclusions from high quality reviews. Numerous caveats and contradictions emerged from the reviews. Case reports identified 95 cases of severe adverse effects from acupuncture, including 5 deaths, with pneumothorax and infections being most common. The review concluded that the evidence does not convincingly demonstrate acupuncture is effective for pain relief and that serious adverse effects continue to be reported.
Artigo (anatomia) - O sistema locomotor segundo os periódicos brasileirosRenato Almeida
The document summarizes 91 articles from Brazilian scientific journals about the locomotor system. It categorizes the articles into anatomical structures, sports modalities, and other topics. The majority of articles discuss the knee, exercise (generically), and metabolic syndrome. Not surprisingly, knee pathology, soccer, running, and the impacts of overweight and obesity on the locomotor system are dominant themes.
O documento discute técnicas de palpação óssea, incluindo cuidados com as mãos, efeitos da palpação no paciente e como aprimorar a habilidade. A palpação é um exame investigativo que fornece informações valiosas através do tato e requer prática constante para desenvolver sensibilidade.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. 2 Evidence-Based Complementary and Alternative Medicine
for assessing acupuncture. This would suggest that a lack of et al. [14] cite following placebo acupuncture do not dis-
difference between real and placebo acupuncture in RCTs count the possibility of expectancy effects. There is also
may result from the omission of important components of evidence that the more invasive the placebo, the larger the
acupuncture, such as facilitating patients active involvement placebo effect. For example, four placebo pills reduced recov-
in their recovery and lifestyle advice, that is common in ery times from duodenal ulcers compared with two placebo
these trials [6, 11]. However, before such a conclusion can pills [30] and a subcutaneous placebo injection reduced pain
be drawn, evidence is required that demonstrates a larger due to migraine headaches more effectively than a placebo
benefit of providing acupuncture treatment than summing pill [31]. As such, placebo acupuncture may simply produce
the benefit of providing the individual components of acu- stronger expectancy effects than placebo pills do. Finally, if
puncture alone, which, to our knowledge, has not yet been both real and placebo acupuncture exert their effects as a
tested. result of expectancy, then this would lead to frequent null
Placebo (or sham) controls adopted in RCTs of acupunc- differences and occasional statistically significant differences
ture include needle insertion at nonacupuncture points between the two treatments caused by sampling variation (cf.
(sham acupuncture), shallow needle insertion that does not Type I error [32]), including placebo acupuncture appearing
penetrate below the skin (minimal or superficial needling), superior to real acupuncture on occasion As a result, there is
and blunt needles that touch, but do not penetrate the skin as yet no conclusive evidence that the currently used placebo
(placebo needling). Lundeberg and colleagues [12–14] have controls are active beyond expectancy.
argued that these techniques are not inert and are, therefore, Perhaps more importantly, the three alternative explana-
invalid as placebo controls. They provide a list of eleven tions for the common lack of statistically significant differ-
reasons why the placebo controls used in acupuncture RCTs ences between real and placebo acupuncture are not mutu-
may be active treatments, including evidence of physiological ally exclusive. Needling may be more efficacious when deliv-
responses to sham acupuncture, evidence that superficial and ered with lifestyle advice, but this does not mean that
sham needling producing larger effects than a placebo pill, patients’ expectancies about the efficacy of an acupunc-
and, rather strangely, that placebo controls can be as effective ture intervention cannot influence their outcomes via the
or even more effective than real acupuncture. placebo effect. Similarly, currently used placebo controls for
However, the evidence provided by Lundeberg et al. [14] acupuncture needling could be invalid, but this does not
can be explained equally well in the context of patient ex- preclude the possibility that expectancies could contribute to
pectancies. Expectancy is proposed to be a key mechanism of responses to real acupuncture. As demonstrated by Benedetti
the placebo effect. Placebo effects are changes that occur in et al. [27], most medical treatments, whether efficacious or
response to receiving treatment but that are not due to the not, appear to be influenced by patient expectancies. Thus,
inherent properties of the treatment itself [15]. Many studies regardless of whether or not the combined effects of an
have found that a saline injection or placebo cream admin- acupuncture intervention cannot be explained by the effects
istered under the guise of a powerful analgesic can, in fact, of each component’s individual efficacy or whether or not
reduce pain, for example [16–22]. There is also evidence for the currently used placebo controls in acupuncture RCTs are
placebo effects across a range of other conditions (see [23] for valid, it remains important to establish both if and how the
a recent review). For example, placebo treatment appears to placebo effect contributes to responses to acupuncture.
reduce depressive symptoms [24], improve sleep quality [25] With this in mind, we conducted a systematic review of
improve motor performance in patients with Parkinson’s the literature to examine whether expectancies can influence
disease [17], modulate heat rate in healthy volunteers [17], acupuncture outcomes. Although we had intended to use
and improve cognitive performance in healthy volunteers meta-analysis to estimate and test the magnitude of the effect
[26]. Perhaps most interestingly, Benedetti et al. [27] found of expectancy on treatment responses following acupunc-
significantly larger treatment effects for postoperative pain, ture, the studies identified were too heterogeneous with
motor performance in patients with Parkinson’s disease, and respect to methodology and reporting to allow such analysis.
heart rate in healthy participants when the initiation of We, therefore, provide a descriptive review of studies inves-
treatment was signalled to the patient by a health profes- tigating placebo effects in acupuncture, drawing particular
sional compared with when it was initiated surreptitiously attention to methodological considerations, and outline
without the patients’ awareness, indicating that most medical some key goals for future research in this area.
treatments involve a placebo component. On this basis, some
researchers have argued that the superiority of both real
and placebo acupuncture techniques over no treatment (or 2. Methods
in some cases standard care) combined with failure to find
significant differences between real and placebo acupuncture 2.1. Search Strategy. Articles were identified through com-
can be explained by the placebo effect [28, 29]. That is, puterized literature searches. Medline, PsycInfo, PubMed,
they argue that any improvement following acupuncture and Cochrane Clinical Trials Register were searched for
treatment, whether real or placebo, results from the patients English publications from inception up to 1st December,
expecting acupuncture to be effective. 2010 using the search terms “expectancy OR expectancies
If expectancies do lead to real changes in symptoms via OR expectation$ OR expected efficacy OR placebo effect$”
the placebo effect, then physiological changes must underlie in combination with “acupuncture” using title and abstract
these effects. Therefore, the physiological changes Lundeberg fields. The reference lists of publications identified through
3. Evidence-Based Complementary and Alternative Medicine 3
the electronic search were also screened for additional rele- Records identified through
vant articles. database searches:
Cochrane CCTR (n = 75)
Medline (n = 151)
2.2. Selection Criteria. To be included, studies needed to PsychInfo (n =59)
either assess or manipulate participants’ expectancies regard- PubMed (n = 107)
ing the efficacy of an acupuncture intervention involving Total: 392
needling and to report on the relationship between these
expectancies or the manipulation and at least one outcome Duplicates removed
(n = 191)
variable. The acupuncture intervention could include man-
ual or electroacupuncture and could be standardised or
Records screened
individualised. Assessing expectancies regarding the efficacy (n = 201)
of acupuncture involved any question asking participants
to rate their expectancies for improvement as a result of Records excluded
(n = 184)
acupuncture but had to be prospective; that is, the ex-
pectancy assessment had to occur before the acupuncture
Full-text articles assessed
treatment. Manipulating expectancies meant allocating par- independently for eligibility
ticipants to receive different information about the likely (n = 17)
effects of their treatment, whether real or placebo acupunc- Records excluded because:
ture was delivered. For example, Suarez-Almazor et al. [33] methodological concerns (n = 5)
data reported elsewhere (n = 3)
randomly allocated participants in a RCT comparing real and
sham acupuncture for osteoarthritis of the knee to receive Studies included in qualitative
suggestion from the acupuncturist that either the treatment synthesis
“will work” (high expectancy) or that it “may or may not (n = 9)
work” (low expectancy). Studies investigating both clinical
and nonclinical conditions (e.g., experimentally-induced Figure 1: Flow diagram for study identification and selection.
pain) were included. The studies could assess any health-
related outcome, whether subjective or objective, and there
were no constraints on study design, as long as the criteria for expectancies retrospectively in the form of guesses about
assessing and/or manipulating expectancies were met. Only treatment allocation [29]. One was excluded because it failed
peer-reviewed publications in English were included. to directly test the effect of its expectancy manipulation [40].
2.3. Study Selection. One author (B. Colagiuri) conducted 2.4. Data Extraction. The authors reviewed the retrieved
the initial search and excluded articles that were clearly not articles and independently extracted information on sample
relevant. Both authors then reviewed the full texts of each of characteristics, study design, outcome variables, relevant
the remaining articles and evaluated them against the selec- results, and whether the study fulfilled the inclusion criteria
tion criteria independently. Any disagreements were resolved using pre-defined coding sheets. The sample characteristics
through discussion. included sample size, proportion of female participants, and
The literature search identified a total of nine indepen- whether the participants had previously used acupuncture.
dent studies reporting on the relationship between expect- Study design included the experimental design, charac-
ancy and treatment response following acupuncture suitable teristics of the acupuncture treatment that was delivered,
for inclusion. Figure 1 displays the flow diagram for study and how expectancies were either assessed or manipulated.
selection. The search of Medline, PsycInfo, PubMed, and Study outcomes involved all outcomes that were analysed
Cochrane Clinical Trials Register provided a total of 392 for relationships with expectancy and were classified into
English references. After removing duplicates, there were 201 either self-report or objective outcomes. Differences were
articles, of which 184 were clearly not relevant. The full texts discussed, and a final assessment was negotiated for each
of the remaining 17 articles were reviewed independently by study. The PRISMA guidelines for reporting of systematic
both authors. Of these, three articles were excluded because reviews and meta-analyses were followed [41, 42].
their results were reported in other articles already identified
[34–36]. This left 14 unique studies. One article was excluded 2.5. Risk of Bias Assessment. Scoring studies numerically
because it reported on the relationship between expectancy based on their quality is controversial. This is because com-
and acupuncture combined with expectancy and an exercise bining quality items into a single score is questionable, par-
intervention [37]. One article was excluded because no ticularly in terms of whether or not these items are additive
details of the expectancy assessment were provided [38]. One [43, 44], and because there is evidence that currently used
was excluded because it focused on patients with psycho- quality scores do not actually predict variance in effect sizes
logical comorbidity [39], which although not an a priori [45, 46]. We, therefore, chose not to attribute quality scores
exclusion criteria, both authors agreed might affect the re- to the included studies. Instead, we conducted a risk of
lationship between expectancy and treatment outcomes. bias assessment using the Cochrane Collaborations tool for
One was excluded because it only assessed participants’ assessing risk of bias [47], which includes six dimensions,
4. 4 Evidence-Based Complementary and Alternative Medicine
namely, adequate sequence generation, allocation conceal- the studies with some studies finding evidence suggestive of
ment, blinding, incomplete data, selective reporting, and an interaction [49, 52, 53] and others failing to find such
other forms of bias. Both authors completed the risk of evidence [33, 54]. Interaction effects were either not reported
bias assessment for each study independently, with any dis- [48, 51, 55] or not relevant (because only one acupuncture
crepancies resolved through discussion. treatment was administered [50]) in the remaining studies.
No study found evidence of significant effects of expectancy
2.6. Data Analysis. Meta-analysis of the studies was not pos- on objective outcomes following acupuncture; however, only
sible due a combination of heterogeneous methodology used three studies included objective outcome variables [33, 48,
across studies and incomplete reporting of results in some 55].
studies. Study results were considered statistically significant There were some patterns in terms of the study char-
if P < 0.05. acteristics and whether or not a significant relationship
between expectancy and acupuncture outcomes was found.
All three studies investigating experimentally-induced pain
3. Results found evidence of a significant relationship [52–54], whereas
only two of the six studies investigating clinical outcomes
3.1. Study Characteristics. A summary of the characteristics found evidence of a significant relationship [49, 51]. Three
of the nine studies we identified is provided in Table 1. The of the four studies that manipulated expectancies found
majority of studies were on pain-related conditions, both evidence of a significant relationship [33, 52, 54], whereas
clinical [33, 48–51] and experimentally-induced [52–54]. only one of the five studies that assessed expectancies found
One study focused on angina pectoris [55]. In six of the evidence of a significant relationship [49]. Four of the five
studies, participants were acupuncture naive [33, 48, 51– studies involving electroacupuncture found evidence of a
54], in two studies, participants had not previously received significant relationship between expectancies and treatment
acupuncture for the condition being treated [50, 55], and response [33, 52–54], whereas only one out of the four
in one study no information was provided on participants’ studies involving manual acupuncture found evidence of
previous use of acupuncture [49]. Electro acupuncture was such a relationship [49]. A high degree of caution is, however,
used in five studies [33, 52–55], manual acupuncture was necessary when attempting to generalise from these patterns
used in three studies [48, 49, 51], and one study only as simple vote counting, that is, summing and comparing the
investigated placebo acupuncture [50]. Five of the studies number of significant results with the number of nonsignifi-
assessed expectancies [49–51, 53, 55], four manipulated cant results, is associated with a number of problems [56]. In
expectancies [33, 48, 52, 54]. Assessing expectancies gener- the current case, for example, even though only two of the six
ally involved asking participants to rate how effective they studies investigating clinical outcomes found evidence of a
expected acupuncture to be for improving their condition significant relationship between expectancy and acupuncture
on Likert-type scales. In the majority of studies assessing outcomes [33, 49], these were the two largest in terms
expectancies, participants were either dichotomised into of sample size and likely had the most statistical power.
high and low expectancies [49, 53, 55] or trichotomised The same applies to the only study finding a significant
into high, medium, or low expectancies [51]. Manipulating relationship that assessed expectancies [49]. It is also worth
expectancies typically involved randomising participants to noting that studies with healthy volunteers in experimental
receive information aimed at enhancing their expectancies settings should require fewer participants to achieve the same
for improvement following acupuncture or either neutral or power as studies in clinical settings, because the former are
negative information although one study used a conditioning often better able control for potential confounding variables
procedure [54]. All studies included self-reported outcomes, due to the controlled laboratory setting, which further
but three also included objective outcome variables [33, 48, complicates comparison across these studies. Therefore,
55]. while it seems clear that expectancies can affect acupuncture
outcomes under at least some circumstances, it is difficult to
3.2. The Effect of Expectancy on Responses to Acupuncture. identify which circumstances these are and how strong this
Table 2 provides a descriptive summary of each of the nine relationship is from the available evidence.
studies’ findings. The results of the studies were clearly
mixed, with some studies finding at least some evidence of 3.3. Risk of Bias. As shown in Table 3, all but one study [33]
a statistically significant effect of expectancy on acupuncture had either some risk or an unclear risk of bias on at least
outcomes [33, 49, 52–54] and others failing to find any one of the six dimensions assessed. Specifically, sequence
such effects [48, 50, 51, 55]. Interestingly, there were also generation was inadequate in one study [52] and unclear
some findings that were suggestive of an interaction between in four studies [48, 53–55]. Allocation concealment was not
expectancy and type of acupuncture (real versus placebo). used in one study [52] and was unclear in three studies
For example, Linde et al. [49] found that the improve- [48, 54, 55]. Participants were blinded to whether or not
ment in patients classified as having “high expectancy” they were receiving real or placebo acupuncture in all studies,
compared with those classified as having “low expectancy” but in four studies the blinding of outcome assessors was
was significantly more marked in patients receiving real unclear [48, 49, 53, 54]. All studies satisfactorily addressed
acupuncture compared with placebo acupuncture. However, incomplete data, and only one had unclear risk regarding
evidence of this type of interaction was inconsistent across selective reporting [55]. In terms of other biases, four studies
5. Table 1: Summary of included studies’ characteristics.
Sample Treatment
Study Design Expectancy Outcome
N % Female Previous use Acupuncturea Placebo
Acupuncture at LI11,
2 × 2 between-subjects
LI4, LI15, GB39, SI9, Noninsertion at the Manipulated—participants randomised
design with
S10, and M-UE-48 three study acupuncture to receive acupuncture with positive
acupuncture (real Objective—
Berk et al. times over 3 weeks. points involving milieu suggesting that acupuncture is an
versus placebo) and 42 29% No shoulder mobility.
(1977) [48] Needles were manually gently pressing the tip effective therapy or a negative milieu
milieu (positive versus Self report—pain.
manipulated, but of the needle against suggesting that acupuncture is an
negative) as factors on
retention time was not the skin. ineffective treatment.
shoulder pain.
reported.
3 × 3 between-subjects As per acupuncture,
design with but stimulated study
acupuncture (real, Electroacupuncture at points unilaterally on
placebo, or none) LI4 and TH5 once for the arm not placed in Manipulated—participants led to expect
Knox et al. versus expectancy 20 min unilaterally on the cold pressor. pain relief, no pain relief, or variable Self report—pain
72 50% No
(1979) [52] (positive, negative, or the arm to be placed in A no treatment effects from acupuncture or from lying at 30 sec.
Evidence-Based Complementary and Alternative Medicine
variable) for the cold pressor. control group lay down for 20 min.
experimentally- Sensation not reported. down for 20 min and
induced pain (cold did not receive either
pressor). treatment.
Assessed—expectancy questionnaire
Electroacupuncture at
RCT of acupuncture comparing treatments (e.g., surgery,
LI5, LI11, SI5, and SI8
versus placebo for Insertion 2 cm distal morphine, aspirin, and acupuncture) for
Norton et al. once for 15 min
experimentally- 24 50% No to study acupuncture relieving pain and then categorised Self Report—pain.
(1984) [53] unilaterally on the arm
induced pain (cold points. participants in to high and low
to be placed in the cold
pressor). expectancy on the basis of this
pressor.
questionnaire.
Assessed—rating of expectancy
concerning anti-anginal effects of Objective—
acupuncture as “very high expectations”, exercise tolerance;
Superficial (shallow)
Electroacupuncture LI4 “somewhat high”, “neutral”, “slightly rate pressure
insertion outside
Ballegaard RCT of acupuncture for 20 mim. Ten negative”, “moderately negative product;
Not for heart Chinese meridians
et al. (1995) versus placebo for 32 22% treatments over 3 weeks. expectations”, or “don’t know”. These nitroglycerin
disease. and not on trigger
[55] angina pectoris. De qi and visible muscle scores were dichotomised into either consumption;
points with no
twitch achieved. maximal expectation consisting of those angina attack rate.
stimulation.
who responded “very high expectations” Self report—daily
and into submaximal expectations for all wellbeing.
others responses.
5
6. 6
Table 1: Continued.
Sample Treatment
Study Design Expectancy Outcome
a
N % Female Previous use Acupuncture Placebo
Assessed—(a) “How effective do you
consider acupuncture in general?” and
could respond “very effective”, “effective”,
Pooled analysis of 4 Superficial needling at
Acupuncture protocol “slightly effective”, “not effective”, or Self report—50%
RCTs of acupuncture nonacupuncture
specific to RCT, but all “don’t know”. (b) “What do you improvement in
versus placebo for points (relevant to
Linde et al. were treated once per personally expect from the acupuncture primary outcome
migraine, headaches, 864 75% Not stated. each RCT) also once
(2007) [49] week for 12 weeks and you will receive?” and could respond related to trial
back pain, and per week for 12 weeks
each session lasted “cure”, “clear improvement”, “slight condition; pain
osteoarthritis of the and each session
30 min. improvement”, “no improvement”, “don’t disability index.
knee. lasting 30 min.
know”. Dichotomised into high
expectancy (top two responses) versus
low expectancy (all other responses).
Streitberger placebo
Comparison of placebo
needles twice per
acupuncture versus Not for arm Assessed—“rate how intense you think
week for 2 weeks at
Bertisch et al. placebo pill within a pain and not the pain or discomfort will be 2 weeks
60 53% N/A between 5–10 sites Self report—pain.
(2009) [50] larger RCT for distal within last from now if you are assigned to
and unilaterally or
upper arm pain due to year. acupuncture” 5-point scale.
bilaterally depending
RSI.
on the patients pain.
2 × 2 between-subjects Streiberger placebo Manipulated—participants given
design with needles placed on the stimulation of pain with intensity
acupuncture (real surface of the skin at surreptitiously manipulated so as to
Kong versus placebo) and Electroacupuncture at the study provide experience of acupuncture
et al. (2009) expectancy (high 48 50% No LI3 and LI4 once for acupuncture points treatment decreasing pain (high Self report—pain.
[35, 54] versus low) as factors 25 min. Di qi achieved. and connected to a expectancy) or with intensity identical to
for experimentally- deactivated baseline so as to provide experience of
induced pain (heat electroacupuncture acupuncture failing to decrease pain (low
stimulation). device. expectancy).
Evidence-Based Complementary and Alternative Medicine
7. Table 1: Continued.
Sample Treatment
Study Design Expectancy Outcome
N % Female Previous use Acupuncturea Placebo
(a) Placebo
acupuncture
(a) Individualised
involving sham
acupuncture with points
insertion using a
and sensation
toothpick in a needle
determined based on
RCT of individualised guide tube as per the
patients’ individual
acupuncture, standardised Assessed—participants rated how helpful
diagnosis. Ten Self
Sherman standardised acupuncture, they believed acupuncture would be for
treatments in 7 weeks. report—disability;
et al. (2010) acupuncture, placebo 477 61% No including their back pain on 11-point scale.
(b) Standardised symptom
[51] acupuncture, and manipulation via Responses trichotomised into low (0–5),
Evidence-Based Complementary and Alternative Medicine
acupuncture at B23, bothersomeness.
standard care for twisting the tooth medium (6 and 7), and high (8–10).
B40, K3 bilaterally and
chronic back pain. pick.
Du3, main trigger point
(b) Standard care was
unilaterally for 20 min
the usual care
with manual stimulation
participants received
to elicit “de qi”.
from their physicians,
if any.
Electro-acupuncture at
2 × 2 trial with
GB34, SP6, SP9,
communication style Self report—pain,
Ear-Knee, Ex-LE2, Manipulated—participants randomised
(positive or negative) satisfaction;
Suarez- Ex-LE4, Ex-LE5, and 1-2 to an acupuncturist who communicated
and acupuncture (real Shallow insertion at physical and
Almazor trigger points. Needle positive messages about acupuncture, for
or placebo) as factors 527 61% No acupoints not mental satisfaction.
et al. (2010) retention was 20 min example, “I think this will work for you”,
and an additional relevant to the knee. Objective—range
[33] and treatment lasted 6 or to neutral communication such as, “It
waitlist control group of motion; timed
weeks although the may or may not work for you”.
for osteoarthritis of the up and go test.
number of sessions per
knee.
week was not reported.
a
All bilateral acupuncture points stimulated bilaterally unless specified otherwise.
7
8. 8 Evidence-Based Complementary and Alternative Medicine
Table 2: Summary of included studies’ results.
Study Expectancy Summary of resultsa
There were no significant differences between real and placebo
acupuncture. There were also no significant differences on shoulder
mobility for those given positive versus negative information about
Berk et al. [48] Manipulated acupuncture. Those given positive information reported lower shoulder
pain than those given negative information, but this did not reach
statistical significance (P = 0.053). Interaction between acupuncture and
expectancy not reported.
There were no significant main effects of acupuncture or expectancy.
However, posttreatment experimentally-induced pain reduced significantly
from baseline in participants given real acupuncture with positive
Knox et al. (1979) [52] Manipulated
information but not in participants given real acupuncture with variable or
negative information, nor in participants given placebo acupuncture with
positive, variable, or negative information.
There was a significant interaction between acupuncture and expectancy.
Simple effects revealed participants receiving real acupuncture reported
significantly less experimentally-induced pain if they had “high
Norton et al. (1984) [53] Assessed (dichotomised) expectancy” compared with “low expectancy”. Participants with “high
expectancy” who received real acupuncture also reported significantly less
pain than those also with “high expectancy” but who received placebo
acupuncture. Main effects of acupuncture and expectancy not reported.
There were no significant differences on any angina outcome between
participants categorised as having “maximal expectancy” and “submaximal
Ballegaard et al. (1995) [55] Assessed (dichotomised)
expectancy”. Main effect of acupuncture and its interaction with
expectancy not reported.
Those receiving real acupuncture were more likely to respond to treatment
than those receiving placebo acupuncture. Higher expectancies for
acupuncture’s efficacy in general and specifically for the patients’
presenting condition were associated with a higher likelihood of
experiencing a 50% improvement in the studies’ main outcome and a
Linde et al. (2007) [49] Assessed (dichotomised)
reduction in pain disability index both immediately posttreatment and at
follow up. Significant interaction on “some” outcomes indicating the
improved outcomes for those with “high expectancy” compared with “low
expectancy” were more marked for patients receiving real acupuncture
than those receiving placebo acupuncture.
No significant relationship was found between expectancies and upper arm
Bertisch et al. (2009) [50] Assessed pain following placebo acupuncture in both unadjusted and multivariate
analysis.
No main effect of acupuncture. Participants allocated to receive
pre-conditioning consistent with acupuncture having an analgesic effect
reported significantly less experimentally-induced pain following
Kong et al. (2009) [35, 54] Manipulated
acupuncture than those allocated to receive pre-conditioning of
acupuncture having no effect. There was no interaction between
acupuncture and expectancy.
Individualised, standardised, and placebo acupuncture were more effective
at reducing chronic low back pain than usual care, but there were no
Sherman et al. (2010) [51] Assessed (trichotomised) significant differences among these three treatments. There were also no
significant differences between those with “high”, “medium”, and “low”
expectancies. Interaction between treatment and expectancy not reported.
No differences were found between real and placebo acupuncture, but both
led to better outcomes compared with the waitlist control group.
Suarez-Almazor et al. Participants allocated to receive positive information had significantly
Manipulated
(2010) [33] lower pain and higher satisfaction than those allocated to receive neutral
information and this was independent of whether real or placebo
acupuncture was administered.
a
All results are main effects unless stated otherwise.
9. Evidence-Based Complementary and Alternative Medicine 9
Table 3: Risk of bias assessment for the included studies.
Adequate Allocation Blinding?a Incomplete Free of selective
Study sequence Concealment? data Free of other bias?
generation? Outcome addressed? reporting bias?
Participant
Assessor
Berk et al.
Unclear Unclear Yes Unclear Yes Yes Yes
(1977) [48]
Knox et al.
No No Yes Yes Yes Yes Yes
(1979) [52]
No—small sample size for
Norton et al.
Unclear Yes Yes Unclear Yes Yes correlational study; dichotomised
(1984) [53]
expectancy
No—small sample size for
Ballegaard et al.
Unclear Unclear Yes Yes Yes Unclear correlational study; dichotomised
(1995) [55]
expectancy
Linde et al.
Yes Yes Yes Unclear Yes Yes No—dichotomised expectancy
(2007) [49]
Bertisch et al. No—small-medium sample size
Yes Yes Yes Yes Yes Yes
(2009) [50] for correlational study
Kong et al.
Unclear Unclear Yes Unclear Yes Yes Yes
(2009) [35, 54]
Sherman et al.
Yes Yes Yes Yes Yes Yes No—trichotomised expectancy
(2010) [51]
Suarez-Almazor
Yes Yes Yes Yes Yes Yes Yes
et al. (2010) [33]
a
Risk of bias for blinding was assessed only for whether participants were intended to be blind to the type of acupuncture they received (real or placebo) and
whether outcome assessors were blind to the participants’ allocation. Blinding of acupuncturists regarding acupuncture treatment is not possible, nor is it
possible to blind participants regarding an expectancy manipulation; therefore, these were not included in the risk of bias assessment. b In Bertisch et al. [50],
even though only placebo acupuncture was delivered for the period of interest, they were told they may receive real or placebo acupuncture and are, therefore,
considered as blind to treatment allocation.
simplified their expectancy assessment via dichotomisation on experimentally-induced pain to manipulate expectancies
or trichotomisation and three studies [49, 51, 53, 55] had and to employ electro-acupuncture, meaning that the effects
relatively small sample sizes given their correlational nature of each cannot be disentangled on the basis of the available
[50, 53, 55]. data. Further, the largest study on a clinical outcome, that
assessed expectancies, and that involved manual acupunc-
4. Discussion ture, did find evidence of a significant relationship between
expectancy and acupuncture outcomes [49]. It was also the
Given that patient expectancies are often proposed to be a case that some studies were at higher risk of bias than others.
key factor in acupuncture’s effectiveness compared with no The differences in study design and inconsistent results
treatment or standard care [28, 29], relatively few studies across the identified studies raise important considerations
have examined the relationship between expectancies and regarding which methodological approach is best equipped
treatment responses following acupuncture. Our systematic to determine the contribution of patient expectancies to
search identified only 14 unique studies testing the relation- acupuncture outcomes. The two most pertinent method-
ship between patient expectancies and outcomes following ological issues are (1) whether to assess or manipulate ex-
acupuncture needling, of which nine met our criteria for pectancies and (2) how to accurately assess expectancies.
inclusion. The high level of heterogeneity across studies Of the nine studies identified here, five assessed expectan-
and incomplete reporting in some meant that meta-analysis cies [49–51, 53, 55] and four manipulated expectancies [33,
was not possible. A descriptive review revealed that while 48, 52, 54]. Studies that involve manipulating expectancies
there was evidence of a significant relationship between are better able to determine how patient expectancies con-
patient expectancies and acupuncture needling outcomes in tribute to acupuncture outcomes because of their experi-
some studies, others failed to find these effects. The pat- mental nature and might be considered superior for this rea-
tern of results suggested that studies on experimentally- son. However, studies that only manipulate expectancies are
induced pain, that manipulated expectancies, or those in- entirely reliant on the ability of the manipulation to influence
volving electroacupuncture were more likely to find a sig- expectancies. This leads to problems determining whether
nificant relationship. However, caution is required in gen- an unsuccessful manipulation failed because it did not suf-
eralising these results, as it was more common for studies ficiently influence expectancies or because the participants’
10. 10 Evidence-Based Complementary and Alternative Medicine
expectancies had no effect on their treatment response, as to the high heterogeneity in methodology and incomplete
is the case in Berk et al.’s [48] study. Studies that assess reporting in some studies. While this does mean that we were
expectancies have the advantage of being able to directly eval- unable to determine an average effect size across studies, the
uate the relationship between expectancy and acupuncture descriptive review provided here does highlight a number
outcomes, thereby overcoming problems to do with relying of important methodological considerations that will inform
on the efficacy of an expectancy manipulation. However, future research in this area. Secondly, as with most systematic
these types of studies might be considered a weaker source reviews, there is the possibility of publication bias. In the
of evidence because they are correlational in nature. current case, this could mean that studies failing to find a
An apparently simple way to overcome this issue is to statistically significant relationship between expectancy and
include an assessment of expectancy in studies involving acupuncture outcomes were less likely to be published than
manipulations. However, there are a number of other poten- those finding statistically significant effects, which may lead
tial limitations associated with assessing expectancies that to overestimation of the influence of expectancy. We, there-
need consideration. First, questioning participants about fore, encourage researchers conducting RCTs of acupuncture
their expectancies regarding acupuncture’s efficacy could to report, even briefly, of any failures to find a significant
undermine the study’s validity if it influences what they relationship between expectancy and acupuncture outcomes.
expect or if it makes them question the purpose of the study. Finally, only papers published in English were reviewed,
Second, determining the best time to assess expectancies is meaning that other relevant studies may be published in
also difficult. Assessing them immediately before the first other languages.
acupuncture treatment provides a prospective assessment, In summary, there have been relatively few research stud-
but expectancies may change during the course of the ies testing the relationship between expectancy and acupunc-
treatment, especially if it lasts for more than a few days. ture outcomes. While there did appear to be evidence for
On the other hand, assessing expectancies immediately a significant relationship between patient expectancies and
before or immediately after the outcomes are assessed could treatment responses following acupuncture, there were some
lead to priming that artificially inflates the strength of the inconsistencies across studies. Future studies attempting to
relationship between expectancy and the outcome. Thirdly, address this question should, where possible, both manipu-
there have been few systematic attempts to develop methods late and assess expectancies. However, considerations regard-
of assessing expectancies, both within acupuncture research ing currently used methods of assessing expectancy, such as
and in the placebo literature more broadly. Most of the timing and wording of the questions, need to be addressed
studies that assessed expectancies identified here used a first in order to establish the best approach and to ensure
single expectancy item. For the most part, these were 5-point the validity of these assessments and any conclusions drawn
Likert-type scales, although, as can be seen in Table 1, both about the relationship between expectancy and acupuncture
the wording of the question and the labels for the response outcomes. Further, investigating potential moderators of the
options varied considerably. It was also common for studies relationship between expectancy and acupuncture outcomes,
assessing expectancies to dichotomise [49, 53, 55], or in such as type of acupuncture (real versus placebo), type
one case trichotomise [51], patients’ responses into different of stimulation (manual versus electroacupuncture) would
levels of expectancy, however, categorising such variables has prove useful for better understanding the circumstances
been heavily criticised, because it can substantially reduce under which expectancies can influence treatment responses
statistical power [57–59]. following acupuncture.
Therefore, while studies that both manipulate and assess
expectancies are best able to test the relationship between
expectancy and acupuncture outcomes, questions regarding Acknowledgments
the influence of asking patients to report their expectancies
We have no conflicts of interest in producing this review. No
and both when and how expectancies should be assessed
funding was obtained for the review.
need to be addressed empirically in order to determine
the most appropriate method of assessing expectancies. Of
course, it may not always be practical to incorporate an References
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