Det har længe været vores ønske, at gøre akupunkturnyt mere interaktivt, og det resulterede i disse sider, hvor vi, som noget nyt, har givet plads til kommentarer fra læserne.
Betingelserne er som altid:
Du er professionel udøver af evidensbaseret akupunktur.
Du har lyst til at deltage i en sober debat om evidensbaseret akupunktur
Du vil til gengæld løbende kunne orientere dig om, hvad der sker indenfor den evidensbasere akupunktur.
Du vil også blive holdt orienteret om de kurser Dansk Selskab for Akupunktur udbyder på akupunkturkursus hjemmesiden.
Som noget helt nyt, kan du nu downloade Palle Rosteds nye bog, HELT GRATIS.
Forskningsenheden for Almen Praksis indbyder interesserede læger, til at deltage i et forskningsprojekt om akupunkturs effekt på kvinders symptomer i overgangsalderen.
De inkluderede kvinder vil alle være noget til meget plaget af hedeture i overgangsalderen. De får alle tilbudt 5 akupunkturbehandlinger svarende til en ugentlig behandling i 5 på hinanden følgende uger. Alle kvinder skal modtage samme behandling i følgende punkter: CV-3, CV-4, LR-8, SP-6, SP-9. Ialt 8 separate punkter, idet LR8, SP6, SP9 gives bilateralt (bilag 1 og 3). Efter indsættelse af nålen roteres denne i få sekunder for at opnå de-qi (nålefornemmelse). Herefter retineres nålen i 10 minutter uden yderligere stimulation. Derefter bliver nålene fjernet. Sideløbende med akupunkturbehandlingerne skal kvinderne på udvalgte tidspunkter udfylde et spørgeskema om symptomer fra overgangsalderen. Disse spørgeskemaer bliver sendt til kvinderne elektronisk, og er ikke noget du, som behandlende læge, behøver at være involveret i.
Artiklen her understreger et par væsentlige pointer: punktvalg bør være lokalt (hvorfor fjernpunkter bør undgås), akupunkturs virkningsmekanisme er knyttet til neurofysiologi og segmental akupunktur virker!
I midten af 2012 måtte jeg på grund af sygdom aflyse de resterende kurser resten af året. I marts 2013 mente jeg, at jeg var klar til at tage fat igen. Det var langt fra tilfældet, og først nu føler jeg, at jeg er oppe på fuld kraft.
Imidlertid havde man opsagt overenskomsten med virkning pr. 01-09-2013, og i resten af foråret og indtil midten af sommeren var lægerne ved at gøre sig kampklar til en storkonflikt. Imidlertid blev resultatet af PLO’s afstemning, at lægerne skulle acceptere regeringens modificerede lovforslag.
Som en konsekvens af denne mulige konflikt var samtlige kurser i efteråret aflyst. Da det ydermere var blevet sommer, og ferieperioden var begyndt, kunne enhver chance om at påbegynde planlægning af kommende kurser ikke påbegyndes før i slutningen af august.
Det at arrangere et kursus tager tid. Hvis man ikke lige har en gruppe, der kan deltage i et planlagt kursus med kort varsel, skal man mindst planlægge kurset tre måneder i forvejen, ofte skal man bruge et halvt år for at få det til af fungere.
Derfor blev DSEA’s bestyrelse enige om, at vi måtte udskyde samtlige kurser til vinteren og foråret 2014. Imidlertid havde en gruppe læger og kiropraktorer længe bedt mig om at lave kurset Bevægeapparatet II, og derfor indvilligede jeg i at lave kurset 30-11-2013 og 01-12-2013. kurset foregår i Odense på Den Gamle Kro. Overnatning finder sted på det nærliggende City Hotel. Der er fortsat ledige pladser. Yderligere oplysninger kan findes på: http://dsea.dk/kursus.html
På tandlægefronten har vi også fået sat to kurser på plads i 2014, Det første er Begynderkurset 21-22 februar 2014 og det avancerede kursus 7-8 marts 2014. Begge kurser foregår i Odense på Den Gamle Kro. Overnatning finder sted på det nærliggende City Hotel. Yderligere oplysninger kan findes på: http://dsea.dk/kursus.html
Fremtiden
Hvad er planerne for resten af året? Den nøjagtige tid og sted er endnu ikke fastlagt, men to yderligere kurser er planlagt i foråret med titlerne:
Bevægeapparatet I – formentlig april/maj 2014.
Akupunktur – ortopædi og idrætsmedicin – formentlig maj/juni 2014.
Akupunktur og viscerale – myogene og neurogene smerter – formentlig august/september 2014.
Bevægeapparatet III – formentlig oktober/november 2014.
Bevægeapparatet II – formentlig november/december 2014.
Jeg regner med at kunne fremlægge et færdigt kursusprogram i midten af oktober. Jeg er på ferie resten af september.
Som jeg har meddelt under referat af Generalforsamlingen i marts 2013, skete der flere ting under generalforsamlingen.
For det første blev det besluttet, at der skulle rekrutteres flere undervisere, og to af dem ortopædkirurgen Bent Pedersen og alment praktiserende læge Anders Rasmussen er allerede i gang med oplæringen.
I takt med tidens tand, er det efterhånden praksis, at alle faggrupper skal akrediteres og re-akkrediteres. Dette er allerede introduceret på sygehusene, hvor denne akreditering og re-akkreditering skal foregå efter Dansk Kvalitets Model. Mange vil måske synes, at det ikke er nødvendigt, men når man ser hvorledes det går i Danmark og den øvrige Verden, kan I ligge så godt vænne Jer til tanken med det samme. Om et år eller to bliver det et krav fra Sundhedsstyrelsen eller et andet organ. Bestyrelsen er i gang med at lave den endelige planlægning af programmet. I vil høre mere herom senere, efterhånden som vi får løst opgaverne.
Når vi har fået styr på det vil der efterfølgende være en liste, hvis medlemmerne ønsker at være inkluderet i denne liste, på akupunktur, hvor eventuelle patienter kan søge oplysninger om akkrediterede medlemmer inden for de tre søjler.
Imidlertid vil vi gerne være på forkant med fremtiden, og derfor har vi allerede nu lavet en kursusrække, hvor vi kan tilbyde medlemmerne en alsidig uddannelse, der opfylder disse krav om akkreditering og re-akkreditering.
Cheuk DKL, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007849. DOI: 10.1002/14651858.CD007849.pub2.
Background
Autism spectrum disorders (ASD) are characterized by impairment in social interaction, impairment in communication and lack of flexibility of thought and behavior. Acupuncture, which involves the use of needles or pressure to specific points on the body, is used widely in Traditional Chinese Medicine and increasingly within a western medical paradigm. It has sometimes been used as a treatment aimed at improving ASD symptoms and outcomes, but its clinical effectiveness and safety has not been rigorously reviewed.
Objectives
To determine the effectiveness of acupuncture for people with ASD in improving core autistic features, as well as communication, cognition, overall functioning and quality of life, and to establish if it has any adverse effects.
Search methods
We searched the following databases on 30 September 2010: CENTRAL (The Cochrane Library, 2010, Issue 3), MEDLINE (1950 to September 2010 Week 2), EMBASE (1980 to 2010 Week 38), PsycINFO, CINAHL, China Journal Full-text Database, China Master Theses Full-text Database, China Doctor Dissertation Full-text Database, China Proceedings of Conference Database, Index to Taiwan Periodical Literature System, metaRegister of Controlled Trials and the Chinese Clinical Trials Registry. We also searched AMED (26 February 2009) and Dissertation Abstracts International (3 March 2009), but these were no longer available to the authors or editorial base at the date of the most recent search. TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System) was last searched on 3 March 2009.
Selection criteria
We included randomized and quasi-randomized controlled trials. We included studies comparing an acupuncture group with at least one control group that used no treatment, placebo or sham acupuncture treatment in people with ASD. We excluded trials that compared different forms of acupuncture or compared acupuncture with another treatment.
Data collection and analysis
Two review authors independently extracted trial data and assessed the risk of bias in the trials. We used relative risk (RR) for dichotomous data and mean difference (MD) for continuous data.
Main results
We included 10 trials that involved 390 children with ASD. The age range was three to 18 years and the treatment duration ranged from four weeks to nine months. The studies were carried out in Hong Kong, mainland China and Egypt.
Two trials compared needle acupuncture with sham acupuncture and found no difference in the primary outcome of core autistic features (RFRLRS total score: MD 0.09; 95% CI -0.03 to 0.21, P = 0.16), although results suggested needle acupuncture might be associated with improvement in some aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning.
Six trials compared needle acupuncture plus conventional treatment with conventional treatment alone. The trials used different primary outcome measures and most could not demonstrate effectiveness of acupuncture in improving core autistic features in general, though one trial reported patients in the acupuncture group were more likely to have improvement on the Autism Behavior Checklist (RR 1.53; 95% CI 1.09 to 2.16, P = 0.02) and had slightly better post-treatment total scores (MD -5.53; 95% CI -10.76 to -0.31, P = 0.04). There was no evidence that acupuncture was effective for the secondary outcome of communication and linguistic ability, though there seemed to be some benefit for the secondary outcomes of cognitive function and global functioning.
Two trials compared acupressure plus conventional treatment with conventional treatment alone and did not report on the primary outcome. Individual study results suggested there may be some benefit from acupressure for certain aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning.
Four trials reported some adverse effects, though there was little quantitative information, and at times both intervention and control groups experienced them. Adverse effects noted included bleeding, crying due to fear or pain, irritability, sleep disturbance and increased hyperactivity. None of the trials reported on quality of life.
There are a number of problems with the evidence base: the trials were few in number and included only children; six of the trials were at high risk of bias; they were heterogeneous in terms of participants and intervention; they were of short duration and follow-up; they reported inconsistent and imprecise results, and, due to carrying out large numbers of analyses, they were at risk of false positivity.
Authors’ conclusions
Current evidence does not support the use of acupuncture for treatment of ASD. There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults. Further high quality trials of larger size and longer follow-up are needed.
Plain language summary
Acupuncture for people with autism spectrum disorders (ASD)
Autism spectrum disorders (ASD) are lifelong disorders of development. People with ASD have particular difficulties with social interaction and communication and they lack flexibility in their thinking and behavior. No cure is currently available but interventions may improve symptoms. Acupuncture involves using needles or pressure on specific areas of the body and is an important therapeutic method in Traditional Chinese Medicine. It is also being used more and more in countries in the west for a range of ailments. Acupuncture has been considered as a possible intervention to improve ASD symptoms, but it has not been thoroughly evaluated to see if it works and is safe.
We wanted to evaluate the effectiveness and safety of acupuncture for ASD by systematically reviewing all studies of acupuncture for ASD where people were randomly allocated to a treatment or control group (placebo, sham or no treatment), i.e. randomized controlled trials (RCTs). We searched through 15 databases, most recently in September 2010, and read over the titles and abstracts to make sure we identified everything relevant. We found10 RCTs to include in this review. These studies, which were carried out in Hong Kong, mainland China and Egypt, involved 390 children aged between three and 18 years.
Two studies compared needle acupuncture with sham acupuncture and found no difference in core autistic features. Results did suggest that needle acupuncture might be associated with improvement in other areas of communication and linguistic ability, cognitive function and global functioning.
Six studies compared needle acupuncture plus conventional treatment with conventional treatment alone. They used a range of tools to measure core autistic features and most could not show that acupuncture led to improvement in these. One trial did report, though, that needle acupuncture led to an improvement in scores on Autism Behavior Checklist. There was no evidence for improvement due to acupuncture on communication and linguistic ability but it might be beneficial for cognitive function and global functioning.
Two studies compared acupressure plus conventional treatment with conventional treatment alone and found no difference in core autistic features, although acupressure seemed to improve some aspects of the secondary outcomes.
Problems that were noted by parents of study participants included crying due to fear or pain, bleeding, sleep disturbance and increased hyperactivity. It is unclear if these were due to the acupuncture treatment. Half of the trials reported some negative effects but did not report how often or how severe these were and sometimes the problems occurred in both the treatment and control groups. None of the studies used measures of quality of life.
Overall, acupuncture did not seem to be effective in improving core features of ASD but it might have improved certain developmental and functioning outcomes, at least in the short term.
There are problems with assessing acupuncture due to the quality of the evidence. There were a small number of studies and they were all conducted with children. Moreover, there is a high likelihood that they may have been biased due to the methods used not being rigorous enough, the wide variety in the people and interventions in the studies, the inconsistent and imprecise reporting of results and the large number of analyses carried out, which make it more likely a significant result will be found just by chance.
In conclusion, current evidence does not support the use of acupuncture for the treatment of ASD. We need high quality trials of larger size and longer follow-up as the evidence base at present has many limitations
Mumps is an acute, viral illness transmitted by respiratory droplets and saliva. A number of studies published in China have suggested that acupuncture is beneficial for children with mumps but the literature reporting the benefits or harms of acupuncture for mumps has not been systematically reviewed.
Objectives
To determine the efficacy and safety of acupuncture for children with mumps.
Search methods
We searched CENTRAL (2012, Issue 4), MEDLINE (1950 to April week 4, 2012), EMBASE (1974 to May 2012), CINAHL (1981 to May 2012), AMED (1985 to May 2012), the Chinese BioMedicine Database (CBM) (1979 to May 2012), China National Knowledge Infrastructure (CNKI) (1979 to May 2012), Chinese Technology Periodical Database (CTPD) (1989 to May 2012) and WANFANG database (1982 to May 2012). We also handsearched a number of journals (from first issue to current issue).
Selection criteria
We included randomised controlled trials comparing acupuncture with placebo acupuncture, no management, Chinese medication, Western medication or other treatments for mumps. Acupuncture included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation (body, electro, scalp, fire, hand, fine needle, moxibustion).
Data collection and analysis
Two review authors independently extracted data and assessed the quality of included studies. We calculated risk ratios (RR) with their 95% confidence intervals (CI) for the effective percentage and standardised mean differences (SMD) with 95% CIs for the time to cure.
Main results
Only one study with 239 participants met our inclusion criteria. There were a total of 120 participants in the acupuncture group, of which 106 recovered, with their temperature returning back to normal and no swelling or pain of the parotid gland; the condition of 14 participants improved, with a drop in temperature and alleviation of swelling or pain of the parotid gland. There were 119 participants in the Western medicine group, of which 56 recovered and the condition of 63 improved. The acupuncture group had a higher recovery rate than the control group. The relative RR of recovery was 1.88 (95% CI 1.53 to 2.30). However, the acupuncture group had a longer time to cure than the control group. The mean was 4.20 days and the standard deviation (SD) was 0.46 in the acupuncture group, while in the control group the mean was 3.78 days and the SD was 0.46.There was a potential risk of bias in the study because of low methodological quality.
Authors’ conclusions
We could not reach any confident conclusions about the efficacy and safety of acupuncture based on one study. More high-quality research is needed.
Acupuncture has been used to treat children with mumps for hundreds of years in China. Benefits attributed to acupuncture include decreased swelling and pain, and shortening of the disease duration. According to traditional Chinese medicine, health is achieved by maintaining an uninterrupted flow of Qi, or energy, along 14 meridians. Mumps is caused by ‘wind warmth evil’ (epidemic heat) and ‘pyretic toxicity’ accumulated in Shaoyang and Yangming meridians, thus the flow of Qi, sputum and ‘heat evil’ stagnate in and around the ears and the cheeks. Acupuncture can help expel ‘wind warmth evil’, clear pathogenic heat, remove toxic substances, act as an anti-inflammatory, alleviate pain and re-establish the normal flow of Qi, thus restoring internal balance.
Although acupuncture has been widely used in China for children with mumps and quite a number of trials claiming to be randomised controlled trials have been published, we identified only one study with 239 participants that met our inclusion criteria. The study results suggest that acupuncture may be beneficial in improving swelling and pain of the parotid gland and returning the body temperature to normal. However, the included study is of low methodological quality and did not report adverse effects and long-term follow-up. Therefore, we could not draw any definite conclusions about the efficacy and safety of acupuncture for children with mumps.
Deltagere fra bestyrelsen: Annette (L), Ivan (L), Bent (L), Palle (L), Mads (TL) og Annie (K).
Øvrige deltagere:Dorte (K), Kim (K) og Thomas (K).
1
Valg af dirigent
Bent blev valgt til dirigent. Han kunne meddele at General-forsamlingen var blevet indvarslet rettidigt. Ligeledes kunne han oplyse, at der under “Eventuelt” var 3 punkter, der alle var meddelt bestyrelsen retettidigt og derfor kunne behandles under punktet eventuelt.
Valg af dirigent blev godkendt af generalforsamlingen.
2
Formandens beretning
Formanden måtte indledningsvis beklage, at hans aktivitetsniveau de sidste 9 måneder havde været stærkt reduceret pga. sygdom. Han var nu så restitueret, så han var klar til at tage fat igen.
Ved den sidste fintælling var der 60 læger, 40 tandlæger og 43 kiropraktorer, totalt 143.
I øvrigt har min sygdom bevirket, at vi har måtte aflyse et par kurser. Det vigtigste var kurset på Lanzarote i januar 2013. I september 2012 nåede vi at afholde bevægeapparatet I og Tandlæger I.
Pga. den verserende konflikt er al kursusaktivitet i resten af 2013 blevet udskudt.
Formanden meddelte, at han planlagde et generationsskifte, der indebar, at flere medundervisere ville blive rekrutteret ved fremtidige kurser.
Formandens berretning blev godkendt af generalforsamlingen.
3
Kasserens beretning
Der er fortsat intet kontingent for at være medlem af DSEA, og kasseren foreslog, at vi skulle bibeholde denne holdning.
Kasserens beretning blev godkendt af generalforsamlingen.
4
Valg af bestyrelse
Formand læge Palle Rosted
Næstformand tandlæge Mads Bundgaard
Sekretær læge Anders Rasmussen
Læge Annette jørgensen
Læge Ivan Bo Nielsen
Læge Bent Pedersen
Kiropraktor Annie W Mikkelsen
Undervisningsudvalg
Formand læge Palle Rosted
Tandlæge Mads Bundgaard
Læge Annette jørgensen
Læge Ivan Bo Nielsen
Læge Bent Pedersen
Læge Anders Rasmussen
Kiropraktor Annie W Mikkelsen
Videnskabeligt udvalg
Formand læge Palle Rosted
Næstformand tandlæge Mads Bundgaard
Læge Bent Pedersen
Læge Ivan Bo Nielsen
Læge Annette Jørgensen
Ad hock medlemmer
Læge Frans Wallendorf
Tandlæge Anne Marie Pedersen
Representanter til DMS
Formand læge Palle Rosted
Læge Annette jørgensen
Valg til bestyrelse og udvalg blev godkendt af generalforsamlingen.
Eventuelt
Indkomne forslag til generalforsamlingen.
1
Refusion fra sygeforsikringer
Forslag til nedsættelse af udvalg med medlemmer fra hver af
de tre søjler.
Formålet er at få de relevante private sygeforsikringer til at udmelde kriterierne for at patienter kan modtage refusion for behandling med akupunktur blandt læger, tandlæger og kiropraktorer.
Ivan, Annie og Mads er gået gang med at undersøge problemet.
2.
Akkreditering
I tråd med andre lande, og til en vis grad også Danmark, er det blevet en rutine, at læger og andre faggrupper skal akkrediteres og gen-akkrediteres hvert femte år.
Da vort stærkeste middel på langt sigt overfor sygeforsikringerne er vor uddannelse, vil vi foreslå en akkrediteringsmodel.
Vi har allerede skitseret kravene for et diplom inden for de enkelte søjler.
Det vi blot skal definere er, hvor mange timer vi skønner er tilstrækkeligt, for at blive godkendt de næste fem år.
Imidlertid kan dette punkt først løses, når der er enighed om kravene til uddannelsen i DSEA’s regi. Dette problem arbejder undervisningsudvalget på i øjeblikket og påregner at have et konkret oplæg til godkendelse på næste generalforsamling.
