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The author discusses the influence of Chinese medicine in Australia and the establishment of the Chinese Medicine Board of Australia (CMBA). She presents three papers on topics such as dry needling, mentoring, and practitioners' views on acupuncture. She also mentions how dry needling became famous in Australia and its threat to the safety public due to some practicing dry needling without proper training.

Anterior knee pain is a chronic condition that presents frequently to sport medicine clinics, and can have a long-term impact on participation in physica activity. Conceivably, effective early management may prevent chronicit and facilitate physical activity. Although a variety of nonsurgical interven' tions have been advocated, previous systematic reviews have consistenty been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for non- surgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EM- BASE, CINAHL® and Pre-CINAHL®, PEDro, PubMed, SportDiscus®, Web of Science®, BIOSIS Previews®, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical inter- vention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta- analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography bio- feedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64,0.21; 8-12 weeks: SMD -0.22,95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required. [ABSTRACT FROM AUTHOR]

In 2012, traditional Chinese medicine (TCM) practitioners in Australia became nationally-registered allied health professionals in three categories: acupuncturist, Chinese herbal medicine practitioner, and Chinese herbal medicine dispenser. Australia was the first Western country to introduce national registration for Chinese medicine, followed by Portugal and, recently, New Zealand. The practice of TCM in Australia can be traced back to the beginning of Chinese immigration to Australia during the Victorian Gold Rush which began in the 1850s. The process which led to national registration commenced in the early 1970s with the establishment of the first acupuncture courses. Decades of gradual development of courses from unaccredited part-time diplomas to accredited bachelor degrees, and the development, by the profession, of national consensus on educational standards were essential elements in the process which led to registration. Professional associations, such as the Australian Acupuncture and Chinese Medicine Association Ltd. (AACMA), also developed a framework of professional selfregulation, including Codes of Ethics, Codes of Conduct, ongoing professional development requirements and Infection Control Guidelines, and provided leadership in the development of the profession. After decades of tribalism and division within the TCM profession, the National Academic Standards Committee brought almost all stakeholders together to reach a consensus on the Australian Guidelines for Traditional Chinese Medicine Education which were published by AACMA in 2001. Professional associations also collaborated on joint submissions to the government in support of registration, which was introduced first in the state of Victoria in 2000, and subsequently became national in 2012. Despite national registration, some barriers still remain, and professional associations continue to lobby the federal government for inclusion in Medicare, chronic disease management scheme, and Veterans Affairs. [ABSTRACT FROM AUTHOR]

Background: Many people with mental health problems use a range of complementary medicine (CM), including over the counter products, practices, and utilise the services of CM practitioners. Psychologists are likely to consult with clients using CM, in some form, as part of their broader mental health care. The aim of this research was to determine the number of types of CM products, practices, and practitioners are recommended and/or referred by Australian psychologists as part of their clinical practice, as well as explore the relationship between psychologists' perspectives on the risk and relevance of engaging with CM in psychology. Methods: Survey data was collected from psychologists in clinical practice who self-selected to participate in the study via an online 79-item questionnaire exploring core aspects of CM engagement in psychology clinical practice. Results: Amongst the 201 psychologists, 5% reported not recommending any type of CM, with 63% recommending four or more types of CM. Further, 25% had not referred to a CM practitioner, while 33% had referred to four or more types of CM practitioner. Psychologists are recommending and referring to CM even when they perceive their knowledge of CM to be poor, and that engaging with CM was a risk. Conclusion: This study provides insights into psychologist perceptions of CM within psychology practice and how these perceptions are associated with rates of recommending and referring to CM as part of their clinical practice. These findings may inform the development of CM relevant education and guidelines for psychologists. [ABSTRACT FROM AUTHOR]

Objectives: Chinese medicine is a complex domain of theoretical and practical approaches that is being increasingly put under the research spotlight. The "Chinese Medicine in Australia"research project attempted to capture the clinical features of practitioners of Chinese medicine. Participants and Interventions: The project involved a national survey of Chinese medicine professional association members and registered practitioners in the state of Victoria, Australia (n = 655; response rate, 42%-55%) completed in 2012-2013. Design: The content and face validated survey was developed using new and previous workforce survey questions. Results: This paper reports on the workforce and practice characteristics of the survey respondents. Chinese medicine practitioners are highly educated, come from diverse backgrounds, and have chosen to practice predominantly in sole or multipractitioner private practice settings. An interest in the philosophy of Chinese medicine and previous experiences contributed to practitioners' decisions to study and practice Chinese medicine. Incorporating a variety of techniques, practitioners describe themselves as practicing predominantly Chinese acupuncture and herbal medicine. Conclusions: The results from this survey contribute to the understanding of the nature and description of Chinese medicine practice in Australia. [ABSTRACT FROM AUTHOR]

Like acupuncture, dry needling involves the insertion of acupuncture needles into specific points on the body to improve health. Unlike acupuncture, the practice of dry needling is unregulated in Australia. This paper challenges the notion that dry needling is not a part of acupuncture practice and also examines the risks associated with the practice of dry needling from a public health perspective. The practice of acupuncture and dry needling are first examined and compared to identify commonalities. A review into the incidence of risks of dry needling reveals very limited literature with only one case report and no review articles identified. Based on the similarities between acupuncture and dry needling, the extensive literature on the serious risks of acupuncture is extrapolated to evaluate the risks of dry needling. Dry needling is not a new or separate practice to acupuncture; rather it is a subsystem of musculoskeletal acupuncture which has been practised continuously for at least 1 400 years. Dry needling is a pseudonym for a brief course of study in myofascial acupuncture also known as ashi acupuncture and trigger point acupuncture. Dry needling is likely to result in an increased incidence of serious risks, particularly pneumothorax, due to the short training courses and deep needling techniques which typify the practice. In the interest of public health and safety, the practice of dry needling should be restricted to suitably qualified practitioners. [ABSTRACT FROM AUTHOR]

The implementation of the National Registration and Accreditation Scheme for the Health Professions incorporates the registration of acupuncturists under the Chinese Medicine Board of Australia from 1 July 2012. Other registered health professionals will still be able to use the title acupuncturist if their board determines that they are suitably qualified to have their registration endorsed for acupuncture. This paper aims to identify the various education and training standards underpinning the practice of acupuncture among the health professions in Australia and create a reference point to determine the impact of registration on future acupuncture education standards. A literature search was conducted to identify scholarly works on acupuncture education standards as well as a search of standard setting bodies and course providers. Results were tabulated for comparison. There is very little literature on acupuncture education standards in Australia despite its practice by a diverse range of health professions. Acupuncture practitioners can be categorised into four groups: Chinese medicine practitioners, medical practitioners, registered allied health practitioners and non-registered health practitioners. The highest education standards are demonstrated by Chinese medicine practitioners who typically complete at least a four year undergraduate degree, whereas the latter two groups appear to favour two or three day continuing professional development courses despite the availability of post graduate programs. The standards for medical practitioners are obscured by a non-transparent accreditation process. Restriction of title registration in Victoria has coincided with a trend for these short courses to be described as ‘dry needling’ rather than acupuncture, thus circumventing the education standards, regulatory processes and protection of public health and safety which underpins occupational regulation. National boards will need to collaborate and carefully consider their acupuncture accreditation standards if they are to fulfil the objectives of the National Registration and Accreditation Scheme. [ABSTRACT FROM AUTHOR]

This paper examines a comprehensive, sociological explanation of the increasing recognition and use of alternative therapies--such as acupuncture--by Australian GPs. Noting the 'pragmatic' motives of clinical legitimacy and market demand, this paper goes on to explore the deeper roots of this phenomenon in a widespread cultural shift often termed postmodernisation. In this instance, this development involves a return to and commodification of nature, spirituality, tradition and pre-modern, often non-Western values and practices. These postmodernising trends are compatible with the holistic health values that underpin alternative therapies. The analytic inductive methodology employed involved the collection of data from 60 health care providers from the Brisbane metropolitan region. This paper, however, draws on only part of the data collected to provide empirical evidence of clinical 'postmodern' encounters of biomedically trained GPs (n=17) who employ alternative medicine in their daily practice. [ABSTRACT FROM AUTHOR]

Introduction: Marginalized populations experience health inequities and are often underserved within existing health systems. Australian marginalized populations and their use of complementary medicine, including acupuncture, lack investigation. We have collected information on the health-seeking behaviors of marginalized individuals who utilize an acupuncture service within a community-based integrative health setting. Methods: A secondary analysis of pre-existing data involving the linking of three datasets. Information was collected across four domains: health characteristics, socio-demographics, health services utilization, and vulnerability markers. Bivariate analysis using Fisher's exact and chi-square tests additional to logistic regression analysis were conducted to determine the characteristics of the study population. All data once analyzed were then presented as a cumulative statistic. Results: Study participants (n = 42) included 28% of individuals with reported histories of homelessness (n = 12) and 32% with a history of psychological trauma (n = 13). Eighty-three percent (n = 31) of the population sought acupuncture to manage pain and 91% (n = 36) for musculoskeletal conditions. Sixty-three percent (n = 24) reported a mental health diagnosis, most commonly depression (n = 18). Participants were most likely to engage with three other health services within the study setting, in addition to acupuncture. Participants with an illicit substance abuse problem were 12 times more likely to seek a greater number of acupuncture treatments, and individuals with trauma histories were twice as likely to attend the acupuncture clinic eight or more times. Discussion: Our study findings suggest a robust level of engagement with acupuncture treatment among the target population and a willingness to engage with integrative health services when barriers to uptake such as accessibility and affordability are removed. Findings support current evidence pertaining to acupuncture's use as an adjunct to managing pain in marginalized populations as well as a perceived acceptability and feasibility of the integration of acupuncture within conventional health settings. There is the further observation that acupuncture in a group setting is suitable for a marginalized population and an interest in commitment to treatment among individuals with substance abuse problems. [ABSTRACT FROM AUTHOR]

Purpose: Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operative nausea and vomiting (PONV). This study aimed to survey healthcare professionals' attitudes towards A/A, influencing factors and barriers to implementing this effective non-drug intervention into peri-operative care. Methods: A validated, anonymous survey with 43 questions was emailed or distributed as a hard copy at meetings to anaesthetists, midwives, nurses, obstetricians, gynaecologists and surgeons at a public hospital in Australia. Descriptive data were presented. Influencing factors were explored using chi-square analysis. Multinomial logistical regression was used to identify the influences of confounding factors. Results: A total of 155 completed surveys were returned, reflecting a response rate of 32%. The majority of participants were female (69%), nurses/midwives (61%) and aged between 20 and 50 years old (76%). Eighty-three percent of respondents considered A/A 'clearly alternative' medicine or 'neither mainstream nor alternative'. Eighty-one percent would encourage patients to use acupressure for PONV if it was offered at the hospital. Previous personal use of A/A was the key factor influencing attitudes and openness to clinical use. The key barriers to implementation were perceived lack of evidence and lack of qualified providers and time. Conclusion: Hospital-based healthcare professionals strongly supported the evidence-based use of A/A for PONV despite considering the therapy to be non-mainstream and having limited A/A education or history of personal use, providing a positive context for an acupressure implementation study. Significant gaps in training and a desire to learn were identified. [ABSTRACT FROM AUTHOR]

Background: Weight gain is common after breast cancer (BC) treatment and may increase the risk of disease recurrence. Complementary medicine (CM) use is high amongst BC patients. This paper describes the use of CM from a cross-sectional self-administered survey on prevalence and management of weight after BC. Methods: Use of CM was assessed using a question modified from the I-CAM Questionnaire. Participants were asked to rate perceived effectiveness, advantages and disadvantages, and which CM they were willing to use for weight management if there was evidence for effectiveness. The survey was emailed to members of the Breast Cancer Network Australia Survey and Review Group, the largest consumer advocacy group in Australia for people with breast cancer. Results: There were a total of 309 responses. Three quarters had used CM in the past 12 months. One third had tried CM for weight loss. Yoga, meditation and pilates were perceived to be effective for weight loss. Perceived advantages of CMs for weight loss were the ability to improve general wellbeing, relaxation, and being non-pharmacological while disadvantages were financial cost, finding a reliable practitioner, and lack of research for effectiveness. Three quarters would be willing to try CM for weight loss if there was evidence for effectiveness, with the most popular CMs being acupuncture, relaxation, yoga, supplements, and meditation. Conclusions: The high use of CM in this group is consistent with previous research. Our research suggests that BC survivors would use acupuncture, meditation, supplements and yoga for weight loss if supported by scientifically-credible evidence. Research into the effectiveness of these treatments on weight loss after BC is warranted. [ABSTRACT FROM AUTHOR]

Context • In the October 2014 issue of the Journal of the American Medical Association (JAMA), Hinman et al published the results of an Australian clinical trial on acupuncture in a paper entitled “Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial” (JAMA report), in which they concluded that neither acupuncture nor laser acupuncture had any greater effects than sham laser acupuncture for pain or function for patients aged 50 y and older with moderate-to-severe knee pain. That study has been criticized extensively by international scholars for its validity because serious methodological flaws existed throughout the study’s design, implementation, and conclusions. Objective • The current study intended to re-examine the prior study’s conclusions about the efficacy of acupuncture for chronic knee pain. Design • The current research team performed a reanalysis of relevant data from the JAMA report. Intervention • The original study included 4 groups: (1) an acupuncture group, which received needle acupuncture, inferred by the current authors to have been set up to be a positive control in the original study; (2) a laser acupuncture group, which received laser acupuncture; (3) a sham laser acupuncture group, which received sham laser acupuncture and acted as the negative controls for the laser acupuncture intervention; and (4) a control group, which received conventional care but no acupuncture or laser treatments. The study lasted 12 wk. Outcome Measures • The measures included evaluations in the following areas: (1) poststudy modifications—an evaluation of the consistency of the JAMA report with the study’s intentions as identified for a grant that was originally approved and funded by the Australian National Health and Medical Research Council (NHMRC) in 2009, as indicated in the study’s trial registration, and as compared with the published protocols and to the study’s originally stated objectives; (2) high heterogeneity—an assessment of the heterogeneity among the 4 groups for the overall outcome related to pain; (3) ineffectiveness of laser acupuncture—an analysis of laser acupuncture’s efficacy for chronic knee pain as stated in the JAMA report, using effect size (ES); (4) effectiveness of acupuncture—a reanalysis of acupuncture’s efficacy for chronic knee pain in comparison with the original analysis in the JAMA report, using ES; and (5) acupuncture after data adjustment—a new analysis of acupuncture’s efficacy for chronic knee pain using data from the original study that was discussed in the JAMA report, using ES, with an estimation after data adjustment and elimination of the dilution effect of the Zelen design. Results • Contrary to a general impression that acupuncture was the focus, laser acupuncture was the primary intervention tested in the actual study, “Laser Acupuncture in Patients With Chronic Knee Pain: A Randomized, Placebo Controlled Trial.” The study discussed in the JAMA report was neither a truly randomized, controlled trial (RCT) for acupuncture nor was it an appropriately designed, randomized study in general. High heterogeneity was found among its groups in the evaluation of overall pain in patients. Both the ES of 0.60 that had been set by Hinman et al for the minimal clinically important difference (MCID) and the resulting interpretation of results in the JAMA report were not appropriate. Using the original study’s criteria of efficacy, the reanalysis has confirmed that the laser acupuncture was not effective, whereas the acupuncture was found to be moderately effective for chronic knee pain (P < .05) for both overall pain and function at 12 wk, with an ES of 0.58, or after the adjustment of the data, with an ES of 0.67. Conclusions • The JAMA study was neither a conventional RCT nor an appropriately randomized trial, and its results are probably invalid. The ES of 0.60 for the MCID that was used in the JAMA study and the resulting explanation were not appropriate. Even with an ES of 0.60 for the MCID, acupuncture remained effective after data adjustment. Consequently, compared with conventional care, acupuncture treatment was found to be moderately effective for chronic knee pain in patients aged 50 y and older. [ABSTRACT FROM AUTHOR]

Objective To determine the feasibility, acceptability and safety of using acupuncture to treat arm lymphoedema in women following treatment for breast cancer. Methods We conducted a randomised controlled trial of acupuncture compared with treatment as usual. Twenty women with stable unilateral intransient lymphoedema present for at least 6 months were recruited from Sydney, Australia. The women received 12 acupuncture treatments administered to body and arm points on the non-lymphoedematous limb over 8 weeks, twice weekly for 4 weeks then once weekly for 4 weeks. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria and compliance with treatment attendance. Clinical outcomes were assessed at baseline and 8 weeks and included extracellular fluid, lymphoedema symptoms, well-being and safety. Results Acupuncture was an acceptable intervention in women with upper limb lymphoedema. Compliance with the treatment protocol was high, with nine women completing all 12 treatments. Outcome forms were completed by 17 women at 8 weeks. No major adverse occurrences, as defined by the study protocol, were reported from the acupuncture group although one woman found the needling uncomfortable, and no study participant experienced an increase in swelling of >10%. There was no change in extracellular fluid or any patient-reported outcome measurement. Conclusions Lymphoedema is a persistent symptom experienced by women recovering from breast cancer. Our study suggests that acupuncture may stabilise symptoms and no major safety concerns were identified, so further research is needed. Trial registration number Australian New Zealand Clinical Trials Registry, http://www. anzctr.org.au ACTRN12612000607875. [ABSTRACT FROM AUTHOR]

Objectives To explore the experience of acupuncture care from the perspective of people with chronic low back pain. Methods A grounded theory, qualitative study using indepth interviews was undertaken with 11 people who had received acupuncture care for chronic low back pain. Interviews were audiorecorded and transcribed verbatim. Initial, focused and theoretical coding were used to identify a core category and several other categories. Results The core category, Reclaiming Control, was related to the sense of well-being experienced by most of the participants as a result of undergoing acupuncture care. The other categories were Gaining Sanctuary, Gaining Trust and Working Together. These categories reflected the processes of participants entering an aesthetically appealing, calm and relaxing space; developing confidence in the acupuncturists' ability to care for them; and negotiating strategies and sharing decisionmaking with acupuncturists about their care. Conclusions Clinicians using acupuncture as a management strategy for low back pain may elicit an immediate sense of calmness in patients with subsequent well-being benefits. A sense of calmness may also be enhanced through providing a relaxing physical environment. The transactional and interpersonal processes of establishing trust and rapport, and shared decision-making are important for clients. Shared decision-making can be improved by clinicians carefully considering the explanation of issues and plans to a particular patient, especially by developing an understanding of each patient's worldview and using language that the suits each individual's healthcare orientation. Our findings should be interpreted cautiously as the results may be generalisable only to private practice in affluent countries, and whether the findings are representative beyond this setting remains unclear. [ABSTRACT FROM AUTHOR]

Objective To determine if infrared laser acupuncture (LA) may have a specific effect in reducing pain and disability in treatment of chronic low back pain (LBP). Methods This was a double-blind sham laser controlled trial performed in general practices in Perth, Western Australia. The participants were 144 adults with chronic non-specific LBP. They were randomised to receive eight once-weekly treatments. Laser machines (20 mW, 840 nm diode, power density 0.1 W/cm2) stimulated points in three treatment groups: sham (0 joules/ point), low dose (0.2 J/point) and high dose (0.8 joules/point). Participants were followed-up at 1 and 6 weeks, and 6 and 12 months post treatment. Primary outcomes were pain (Numerical Pain Rating Scale (NPRS)) and disability (Oswestry Disability Inventory (ODI)) at 6 weeks post treatment. Secondary outcomes included numerical rating scale for limitation of activity, global assessment of improvement, analgesic usage and adverse effects after treatment. Results The analysis showed no difference between sham and the laser groups at 6 weeks for pain or disability. There was a significant reduction in mean pain and disability in all groups at 6 weeks (p<0.005); NPRS: sham (-1.5 (95% CI -2.1 to - 0.8)), low dose (-1.3 (-2.0 to -0.8)), high dose (-1.1 (-1.7 to -0.5)). ODI: sham (-4.0 (-7.1 to -1.0)), low dose (-4.1, (-6.7 to -1.5)), high dose (-2.6 (-5.7 to 0.5)). All secondary outcomes also showed clinical improvement over time but with no differences between groups. Conclusions LA using energy density range (0-4 J/cm2) for the treatment of chronic nonspecific LBP resulted in clinical improvement unrelated to laser stimulation. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a popular treatment for women's health. Several trials and meta-analysis have been published in recent years on key women's health conditions but it is unclear if this has led to any changes in clinical practice or referrals from other health professionals. The aim of this survey was to explore if, how, and why, aspects of acupuncture practice have changed since our survey in 2013. Method: An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women's health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results: One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women's health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners' referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women's health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion: Acupuncture practitioners in Australia and New Zealand commonly treat women's health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women's health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy. [ABSTRACT FROM AUTHOR]

The use of complementary and alternative medicines (CAM), including acupuncture, in Australia is increasing. While data describing the characteristics of traditional Chinese medical practitioners and the nature of the workforce exist, there is comparatively little research into the users of traditional Chinese medicine in a private practice context. This study explores the characteristics of patients presenting at a rural Victorian acupuncture practice during the first two years of operation. Patients were typically female, married, and had a mean age of 44 years. The typical patient self-referred or was referred through the multidisciplinary clinic, and was taking vitamins or supplements. The most common reason for presentation was pain. Patient characteristics were similar to existing data for Australian CAM patients. In order to more accurately describe the users of acupuncture, practitioners must contribute to the literature. In addition, practitioners should describe issues that are unique to practice in their context. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain whether ear acupuncture (modified Battlefield technique) as an adjunct (Adj‐BFA) to standard analgesia care (SAC) significantly reduces pain scores compared with sham acupuncture (Adj‐Sham) or SAC alone, when delivered by medical and nursing practitioners in an ED. Methods: A randomised controlled trial using a convenience sample of 90 patients attending an ED with acute abdominal, limb trauma or low back pain were allocated to three treatment arms: Adj‐BFA, Adj‐Sham and SAC. The primary outcome of change in pain scores out‐of‐10 (NPRS‐10) from triage were assessed immediately after intervention and at 1 and 2 h post‐intervention. Secondary outcomes were the percentage of patients reporting 'adequate analgesia' or ≥30% reduction in pain score, analgesic medication use (in morphine equivalent dose [milligrammes]), analgesics and needle costs (Australian dollars), adverse effects and patient satisfaction (Likert scale). Results: There was no significant difference in pain scores (P = 0.582) or secondary outcomes measures between Adj‐BFA, Adj‐Sham and SAC. Conclusion: The present study on 90 patients did not show a significant difference in analgesia outcomes in the first 2 h using Adj‐BFA for acute pain in the ED, and there were no significant differences for secondary outcomes between treatment arms. Given the mixed results of recent BFA trials, further research using the original BFA technique on different painful conditions, as either stand‐alone or as‐adjunct to non‐opioid analgesia are needed before BFA can be recommended as a technique for acute pain management in the ED. Battlefield (ear) acupuncture (BFA) was not found to be beneficial as an adjunct to routine analgesia for abdominal, low back or limb trauma pain in the first 2 h. BFA did not reduce opioid administration or improve patient satisfaction in this time frame. In the context of mixed results from this and other published trials, BFA needs to be subject to more research in EDs before it can be recommended. [ABSTRACT FROM AUTHOR]

Background: The proportional method of acupuncture point location (APL) currently taught at Endeavor College of Natural Health and advocated by the World Health Organization Regional Office for the Western Pacific (WPRO) was found to be imprecise and/or inaccurate in previous student studies. The ruler and elastic methods of APL were identified as more accurate or precise than the proportional method of APL but were not well received by student participants. Use of an adjustable ruler may overcome barriers to uptake of the more accurate APL methods. This pilot study was the first to evaluate the comparative accuracy of the adjustable ruler and the proportional methods of APL in first-year students at a major Australian acupuncture training college. Methods: After 10 weeks of in-class instruction in both proportional and adjustable ruler methods of APL, student participants (n = 14) attempted location of three acupuncture points (LI10, SP6 and ST38) on a volunteer using both APL methods of interest. A self-administered questionnaire and lecturer field notes elucidated attitudes to implementation of both APL methods. Results: Points marked using the adjustable ruler were closer to the correct location than those marked using the proportional method across all three acupuncture points. Students and lecturers rated the adjustable ruler more highly than the proportional method for ease of learning and ease of use. Conclusion: Encouraging results with the adjustable ruler method warrant further larger scale studies. Use of the adjustable ruler method of APL should be considered for use in point location training at educational institutions teaching traditional acupuncture. [ABSTRACT FROM AUTHOR]

aimed to demonstrate the state of the present situation and trends concerning the global use of acupuncture for cancer pain in the past 20 years. Methods: Searched the Web of Science database from 2000 to 2019 related to acupuncture for cancer pain, and then used CiteSpace to conduct scientometric analysis to acquire the knowledge mapping. Results: Yearly output has increased year by year, and the growth rate has become faster after 2012. According to the cluster analysis of institutions, authors, cited references, and keywords, 4, 4, 15, and 14 categories were obtained, respectively. The most productive countries, institutions, and authors are the USA, Mem Sloan Kettering Cancer Center, and Mao JJ, whose frequencies are 196, 24, and 17, respectively. However, the most important of them are Australia, Univ. Maryland, and Bao T, owing to their highest centrality, they are 0.90, 0.21, and 0.09 separately. Moreover, cited references that contributed to the most co-citations are Crew KD (2010), however, the most key cited reference is Roscoe JA (2003). Keywords such as acupuncture, pain, breast cancer, palliative care, and quality of life are the most frequently used. But auricular acupuncture is the crucial keyword. In the cluster analysis of institutions, authors, cited references, and keywords, the more convincing research categories are multiple myeloma, placebo effect, neck malignancies, and early breast cancer, with S values of 0.990, 0.991, 0.990, and 0.923, respectively. Therefore, they can be regarded as research hotspots in this field. Conclusion: Based on the scientometric analysis in the past 20 years, the knowledge mapping of the country, institution, author, cited reference, and the keyword is gained, which has an important guiding significance for quickly and accurately positioning the trend in this field. [ABSTRACT FROM AUTHOR]

Background: Lateral elbow pain (LEP) due to tendinosis is one of the most common musculoskeletal pains of the upper limbs, yet there is no satisfactory treatment. This study was an international, prospective, multi-centre, randomized, controlled, clinical trial to evaluate the efficacy of acupuncture compared to sham laser in the treatment of LEP.Methods: The study used a parallel and stratified design (1:1 allocation using a computer-generated sequence) and was participant-, outcome assessor- and statistician-blinded. Subjects from 18 to 80 years with unilateral chronic LEP (minimum three months) were recruited at four centres in Australia, China, Hong Kong and Italy. The treatment group received manual acupuncture at acupoints LI 10 and LI 11 on the affected side whereas the control group received sham laser acupuncture at the same acupoints. The primary endpoint was disabilities of the arm, shoulder, and hand (DASH) questionnaire score at the three-week post-treatment follow-up visit. Three VAS scales (pain at rest, pain on motion and pain during exertion) were secondary outcomes measures. Ninety-six subjects were allocated to either the treatment group (n = 47) or control group (n = 49) and were all included in the analysis.Results: At the follow-up visit, we found significant differences in DASH score between the two groups (p = .015). The median change to baseline for the treatment group was -11.7 (interval: -50.83 to 23.33), and for the control group -7.50 (interval: -36.67 to 29.10). The estimated effect size was 0.47, indicating a medium effect. Significant differences were also found for secondary outcome measures for VAS of pain. There were no severe adverse events. Our findings suggest that acupuncture has a moderate efficacy in the treatment of LEP.Conclusions: Acupuncture was shown to be efficacious in improving the function of the arm associated with lateral elbow tendinosis. Both the DASH score and the pain VAS on two occasions (at rest and during motion) showed a significant change over time indicating acupuncture as a potential treatment for LEP due to tendinosis. [ABSTRACT FROM AUTHOR]

Objectives: An acceptable level of diagnostic agreement is a prerequisite for consistent administration of treatment. It is critical for investigating effectiveness of different treatment approaches using multiple practitioners. To the best of our knowledge, no previous investigation of diagnostic consensus using open populations in Chinese medicine (CM) has been reported. Investigations restricted to individual medical conditions, such as have been usually studied, do not reveal any information as to what occurs in real world clinical settings. This knowledge gap led to the current study being conducted. Design/Location/Subjects/Interventions: Investigating diagnostic agreement specifically in Traditional Chinese Medicine (TCM) in an open population, two or three practitioners diagnosed 35 subjects at the University of Technology, Sydney (UTS), TCM clinic. The practitioners were restricted to a list of the 56 most frequently used TCM diagnoses at the UTS clinic. Up to three diagnostic patterns per subject could be selected, with nominated patterns scored between 1 and 5. Outcome measures: Agreement was determined with two criteria, both expressed as simple percentages: pattern and linearly weighted agreements. Results: The results showed that 23% of practitioners obtained pattern agreement, while 19% demonstrated weighted agreement. Conclusion: There appears to be very low diagnostic agreement between practitioners. This is an important finding. If unchallenged by further investigation, the recognition of such poor diagnostic consensus may lead to rejection of TCM theory before it has been adequately assessed. Diagnostic agreement must be improved so that future investigations into treatment effectiveness or mechanisms of action are made on a valid basis. Additionally, the current TCM diagnostic format must be altered to allow the application of chance-removed statistics or the calculation of a standard error with open populations. This article is the first of a series of three that report problems in TCM diagnostic reliability and proposes solutions to the issues outlined. [ABSTRACT FROM AUTHOR]

A conference paper about Australasian Acupuncture and Chinese Medicine Annual Conference (AACMAC) held in Perth, Australia in 2016 is presented. The participants in the conference included Chinese medicine practitioners, academics, the Therapeutic Goods Administration (TGA), the Chinese Medicine Board of Australia (CMBA). The keytone speakers at the conference included Dr Stephen Boyanton from U.S., Professor Wanbiao Zhao from China and AACMA Vice President, Waveny Holland.

Background: There is growing acupuncture use amongst people with osteoarthritis, and acupuncture has been shown to have a positive effect on osteoarthritis. The aim of the study is to identify the characteristics of Australian women who consult acupuncturists for osteoarthritis treatment in order to help inform patients, practitioners and policy makers about the range of health care options accessed by older women with osteoarthritis.Methods: The research reported here involved participants from a sub-study of the Sax Institute's 45 and Up Study in Australia. The data of 403 Australian women aged 45 and over with osteoarthritis were analysed. Chi-squared tests and stepwise multiple logistic regression modelling were used to determine the characteristics of women who used acupuncture for the treatment of their osteoarthritis.Results: Analysis revealed that 7.7% of women reported using acupuncture in the previous 12 months for their osteoarthritis. Acupuncture use is positively associated with women experiencing longer duration of time since initial diagnosis of osteoarthritis (OR = 1.04), undertaking more exercise (OR = 5.41), living in a rural area (OR = 3.62), having consulted a psychologist (OR = 12.21), and having consulted another complementary and alternative medicine practitioner (OR = 4.18).Conclusions: Our study reveals considerable acupuncture use amongst women with osteoarthritis. There is a need for health care practitioners to be mindful of acupuncture use among their patients presenting with osteoarthritis. Further research is needed to examine the potential benefits of acupuncture for osteoarthritis and to help inform efficient and safe use of this treatment alongside conventional care. [ABSTRACT FROM AUTHOR]

The article examines the surface conditions and other properties of stainless steel acupuncture needles manufactured by suppliers from China and Japan to Australia. It mentions that the needles were inserted into a gel material to be surrogate human tissue and were manipulated through lifting and thrusting, and rotation. It also discusses the microscopic images of the tips and shafts of the needles as H and S and were demonstrated before and after using.

Background: It is important that potential study participants are appropriately informed and understand what is involved with their research participation. A few studies have examined study participants' understanding of the informed consent process and the adequacy of the information they received when agreeing to participate in a randomised controlled trial. Deficiencies in the consent process have been found. This topic remains an under researched area of acupuncture research. The aim of this study was to examine participants' understanding of their informed consent and the adequacy of the information presented when agreeing to participate in a randomised controlled trial of acupuncture. Methods: All women who participated in a randomised controlled trial over an 11 month period were invited to participate in a survey. An anonymous self-completion questionnaire was designed and covered participants' understanding of informed consent in the clinical trial, their views of the information provided, the opportunity to ask questions, the use of sham acupuncture, their recall of study visits and processes for withdrawal, and their reason for participating in the trial. Results: A response rate of 59 % was obtained. Over 90 % of subjects indicated there was plenty of opportunity to discuss the study prior to giving consent, and 89 % indicated that questions asked were answered to their satisfaction. The majority of women indicated the amount of information describing acupuncture was about right, however 24 % would have liked more. Information describing sham acupuncture was not considered adequate by 48 % of women, and 35 % would have liked more information, 30 % could not recall why, or were uncertain why a sham group was used. Participants indicated less understanding of the information relating to payment if they became ill due to study participation, risks and discomforts from the study interventions, which of the procedures were experimental and for how long they would be involved in the study. Conclusion: Trial participants' understanding of informed consent was overall satisfactory but highlighted some areas of deficiency. Future studies could consider use of supplementary material such as Q and A fact sheets. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Vickers et al. on personal insults and unscientific ignorance voiced in response to the Acupuncture Trialists’ Collaboration, one by Molassiotis on acupuncture used to treat fatigue in cancer patients and one by Vas et al. on moxibustion for breech presentation during childbirth.

Objectives To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Design Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Main outcome measures Use of acupuncture by GPs, patients’ sex and age and the socioeconomic disadvantage index of GP’s practice. Results There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Conclusions Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specific factors affecting reimbursement for non-vocationally registered GPs. [ABSTRACT FROM AUTHOR]

Objectives: The study objectives were to examine the effectiveness of acupuncture for reducing infertility-related stress. Design: The study design was a randomized controlled trial of acupuncture compared with a wait-list control. Setting: The study was conducted at The University of Western Sydney. Subjects: Thirty-two (32) women aged 20-45 years, with a diagnosis of infertility, or a history of unsuccessfully trying to conceive for 12 months or more, were the subjects of the study. Interventions: Women received six sessions of acupuncture over 8 weeks. Outcome measures: The primary outcomes were infertility self-efficacy, anxiety, and infertility-related stress. The women's experience of infertility and acupuncture is also reported. Results: At the end of the 8-week intervention, women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory with less social concern (mean difference [MD] −3.75, 95% confidence interval [CI] −7.58 to 0.84, p=0.05), and less relationship concern (MD −3.66, 95% CI −6.80 to −0.052, p=0.02). There were also trends toward a reduction of infertility stress on other domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI −2.20 to 26.0, p=0.09) and less anxiety (MD −2.54, 95% CI −5.95 to 0.86, p=0.08) in the acupuncture group compared with the wait-list control. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and time out, the engagement with the practitioner, and an intervention that had very few negative side-effects. Changes were also perceived after treatment with women describing a physical and psychologic sense of relaxation and calmness, and a changed perspective in relation to coping. Conclusions: Acupuncture may be a useful intervention to assist with the reduction of infertility-related stress. Further research is justified. [ABSTRACT FROM AUTHOR]

Highlights the 2004 World Federation of Acupuncture Societies, held in Australia. Hosting of the event by the Australian Acupuncture and Chinese Medicine Association; Clinical papers presented on areas such as menopause, autism and cancer; Importance of the conference for traditional Chinese medicine practitioners in Australia.

Almost one in ten Australians has received acupuncture treatment by acupuncturists and/or medical doctors in private clinics. The majority of Australian health insurance funds offer rebates for acupuncture. Statutory regulations for acupuncture have been implemented in the State of Victoria, Australia. Six acupuncture degree courses have been approved by the Chinese Medicine Registration Board of Victoria and/or accredited by the Australian Acupuncture and Chinese Medicine Association. Furthermore, a number of clinical trials of acupuncture on allergic rhinitis, pain and women's health were carried out in Australia. Recent developments of acupuncture in Australia indicate that through adequate and appropriate evaluation, acupuncture begins to integrate into mainstream health care in Australia. [ABSTRACT FROM AUTHOR]

Background: There have been no published national studies on the use in Australia of the manipulative therapies, acupuncture, chiropractic or osteopathy, or on matters including the purposes for which these therapies are used, treatment outcomes and the socio-demographic characteristics of users. Methods: This study on the three manipulative therapies was a component of a broader investigation on the use of complementary and alternative therapies. For this we conducted a cross-sectional, population survey on a representative sample of 1,067 adults from the six states and two territories of Australia in 2005 by computer-assisted telephone interviews. The sample was recruited by random digit dialling. Results: Over a 12-month period, approximately one in four adult Australians used either acupuncture (9.2%), chiropractic (16.1%) or osteopathy (4.6%) at least once. It is estimated that, adult Australians made 32.3 million visits to acupuncturists, chiropractors and osteopaths, incurring personal expenditure estimated to be A$1.58 billion in total. The most common conditions treated were back pain and related problems and over 90% of the users of each therapy considered their treatment to be very or somewhat helpful. Adverse events are reported. Nearly one fifth of users were referred to manipulative therapy practitioners by medical practitioners. Conclusion: There is substantial use of manipulative therapies by adult Australians, especially for back-related problems. Treatments incur considerable personal expenditure. In general, patient experience is positive. Referral by medical practitioners is a major determinant of use of these manipulative therapies. [ABSTRACT FROM AUTHOR]

ABSTRACT: Craniofacial identification methods heavily rely on the knowledge of average soft tissue depths. This study measured soft tissue thicknesses of an Australian cadaver sample (N=33) using published needle puncture techniques at 13 anatomical locations. Data were compared and contrasted with other studies that used essentially identical samples and methods. Full descriptive statistics were calculated for measurements made in this study and means, medians, and modes were reported. Differences between mean values for males and females were found to be minimal (2.2 mm or less) and considerable overlap was found between the groups. There were no statistically significant differences between the soft tissue depths of the sexes (P>0.05). These findings indicate that differences between male and female soft tissue depths are of little practical significance for craniofacial identification and, therefore, data (means, standard deviations, and sample sizes) reported for Australians were pooled across the sexes and the studies. Although these new pooled means have increased statistical power, data distributions at some landmarks were skewed and thus emphasis is placed on median and modes reported for this study rather than upon the collapsed data means. [ABSTRACT FROM AUTHOR]

The authors discuss the national registration for the national standards of Chinese medicine education in Australia which creates basis for an entry in the profession. They state that Australian Acupuncture and Chinese Medicine Association Ltd., (AACMA) will monitor the developments carefully to secure the core values and practices of Chinese medicine. They say that the profession will keep on demanding a strong and viable association to offer leadership and representation.