Background The Massachusetts General Hospital Acupuncture Sensation Scale (MASS) is a tool to measure needle sensations. The aims of the present study were to develop a Chinese version and to assess its psychometric properties. Methods This study was a methodological and exploratory study. The English version of the MASS was translated into Chinese using standardised translation procedures. Content validity was conducted by nine acupuncture experts. The prefi nal Chinese version (C-MASS) was then administered to 30 acupuncture-naïve, healthy subjects. Electroacupuncture was performed on the right LI4 and LI11 acupoints for 30 min. A test-retest reliability measurement was administered 1-2 weeks later. Construct validity was examined by comparing results from C-MASS and the Short-Form McGill Pain Questionnaire (SF-MPQ). The construct validity was further assessed by the principle component analysis. Results C-MASS demonstrated a content validity ratio on relevance and importance from −0.04 to 1.00. Convergent validity was demonstrated by its signifi cant association with the sensory dimension of p<0.05). Discriminant validity was demonstrated by its low association with the affective dimension of p=0.111). A fi ve-factor structure of C-MASS was established by factor analysis. C-MASS demonstrated good internal consistency (Cronbach's α=0.71) and test-retest reliability (intraclass correlation coeffi cient=0.92). Since the descriptor 'sharp pain' was not a valid needle sensation related to deqi, this was removed from C-MASS. We renamed the scale as the Modifi ed MASS-Chinese version (C-MMASS). Conclusions A 12-descriptor C-MMASS was established and shown to be a reliable and valid tool in reporting needle sensations associated with deqi among healthy young Chinese people. INTRODUCTIONAcupuncture has been widely used in China for thousands of years.1-3 One of the fundamental characteristics of acupuncture is to 'obtain qi' during acupuncture, a sensation referred to as 'deqi'. Based on the concept of traditional Chinese medicine (TCM), qi must fl ow in correct strength and quality along the meridians so that health can be maintained. It was believed that restoration of health can only be achieved if the acupuncture technique is able to elicit deqi, thereby allowing the fl ow of qi to be altered.3 4 While investigations of the relationship between the therapeutic effectiveness of acupuncture and the deqi experience have been reported in the literature, 3 5-7 scientifi c evidence to support such a relationship is still lacking. 7When deqi occurs, the acupuncturist and the subject may experience some 'unusual' sensations around the needle. The acupuncturist may perceive heaviness or tenseness around the needle when qi arrives. 8 However, the feelings of the acupuncturist are more often subjected to biased preconceptions of 'what one ought to feel' and thus hold greater likelihood of a biased subjective report. 9 In recent years, researchers have focused more on sensations perceived by the subjects. Standard ...
Background Studies on the relationship between de qi intensity and activity changes in the autonomic nervous system (ANS) are scarce. This study investigates the physiological responses associated with de qi. The relationship between de qi intensity and such responses was determined. Method This was a single-blinded, randomised, placebo-controlled trial. A total of 36 subjects (19 men, 17 women), aged 34.5±4.6 years, were randomly assigned to group 1 (electroacupuncture at 2 Hz, 0.4 ms to right LI4 and LI11 for 30 min), group 2 (electroacupuncture stimulation to bilateral patellae) or group 3 (sham electroacupuncture to right LI4 and LI11 but over Duoderm pads). Heart rate (HR), mean arterial blood pressure (MAP) and HR variability by low/high frequency (LF/HF) were recorded 5 min before, during and 5 min after the intervention. Needle sensations were quantified by the Modified Massachusetts General Hospital Acupuncture Sensation Scale – Chinese version (C-MMASS) and the C-MMASS index was computed. Results A significant increase in LF/HF, MAP and HR was observed in group 1. A small and significant increase in LF/HF was observed in group 2 but the changes in MAP and HR in groups 2 and 3 were not significant. The C-MMASS index was highest in group 1 (5.3±1.3), moderate in group 2 (3.5±0.7) and lowest in group 3 (0.77±0.2). A positive correlation between de qi intensity and changes in LF/HF, MAP and HR was observed. Conclusions This study suggests that de qi is associated with physiological changes, and that de qi intensity increases with an increase in sympathetic discharge of the ANS.
Objectives: To assess the impact of a 90-second animated video on parents' interest in receiving an antibiotic for their child. Study design:This pre-post test study enrolled English and Spanish speaking parents (n=1051) of children ages 1-5 years presenting with acute respiratory tract infection symptoms. Before meeting with their provider, parents rated their interest in receiving an antibiotic for their child, answered six true/false antibiotic knowledge questions, viewed the video, and then rated their antibiotic interest again. Parents rated their interest in receiving an antibiotic using a visual §
BackgroundChildren with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical.ObjectivesCompare two feasible (higher vs lower intensity) interventions for enhancing parent–clinician communication on the rate of inappropriate antibiotic prescribing.DesignMultisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019.SettingAcademic and private practice outpatient clinics.ParticipantsClinicians (n=41, 85% of eligible approached) and 1599 parent–child dyads (ages 1–5 years with ARTI symptoms, 71% of eligible approached).InterventionsAll clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video.Main outcome(s) and measure(s)Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales).ResultsMost clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent–child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%)<2 years). Inappropriate antibiotic prescribing was similar among patients who consulted with a higher intensity (54/696, 7.8%) versus a lower intensity (85/904, 9.4%) clinician. A generalised linear mixed effect regression model (adjusted for the two-stage nested design, clinician type, clinic setting and clinician experience) revealed that the odds of receiving inappropriate antibiotic treatment did not significantly vary by group (AOR 0.99, 95% CI: 0.52 to 1.89, p=0.98). Secondary outcomes of revisits and adverse reactions did not vary between arms, and parent ratings of satisfaction with quality of parent–provider communication (5/5), shared decision making (9/10) and visit satisfaction (5/5) were similarly high in both arms.Conclusions and relevanceRate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years.Trial registration numberNCT03037112.
IntroductionChildren with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent–provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent–provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent–provider communication and visit satisfaction (secondary outcomes).Methods/analysisWe will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic children’s hospital and a private practice. Using a 1:1 randomisation, providers will be assigned to a higher intensity education and communication skills or lower intensity education-only intervention and trained accordingly. We will recruit 1600 eligible parent–child dyads. Parents of children ages 1–5 years who present with ARTI symptoms will be managed by providers trained in either the higher or lower intensity intervention. Before their consultation, all parents will complete a baseline survey and view a 90 s gain-framed antibiotic educational video. Parent–child dyads consulting with providers trained in the higher intensity intervention will, in addition, receive a gain-framed antibiotic educational brochure promoting cautious use of antibiotics and rate their interest in receiving an antibiotic which will be shared with their provider before the visit. All parents will complete a postconsultation survey and a 2-week follow-up phone survey. Due to the two-stage nested design (parents nested within providers and clinics), we will employ generalised linear mixed-effect regression models.Ethics/disseminationEthical approval was obtained from the Children’s Mercy Hospital Pediatric Institutional Review Board (#16060466). Results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03037112; Pre-results.
What was the research about?Each year, millions of children take antibiotics to treat ear, nose, throat, and chest infections. Antibiotics don't work to treat infections caused by viruses, such as the common cold or flu. Educating parents and clinicians, such as doctors and nurses, about antibiotic use may help reduce unneeded prescriptions.
This study showed that 'acupuncture point sensations' were experienced during acu-TENS to LI4 and LI11, but such sensations were not associated with physiological responses induced during the stimulation.
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