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Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms "acupuncture" + "palliative" and adding the term "safety" to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group. [ABSTRACT FROM AUTHOR]

Several systematic reviews suggest that acupuncture is effective for knee osteoarthritis (OA), and furthermore a safe and cost-effective treatment for this condition. A recent clinical practice guideline (CPG) from the National Institute for Health and Care Excellence (NICE), in the United Kingdom, recommended against the use of acupuncture on the grounds that the effect size (ES) in comparison with sham acupuncture is too small. Safety data were not considered in the review, in addition the levels of evidence for acupuncture against other recommended therapies were not compared. Consequently, it is argued that this NICE guideline has limitations that lead to several potential biases in its evaluation of acupuncture, which were not addressed correctly: (1) NICE's prior scoping process limited its review. (2) NICE introduced the method of developing recommendations based on the consideration of which interventions make 'minimal important differences' of an ES of 0.5 or greater, rather than the statistical significance of the effect of an intervention when compared with an appropriate comparison. (3) Evidence that sham acupuncture is not physiologically inert and has some level of beneficial effect, hence artificially reducing the magnitude of the ES in comparison with sham. (4) The low adverse effects profile of acupuncture. (5) Evidence from trials comparing acupuncture with usual or standard care was not considered, nor was cost-effectiveness data. (6) Lack of the usual CPG 'head-to-head' comparisons between interventions. If the same criteria and methods that have been applied to acupuncture were applied to other NICE-recommended therapies for knee OA, including patient centeredness, patient education, self-management and weight loss, nonsteroidal anti-inflammatory drug (NSAIDs), and cyclooxygenase-2 inhibitor (COX-2 inhibitors), these too would no longer be recommended and opiates would become the first line of drug prescription. Given the problems with sham acupuncture, perhaps now is the time to embrace pragmatic studies and employ comparative effectiveness studies instead. [ABSTRACT FROM AUTHOR]

We show that intensification of treatment with maraviroc in patients chronically infected with HIV-1 receiving successful long-term antiretroviral therapy was not associated with improvements in HIV-related morbidity, HIV reservoir, microbial translocation, immune activation, or immune exhaustion in either gut or peripheral blood. The measurement of reservoir in both gut and blood longitudinally contributes to a paucity of data in the area. [ABSTRACT FROM AUTHOR]

HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The complex health and social issues associated with living with HIV mean that people living with HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM). This article provides an overview of the literature on HIV and CAM. Databases were searched using keywords for CAM and HIV from inception to December 2012. Articles in English and in Western countries were included; letters, commentaries, news articles, articles on specific therapies and basic science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%, with national studies suggesting CAM is used by around 55% of PLWHA, practitioner-based CAM by 15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater number of medications/symptoms, with CAM often used to address limitations or problems with antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can have potentially serious side effects or interactions with ART. CAM was used as a self-management approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians, particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to encourage valuable self-management and ensure patient safety. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study on the use of traditional Chinese acupuncture (TCA) to treat chronic stress explored the use of the diurnal salivary cortisol profile as a potential outcome measure. Design and methods: Adult volunteers ( n=18) with high self-reported stress levels, ascertained by screening with the Perceived Stress Scale 14, were randomized into three groups. Group 1 received weekly sessions of TCA for 5 weeks; Group 2 received attention only weekly (practitioner present and subject supine) for 5 weeks, and group 3 acted as a waiting-list control. A diurnal cortisol profile was constructed for each individual at nine data points: two at baseline, five during the intervention, and two postintervention. A salivary cortisol sample was taken at four time points (on waking, 30 minutes, 3 hours, and 12 hours after waking). Outcome measures: Salivary cortisol concentrations were measured using a high-sensitivity salivary cortisol enzyme immunoassay. Results: The cortisol awakening response showed an average increase during the intervention for both TCA and attention groups, indicating that for these two groups the cortisol response had normalized and they were in a lower state of stress. These trends did not reach statistical significance due to individual variation and the small number of study participants. The control group showed an overall decrease in the average morning increase over the same period. No significant difference in the day decline in cortisol was found between groups at any point in the study. Conclusions: This pilot study suggests that TCA could reduce stress and increase the morning rise of the cortisol profile; however, this was not distinguishable from the effect of attention only. Further work with a larger sample is necessary to provide a definitive answer regarding whether this could be sustained with more TCA treatments. The morning cortisol increase could be a useful outcome measure for monitoring the effects of treatment on perceived stress. [ABSTRACT FROM AUTHOR]

Five focus group discussions were conducted with 28 (fourth-year) medical students from the Chinese University of Hong Kong (CUHK) to explore attitudes to Traditional Chinese Medicine (TCM) and its impact on the future of medical training. Most students perceived that TCM was a good alternative for certain health problems but lack of scientific evidence and the absence of regulation were major barriers. Students were concerned about the limitations of TCM, but identified their need to understand TCM to effectively communicate with their patients. Paralleled with the experience in the United Kingdom and other countries, if traditional and conventional doctors are to work effectively side by side, current medical education and health service arrangements need to change. [ABSTRACT FROM AUTHOR]

A pilot study was undertaken to examine the feasibility of auditing and developing a nationaldatabase of acupuncture practice in the United Kingdom.One hundred forty-five (145) practitioners, members of the British Acupuncture Council, were invitedto participate in the study. Those who accepted were given training and then asked to record demographicand treatment outcomes data on new patients attending their practices over a 3-month period. Two questionnaires,the Measure Your Own Medical Outcomes Profile and the College of Integrated Chinese Medicine outcomequestionnaire, were compared. Baseline health status was assessed and repeated patient feedback questionnairesemployed.Of the 31 (21%) of practitioners who responded, only 9 (6%) eventually contributed data. A totalof 69 patients participated in the study: 43 (68%) of the patients were female, and 46 (73%) were aged between30 and 59. More than half (52%) had had their presenting problem for over 5 years and most (78%) were affecteddaily by it. Nineteen (30%) had had prior acupuncture treatment for their condition. The main categoriesof complaints reported were musculoskeletal and psychologic. Thirty-two (32) out of 41 (78%) patients withcompleted final outcomes data recorded moderate or major benefit in their main complaint, with no reports ofdeterioration.Although willing to be involved, practitioners found the research process time-consuming andwere concerned how it could be balanced against the demands of a busy practice and the interests of patients.For a national audit study to succeed, the process would have to be simplified and practitioners encouraged toengage; collection of such information could then help to provide much-needed data on acupuncture treatmentin the United Kingdom. [ABSTRACT FROM AUTHOR]

An abstract of the study "Acupuncture Related Integrative Treatment for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" by Xiaoyang Hu, Nini Chen, Qianyun Chai, Guoyan Yang, Esme Trevelyn , Ava Lorenc, Jianping Liu and Nicola Robinson is presented.