Efficacy of acupuncture in treating chronic non-specific low back pain / 针灸推拿医学（英文版）

Objective: To provide an update on the evidence of the effectiveness of acupuncture in treating chronic non-specific low back pain (CNSLBP) based on randomized controlled trials (RCTs) of acupuncture for CNSLBP published between 2006 and 2020. Methods: A comprehensive literature search was conducted through the University of Malta website, using the HyDi search engine. The 'Advanced Search' option was chosen in order to search for articles that were published in English, and associated with the key words, 'Chronic', 'Acupuncture', 'Needle', 'Needling', 'Non-specific' and 'Low Back Pain', which were entered in their 'Subject' field, from the year 2006 till 2020. A comprehensive reading and analysis was done for the search result. Results: Through the use of the HyDi search engine, accessible through the University of Malta, eighteen randomized controlled trials that met the criteria of this study were selected. Conclusion: Through the analysis and comparison of the studies selected for this literature review, there is evidence providing that acupuncture is significantly more effective than current conservative treatment modalities for patients with CNSLBP in reducing pain and improving function.

Anxiety and the management of asthma in an adult outpatient population.

BACKGROUND: Review of the literature suggests that anxiety is more common among patients with asthma than among the general population, yet it does not appear to be given the attention it deserves as part of the overall management of asthma. The aim of this study was to investigate the relationship between anxiety and asthma management, in terms of Global Initiative for Asthma steps, lung function and medication. METHODS: A total of 201 consecutive patients with respiratory physician-diagnosed asthma were recruited from an adult outpatient asthma clinic. Participants underwent a sociodemographic review, and a medical interview which included a detailed drug history. Forced expiratory volume in 1 second (FEV(1)) and peak expiratory flow (PEF) values were recorded using a Micro Medical((R)) portable spirometer. The level of anxiety was assessed using the Beck Anxiety Inventory (BAI). RESULTS: A total of 51.5% of participants registered clinically significant levels of anxiety. Of these only 21% had already been diagnosed and were receiving treatment. Females reported significantly higher BAI scores than males (p < 0.01). More females (66.3%) registered clinically significant levels of anxiety as compared with males (33.7%) (p < 0.05). There was a positive correlation between the BAI score and the prescribed dose of inhaled glucocorticoids (r(s) = 0.150, p < 0.05) and between anxiety and GINA treatment step (r(s) = 0.139, p < 0.05). There was also a positive correlation between anxiety and the number of medicines taken by patients (r(s) = 0.259, p < 0.001). CONCLUSIONS: Physicians treating patients with asthma should be sensitised to the association between asthma and anxiety, and should also consider assessing patients for the possibility of anxiety disorders as part of asthma management plans.

Rosella parrot exposure as a cause of bird fancier's lung.

A case of a 30-year-old man who presented with a 2-month history of progressively worsening dyspnoea, cough, and reduced exercise tolerance is discussed. A chest x-ray and computerized tomography of the chest suggested interstitial lung disease, which was confirmed on histology of an open lung biopsy. Careful questioning revealed that the patient had sustained close exposure to a rosella parrot acquired as a pet 9 months prior to presentation, which led to the diagnosis of bird fancier's lung. The case, investigations, and outcome are presented. This is followed by a discussion on extrinsic allergic alveolitis with particular emphasis on the importance of a complete social and environmental history in patients presenting with similar respiratory symptoms.

The impact of guidelines on long-term asthma care: a study of hospitalised patients in Malta.

OBJECTIVE: To compare actual practice to that recommended in asthma guidelines, published in Malta in February 1998, with respect to the management of asthma. These were the first national clinical guidelines to be published locally. METHOD: A piloted, structured interview was conducted with patients between 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 min. The four-year prospective study started in February 1997 (one year before publication of guidelines and aimed at collecting baseline data) and finished in January 2001 (three years after publication of the local guidelines). MAIN OUTCOME MEASURES: Inhaled steroids on admission. Patient partnership: use of a written self-management plan and home peak flow monitoring. Patient compliance with inhaled steroids. RESULTS: 304 patients (68% females; mean population age 33.9 years SD +/- 13.41) were interviewed over the four-year period. The difference in proportions test (Z-test) was used to analyse the data comparing years 2, 3 and 4 with year 1. No statistical differences were found when comparing the groups for inhaled steroid treatment on admission or availability of a home peak flow meter. Similarly, no differences were found between groups when comparing compliance with inhaled steroids. A statistically significant increase in availability of a self-management plan was found over the study period (3% in year 1; 1% in year 2; 11% in year 3; 9% in year 4), but the overall use of such plans remains disappointingly low. CONCLUSION: With the exception of an increased use of self-management plans, there appears to be lack of adherence to guidelines with consequent undertreatment of asthma, despite the fact that guidelines were published three years ago. This indicates a need to ensure better dissemination and implementation strategies to promote adherence. It is suggested that the clinical pharmacist is well-placed to promote adherence to guidelines.