significant. These event rates are per consultation, and they do not give the risk per individual patient.Demographic data suggest that the acupuncturist volunteers were reasonably representative of the members of the two societies, but over-reporting and underreporting are inherently possible in such studies. High individual rates may be due to a low personal threshold for reporting, or they may indicate the need for further training of the acupuncturist. Some avoidable adverse events occurred, and acupuncturists might consider modifying their practice to reduce the incidence of such events.We thank members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists for collecting data, Mike Fitter and Hugh MacPherson for advice in designing the questionnaire, and Val Hopwood for help in recruiting volunteers.Contributors: EE, SH, and AW planned the study, which was supervised by AW. The data were collected by members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. The results were collated by AW, and AH performed the statistical analysis. The final report was written by AW, SH, AH, and EE. AW and EE will act as guarantors.Funding: The posts of AW and EE are funded by the Maurice Laing Foundation.Competing interests: AW has received fees for lecturing at scientific and educational meetings arranged by the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. SH has received fees for lecturing and for acting as editor of the professional journal of the British Medical Acupuncture Society, Acupuncture in Medicine.

IBS affects patients through reduced quality of life, more time off work and greater healthcare utilisation than a control group of patients without IBS. The difference in quality of life was pronounced and unusual in that it was influential in every dimension of both the SF-36 and the EQ-5D.

Evidence from this study supports the CRQ and the SF-36 as comprehensive outcome measures for patients with longstanding COPD.

Satisfaction with care, use of services, and personal costs were also monitored. Results:The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P = 0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03). No significant differences were found between the groups in health status. Mean total NHS costs were £878.06 per year for the clinic group and £859.34 for the control (P = 0.89). Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used.

The paper describes the type and frequency of adverse events and transient reactions following consultations with professional acupuncturists. In a postal survey, involving 1848 professional acupuncturists, all of whom were members of the British Acupuncture Council and practising in the UK, details of adverse events and transient reactions following treatment were recorded on standardised self-report forms. A sample size of 30,000 treatments was sought, and piloting indicated that a four-week period was required. Practitioners also provided information on themselves, including age, sex, length of training and years of practice. A total of 574 practitioners responded, 31% of the total population. These practitioners reported on adverse events and transient reactions associated with 34,407 treatments. No serious adverse events were reported, where these were defined as requiring hospital admission, prolonging hospital stays, permanently disabling, or resulting in death (95% CI: 0 to 1.1 per 10,000 treatments). A total of 43 significant minor adverse events were reported, a rate of 1.3 per 1,000 treatments (95% CI: 0.9 to 1.7). These included severe nausea and actual fainting (12), unexpected, severe and prolonged aggravation of symptoms (7), prolonged and unacceptable pain and bruising (5) and psychological and emotional reactions (4). There were three avoidable events: two patients had needles left in by mistake, and one patient had moxa burns to the skin, also caused by practitioner error. The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments, 15% (95% CI: 14.6 to 15.3) of the 34,407 total. In terms of local reactions, there were reports of mild bruising (1.7%), pain (1.2%) and bleeding (0.4%). Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8% of treatments. The most common mild transient reactions to treatment were feeling relaxed (11.9%) and feeling energised (6.6%). In this prospective survey of 34,407 treatments, practitioners reported no serious adverse events. This conclusion was based on data collected from one in three members of the British Acupuncture Council. Given that the whole membership delivers between one and a half and two million treatments a year, this is important evidence on public health and safety. When compared with medication routinely prescribed in primary care, the results suggest that acupuncture is a relatively safe treatment modality.