Kien Trinh

Predictive validity of the multiple mini-interview for selecting medical trainees.

Introduction  In this paper we report on further tests of the validity of the multiple mini‐interview (MMI) selection process, comparing MMI scores with those achieved on a national high‐stakes clinical skills examination. We also continue to explore the stability of candidate performance and the extent to which so‐called ‘cognitive’ and ‘non‐cognitive’ qualities should be deemed independent of one another.

The effect of defined violations of test security on admissions outcomes using multiple mini‐interviews

Introduction  Heterogeneous results exist regarding the impact of security violations on student performances in objective structured clinical examinations (OSCEs). Three separate studies investigate whether anticipated security violations result in undesirable enhancement of MMI performance ratings.

Chinese Herbal Medicine for Chronic Neck Pain due to Cervical Degenerative Disc Disease

Study Design. Systematic review. Objective. To assess the efficacy of Chinese herbal medicines in treating chronic neck pain with radicular signs or symptoms. Summary of Background Data. Chronic neck pain with radicular signs or symptoms is a common condition. Many patients use complementary and alternative medicine, including traditional Chinese medicine, to address their symptoms. Methods. We electronically searched CENTRAL, MEDLINE, EMBASE, CINAHL, and AMED (up to 2009), the Chinese Biomedical Database and related herbal medicine databases in Japan and South Korea (up to 2007). We also contacted content experts and hand searched a number of journals published in China. We included randomized controlled trials with adults with a clinical diagnosis of cervical degenerative disc disease, cervical radiculopathy, or myelopathy supported by appropriate radiologic findings. The interventions were Chinese herbal medicines. The primary outcome was pain relief, measured with a visual analogue scale, numerical scale, or other validated tool. Results. All 4 included studies were in Chinese; 2 of which were unpublished. Effect sizes were not clinically relevant and there was low quality evidence for all outcomes due to study limitations and sparse data (single studies). Two trials (680 participants) found that Compound Qishe Tablets relieved pain better in the short-term than either placebo or Jingfukang; one trial (60 participants) found than an oral herbal formula of Huangqi relieved pain better than Mobicox or Methycobal, and another trial (360 participants) showed that a topical herbal medicine, Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel. Conclusion. There is low quality evidence that an oral herbal medication, Compound Qishe Tablet, reduced pain more than placebo or Jingfukang and a topical herbal medicine, Compound Extractum Nucis Vomicae, reduced pain more than Diclofenac Diethylamine Emulgel. Further research is very likely to change both the effect size and our confidence in the results.

Blinding in acupuncture research: a systematic review of randomized controlled trials for pain using a sham acupuncture control

Abstract Objective: To study the various methods and levels of blinding in acupuncture research. Data sources: Reference lists of the most recent systematic review of acupuncture on pain, systematic search of MEDLINE from 1966 to August 2000, CINAHL from 1982 to August 2000, and HealthSTAR from 1975 to August 2000. Study selection: Randomized studies were included if they evaluated the effectiveness of acupuncture in painful conditions using a blinded design. Data extraction: The hard copy of each of the eligible studies available was reviewed. The following information was extracted: name of first author, publication year, study design, blinding testing, treatment sham group received, and the outcome measures. Data synthesis: There were 19 studies identified. They were described as ‘double blinded’ by the authors, referring to blinding of patients and evaluators. Sixteen studies did not perform any blinding testing after the treatments were over. Only three studies provided information that the blinding of patients was successful. These three studies used different questionnaires to assess the success of blinding. There was no study that evaluated the success of blinding of treatment evaluators. Also, no study attempted blinding of the treating acupuncturists. Conclusions: Proper blinding of patients and evaluators is possible in acupuncture research and many different techniques of proper blinding exist. Assessment of blinding is a critical aspect of any sham or placebo controlled trial and should be routinely incorporated into the design of such trials of acupuncture.

The Challenges of Nonpharmacological Trials: Blinding and Other Issues using Acupuncture Research as an Example

Objective: To discuss some of the methodological challenges of nonpharmacological trials using acupuncture as an example. Summary: Challenges in nonpharmacological trials are plenty. In acupuncture trials, choosing the most credible blinding technique and selecting the appropriate treatment parameters are some of the many difficulties facing clinicians. There is no consensus about the most appropriate type of sham acupuncture. The parameters to be considered in the sham group are the location of the points (wrong points, same spinal segment as the actual points of interest, outside the spinal segment of the actual points of interest), depth of needle insertion (no insertion, superficial insertion, or regular insertion), amount of stimulation to the needles (no stimulation, minimal stimulation, or regular stimulation), or a combination of these parameters. In a review, the average number of acupuncture treatments used was six. The average frequency of treatments per week was two. The duration of treatment was between 4 to 30 minutes with the mean at 20 minutes. About an equal number of studies used electrical or manual needle stimulation. Deep needle insertions were used in the studies that reported depth of insertion. The depth was either reported as deep or between 10 to 30 mm. On average, five needles were used during treatment sessions. “De qi” was elicited in only five of the studies. It appeared that most of these high-quality trials for musculoskeletal problems used combinations of segmental and nonsegmental point locations.

Research methodology: Evaluating complementary and alternative therapies

Complementary and alternative medicine (CAM) represents an opportunity to expand tools for assisting patients with health care issues, retain or increase market share by proactively responding to consumers, and increase our understanding of interventions outside of conventional medicine. CAM research is a flourishing area that is currently receiving a new focus as a result of the creation of recognized CAM research centers in university settings worldwide. Several botanical products, complex CAM interventions and individual approaches are now being tested with rigorous and well-controlled research. Adequate execution of clinical trials, however, represents a major challenge, particularly in medical fields such as pediatrics and CAM therapies such as acupuncture and herbal medicine. The scientific community, industry, and consumers are joining efforts to provide reliable and objective information about the efficacy and safety of CAM therapies. Medical journals are publishing CAM-related issues regularly and there is concern about quality of clinical trials, reliability of results, placebo effect, and publication bias. The number of CAM clinical trials continues to grow although it is still very low compared with conventional medicine trials. There are major research methodology issues that need to be considered in CAM research that have not been completely and thoroughly evaluated. Nevertheless, ideas have been proposed and innovative projects are ongoing. The conduct of CAM research requires the commitment of the scientific community as well as substantial funding from governmental institutions and the pharmaceutical industry.

Effect of pseudoephedrine in sport: a systematic review

Objective Pseudoephedrine is a stimulant that can be purchased over-the-counter to relieve symptoms of nasal and sinus congestion. Owing to its similar composition to ephedrine and other amphetamines, pseudoephedrine mirrors some of its ergogenic effects. This study investigates its possible ergogenic effect through a systematic review. Our primary aim was to determine the effects of pseudoephedrine in sport and its potential for performance enhancement. Design We searched EMBASE, MEDLINE, PsychINFO and The Cochrane Library for trials conducted from their beginning to March 2015. Any published trial that used randomised assignment to the intervention and control groups in full text and measured pseudoephedrine as an independent variable were included. Results Overall, the review showed that the ergogenic effect of pseudoephedrine is dose-dependent. None of the reviewed studies showed an ergogenic effect at the therapeutic dose of the drug (60–120 mg); however, supratherapeutic doses (≥180 mg) yielded clinically significant results. Conclusions Owing to the limitations of the published studies in this field, we were unable to make any firm conclusions with respect to the overall effect of pseudoephedrine and its ergogenic effect. It is evident that there is a correlation between the dose administered and its ergogenic effects, but it is also evident that the side effects of using above the therapeutic dose outweigh the possible benefits of using pseudoephedrine in sport. Further research with larger sample sizes is required to determine the relationship between doses (≥180 mg) and concentrations in urine that cause an ergogenic effect.

Acupuncture for obesity: a systematic review

Obesity has become a major health challenge for both patients and family physicians. Well-known methods of weight reduction such as diet and exercise are often difficult to comply with due to lifestyle and quality of life issues. Other methods such as diet pills or surgery have potentially serious side effects and often do not show long-term benefit. In an attempt to find a less invasive and effective modality of treatment, traditional Chinese medicine, particularly acupuncture and auriculotherapy, has become a topic of research in this field. The authors conducted a review of the current evidence regarding the use of auricular and body acupuncture in the treatment of obesity from their beginning to June 2014. Any published trial using randomized assignment to the intervention and control groups, in full text were included. Overall, moderate evidence in favor of acupuncture over exercise in the treatment of obesity was found. However, due to the limitations of the published studies in this field, it is necessary to conduct a large high quality randomized controlled trial in order to determine whether acupuncture should be used as a treatment modality to achieve weight loss in obese individuals.摘要肥胖现已成为患者和医生一大共同的健康难题。因生活方式及生活质量等原因, 节食和运动虽是主要的减肥方法, 但其依从性却往往不高。其他诸如药物及手术等方法则有潜在的严重副作用, 且远期效果并不理想。为寻找一种有效且副作用小的疗法, 中医药尤其是针刺和耳针疗法已成为这一领域的一个研究主题。因此, 将2014 年6 月以前全文发表的以针刺及耳针疗法治疗肥胖的随机对照试验纳入综述。结果发现: 与运动相比, 针刺治疗减肥的效果具有一定优势。然而, 因现有研究的局限性, 仍需大样本的随机对照试验来证实针刺是否应该纳入减肥的常规治疗。

Concern with meta-analysis of acupuncture for neck pain.

Dear Editor: In the review ‘‘Randomized Controlled Trials of Acupuncture for Neck Pain: Systematic Review and Meta-Analysis,’’ Dr. Fu and colleagues found 29 randomized trials on acupuncture treatment for neck pain, and determined that only 14 of those trials were eligible for their review. The authors then performed nine meta-analyses under various objectives to assess the effects of acupuncture on neck pain. In their metaanalysis examining the effect of acupuncture for treatment of cervical radiculopathy, only one of the three studies used was included in the original systematic review. The other two studies had been excluded because their full reports were not available in English, and so only the data published in their abstracts were pooled. Based on the results from this metaanalysis, the authors concluded that acupuncture was effective for cervical nerve root pain from the statistical standpoint. Aside from limitations with using data from abstracts alone in meta-analyses, a bigger concern that warrants our attention is that these two studies did not meet the inclusion criteria stated in the systematic review. One of the inclusion criteria established by the review authors was that subjects participating in the study had neck pain for at least a month. However, upon reviewing the abstracts of these studies, we found that neither of them explicitly stated the duration of neck pain subjects had experienced prior to their participation in the study. Thus, these two studies should not have been used in the meta-analysis, and the conclusion drawn from it must be interpreted with caution. Disclosure Statement