Can a standardized acupuncture technique palliate disabling breathlessness: a single-blind, placebo-controlled crossover study.

STUDY OBJECTIVES: The management of disabling breathlessness is poor, and a standardized form of acupuncture has been reported as offering benefit. This study was designed to evaluate the efficacy of standardized acupuncture treatment. DESIGN: A single-blind, randomized, crossover study. SETTING: This study was carried out on a domiciliary basis in Southampton (UK). INTERVENTIONS: This study evaluated a standardized acupuncture technique vs an appropriately validated placebo/control (mock transcutaneous electrical nerve stimulation [TENS]) for disabling, nonmalignant breathlessness (largely COPD). The acupuncture was provided by an appropriately trained nurse acupuncturist. Each patient received six treatments in each phase of the study, with an intervening 2-week washout period. MEASUREMENTS AND RESULTS: The primary outcome was worst breathlessness (visual analog scale, 0 to 100 mm), with the sample size based on an 80% power to detect a 10-mm difference between treatment means. Secondary outcomes included the St George's respiratory questionnaire score and treatment credibility. RESULTS: Thirty-six patients were entered into the study (33 with COPD), and 24 patients completed both treatment phases. The primary outcome improved significantly during the course of the study, but there were no significant treatment differences between acupuncture and the placebo/control of mock TENS for either primary or secondary outcomes. The placebo was shown to be a credible control. There was no evidence of a carryover effect from the first to second phase of the study. CONCLUSION: This standardized acupuncture technique does not show specific efficacy in disabling nonmalignant breathlessness, but those entered into the study did experience clinically significant benefit from both treatments.

A perinatal intervention program for urban american indians part 2: the story of a program and its implications for practice.

This is the story of how a culturally aware staff successfully intervened with a clientele of another culture. A high infant mortality rate for American Indians in Milwaukee, WI, prompted a community health agency to initiate a program to address the problem. Efforts were made to educate the American Indian community about the importance of both prenatal and postnatal care. Part 1 of this report was published (Davis & Prater, 2001) and presented the design and implementation of the program, as well as program outcomes. Here, Part 2 describes aspects of the same program, including the personal story of a client and the results of an evaluation conducted by a three-person research team. Implications for practice are also presented. Among these are suggestions for hiring and retaining staff, locating and retaining clients, addressing cultural sensitivity, and identifying administrative actions that enhance program operation. The personal stories of two additional clients are included to illustrate the difficult reality of some clients' lives and the resulting necessity for flexibility and resourcefulness on the part of program staff. This program represents the positive impact that program workers had on the problem of American Indian infant mortality.