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The American College of Clinical Pharmacy (ACCP) published an initial white paper on herbal products in 2000. Since then, the global market for natural products has continued to expand, with tens of millions of consumers using such products on an annual basis in the United States alone. However, despite this expansion, natural products remain largely unregulated compared with prescription medications, have moderate- to low-level clinical evidence for efficacy, and continue to have safety concerns, including adulteration and misbranding. As comprehensive medication management experts, clinical pharmacists are uniquely qualified to navigate these concerns and advise patients appropriately. To develop and recommend a suitable care plan involving natural products, clinical pharmacists must establish a strong pharmacist-patient relationship, assess the appropriateness of therapy, educate the patient regarding key issues, and continuously monitor and follow up on the effectiveness of the care plan. This process should not only occur in an individual community or hospital setting, but also whenever a patient transitions from one care setting to another in cooperation with other clinicians.

In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding (1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using "fascia" hypothesis) in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain (dry needling promoters redefined it as "myofascial pain"). Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture's local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients' safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.

Background The standards of Ayurveda education in India are being questioned in the recent years and many suggestions related to educational reforms are being put forth by educators and health policy experts. However, the Post Graduate Entrance Examinations (PGEEs) that are carried out to select the candidates to pursue postgraduate programs have received little attention in this context. Objectives The objective of this study was to classify the Multiple Choice Questions (MCQs) from Ayurveda PGEEs conducted in different universities of India during the five year period (ranging from 2010 to 2014) into six levels of Bloom's Taxonomy in cognitive domain. Methods This is a retrospective observational study. The sampling method followed was purposive sampling. Totally, 3299 MCQs obtained out of 25 question papers from seven universities spread across four zones of India (North, South, West and East) were included in the study and were classified based on the Bloom's taxonomy. Results About 93.3% of MCQs assessed only the ‘recall’ component whereas 6.2% of the MCQs assessed ‘comprehension’. Percentage of MCQs that assessed ‘application’ level was a mere 0.3% whereas the percentage of MCQs that assessed the ‘analysis’ component was found to be only 0.2%. There was not even a single question to assess the ‘synthesis’ and ‘evaluation’ components. Conclusions We conclude that an appropriate proportion of MCQs assessing ‘higher order thinking’ are required to be included in Ayurveda PGEEs. While it is possible to frame MCQs to assess all six levels of Bloom's taxonomy in cognitive domain, the teachers are required to be trained well in the skills of MCQ writing. We propose that our study may be taken as a lead to introduce the required reforms in PGEEs. Clinical Trial Registration No.: Not applicable.

Non-conventional medical practices that make use of dietary supplements, herbal extracts, physical manipulations, and other practices typically associated with folk and Traditional Medicine are increasingly becoming popular in Western Countries. These practices are commonly referred to by the generic, all-inclusive term “Complementary and Alternative Medicine.” Scientists, practitioners, and medical institutions bear the responsibility of testing and proving the effectiveness of these non-conventional medical practices in the interest of patients. In this context, the number of peer-reviewed journals and published articles on this topic has greatly increased in the recent decades. In this editorial article, we illustrate the policy of the Journal of Traditional and Complementary Medicine for publishing solid and scientifically sound papers in the field of Traditional and Complementary Medicine.

Wenchao Gu,1YapingYuan,1 HuaYang,1GuangshengQi,1XiaoyanJin,2JinYan2 1Department of Respiratory Medicine, People’s Hospital of Shanghai, Pudong New Area, 2Department of Respiratory Medicine, Tongren Hospital, Shanghai, People’s Republic of China Objective: We aimed to identify the 100 top-cited articles published on chronic obstructive pulmonary disease (COPD) and to analyze their characteristics so as to provide information on the achievement and development in COPD research over the past decades. Methods and materials: A comprehensive list of citation classics in COPD was generated by searching the Science Citation Index expanded database, using the keywords “COPD” or “chronic obstructive pulmonary disease” or “chronic obstructive pulmonary diseases”. The 100 top-cited research papers were retrieved by reading the abstract or full text if needed. All eligible articles were read for basic information, including country of origin, organizations, article type, journals, research field, and authors.Results: The 100 top-cited articles on COPD were published between 1966 and 2010. The number of citations ranged from 254 to 2,164, with a mean of 450 citations for each article. These citation classics were from 32 countries, with 38 from the United States. The Imperial College London led the list of classics, with 16 papers. The 100 top-cited articles were distributed in 18 journals, with the American Journal of Respiratory, Critical Care Medicine, and Journal of the American Medical Association topping the list. Among the various fields, both respiratory system (63%) and general internal medicine (63%) were the most common fields of study for the 100 articles. Conclusion: Our bibliometric analysis provides a historical perspective on the progress of scientific research on COPD. Articles originating from the United States and published in high-impact specialized respiratory journals are most likely to be cited in the field of COPD research. Keywords: citation analysis, top-cited, chronic obstructive pulmonary disease

Research dissemination is becoming more and more global. There is, however, limitation in allowing researchers who speak a language other than Chinese to follow the research trends in China, a country with the largest population in the world. Therefore, the purpose of this review article was to introduce the current research studies conducted in Mainland China. We limited our search of publications between 2012 and 2013 from three tier one Chinese mental health journals. We identified and reviewed seven papers which were highly downloaded by Chinese readers and which had not been published in English.

Healing of chronic lower extremity wounds is a global problem, especially in the developing world where it is often only folk and traditional medicine that can be afforded. In the structured health services of the developed world, there are usually a wider range of possible therapies. In India, traditional medicines flourish in parallel with Western systems, and those who treat wounds may use the expertise of more than one system. Ayurveda is a traditional system that has evolved in India over centuries using especially native plant sources as remedies. Like many Asian systems, its theoretical basis concerns balance and energy in the individual. In this perspective paper, the author advocates awareness of plant products available for wound healing and a study of the extent of their utilization. They must be developed for safe use and their efficacy reviewed, taking into account cure well-being and patient satisfaction as well as cost. Developing a list of products and classifying them appropriately is a beginning for such studies.

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Introduction This article shares the findings of a preliminary survey undertaken for the Ministry of Health in Turkey to help develop their policies on the use of Traditional and Complementary Medicine (T&CM).The primary aim was to find out how T&CM is used by the patients as a part of their treatment processes and also to find out whether some practices that are not included in the Western description of T&CM are in common use in Turkey and their cultural implications. Methods This cross sectional, paper based questionnaire survey was carried out in 39 public hospitals and 21 general practice clinics within seven geographical areas of Turkey. Patients in the waiting rooms with an appointment on that particular day were included. Results 2770 women (47.1%) and 3112 men (52.9%) participated in the survey. The overall T&CM use was 60.5%. Women's frequency of T&CM use was higher than men (P = 0.001). Strong gender component of T&CM use needs further quantitative research taking cultural aspects into consideration. 59.4% of the participants who used T&CM reported that it was recommended to them by others and only 54.3% shared information about their use of T&CM with their physicians. Leech therapy and cupping prevalence was higher in Turkey compared to other countries possibly due to religious and cultural beliefs. Conclusion The frequency of T&CM use is high which was a reflection of belief based therapeutic approaches in other words, there is a divide between traditional medicine and complementary and alternative medicine in Turkey, which needs to be separately evaluated.

Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana’s Northern Region (2013–2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff.

// Chun-Ting Liu 1, * , Bei-Yu Wu 1, * , Yu-Chiang Hung 1, 2, * , Lin-Yi Wang 3 , Yan-Yuh Lee 3 , Tsu-Kung Lin 4 , Pao-Yen Lin 5 , Wu-Fu Chen 6 , Jen-Huai Chiang 7, 8 , Sheng-Feng Hsu 9, 10 and Wen-Long Hu 1, 11, 12, * 1 Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan 3 Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 4 Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 5 Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 6 Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 7 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan 8 College of Medicine, China Medical University, Taichung, Taiwan 9 Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan 10 Department of Chinese Medicine, China Medical University Hospital, Taipei Branch, Taipei, Taiwan 11 Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan 12 Fooyin University College of Nursing, Kaohsiung, Taiwan * These authors contributed equally to this work Correspondence to: Wen-Long Hu, email: oolonghu@gmail.com Keywords: dementia, migraine, pharmaco-epidemiology, national health insurance research database, Chinese herbal product Received: February 27, 2017 Accepted: June 28, 2017 Published: July 08, 2017 ABSTRACT Patients with migraine are reportedly at increased risk of developing dementia. We aimed to investigate the association between traditional Chinese medicine (TCM) use and dementia risk in migraine patients. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 32,386 diagnosed migraine patients aged 20 years and above who received treatment from 1997 to 2010. To balance comparability between TCM users and non-TCM users, we randomly selected equal numbers from each group, and compared subgroups compiled based on combinations of age, sex, index year, and year of migraine diagnosis. All enrollees received follow-up until the end of 2013 to measure dementia incidence. We identified 1,402 TCM users and non-TCM users after frequency matching. A total of 134 subjects were newly diagnosed with dementia during the follow-up period. TCM users were significantly less likely to develop dementia than non-TCM users. The most frequently prescribed formulae and single Chinese herbal products were Jia-Wei-Xiao-Yao-San and Yan-Hu-Suo, respectively. This population-based study revealed a decreased dementia risk in migraine patients with TCM use. These findings may provide a reference for dementia prevention strategies, and help integrate TCM into clinical intervention programs that provide a favorable prognosis for migraine patients.

// Yu Mao 1, * , Jian Hao 1, * , Zi-Qi Jin 2 , Yang-Yang Niu 3 , Xue Yang 1 , Dan Liu 1 , Rui Cao 4 , Xiong-Zhi Wu 4 1 Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China 2 Tianjin Medical University, Tianjin, 300070, China 3 Tianjin Children’s Hospital, Tianjin, 300134, China 4 Zhong-Shan-Men Inpatient Department, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China * These authors have contributed equally to this study and share first authorship Correspondence to: Xiong-Zhi Wu, email: wuxiongzhi@163.com Keywords: metastatic breast cancer, Chinese herbal medicine, network pharmacology, estrogen receptor, HSP90 Received: October 25, 2016 Accepted: January 22, 2017 Published: February 15, 2017 ABSTRACT Chinese Herbal Medicine (CHM) plays a significant role in breast cancer treatment. We conduct the study to ascertain the relative molecular targets of effective Chinese herbs in treating stage IV breast cancer. Survival benefit of CHM was verified by Kaplan-Meier method and Cox regression analysis. A bivariate correlation analysis was used to find and establish the effect of herbs in complex CHM formulas. A network pharmacological approach was adopted to explore the potential mechanisms of CHM. Patients in the CHM group had a median survival time of 55 months, which was longer than the 23 months of patients in the non-CHM group. Cox regression analysis indicated that CHM was an independent protective factor. Correlation analysis showed that 10 herbs were strongly correlated with favorable survival outcomes ( P

A biosimilar (BS) is a biological drug that contains a version of the active substance of an already authorized original biological product. The BSs are marketed after patent period of the original drug has ended and once it has been demonstrated that the differences regarding the innovative medicine have no relevant effect on its safety or clinical efficacy. The Spanish Society of Rheumatology, in line with the European Medicines Agency, considers that because of its nature and complexity of production, a BS cannot be considered to be the same as a generic drug. The Spanish Society of Rheumatology expresses an unequivocal commitment to the sustainability of the health system in our country and our steadfast alignment with all measures designed to ensure continuity, without reducing the quality of care. Therefore, we believe that the advent of BSs will likely facilitate access of patients with rheumatic diseases to the biological drugs. This article reviews the European Medicines Agency requirements for authorization, the Spanish legal framework and controversies on BS and presents the position paper of the Spanish Society of Rheumatology on these drugs.

Breast cancer has become a big oncological concern both in Poland and most countries around the world. Epidemiological studies show that women who are directly in danger of suffering from breast cancer are mainly postmenopausal women. Due to the seriousness of the problem more attention is devoted to preventative measures that should be undertaken. That is why, Mediterranean diet and its beneficial effects on health started to be discussed. This diet contains antioxidants and shows anti-inflammatory properties which are crucial in breast cancer prevention. Its components are fish, olive oil, unrefined cereals, herbs, fruits and vegetables. In 1960s there was research done on the influence of low fat diet, as a preventative measure, on coronary artery disease. In 1980s, an interest in this diet grew and there was a great come-back to the origins of the diet. It led to estimation of its influence on cardiological and cancer diseases. Many positive effects were observed among people living in the Mediterranean area as far as health qualities of the diet are concerned. Mediterranean diet was compared with high fat diet of people living in Northern Europe and the USA. It seems to create new dietary recommendations as a preventative measure in breast cancer disease. The following article presents most recent data on the importance of Mediterranean diet as a prevention against breast cancer.

Medical management, or to be more precise, health management of the community is one of the important tools in modern medicine. Meanwhile, one of the fundamental differences between the developed and underdeveloped countries is their attitude towards medical management. In Islamic medicine, the medical management has received little attention comparing the technical aspects of the edicine. However, Islam can offer some important, new and significant insights into medical management, and more importantly, to promote health, the Muslim communities need Islamic management of medicine. This short paper aims to address the Islamic management of medicine and paves the way for more serious discussions in this regard.

Background:Use of alternative medications and herbal remedies is widespread in the United States and across the globe. These traditional medications can be contaminated with toxic metals. Despite several case reports of poisoning from such contamination, the epidemiological data are still limited.Objectives:To report on a cluster of lead and mercury toxicity cases in 2011 among a community of adherents of traditional medical practice of Ayurveda.Methods:Adherents of Ayurveda were offered heavy metals screening following the identification of the index case.Results:Forty-six of 115 participants (40%) had elevated blood lead levels (BLLs) of 10 μg/dl or above, with 9.6% of BLLs at or above 50 μg/dl.Conclusions:This is the largest cluster of lead and mercury toxicity following use of Ayurvedic supplements described in the literature in the US. Contamination of herbal products is a public health issue of global significance. There are few regulations addressing contamination of “natural” products or supplements.

ObjectiveTo investigate university students’ knowledge, attitudes and practice (KAP) regarding vitamin D.DesignThe students were requested to answer a questionnaire related to vitamin D and sun exposure. The consumption frequency of foods rich in vitamin D was assessed. Additionally, the intake of vitamin D-containing supplements was recorded.SettingA medical university in Nanjing, China.SubjectsFive hundred and fifteen medical students were included.ResultsThe highest rate of correct responses for the quiz was 68·0 %, while the lowest was 9·6 %. Most students lacked sun exposure because they did not want to get tanned; 82·7 % of students used some sun protection and sunscreen use was more popular in the female group. The consumption frequency of foods rich in vitamin D was low and 5·6 % of the students used vitamin D supplements. The students’ knowledge on vitamin D was derived mainly from the media and health professionals. Most of the students were interested to know more about vitamin D.ConclusionsThe present study suggested that medical students had little knowledge and unfavourable behaviours. They should get more health education through the media and health professionals. It is advisable to increase their consumption of foods rich in vitamin D.

ObjectivesIn this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them. MethodMost evidence-based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented. Results and conclusionsIt is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed. ObjectifsIdentifier et discuter les principaux enjeux ethiques lies a la conduite des surveillances et formuler des suggestions sur la facon de les aborder. MethodeLa plupart des informations fondees sur des preuves en ce qui concerne la qualite des medicaments decoule des enquetes. Cependant, les directives ethiques de recherche existantes ne fournissent pas d'indications precises pour les enquetes sur la qualite de la medecine. Par consequent, ceux menant des enquetes sont souvent laisses a se demander comment juger ce qui compte comme la meilleure pratique. Une liste des principaux defis ethiques dans la conception et la conduite des enquetes est presentee. Resultats et conclusionsIl est essentiel que la conception et la conduite des enquetes sur la qualite de la medecine respectent les obligations morales et ethiques et analysent les implications ethiques et les consequences d'un tel travail. Celles-ci sont: l'impact sur la disponibilite locale et l'acces aux medicaments, la confidentialite et la protection de la vie privee des enqueteurs et des enquetes, des questions quant a savoir si les membres du personnel de sortie doivent etre informes quils font partie d'une enquete, la necessite d'approbations reglementaires et d'ethique et la facon dont les resultats devraient etre diffuses. Les enquetes sur la qualite de la medecine devraient idealement etre menees en partenariat avec les autorites relevantes de reglementation des medicaments nationaux. Un modele international, mais contextuellement sensible, de bonne pratique ethique pour ces enquetes est necessaire. ObjetivosIdentificar y discutir los principales retos eticos relacionados con la realizacion de encuestas y hacer sugerencias sobre la forma de abordarlas. MetodoLa mayor parte de la informacion basada en la evidencia en lo que respecta a la calidad de los medicamentos se obtiene a traves de encuestas. Sin embargo, las guias eticas de investigacion existentes no proveen una guia especifica para las encuestas de calidad de medicamentos. Por lo tanto, aquellos que llevan a cabo las encuestas a menudo no saben como definir lo que se considera como la mejor practica. Aqui se presenta una lista de los principales retos eticos en el diseno y en la realizacion de encuestas. Resultados y conclusionesEs vital que el diseno y el pase de encuestas de calidad de medicamentos apoyen obligaciones eticas y morales, asi como el analisis de las implicaciones y las consecuencias eticas de dicho trabajo. Estas son: el impacto sobre la disponibilidad local de y el acceso a las medicinas; la confidencialidad y la privacidad de los encuestados y encuestadores; preguntas sobre si los trabajadores del punto de entrega deberian ser avisados de que estan formando parte de un estudio; la necesidad de aprobaciones eticas y regulatorias; y como diseminar los hallazgos obtenidos. Las encuestas sobre la calidad de los medicamentos deberian idealmente realizarse junto con las autoridades nacionales relevantes en regulacion de medicamentos. Se requiere un modelo internacional, pero contextualmente sensible, de buenas practicas eticas.

Background Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. Methods The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20-–21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations.Results: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Results Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. Conclusion Vitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.

Objective Acupuncture systematic reviewers have increasingly searched Chinese databases and journals to identify eligible randomised clinical trials (RCTs). However, reviewers have infrequently searched for eligible RCTs in Korean databases and journals. This study aimed to identify difficult to locate acupuncture RCTs in Korean databases and journals and to assess the characteristics and quality of the identified RCTs. Methods Eleven electronic databases and seven journals were searched up to December 2012. All RCTs using needle acupuncture were considered for inclusion. Key study characteristics were extracted and risk of bias was assessed using the Cochrane Collaboration tool. Results One hundred and forty-three publications met our inclusion criteria. Acupuncture RCTs in the Korean literature emerged in the mid-1990s and increased in the mid-2000s. Diverse methods of acupuncture were used, including some methods unique to Korea (eg, Saam acupuncture). The largest proportion of trials evaluated acupuncture for musculoskeletal conditions (27.3%). The mean sample size was 44.3±25.3 per trial. Random sequence generation methods were reported in 44.8% of the RCTs, whereas only 11.9% reported methods of allocation concealment. A low proportion of trials reported participant blinding (32.9%) and outcome assessment blinding (18.9%). Conclusions Korean acupuncture trials, many of which evaluate acupuncture styles unique to Korea, are typically omitted from systematic reviews of acupuncture, resulting in the potential for language bias. The development of this database of difficult to locate Korean trials, which includes English language translations of abstracts, will enable these trials of varying quality to be assessed for inclusion in future acupuncture systematic reviews.

Objective: To investigate the views of pharmacists in North-Central Nigeria on generic medicines and generic substitution practices. Subjects and Method: A cross-sectional survey was conducted in 4 cities in North-Central Nigeria from April to June 2012 among 330 pharmacists in hospital and community pharmacy settings, recruited through a convenience sampling strategy. Data were collected using a prevalidated self-administered questionnaire and entered into SPSS version 16.0 software to generate descriptive statistics. Binary logistic regression was conducted to determine the demographic predictors of preference for generic substitution among respondents. Results: The response rate was 46.7% (n = 154). Eighty-four (54.5%) respondents reported that generic medicines were not of equivalent quality to branded ones. There was no significant difference (p > 0.05) in the perception of respondents regarding the quality of imported generic medicines over locally manufactured ones. While 143 (92.9%) respondents supported generic substitution practices, 105 (68.2%) would prefer to recommend generic medicines over branded ones. Hospital pharmacists were more likely (OR = 2.6; 95% CI 1.2-5.8) than community pharmacists to recommend generic medicines. One hundred and fifty-three (99.4%) respondents would support the implementation of a future generic substitution right for pharmacists in Nigeria. Conclusion: The present study showed a high support for generic substitution and future generic substitution rights for pharmacists in Nigeria.

This paper analyses how the conceptual and therapeutic formation of Japanese traditional medicine (Kampo) has been socially constructed through interactions with popular interpretations of illness. Taking the example of emotion-related disorders, this paper focuses on the changing meaning of constraint (utsu) in Kampo medicine. Utsu was once a name for one of the most frequently cited emotion-related disorders and pathological concerns during the Edo period. With the spread of Western medicine in the Meiji period, neurasthenia replaced utsu as the dominant emotion-related disorder in Japanese society. As a result, post-Meiji doctors developed other conceptual tools and strategies to respond to these new disease categories, innovations that continue to influence contemporary practitioners. I begin this history by focusing on Wada Tōkaku, a Japanese doctor of the Edo period who developed a unique theory and treatment strategy for utsu. Secondly, I examine. Yomuto Kyūshin and Mori Dōhaku, Kampo doctors of the early twentieth century, who privileged neurasthenia over utsu in their medical practice. The paper concludes with a discussion of the flexibility and complexity of Kampo medicine, how its theory and practices have been influenced by cross-cultural changes in medicine and society, while incorporating the popular experience of illness as well.

It is believed that emergency treatment in ayurveda is not present and in emergency one need to take only allopathic medicines, and ayurveda has limited role to play in chronic ailments only. This belief in society and ayurvedic physicians has arrested development of ayurveda, and limiting its role as adjuvant therapy. Ayurveda to become main line of medicine needs to have emergency management. The emergency management was described in ayurveda, which needs only enlightenment. In this paper an attempt has been made to understand ayurvedic basics of emergency management. It includes understanding emergency condition according to ayurveda and management accordingly. It is important to note that mild to moderate emergency can very well be managed according to ayurveda. The concept of emergency, management, etc. is discussed in full paper.

Objectives De qi is a sensation experienced by a patient or an acupuncturist during acupuncture treatment. Although de qi is considered to be important in acupuncture treatment, there are not many studies about de qi and its character. The purpose of this study is to review de qi questionnaires and evaluate the relationship between de qi and acupuncture points, stimulation and treatment effects. Methods A search was conducted using three English-language databases (PubMed, Cochrane and ScienceDirect) and seven Korean databases with the keywords ‘ de qi’ and ‘needle sensation’. The included studies were then categorised as following: (1) de qi measurement tools, (2) the relationship between de qi and acupuncture points, (3) the relationship between de qi and stimulation, (4) the relationship between de qi and treatment effects and (5) attitudes and opinions toward de qi. Results Several questionnaires have been developed to evaluate de qi, and the most frequent sensation in those questionnaires was ‘heavy’ and ‘numb’. Although a few studies showed specificity to acupuncture points, information is still lacking to be able to draw a clear conclusion about the relationship between de qi and acupuncture points. Also, greater de qi was elicited in real acupuncture than placebo acupuncture in many studies. The relationship between de qi and treatment effects was controversial. Conclusions It seems that real acupuncture induced greater de qi than sham acupuncture, and the relationship between de qi, acupuncture points and treatment effects was controversial. However, the current literature evaluating de qi is not sufficient to derive clear conclusions. Further studies with more objective indices and rigorous methodologies are needed.

Introduction: Scientific productions have been accelerated in Iran in past decades but its association with health problems and disease burden is doubtful. The aim of this study is assessment of the relationship between scientific productions with disease burden in Iran in PubMed dataset during 2010 to 2014. Method: The study was performed with the library method. Data Gathered using Scientometrics indicators and direct observation. The current research includes all articles written by Iranian researchers during 2010 to 2014 which were published in PubMed–indexed journals. The search was performed using keywords included road accident, ischaemic heart diseases, major depression disorders and cerebral vascular diseases. Results: In total 910 articles had been published PubMed -indexed journals. Among them Substance-Related Disorders and Accidents, Traffic had the highest (263 records) and lowest (94 records) records respectively. There was not a direct correlation between Years of Life Lost, Years Lost due to Disability and mortality rate with scientific productions. Conclusions: our results showed Iranian scientific productions in PubMed data set are not related to disease burden however they are not related to high mortality diseases.

Background : This paper aimed to demonstrate the research and development of a rule-based expert system for skin problem consulting in the areas of acne, melasma, freckle, wrinkle, and uneven skin tone, with recommended treatments from Thai traditional medicine knowledge. Materials and Methods: The tool selected for developing the expert system is a software program written in the PHP language. MySQL database is used to work together with PHP for building database of the expert system. The system is web-based and can be reached from anywhere with Internet access. Results: The developed expert system gave recommendations on the skin problem treatment with Thai herbal recipes and Thai herbal cosmetics based on 416 rules derived from primary and secondary sources. The system had been tested by 50 users consisting of dermatologists, Thai traditional medicine doctors, and general users. The developed system was considered good for learning and consultation. Conclusion: The present work showed how such a scattered body of traditional knowledge as Thai traditional medicine and herbal recipes could be collected, organised and made accessible to users and interested parties. The expert system developed herein should contribute in a meaningful way towards preserving the knowledge and helping promote the use of Thai traditional medicine as a practical alternative medicine for the treatment of illnesses. Keywords : Rule-based expert system, Knowledge representation, Knowledge inference, User interface, Thai traditional medicine, Thai herbal recipes

Introduction : Osteoporosis as a chronic disease, affecting especially women in postmenopausal age, is an important, social and economic health problem especially of women of today’s world. The aim of the study was to assess the level of knowledge of women in the peri- and postmenopausal period about the prevention of osteoporosis and show the influence of chosen risk factors on the level of this knowledge. Material and methods : A group of 300 women aged 45-65, being patients of healthcare centres in Chełm, Lublin and Zamość (Lublin voivodeship, south-eastern Poland) were included in the study. The purposive sampling was used. Osteoporosis Knowledge Test (OKT) 2011 was the research tool. Gathered material was subjected to descriptive and statistical analysis. Tukey’s test, t-student test and variance analysis (ANOVA) were all applied. An accepted p materiality level was < 0.05 and p < 0.01. Results : Respondents presented the average level of knowledge about the role of physical activity in the prevention of osteoporosis (M = 13.93) and a low level of knowledge about well-balanced diet rich in calcium (M = 9.77). The knowledge about risk factors, screening and treatment remained on the average level (M = 8.00). An influence of socio-demographic factors on the level of knowledge was shown. Also some behaviours, associated with the lifestyle indeed influenced the level of this knowledge. Conclusions : Professional educational programs on osteoporosis should be implemented in the population of Polish peri- and postmenopausal women.

In order to alleviate diabetic foot problems, patients sometimes seek complementary therapies outside the professional context. This paper describes the use of complementary remedies as a topical treatment for diabetic foot ulcers among Jordanians. Qualitative content analysis was used to analyse written responses of 68 patients with diabetes who haveused complementary therapies to treat diabetic foot problems. These 68 persons represented a subgroup of the study population surveyed using a questionnaire, to the effect of investigating diabetic foot treatments provided in Jordan. Informants were recruited from eight healthcare facilities established in the southern part of Jordan plus from one hospitalestablished in the Jordanian capital. The study was approved by the Boards of Ethics of the participating healthcare facilities. Content analysis yielded the category “Complementary Therapies Used”, which included a range of household items (olive oil, sesame oil, honey, and vinegar), and also some indigenous Jordanian herbs (Wormwood, Myrrh, Caper, and Henna among others). The remedies were used either as a monotherapy or as mixtures, to the common goal of treating diabetic foot problems. Other interventions like Al-cowy were also sought from traditional healers. Educational campaigns are required to increase the awareness of patients and their families on possible hazards of unwise complementary therapy use. The decisions on the use of such therapies should be made in agreement with the attending healthcare professionals.

The people of far-flung rural areas still depend to a large extent upon plants and household remedies for curing veterinary ailments. The folk knowledge of ethnoveterinary medicine and its significance has been identified by the traditional communities through a process of experience over hundreds of years. The paper deals with 34 ailments commonly found in nine different categories of livestock/animals (i e. buffalo, cow, oxen, sheep, goat, horse, mule, dog and cat) and their treatment with 73 medicinal plant species belonging to 70 genera and 45 families that occur in forests as well as close vicinity of the rural settlements. Out of the total population, majority of the people (more than 80%) was found dependent on traditional (herbal) system of treatments practiced by local herbal healers (Pashu Vaidyas), while rest of the people preferred modern (allopathic) system of treatments for curing veterinary ailments. In this study we observed that old aged people have more knowledge and experience particularly in remote areas for curing veterinary ailments. The traditional system of treatment is one of the most important prevailing systems in the area where modern veterinary health care facilities are rare or in very poor conditions.Keywords: Ethnoveterinary uses, Medicinal plants, Veterinary ailments, Livestock, Traditional herbal healers, Alaknanda catchment

In this paper we present the Karanga traditional system of therapy of illness and disease manifest in the treatments administered by the medical practitioners. In order to establish the traditional system of therapy of illness and disease, numerous interviews were carried out with healers, herbalists and elders in the field area. This enabled a systematic compilation of cases. There was also the pressing need to be present at rituals and instances where healing was effected and to observe therapeutic processes.African Journal of Traditional and Complementary Medicine Vol. 4 (4) 2007: pp. 501-509