The effect of acupressure on sleep quality in hemodialysis patients. [Effect of acupuncture on hemorheology in patients with diabetic nephropathy]. Effects of far infrared acupoint stimulation on autonomic activity and quality of life in hemodialysis patients. Undertreatment of symptoms in patients on maintenance hemodialysis. Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients. [Effects of acupuncture on gastrointestinal responses after renal transplantation]. Auricular Acupressure on Specific Points for Hemodialysis Patients with Insomnia: A Pilot Randomized Controlled Trial Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis. Effect of acupressure on fatigue in patients on hemodialysis Effect of Acupressure on Thirst in Hemodialysis Patients CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials [Acupuncture for treatment of kinetic insufficiency of kidney-qi and study on the mechanism]. Use of Auricular Acupressure to Improve the Quality of Life in Diabetic Patients with Chronic Kidney Diseases: A Prospective Randomized Controlled Trial ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Better Reporting of Harms in Randomized Trials: An Extension of the CONSORT Statement Commentary on the Cochrane Review of acupuncture and assisted conception. [Clinical observation on acupuncture for treatment of diabetic nephropathy]. The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT). [Effects of different acupuncture manipulation on plasma estradiol, testosterone and cortisol in patients with kidney deficiency]. Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes The effect of acupressure on the level of fatigue in hemodialysis patients. Non-penetrating sham needle, is it an adequate sham control in acupuncture research? Acupressure and Transcutaneous Electrical Acupoint Stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. [Effect of moxibustion on quality of life in hemodialysis patients]. Acupressure and fatigue in patients with end-stage renal disease-a randomized controlled trial. Acupuncture treatment for 34 cases of uremic cutaneous pruritus. The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: a randomized controlled trial. Clinical analysis for the acupuncture treatment in 42 cases of gouty renal damage. Acupuncture in haemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus. Acupressure and quality of sleep in patients with end-stage renal disease--a randomized controlled trial. [Effect of acupoint injection on erythropoietin resistance in patients with chronic renal failure]. [Randomized controlled trail on moxibustion for maintenance hemodialysis patients in deficiency syndrome]. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. [The influence of different acupuncture manipulations on the plethysmogram of the patient with kidney deficiency]. Acupressure therapy inhibits the development of diabetic complications in Chinese patients with type 2 diabetes. Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Acupuncture as Palliative Therapy for Physical Symptoms and Quality of Life for Advanced Cancer Patients
OBJECTIVE Our purpose was to investigate the effects of acupressure on sleep quality in hemodialysis patients . DESIGN R and omized clinical trial . SETTING The setting of the study was dialysis wards located in two university hospitals ( Imam and Golestan ) in Ahvaz , Iran . INTERVENTIONS 48 end-stage renal disease patients on hemodialysis who scored 5 points or higher on the Pittsburgh Sleep Quality Index ( PSQI ) were enrolled to the study .  Acupressure group received acupressure intervention on the Shenmen ( He7 ) and He Gu ( Li4 ) points in the h and s and Sanyingjao ( sp6 ) point in the feet for 4 weeks beside routine care and control group received only routine care . MAIN OUTCOME MEASURES subjective sleep quality , latency and duration , habitual sleep efficiency ; sleep disturbances , daytime functional status , and use of sleeping medications . RESULTS The result indicated significant differences between the acupressure group and the control group after intervention in PSQI global scores ( p<0.001 ) and all sleep quality indices between two groups after intervention : subjective sleep quality ( p<0.001 ) , sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p=0.006 ) , sleep disturbance ( p<0.001 ) , the use of sleeping medication ( p=0.028 ) , and daytime dysfunction ( p<0.001 ) . CONCLUSION This study supports the effectiveness of acupressure in improving sleep quality of end-stage renal disease patients as a noninvasive therapy OBJECTIVE To explore the underlying mechanisms of acupuncture in treating diabetic nephropathy ( DN ) by observing the effect of acupuncture on blood rheology of DN . METHODS A total of 54 cases of DN patients were r and omly divided into control ( n=24 ) and acupuncture group ( n=30 ) . Patients of control group were treated with diet-control , oral administration of Gliguidone ( 30 - 60 mg , t. i. d. ) or subcutaneous injection of insulin , and those of acupuncture group treated with the same medication as those of control group and additional manual acupuncture stimulation of Ganshu ( BL18 ) , Pishu ( BL20 ) , Zusanli ( ST 36 ) , etc . , once daily for 30 days . Hemorheology was detected with LBY-N6A Automatic Hemorheological Analyser . The treatment duration in 2 groups was 30 days . RESULTS After the treatment , of the 24 and 30 cases in control and acupuncture groups , 6 ( 25.0 % ) and 16 ( 53.3 % ) cases experienced remarkable improvement in their symptoms ; 10 ( 41.6 % ) and 12 ( 40.0 % ) had improvement , 8 ( 33.3 % ) and 2 ( 6.7 % ) failed , with the effective rates being 66.7 % and 93.3 % respectively . Self-comparison showed that after the treatment , no significant changes were found in lower shear rate ( LSR ) and higher shear rate ( HSR ) of whole blood viscosity , plasma viscosity ( etap ) , hematocrit ( HCT ) and profibrin in control group ; while LSR of whole blood viscosity , etap and profibrin in acupuncture group decreased significantly ( P<0.05 ) . The therapeutic effect of acupuncture group was significantly superior to that of control group in lowering LSR of whole blood viscosity and profibrin ( P<0.05 ) . CONCLUSION Acupuncture can improve DN patients ' clinical symptoms and blood rheology , and hence , has a certain effect in postponing the development of DN Patients receiving regular hemodialysis sessions have been known to suffer from fatigue and depression . This experiment was design ed to determine the effects of far infrared ray ( FIR ) stimulation on acupoints of patients suffering from renal failure who are receiving regular hemodialysis . Patients receiving long-term and regular hemodialysis who volunteered for this procedure were r and omly selected to undergo either FIR or heat pad ( HP ) therapy to determine the impact of FIR treatment on these patients . Both the activities of the autonomic nervous system and changes in quality of life were measured before and after treatment to determine the effectiveness of the FIR treatment . Results from this study show that FIR therapy decreases both stress and fatigue levels of these patients . It also stimulates autonomic nervous system ( ANS ) activity in patients who are diagnosed with end-stage renal disease ( ESRD ) and are receiving regular hemodialysis ( HD ) . Therefore , benefits of FIR stimulation on these patients are clearly demonstrated in this preliminary study CONTEXT Hemodialysis patients suffer a large symptom burden , and little is known about how effectively symptoms are treated . OBJECTIVES To assess the management of treatable symptoms in hemodialysis patients , we administered a 30-item question naire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia . METHODS We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy . By means of chart review , we also documented whether medications were prescribed for these symptoms . RESULTS We approached 87 patients and enrolled 62 ( 71 % ) . The most commonly reported , potentially treatable symptoms included bone/joint pain , insomnia , mood disturbance , sexual dysfunction , paresthesia , and nausea . Only 45 % of patients with bone/joint pain reported receiving an  analgesic medication . Twenty-three percent of patients with trouble falling asleep and 53 % of patients with nausea reported receiving a medication to alleviate this symptom . Chart review revealed that 58 % of patients who reported the presence of bone/joint pain were prescribed an  analgesic  , 23 % of patients with trouble falling asleep were prescribed a  sleep aid  , and 42 % of patients with nausea received an  antiemetic .  Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet , and this difference was significant for the treatment of worrying ( 3/3 vs. 0/3 , P=0.05 ) and nervousness ( 4/5 vs. 0/5 , P=0.02 ) . CONCLUSION Potentially treatable symptoms in hemodialysis are undertreated . Pharmacologic therapy , particularly for emotional symptoms , was more commonly prescribed by primary care providers than nephrologists . Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity , mortality , and quality of life . We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview ( MINI ) . In a r and omized trial conducted in Brazil , an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit . In both groups , the Beck Depression Inventory , the MINI , and the Kidney Disease and Quality of Life-Short Form question naires were administered at baseline , after 3 months of intervention or usual treatment , and after 9 months of follow-up . The intervention group had significant improvements , compared to the control group , in the average scores of the Beck Depression Inventory overall scale , MINI scores , and in quality -of-life dimensions that included the burden of renal disease , sleep , quality of social interaction , overall health , and the mental component summary . We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients OBJECTIVE To observe the effect of acupuncture on gastrointestinal responses  after renal transplantation . METHODS Sixty cases with gastrointestinal responses after renal transplantation were r and omly divided into an acupuncture group and a medication group , 30 cases in each group . The acupuncture group were treated with acupuncture at Neiguan ( PC 6 ) , Zusanli ( ST 36 ) , Sanyinjiao ( SP 6 ) , etc . ; the medication group were treated with oral administration of Weilexin . The symptoms of abdominal pain , nausea , gastric distention , and other gastrointestinal responses were observed in the two groups . RESULTS The effective rate was 93.3 % in the acupuncture group and 76.7 % in the medication group with a very significant difference between the two groups ( P < 0.01 ) , the acupuncture group being significantly better than the medication group . CONCLUSION Acupuncture has a good effect of promoting recovery of gastrointestinal function after renal transplantation Objectives To assess the feasibility and acceptability of a r and omized controlled trial compared auricular acupressure ( AA ) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis ( MHD ) patients with insomnia . Methods Sixty three ( 63 ) eligible subjects were r and omly assigned into either AA group received AA on specific acupoints ( n=32 ) , or sham AA ( SAA ) group received AA on points irrelevant to insomnia treatment ( n=31 ) for eight weeks . All participants were followed up for 12 weeks after treatments . The primary outcome was clinical response at eight weeks after r and omization , defined as a reduction of Pittsburgh Sleep Quality Index ( PSQI ) global score by 3 points and more . Results Fifty-eight ( 58 ) participants completed the trial and five dropped out . Twenty participants in AA group ( 62.5 % ) and ten in SAA group ( 32.3 % ) responded to the eight-week interventions ( χ2 = 5.77 , P = 0.02 ) . PSQI global score declined 3.75 ± 4.36 ( 95%CI -5.32 , -2.18 ) and 2.26 ± 3.89 ( 95%CI -3.68 , -0.83 ) in AA group and SAA group respectively . Three participants died during the follow-up period . No evidence supported their deaths were related to the AA intervention . No other adverse event was observed . Conclusion Feasibility and logistics of patient recruitment , r and omization procedure , blinding approach , interventions application and outcome assessment had been tested in this pilot trial . The preliminary data appeared to show a favorable result on AA treatment . A full-scale trial is warranted . Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272 TITLE Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis . AIM This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters . BACKGROUND Uremic pruritus remains one of the most frustrating , common , and potentially disabling symptoms in patients undergoing haemodialysis . The mechanism underlying uremic pruritus is poorly understood . Although enough is known to determine a reasonable treatment approach , more research is needed to evaluate more reliable treatments . METHODS A r and omized , double-blind , controlled trial was conducted in 2005 using question naires and measurement of blood biochemical parameters . A total of 41 uremic patients on maintenance haemodialysis were r and omly assigned either to the thermal therapy group or the control group . The thermal therapy group was treated with 40 degrees C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions . The control group received a plain adhesive patch placed on the same acupoint . FINDINGS Both groups showed statistically significant improvements but there were no differences between groups , while a relatively large decrease in pruritus scores was found in the thermal therapy group ( P < 0.001 ) as compared with the non-thermal therapy group . Serum calcium level decreased statistically significantly in the thermal therapy group and was statistically significantly different from that of the control group . CONCLUSION The lack of effect does not necessarily demonstrate that thermal therapy is not effective or has no therapeutic benefits for uremic pruritus in patients having haemodialysis . Further investigation is warranted , with larger sample s and longer intervention Background : Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life . The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients . Material s and Methods : This is a clinical trial study in which 96 hemodialysis patients participated . Patients were r and omly assigned into acupressure , placebo , and control groups ( 32 subjects fulfilling the inclusion criteria assigned to each group ) . The measures included the form of demographic characteristics , visual analog scale of fatigue , and Piper Fatigue Scale . Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day , 3 days per week for 4 weeks . In the placebo group , acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site . Patients in the control group received routine unit care only . Chi- quare test , Kruskal-Wallis , paired t-test , one-way analysis of variance ( ANOVA ) , and Duncan test were used for data analysis . Results : One-way ANOVA tests showed significant differences in the total mean score of fatigue and fatigue mean scores in the behavioral , emotional , sensory , and cognitive dimensions in the acupressure , placebo , and control groups . Conclusion : The results of this study showed that acupressure may reduce fatigue in hemodialysis patients , and use of this non-pharmacologic technique for hemodialysis nurses is suggested Background : Thirst and dry mouth are common among hemodialysis ( HD ) patients . This paper reports a study to evaluate the impact of an acupressure program on HD patients ’ thirst and salivary flow rates . Methods : The acupressure program included placebo , followed by true acupressure each applied for 4 weeks . Twenty-eight patients ( mean age 57.6 , SD = 16.13 years ) first received a sticker as placebo acupressure at two acupoints CV23 and TE17 three times a week for 4 weeks , and then received true acupressure in the same area for the next 4 weeks . Salivary flow rate and thirst intensity were measured at baseline , during and after treatment completion for both the placebo and true acupressure program . Results : The true acupressure program was associated with significantly increased salivary flow rate ( 0.09 ± 0.08 ml/min at baseline to 0.12 ± 0.08 ml/min after treatments completion , p = 0.04 ) . The mean thirst intensity also improved from 4.21 ± 2.66 at baseline to 2.43 ± 2.32 ( p = 0.008 ) after treatment completion in HD patients . There was no statistically significant difference in pre-post program salivary flow rate ; however , significant improvement in thirst intensity scores was observed ( p = 0.009 ) in the placebo acupressure program . Conclusion : This study provides preliminary evidence that acupressure may be effective in improving salivary flow rates and thirst intensity The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To observe the therapeutic effect of acupuncture on kinetic insufficiency of kidney-qi and to study on the mechanism . METHODS Forty-four healthy professional sportsmen were r and omly divided into an acupuncture group and a control group . They trained for 4 weeksq with regular detection . In the latter 2 weeks , the acupuncture group received scalp and body-acupuncture . RESULTS Three weeks later , signs of insufficiency of kidney-qi appeared in most of the sportsmen in the two groups . Two weeks after treatment , in the acupuncture group the signs improved , and testosterone ( T ) and estradiol ( E2 ) levels increased ( P < 0.05 ) ; the symptoms did not significantly improve and the T and EZ levels decreased in the control group ( P < 0.05 ) . CONCLUSION Acupuncture therapy can regulate excitatory and inhibitory functions of the nervous system , improve symptoms of kinetic insufficiency of kidney-qi , and has regulative and repairing action on the sexual gl and s and adrenal gl and Background . Diabetic patients with chronic kidney disease ( CKD ) suffer from low quality of life ( QOL ) . We aim to assess the effectiveness of auricular acupressure for QOL improvement in these patients . Material s and Methods . Sixty-two participants were r and omly assigned to an auricular or a control arm in a r and omized controlled trial . Participants in the auricular arm were instructed to perform auricular acupressure 3–5 times per day for 3 months , when they were receiving conventional treatments . Participants in the control arm received conventional treatments only . The primary outcome was the summarized score of Kidney Disease and Quality of Life Short-Form ( KDQOL-SF ) at 3 months after r and omization . The secondary outcomes included the 36-Item Short Form Health Survey ( SF-36 ) , glycosylated hemoglobin ( HbA1c ) , and estimated glomerular filtration rate ( eGFR ) . Results . The summarized KDQOL differed significantly between the acupressure ( 76.6 , 95 % CI , 72.2 to 81.0 ) and the control group ( 61.8 , 95 % CI , 57.7 to 65.9 ) . Similar results were found in the SF-36 scores . HbA1c and eGFR were not found to be significantly different between the arms and neither were the adverse events . Conclusion . Auricular acupressure was well tolerated in diabetic patients with chronic kidney diseases receiving hemodialysis . Future research is needed to confirm these results BACKGROUND Radiation treatment of head and neck cancer can cause chronic xerostomia which impairs patients ' quality of life . The study reported here examined the efficacy of acupuncture in alleviating xerostomia symptoms especially dry mouth . PATIENTS AND METHODS A total of 145 patients with chronic radiation-induced xerostomia > 18 months after treatments were recruited from seven UK cancer centres . The study employed a r and omised crossover design with participants receiving two group sessions of oral care education and eight of acupuncture using st and ardised methods . Patient-reported outcome ( PROs ) measures were completed at baseline and weeks 5 , 9 , 13 , 17 , and 21 . The primary outcome was improvement in dry mouth . OBJECTIVE saliva measurements were also carried out . RESULTS Acupuncture compared with oral care , produced significant reductions in patient reports of severe dry mouth ( OR = 2.01 , P = 0.031 ) sticky saliva ( OR = 1.67 , P = 0.048 ) , needing to sip fluids to swallow food ( OR = 2.08 , P = 0.011 ) and in waking up at night to drink ( OR = 1.71 , P = 0.013 ) . There were no significant changes in either stimulated or unstimulated saliva measurements over time . CONCLUSION Eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of symptoms in patients suffering from chronic radiation-induced xerostomia Reporting harms may cause more trouble and discredit than the fame and glory associated with successful reporting of benefits ( 1 ) . The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement , a checklist ( Table 1 ) flow diagram first published in 1996 and revised 5 years later ( 2 , 3 ) , is an effort to st and ardize , and thereby improve , published reports of r and omized , controlled trials ( RCTs ) . One of the additions to the 2001 revision was an item about reporting adverse events . This single item did not do full justice to the importance of harms-related issues . The CONSORT Group met in September 2001 to discuss how to correct this deficiency . We aim ed to provide evidence -based guidance on the reporting of harms in RCTs . First , we search ed MEDLINE , EMBASE , Web of Science , and the Cochrane Library using a wide array of terms related to harms and identified pertinent evidence . We also communicated with experts and review ed bibliographies of identified articles to find additional studies . At a meeting in Montebello , Quebec , Canada , in May 2003 , CONSORT Group members , including several journal editors and additional experts in related fields , held a structured discussion of recommendations about reporting of harms-related issues in RCTs . The discussion s led to a written document that we circulated among the team members for comment . The present manuscript describes our recommendations on the appropriate reporting of harms in RCTs . Table 1 . Original CONSORT Checklist The terminology of harms-related issues in RCTs is confusing and often misleading or misused ( see Glossary ) ( 4 , 5 ) . Safety is a reassuring term that may obscure the real and potentially major harms that drugs and other interventions may cause . We encourage authors to use the term harms instead of safety . In addition to misused terminology , reporting of harms in RCTs has received less attention than reporting of efficacy and effectiveness and is often inadequate ( 6 - 14 ) . In short , both scientific evidence and ethical necessity call for action to improve the quality of reporting of harms in RCTs ( 15 , 16 ) . Here , we present a set of recommendations and accompanying explanations for the proper reporting of harms in RCTs . These recommendations should complement the existing CONSORT statement ( Table 2 ) . Examples are presented on the Annals and CONSORT ( www.consort-statement.org ) Web sites . Table 2 . Checklist of Items To Include When Reporting Harms in R and omized , Controlled Trials Recommendations Title and Abstract Recommendation 1 . If the study collected data on harms and benefits , the title or abstract should so state . The title should mention harms if the study of harms was a key trial objective . Many phase I and phase II trials , some phase II/III trials , and most phase IV trials ( 17 , 18 ) target harms as primary outcomes . Yet , the title and abstract seldom contain the word harm . Among 375143 entries in the Cochrane Central Register of Controlled Trials ( Cochrane Library , issue 3 , 2003 ) , search ing titles with the search terms harm or harms yielded 337 references ( compared with 55374 for efficacy and 23415 for safety ) . Of the 337 , excluding several irrelevant articles on self-harm or harm reduction , only 3 trial reports and 2 abstract s contained the word harm in their titles . Authors should present information on harms in the abstract . If no important harms occurred , authors should so state . Explicit reference to the reporting of adverse events in the title or abstract is also important for appropriate data base indexing and information retrieval ( 19 ) . Introduction Background Recommendation 2 . If the trial addresses both harms and benefits , the introduction should so state . The introduction states the scientific background and rationale of an RCT . This requires a balanced presentation whereby the possible benefits of the intervention under investigation are outlined along with the possible harms associated with the treatment . R and omized , controlled trials that focus primarily on harms should clearly state this interest when describing the study objectives in the Introduction and in defining these objectives in the Methods . Methods Outcomes Recommendation 3 . List addressed adverse events with definitions for each ( with attention , when relevant , to grading , expected vs. unexpected events , reference to st and ardized and vali date d definitions , and description of new definitions ) . The Methods section should succinctly define the recorded adverse events ( clinical and laboratory ) . Authors should clarify whether the reported adverse events encompass all the recorded adverse events or a selected sample . They should explain how , why , and who selected adverse events for reporting . In trials that do not mention harms-related data , the Methods section should briefly explain the reason for the omission ( for example , the design did not include the collection of any information on harms ) . Authors should also be explicit about separately reporting anticipated and unexpected adverse events . Expectation may influence the incidence of reported or ascertained adverse events . Making participants aware in the consent form of the possibility of a specific adverse event ( priming ) may increase the reporting rate of the event ( 20 ) . Another example of priming is the finding that the rates of withdrawals due to adverse events and the rates of specific adverse events were significantly higher in trials of aspirin , diclofenac , or indomethacin with comparator drugs compared with placebo-controlled trials ( 21 ) . Presumably , participants were more eager to come forth and report an adverse event or to withdraw from treatment when they knew they could not be receiving inactive placebo . Authors should report whether they used st and ardized and vali date d measurement instruments for adverse events . Several medical fields have developed st and ardized scales ( 22 - 32 ) . Use of nonvali date d scales is common . The source document for well-established definitions and scales should be referenced . New definitions for adverse events should be explicit and clear . Authors should describe how they developed and vali date d new scales . For interventions that target healthy individuals ( for example , many preventive interventions ) , any harm , however minor , may be important to capture and report because the balance of harms and benefits may easily lean toward harms in a low-risk population . For other population s and for interventions that improve major outcomes ( for example , survival ) , severe and life-threatening adverse events may be the only ones that are important in the balance of benefits and harms . Recommendation 4 . Clarify how harms-related information was collected ( mode of data collection , timing , attribution methods , intensity of ascertainment , and harms-related monitoring and stopping rules , if pertinent ) . It is important to describe the question naires , interviews , and tests used to collect information on harms , as well as their timing during follow-up . Passive surveillance of harms leads to fewer recorded adverse events than active surveillance ( 4 ) . Open-ended questions may yield different information , both quantitatively and qualitatively , than structured question naires ( 33 ) . Studies of nonsteroidal , anti-inflammatory drugs ( NSAIDs ) exemplify how data collection methods can affect the detection and reporting of harms . When selective NSAIDs with fewer gastrointestinal adverse events became available , trials reported more than 10 times as many ulcers when comparing these drugs with older NSAIDs as when older NSAIDs were compared with placebo . In the newer trials , more ulcers were detected because participants had regular endoscopy , and the case definition of ulcers was more sensitive ( 34 ) . Authors should specify the time frame of surveillance for adverse events . Some investigators stop recording adverse events at the end of the intervention period or a certain number of days afterward ( for example , 30 days after discontinuation of drug therapy ) and miss events with long latency ( 35 ) . Surgical trials often capture only the adverse events that occur intraoperatively . Several important surgical complications are likely to occur later . Finally , in crossover trials , delayed events might occur while the patient is taking a subsequent assigned treatment . Attribution is the process of deciding whether an adverse event is related to the intervention . Whenever authors filter events through an attribution process , they should state who makes the attribution ( investigators , participants , sponsors , or combinations ) , whether the process is blinded to assigned treatment , and what definitions of adverse events they use ( 4 ) . Discontinuations and withdrawals due to adverse events are especially important because they reflect the ultimate decision of the participant and /or physician to discontinue treatment . Although treatment may occasionally be discontinued for mild or moderate adverse events , attributing discontinuation to a specific reason ( to toxicity , lack of efficacy , other reasons , or combinations of reasons ) may be difficult . For example , in psychopharmacology , dropouts may reflect treatment ineffectiveness as much as toxicity-related intolerance ( 36 ) . Trial reports should specify who gave the reasons for discontinuation ( participants or physicians ) and whether attribution was blinded to the assigned treatment . For example , even in blinded trials , participants and their clinicians are often unblinded before they decide whether to discontinue the intervention . It is important to report participants who are nonadherent or lost to follow-up because their actions may reflect their inability to tolerate the intervention . Moreover , authors should specify how they h and led withdrawals in the analyses of the data . R and omized , controlled trials should report any plan for monitoring for harms and rules for stopping the trial because of harms ( 37 ) . They should clarify whether stopping guidelines examine benefits and harms Background —Acupuncture has recently been studied in assisted reproductive treatment ( ART ) although its role in reproductive medicine is still debated . Objectives —To determine the effectiveness of acupuncture  in the outcomes of ART . Search strategy —All reports which describe r and omised controlled trials of acupuncture in assisted conception were obtained through search es of the Menstrual Disorders and Subfertility Group Specialised Register , CENTRAL , Ovid MEDLINE ( 1996 to August 2007 ) , EMBASE ( 1980 to August 2007 ) , CINAHL ( Cumulative Index to Nursing & Allied Health Literature ) ( 1982 to August 2007 ) , AMED , National Research Register , Clinical Trials register ( www . clinical trials.gov ) , and the Chinese data base of clinical trials . Selection Criteria —R and omised controlled trials of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment , placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility . Women with medical illness deemed contraindications for ART or acupuncture were excluded . Data Collection and Analysis —Sixteen r and omised controlled trials were identified that involved acupuncture and assisted conception . Thirteen trials were included in the review and three were excluded . Quality assessment and data extraction were performed independently by two review authors . © 2010 Elsevier Inc. All rights reserved . Corresponding author : Eric Manheimer , MS , Research associate , University of Maryl and School of Medicine , Center for Integrative Medicine East Hall , 520 W. Lombard Street Baltimore , MD 21201 , emanheimer@compmed.umm.edu , Telephone : 410 - 706 - 6169 , Fax : 410 - 706 - 6214 . * Both authors contributed equally to this work . The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic review s of CAM therapies . The CAM Field represents an international collaborative effort among research ers , clinicians , consumers , and CAM practitioners from nearly every continent . The Field ’s central office is located at the Center for Integrative Medicine , University of Maryl and School of Medicine , 520 W. Lombard St , Baltimore , MD 21201 . For more information , contact Eric Manheimer at : emanheimer@compmed.umm.edu . Publisher 's Discl aim er : This is a PDF file of an unedited manuscript that has been accepted for publication . As a service to our customers we are providing this early version of the manuscript . The manuscript will undergo copyediting , type setting , and review of the result ing proof before it is published in its final citable form . Please note that during the production process errors may be discovered which could affect the content , and all legal discl aim ers that apply to the journal pertain . NIH Public OBJECTIVE To observe the clinical therapeutic effect of acupuncture on early metaphase diabetic nephropathy . METHODS Fifty-four cases of diabetes were r and omly divided into an acupuncture group ( n=30 ) and a control group ( n=24 ) . The patients in the two groups were all treated by oral administration of Gliguidon or subcutaneous injection of insulin with acupuncture at Ganshu ( BL 18 ) , Weiwanxiashu ( EX-B 3 ) , Shenshu ( BL 23 ) , Guanyuan ( CV 4 ) and other acupoints added in the acupuncture group , for 30 days . RESULTS The total effective rate was 93.3 % in the acupuncture group and 66.7 % in the control group . After treatment , blood beta2-microglobulin ( beta2-MG ) , and urine beta2-MG in the acupuncture group decreased significantly with a significant difference as compared with those in the control group ; total cholesterol ( TC ) and triglyceride ( TG ) significantly decreased and high density lipoprotein ( HDL ) significantly increased in the acupuncture group with significant differences compared with the control group . CONCLUSION Acupuncture can improve lipid metabolism and protect the renal function of the patient with early metaphase diabetes Fatigue and depressive mood are the most significant symptoms experienced by patients with end-stage renal disease . The purpose of this study was to examine the effectiveness of acupressure with massage in fatigue and depression in patients with end-stage renal disease ( ESRD ) receiving hemodialysis treatment . The study applied an experimental pretest and posttest design . Sixty-two hemodialysis patients participated in the study . Data were collected from two hemodialysis clinics in major hospitals in southern Taiwan . Following consent to the study , subjects were r and omly assigned to an acupressure group or a control group . Patients in the acupressure group received acupoint massage for 12 minutes per day , three days per week , for four weeks . Subjects in the control group only received routine unit care . The measures included the Revised Piper Fatigue Scale , and Beck ' s Depression Inventory . Descriptive statistics , chi 2 tests , t-test and analyses of covariance were used for data analysis . The results indicate that subjects experienced a moderate level of fatigue . Nearly 65 % of hemodialysis patients had a depressed mood . ANCOVA results indicated that fatigue ( F((1.54 ) ) = 9.05 , p = .004 ) and depression ( F((1.54 ) ) = 4.20 , p = .045 ) among patients in the acupressure group showed significantly greater improvement than patients in the control group . The findings of this study provide an interventional model for nurses taking care of ESRD patients BACKGROUND Dyspnea on exertion ( DOE ) is a major symptom of chronic obstructive pulmonary disease ( COPD ) and is difficult to control . This study was performed to determine whether acupuncture is superior to placebo needling in improving DOE in patients with COPD who are receiving st and ard medication . METHODS Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving st and ard medication participated in a r and omized , parallel-group , placebo-controlled trial ( July 1 , 2006 , through March 31 , 2009 ) in which the patients , evaluators , and statistician were unaware of the r and om allocation . Participants were r and omly assigned to traditional acupuncture ( real acupuncture group , n=34 ) or placebo needling ( placebo acupuncture group , n=34 ) . Both groups received real or placebo needling at the same acupoints once a week for 12 weeks . The primary end point was the modified Borg scale score evaluated immediately after the 6-minute walk test . Measurements were obtained at baseline and after 12 weeks of treatment . RESULT After 12 weeks , the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group ( mean [ SD ] difference from baseline by analysis of covariance , -3.6 [ 1.9 ] vs 0.4 [ 1.2 ] ; mean difference between groups by analysis of covariance , -3.58 ; 95 % CI , -4.27 to -2.90 ) . Patients with COPD who received real acupuncture also experienced improvement in the 6-minute walk distance during exercise , indicating better exercise tolerance and reduced DOE . CONCLUSION This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD . TRIAL REGISTRATION umin.ac.jp/ctr Identifier : UMIN000001277 Observation was made on the effect of different acupuncture manipulation on plasma estradiol ( E2 ) , testosterone ( T ) , E2/T and cortisol ( C ) in 78 patients with kidney deficiency . The results showed that the level of E2 and T in women was lowered by both reinforcing manipulation ( RFM ) and reducing manipulation ( RDM ) . E2/T index was lowered by RDM but not by RFM , and there was significance ( P < 0.05 ) between the RDM group and RDM group in E2/T , but no significance between the man 's groups . The level of C was decreased by RDM but not by RFM . The results suggest that the different manipulation effects are different on the level of sex hormones in women and the C content in patients with kidney deficiency Purpose Evaluate effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on health-related quality -of-life ( HRQoL ) and sleep in breast cancer survivors with vasomotor symptoms . Methods Forty-five women , r and omized to EA ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months , were followed for up to 2 years . Distress caused by , and numbers of , hot flushes , hours slept and times woken up/night , Psychological and General Well-being Index ( PGWB ) and Women ’s Health Question naire ( WHQ ) were registered before and during treatment and at 6 , 9 , 12 , 18 and 24 months after start of treatment . Results After 12 weeks of EA ( n = 19 ) , WHQ improved from 0.32 ( IQR 0.23–0.53 ) at baseline to 0.24 ( IQR 0.12–0.39 ; p < 0.001 ) and PGWB from 78 ( IQR 53–89 ) to 79 ( IQR 68–93 ; p = 0.002 ) . All sleep parameters improved and Hot Flush Score ( HFS ) decreased by 80 % . At 12 months , WHQ , PGWB and all sleep parameters remained significantly improved ( n = 14 ) and HFS decreased by 65 % . After 12 weeks of HT ( n = 18 ) , WHQ improved from 0.29 ( IQR 0.15–0.44 ) at baseline to 0.15 ( IQR 0.05–0.22 ; p = 0.001 ) , PGWB from 75 ( IQR 59–88 ) to 90 ( 62–97 ; p = 0.102 ) and three of five sleep parameters improved . Conclusion Both EA and HT  increased HRQoL and sleep , probably through decreasing numbers of and distress by hot flushes . Although flushes decreased less in the EA group than in the HT group , HRQoL improved at least to the same extent maybe due to other effects of EA , not induced by HT , e.g. on anxiety , vitality and sleep , supported by subscale analyses . EA should be further evaluated as treatment for women with breast cancer and climacteric complaints , since HT no longer can be recommended for these women BACKGROUND Fatigue is one problem that is seen in high numbers in hemodialysis patients . Fatigue decreases quality of life by negatively affecting an individual 's daily performance , activities , professional life , relations with family and friends , and treatment process . OBJECTIVE This study was carried out to determine the effect of acupressure on the level of fatigue in hemodialysis patients . METHODS / DESIGN The study was conducted as experimental research with an acupressure ( intervention ) group and a control group . SETTING The research , for which an ethics committee 's approval and institutional permission was obtained , was conducted in two central provinces of Turkey , Nevşehir and Aksaray , at two hemodialysis centers with similar characteristics . PARTICIPANTS The research was completed with a total of 118 participants ( 52 in the intervention group and 66 in the control group ) who met the inclusion criteria . INTERVENTIONS A total of 12 acupressure sessions , 3 ×/wk for 1 mo , were performed for all participants in the intervention group , as required by the acupressure application protocol , applying acupressure at the Stomach 36 ( ST-36 ) , Gallbladder 34 ( GB-34 ) , Spleen 6 ( SP-6 ) , and Kidney 1 ( K-1 ) acupuncture points with a transcutaneous electrical nerve stimulation ( TENS ) acupuncture pen ( XFT-320 acupuncture pen , Shenzhen Xunfegtong Electronics Co , Ltd , Shenzhen , China ) . PRIMARY OUTCOME MEASURES A visual analog scale ( VAS ) for fatigue and the Piper Fatigue Scale ( PFS ) were used to evaluate the fatigue level of the participants before and after the acupressure application . RESULTS After the acupressure applications for 1 mo , the subscale and total fatigue scores for the VAS ( P < .001 ) and PFS were lower ( P < .05 ) for participants in the intervention group compared to the controls , except for the cognitive subscale on the PFS ( P < .05 ) . CONCLUSIONS The study found that acupressure , applied using an acupuncture pen , was effective in decreasing fatigue in hemodialysis patients . Based on this result , the current research team suggests that hemodialysis patients and nurses should be informed about acupressure application so as to extend the use of acupressure in reducing fatigue symptoms OBJECTIVES This study aim ed to determine whether a non-penetrating sham needle can serve as an adequate sham control . DESIGN We conducted a r and omised , subject-blind , sham-controlled trial in both acupuncture-naïve and experienced healthy volunteers . SETTING AND INTERVENTIONS Participants were r and omly allocated to receive either real acupuncture ( n=39 )  or non-penetrating sham acupuncture ( n=40 ) on the h and ( LI4 ) , abdomen ( CV12 ) and leg ( ST36 ) . The procedures were st and ardised and identical for both groups . MAIN OUTCOME MEASURES Participants rated acupuncture sensations on a 10-point scale . A blinding index was calculated based on the participants ' guesses on the type of acupuncture they had received ( real , sham or do not know ) for each acupuncture point . The association of knowledge about and experience in acupuncture with correct guessing was also examined . RESULTS The subjects in both groups were similar with respect to age , gender , experience or knowledge about acupuncture . The sham needle tended to produce less penetration , pain and soreness only at LI4 . Blinding appeared to be successfully achieved for ST36 . Although 41 % of participants in the real acupuncture group made correct guesses for LI4 , 31 % guessed incorrectly for CV12 , beyond chance level . People with more experience and knowledge about acupuncture were more likely to correctly guess the type of needle they received at ST36 only , compared to that at the other points . CONCLUSIONS A non-penetrating sham needle may successfully blind participants and thus , may be a credible sham control . However , the small sample size , the different needle sensations , and the degree and direction of unblinding across acupuncture points warrant further studies in Korea as well as other countries to confirm our finding . Our results also justify the incorporation of formal testing of the use of sham controls in clinical trials of acupuncture The purpose of this study was to test the effectiveness of acupressure and Transcutaneous Electrical Acupoint Stimulation ( TEAS ) on fatigue , sleep quality and depression in patients who were receiving routine hemodialysis treatment . The study was a r and omized controlled trial ; qualified patients were r and omly assigned to acupressure , TEAS or control groups . Patients in the acupressure and TEAS groups received 15 minutes of treatment 3 times a week for 1 month , whereas patients in the control group only received routine unit care .  A total of 106 patients participated in the study . Methods of measurement included the revised Piper Fatigue Scale ( PFS ) , the Pittsburgh Sleep Quality Index and the Beck Depression Inventory . Data were collected at baseline , during the intervention and post-treatment . The results indicated that patients in the acupressure and TEAS groups had significantly lower levels of fatigue , a better sleep quality and less depressed moods compared with patients in the control group based upon the adjusted baseline differences . However , there were no differences between acupressure and TEAS groups in outcome measures . This study provides an alternative method for health care providers in managing dialysis patients with symptoms of fatigue , poor sleep or depression BACKGROUND Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort . Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem . Aim . The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life .  METHODS The study was a r and omized control trial . A total of 98 end-stage renal disease patients with sleep disturbances  were r and omly assigned into an acupressure group , a sham acupressure group , and a control group . Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks . The measures included the Pittsburgh Sleep Quality Index , Sleep Log , and the Medical Outcome Study - Short Form 36 . FINDINGS The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality , sleep duration , habitual sleep efficiency , sleep sufficiency , and global Pittsburgh Sleep Quality Index scores . Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group . Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life . CONCLUSION This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients , and offers a noninvasive therapy for sleep-disturbed patients OBJECTIVE To probe the effect of moxihustion on the quality of life in the end-stage renal failure patients in hemodialysis . METHODS Seventy-one hemodialysis patients were r and omly divided into 2 groups , and the quality of life of all the patients was evaluated with the Kidney Disease Quality of Life Short Form ( KDQOL-SF ) . The Control group were treated with routine comprehensive therapy ( including hemodialysis and medication ) , and the observation group with the routine comprehensive therapy and moxibustion at Zusanli ( ST 36 ) , Guanyuan ( CV 4 ) , Sanyinjiao ( SP 6 ) . Changes of the quality of life in the patients before and after hemodialysis were recorded and analyzed . RESULTS After treatment there were significant differences between the two groups in DSF , RE and GH ( P<0.05 ) , and 7 fields including RE , BP , QSI and others significantly improved in the both groups ( P<0.05 ) . Additionally , the 4 fields including RP , EB , VT and WS significantly improved in the observation group ( P<0.05 ) . CONCLUSION Moxibustion can improve physical strength and mood in the quality of life of the hemodialysis patients ; to evaluate the quality of life of hemodialysis patients should consider effects of society , climate and geographical condition and other factors The purpose of the study is to investigate the effectiveness of acupressure on fatigue in patients with end-stage renal-disease ( ESRD ) . The study was a r and omized control trial ; qualified patients were r and omly assigned into acupressure group , sham group or control group .  A total of 106 participants were included in the study . The measures included the revised Piper Fatigue Scale ( PFS ) , VAS of Fatigue , the Pittsburgh Sleep Quality Index and the Beck Depression Inventory . Data of fatigue measures were collected at pretreatment and a week following treatment . Sleep quality and depression were collected during post-test only . The statistical methods included the descriptive statistics , one-way ANOVA , ANCOVA , and repeated- measures ANOVA . ANCOVA that adjusted for differences in baseline fatigue scores ( PFS ) , post-test of depression and sleep quality , result was significant , F(2,100)=3.99 , p=0.02 . Post-hoc tests revealed that patients in the acupressure group were significantly having lower scores of fatigue than patients in the control group . ANCOVA results also significant for VAS of Fatigue among groups , F(2,100)=5.63 , p=0.003 . Comparisons indicated that there were significant differences between the acupressure group and the control group ( p=0.01 ) and between the sham group and control group ( p=0.003 ) . Predialysis fatigue was assessed routinely by using a rating of 0 - 10 . Repeated- measures ANOVA results demonstrate the group main effect was significant in the perceived fatigue ( F(2,88)=19.46 , p<0.001 ) . Follow-up tests indicated there were significant differences between the acupressure group and the control group ( p<0.001 ) and between the sham group and control group ( p<0.001 ) . The study provided an alternative method for health care providers to managing ESRD patients with fatigue Chronic renal insufficiency is the result of renal injuries and progressive deterioration caused by various reasons . At the late stage , i.e. the period of uremia , it may be complicated with abnormalities of various systems . Along with the development and popularization of hemodialysis , the survival time of uremic patients can be prolonged , but uremic pruritus affects greatly the quality of life of the patients . For this purpose , we have treated 68 cases of the patients with acupuncture and western medicine respectively , and made clinical observations on the therapeutic results . A report follows . BACKGROUND Patients with end stage renal disease on hemodialysis are affected by physiological and psychological stressors , which contribute to poor quality of life and negative clinical outcomes . Depression , anxiety , and stress are highly prevalent in this population . Effective interventional strategies are required to manage these psychological symptoms . Acupressure has been believed to be one of the complementary therapies that could promote psychological wellbeing . OBJECTIVE The aim of this study was to evaluate the effects of acupressure on depression , anxiety , stress , and general psychological distress in patients with hemodialysis . DESIGN Open-label r and omized controlled trial . SETTING Three hemodialysis centers . PARTICIPANTS A total of 108 patients with hemodialysis were r and omly recruited into the acupressure group ( n=54 ) and the control group ( n=54 ) . METHOD The intervention was carried out from January to March 2014 . The acupressure group received routine hemodialysis treatment plus 15 min acupressure applied three times a week for four weeks . The control group received only usual care with routine hemodialysis treatment . The outcome measurements were the Depression , Anxiety Stress Scales ( DASS-21 ) , and general psychological distress using the General Health Question naire ( GHQ-28 ) . Statistical analysis was performed using Wilcoxon signed-rank test to compare DASS scales and GHQ-28 scores before and after acupressure intervention . RESULTS The acupressure group had significantly lower DASS scores and GHQ scores compared to the control group , signifying improvements in depression , anxiety , stress and general psychological distress . The sub-score of the GHQ-28 for social dysfunction , however , were similar in both groups . CONCLUSION Findings from this study indicates that acupressure therapy delivered three times a week for four weeks was able to significantly reduce depression , anxiety , stress , and general psychological distress in patients with hemodialysis . This positive finding suggests that acupressure may have a role in promoting psychological wellbeing of patients . Promoting psychological wellness will improve patients ' quality of life , and reduce negative outcomes associated with psychological illnesses and distress experienced by patients with hemodialysis OBJECTIVE To observe the therapeutic effects of acupuncture on gouty renal damage . METHOD 72 cases of gouty renal damage were r and omly divided into a treatment group of 42 cases and a control group of 30 cases to observe the therapeutic effects and the changes in 24-hour urinary protein content , blood creatinine , uric acid and urea nitrogen in blood before treatment and one month after treatment . RESULTS The total effective rate in the treatment group reached 95.24 % , which was remarkably higher than 63.33 % in the control group . After one month of treatment , the indexes were found reduced in both groups , but the reduction rate in the treatment group was obviously superior to that in the control group . CONCLUSION The patients with repeated attacks of gout may have a higher possibility to suffer from renal damage . Therefore , attention should be paid to its early diagnosis and treatment . Acupuncture may exert good therapeutic effects on early gout complicated with renal damage by adjusting the metabolism and improving the renal function BACKGROUND Uraemic pruritus is a common problem in end-stage renal failure patients . Traditional therapies produce marginal or no results . Acupuncture has been reported to be effective . The aim of this r and omized , controlled study was to vali date a single acupoint for relieving uraemic pruritus . METHODS We r and omized 40 patients with refractory uraemic pruritus into two groups . In group 1 ( n = 20 ) , acupuncture was applied unilaterally at the Quchi ( LI11 ) acupoint thrice weekly for 1 month . In group 2 ( controls , n = 20 ) , acupuncture was applied at a non-acupoint 2 cm lateral to Quchi ( LI11 ) thrice weekly for 1 month . Subjects responded to a pruritus score question naire given before and at the end of the 1 month treatment and at a 3 months follow-up . The results of the pruritus scores were analysed with the repeated measures general linear model to examine the effect of acupuncture on pruritus scores . RESULTS In group 1 , pruritus scores before and after acupuncture and at the 3 month follow-up were 38.3+/-4.3 , 17.3+/-5.5 and 16.5+/-4.9 , and in group 2 ( controls ) they were 38.3+/-4.3 , 37.5+/-3.2 and 37.1+/-5 , respectively . Laboratory tests showed no significant differences between the two groups . Pruritus scores were significantly lower after acupuncture and at the 3 month follow-up , P<0.001 . CONCLUSIONS Acupuncture at the Quchi ( LI11 ) acupoint is an easy , safe and effective means of relieving uraemic pruritus The purpose of the study is to test the effectiveness of acupressure on sleep quality of end-stage renal disease patients . The study was a r and omized controlled trial ; qualified patients in the dialysis centers of four major hospitals were r and omly assigned into an acupressure group , a sham acupressure group , and a control group .  A total of 98 participants were included in the study . The main outcomes measured were the Pittsburgh sleep quality index ( PSQI ) and the sleep log . Data were collected at pretreatment and following treatment . Primary statistical analysis was by means of Analysis of Covariance , the Kruskal-Wallis Test and repeated measure ANOVA . The results indicated that PSQI scores of the acupressure group have a significantly greater improvement ( p < 0.01 ) than the control group . However , there were no differences between the acupressure group and the sham group or the sham group and the control group ( p > 0.05 ) . Subscales of PSQI were further analyzed . Results demonstrated significant differences between the acupressure group and the control group in subjective sleep quality ( p = 0.009 ) , sleep duration ( p = 0.004 ) , habitual sleep efficiency ( p = 0.001 ) , and sleep sufficiency ( p = 0.004 ) . Significant differences in the subscale of subjective sleep quality ( p = 0.003 ) between the sham acupressure group and the control group were also observed . Sleep log data showed that the acupressure group significantly decreased awake time and improved quality of sleep over time more than the control group ( p < 0.01 ) . The improvement could be seen as soon as the acupoints massage was implemented , and it was maintained through the post intervention OBJECTIVE To compare the effect on erythropoietin ( Epo ) resistance between acupoint injection and subcutaneous injection of rHuEpo in patients with chronic renal failure ( CRF ) . METHODS Thirty-eight cases were r and omly divided into two groups , 19 cases in each one . In subcutaneous injection group ( control group ) , subcutaneous injection of rHuEpo was administered , 3 times a week , lasting 2 months . In acupoint group ( observation group ) , rHuEpo was injected on unilateral Shenshu ( BL 23 ) and Zusanli ( ST 36 ) , one point was chosen each time , the bilateral acupoints were injected alternatively , 3 times a week , for 2 months . Meanwhile , a normal control group of 19 healthy persons was set up . The levels of CRP , IL-6 , TNF-alpha , Scr , BUN , Hb , Hct and SF were observed . RESULTS Before treatment , the values of CRP , IL-6 and TNF-alpha in two groups were all higher than those in normal control group ( all P < 0.01 ) . After treatment for 2 months , the values of CRP , IL-6,TNF-alpha , Scr and BUN in two groups decreased apparently and those of Hb , Hct and SF increased obviously , indicating statistic significant differences as compared with the values before treatment separately ( P < 0.05 , P < 0.01 ) . In comparison between two groups after treatment , every index above in observation group was improved much significantly ( P < 0.05 , P < 0.01 ) . CONCLUSION Acupoint injection of rHuEpo at Zusanli ( ST 36 ) and Shenshu ( BL 23 ) increases significantly the values of Hb , Hct and SF , and decreases apparently the values of BUN , Scr and inflammatory factors , such as CRP , IL-6 and TNF-alpha as compared with subcutaneous injection . Acupoint injection improves Epo resistance and enhances Epo efficacy via alleviating micro-inflammatory state of the body OBJECTIVE To explore the effective therapy for maintenance hemodialysis patients in dificiency syndrome in end-stage renal disease . METHODS Ninety-seven cases were divided into an observation group ( 51 cases ) and a control group ( 46 cases ) r and omly , and routine western medicine was used in both of them . On this base , moxibustion was used in Zusanli ( ST 36 ) and Sanyinjiao ( SP 6 ) in paper-tube-moxibustion equipment in the observation group . Evaluate the therapeutic effect on symptoms by comparing the symptom scores in two groups before and after treatment . RESULTS All the symptom scores in the observation group were improved after treatment , and the differences were significant ( all P < 0.05 ) . Among all symptoms , the most improved ones included lassitude and fatigue , short breath and aversion to talk , poor appetite , soreness and softness of waist and knees , aversion to cold , cold extremities and so on . In the aspect of therapeutic effect on symptoms , the total effective rate in observation group ( 64.7 % , 33/51 ) was higher than that in control group ( 23.9 % , 11/46 ) , and the difference was significant ( P < 0.05 ) . CONCLUSION Moxibustion can improve the clinical symptoms of maintenance hemodialysis patients in end-stage renal disease , and can generate some therapeutic effect to the dificiency syndrome of this disease BACKGROUND Depression is not uncommon among patients with end-stage renal disease ( ESRD ) being treated by hemodialysis .  We investigated whether risk of mortality and rate of hospitalization may be predicted from physician-diagnosed depression and patients ' self-reports of depressive symptoms . METHODS Data were analyzed from the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) for r and omly selected ESRD patients being treated by hemodialysis in the United States ( 142 facilities , 2855 patients ) and five European countries ( 101 facilities , 2401 patients ) . The diagnosis of depression during the past year was abstract ed from the medical records . In addition , the patients were asked to indicate how much of their time over the previous four weeks they had felt ( 1 ) " so down in the dumps that nothing could cheer you up " and ( 2 ) " downhearted and blue . " A response of " a good bit,""most , " or " all " of the time were classified as depressed . RESULTS The prevalence of depression was nearly 20 % . The relative risks of mortality and hospitalization among depressed ( vs. non-depressed ) , adjusted for time on dialysis , age , race , socioeconomic status , comorbid indicators and country were , respectively : 1.23 and 1.11 for physician-diagnosed depression , 1.48 and 1.15 for the " so down in the dumps " question , and 1.35 and 1.11 for the " downhearted and blue " question ( P < 0.05 for all six relative risks ) . These associations were not significantly different between US and European patients . CONCLUSIONS Self-reported depression by two simple questions was associated with increased risks of mortality and hospitalization for hemodialysis patients . Future research needs to assess whether early identification and treatment of depression may help to improve quality of life and survival in hemodialysis patients In order to prove the specific property between the tonifying manipulation ( TM ) and reducing manipulation ( RM ) , and search further for the key in improving the effect of manipulation , the influence of to on two different manipulations . The plethysmogram in the same body-condition ( kidney-deficiency ) One was TM with slow-trusting and quick lefting ; the other was RM with the converse movement . R and omized block design , cross-over design and single-blind design were used . The result showed that the TM increased the amplitude of the plethysmogram obviously , whereas the RM had no significant influence on it . There was significant difference not only between the TM group and the central group , but also between the TM group and RM group ( P less than 0.01 or P less than 0.05 ) . The difference between the RM group and the control group was not significant ( P greater than 0.05 ) . Meanwhile , it was recommended that " mind concentration " on acupuncture manipulation is important . In conclusion , the experiment demonstrated the experimental evidence for explaining the mechanism of TM and RM . It was suggested that acupuncture manipulations are worthy to pay attention so as to improve clinical effect OBJECTIVES The objectives of this study were to investigate the effects of acupressure therapy ( AT ) on the development and progression of diabetic complications in Chinese patients with type 2 diabetes ( T2D ) . DESIGN AND METHODS A total of 80 patients with T2D were recruited for a r and omized clinical study of the effect of AT on the progression and development of diabetic complications , and 64 patients were followed up for 3 years . All patients with T2D were treated with regular medicines and participated in diet and exercise programs for the control of hyperglycemia and hypertension . The patients in the AT group received additional treatment of a 90-minute AT 4 - 6 times per week for 3 consecutive years . Their blood lipids , fasting glucose levels , and heart and kidney functions and nerve conduction velocity ( NCV ) were longitudinally monitored before and every 12 months after AT . RESULTS Following AT therapy for 3 years , significantly lower levels of total cholesterol , triglycerides , low-density lipoprotein-cholesterol , and higher levels of high-density lipoprotein-cholesterol ( HDL-C ) were observed and no significantly increased levels of serum creatinine and urine protein were detected in the AT group , as compared with that in controls . Furthermore , the mean values of NCV in the AT group at 2 years post-treatment were significantly greater than those of controls and were further elevated at the end of this study . Therefore , AT inhibited the progression of hyperlipidemia and improved diabetes-associated kidney function and neuropathy in Chinese patients with T2D . CONCLUSIONS AT may be an effective nonpharmacological adjunctive strategy for alleviating the development and progression of T2D-related complications BACKGROUND We investigated whether indicators of health-related quality of life ( HRQOL ) may predict the risk of death and hospitalization among hemodialysis patients treated in seven countries , taking into account serum albumin concentration and several other risk factors for death and hospitalization . We also compared HRQOL measures with serum albumin regarding their power to predict outcomes . METHODS We analyzed data from the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) , an international , prospect i ve , observational study of r and omly selected hemodialysis patients in the United States ( 148 facilities ) , five European countries ( 101 facilities ) , and Japan ( 65 facilities ) . The total sample size was composed of 17,236 patients . Using the Kidney Disease Quality of Life Short Form ( KDQOL-SFTM ) , we determined scores for three components of HRQOL : ( 1 ) physical component summary ( PCS ) , ( 2 ) mental component summary ( MCS ) , and ( 3 ) kidney disease component summary ( KDCS ) . Complete responses on HRQOL measures were obtained from 10,030 patients . Cox models were used to assess associations between HRQOL and the risk of death and hospitalization , adjusted for multiple sociodemographic variables , comorbidities , and laboratory factors . RESULTS For patients in the lowest quintile of PCS , the adjusted risk ( RR ) of death was 93 % higher ( RR = 1.93 , P < 0.001 ) and the risk of hospitalization was 56 % higher ( RR = 1.56 , P < 0.001 ) than it was for patients in the highest quintile level . The adjusted relative risk values of mortality per 10-point lower HRQOL score were 1.13 for MCS , 1.25 for PCS , and 1.11 for KDCS . The corresponding adjusted values for RR for first hospitalization were 1.06 for MCS , 1.15 for PCS , and 1.07 for KDCS . Each RR differed significantly from 1 ( P < 0.001 ) . For 1 g/dL lower serum albumin concentration , the RR of death adjusted for PCS , MCS , and KDCS and the other covariates was 1.17 ( P < 0.01 ) . Albumin was not significantly associated with hospitalization ( RR = 1.03 , P > 0.5 ) . CONCLUSION Lower scores for the three major components of HRQOL were strongly associated with higher risk of death and hospitalization in hemodialysis patients , independent of a series of demographic and comorbid factors . A 10-point lower PCS score was associated with higher elevation in the adjusted mortality risk , as was a 1 g/dL lower serum albumin level . More research is needed to assess whether interventions to improve quality of life  lower these risks among hemodialysis patients Background . Acupuncture is underutilized as an adjunct cancer therapy . The main study objectives were to determine the feasibility of administering acupuncture as palliative therapy to patients with advanced ovarian or breast cancer and to assess the effect on symptoms and quality of life ( QOL ) . Methods . This study was a pilot , single-armed prospect i ve clinical trial for patients with advanced cancer to receive 12 acupuncture sessions over 8 weeks with follow-up at weeks 9 and 12 . Ambulatory patients with advanced ovarian or breast cancer were enrolled to receive treatments at an outpatient academic oncology center . Symptom severity was measured before and after each acupuncture session . A composite QOL assessment tool , consisting of vali date d instruments , was completed at 5 time points . Results . Forty patients enrolled in the study . Twenty-eight patients ( 70 % ; 95 % confidence interval [ CI ] = 53%-83 % ) completed 4 weeks of treatment , and 26 patients ( 65 % ; 95 % CI = 48%-79 % ) completed 8 weeks . Eight patients ( 20 % ) withdrew before receiving acupuncture , and 6 patients ( 15 % ) discontinued treatment early because of disease progression or scheduling dem and s. Among all 32 assessed patients , there was self-reported improvement immediately post-treatment in anxiety , fatigue , pain , and depression and significant improvement over time for patients with anxiety ( P = .001 ) and depression ( P = .02 ) . Among patients experiencing baseline symptoms , there was improvement in anxiety ( P = .001 ) , fatigue ( P = .0002 ) , pain ( P = .0002 ) , and depression ( P = .003 ) . QOL measures of pain severity and interference , physical and psychological distress , life satisfaction , and mood states showed improved scores during treatment , with sustained benefit at 12 weeks . Conclusions . This pilot study demonstrates that an 8-week outpatient acupuncture course is feasible for advanced cancer patients and produces a measurable benefit that should be evaluated in controlled trials
BACKGROUND People living with chronic kidney disease ( CKD ) experience a range of symptoms and often have complex comorbidities .
Many pharmacological interventions for people with CKD have known risks of adverse events .
Acupuncture is widely used for symptom management in patients with chronic diseases and in other palliative care setting s. However , the safety and efficacy of acupuncture for people with CKD remains largely unknown .
OBJECTIVES We aim ed to evaluate the benefits and harms of acupuncture , electro-acupuncture , acupressure , moxibustion and other acupuncture-related interventions ( alone or combined with other acupuncture-related interventions ) for symptoms of CKD .
In particular , we planned to compare acupuncture and related interventions with conventional medicine , active non-pharmacological interventions , and routine care for symptoms of CKD .