Wu, IXY, Wong, CHL, Ho, RST, Cheung, WKW, Ford, AC, Wu, JCY, Mak, ADP, Cramer, H & Chung, VCH 2019, 'Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis', Therapeutic Advances in Gastroenterology, vol. 12, pp. 1-34.View/Download from: UTS OPUS or Publisher's site
© The Author(s), 2019. Background: An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other irritable bowel syndrome (IBS) treatments. Methods: A total of eight international and Chinese databases were searched for SRs of randomized controlled trials (RCTs). The methodological quality of SRs was appraised using the AMSTAR instrument. From the included SRs, data from RCTs were extracted for the random-effect pairwise meta-analyses. An NMA was used to evaluate the comparative effectiveness of different treatment options. The risk of bias among included RCTs was assessed using the Cochrane risk of bias tool. Results: From 15 SRs of mediocre quality, 27 eligible RCTs (n = 2141) were included but none performed proper blinding. Results from pairwise meta-analysis showed that both needle acupuncture and electroacupuncture were superior in improving global IBS symptoms when compared with pinaverium bromide. NMA results showed needle acupuncture plus Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options, but a slight inconsistency exists. Conclusion: The risk of bias and NMA inconsistency among included trials limited the trustworthiness of the conclusion. Patients who did not respond well to first-line conventional therapies or antidepressants may consider acupuncture as an alternative. Future trials should investigate the potential of (1) acupuncture as an add-on to antidepressants and (2) the combined effect of Chinese herbs and acupuncture, which is the norm of routine Chinese medicine practice.
Wong, CHL, Wu, IXY, Cheung, WKW, Ho, RST, Leach, MJ, Peng, W, Zhang, Y, Wu, JCY & Chung, VCH 2019, 'Impact of evidence-based healthcare education for Chinese medicine practitioners: A pre-post evaluation.', Complementary therapies in medicine, vol. 45, pp. 38-44.View/Download from: UTS OPUS or Publisher's site
WHO Traditional Medicine Strategy 2014-23 recommended evidence-based healthcare (EBHC) education for traditional and complementary medicine (T&CM) professionals, including Chinese medicine practitioners (CMPs). We evaluated the impact of a customized educational workshop on Hong Kong CMPs' knowledge, attitude and practice of EBHC. Two validated instruments, Evidence-based Practice Questionnaire (EPQ) and Evidence-based Practice Inventory (EPI), were used to assess the impact of EBHC education. Paired t-tests were used to compare scores before and after the workshop. Multiple linear regression was performed to explore the associations between changes in EPQ/EPI scores and CMPs' characteristics. CMPs who completed the workshop (n = 59) demonstrated significant improvements in the attitude (p = 0.013) and knowledge domains of the EPQ (p = 0.005). Significant improvements were also observed in the attitude, perceived behavioural control, decision making, and intention and behaviour domains of the EPI. CMPs who had never received prior EBHC training showed a larger magnitude of improvement in the EPI attitude (p = 0.032), decision making (p = 0.015), and intention and behaviour (p = 0.015) domains post-workshop. Our findings suggest that tailored workshop is effective in strengthening knowledge and in improving attitudes towards EBHC. Future RCTs should be conducted to affirm our findings. Future initiatives may consider incorporating this education approach into CMP curricula, as well as facilitating implementation of EBHC in routine Chinese medicine practice.
Chu, MHK, Wu, IXY, Ho, RST, Wong, CHL, Zhang, AL, Zhang, Y, Wu, JCY & Chung, VCH 2018, 'Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews', Therapeutic Advances in Gastroenterology, vol. 11.View/Download from: UTS OPUS or Publisher's site
© The Author(s), 2018. Background: Pharmacotherapy, including prokinetics and proton pump inhibitors for functional dyspepsia (FD) have limited effectiveness, and their safety has been recently questioned. Chinese herbal medicine (CHM) could be considered as an alternative. A systematic review (SR) of SRs was performed to evaluate the potential effectiveness and safety of CHM. Method: We conducted a comprehensive literature search for SRs with meta-analyses in eight international and Chinese databases. Pooled effect estimation from each meta-analysis was extracted. The AMSTAR instrument was used to assess the methodological quality of the included SRs. Results: A total of 14 SRs of mediocre quality assessing various CHMs, alone or in combination with conventional pharmacotherapy, were included. Meta-analyses showed that CHM was more effective than prokinetic agents for the alleviation of global dyspeptic symptoms. Three specific CHM formulae appeared to show superior results in the alleviation of global dyspeptic symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun Zi decoction. No significant difference in the occurrence of adverse events in using CHM or pharmacotherapy was reported. Conclusion: CHM can be considered as an alternative for the treatment of FD symptoms when prokinetic agents and proton pump inhibitors are contraindicated. Future trial design should focus on measuring changes in individual dyspeptic symptoms and differentiate the effectiveness of different CHM for postprandial distress syndrome and epigastric pain syndrome. A network meta-analysis approach should be used to explore the most promising CHM formula for FD treatment in the future.
Zhang, Y, Dennis, JA, Leach, MJ, Bishop, FL, Cramer, H, Chung, VCH, Moore, C, Lauche, R, Cook, R, Sibbritt, D & Adams, J 2017, 'Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results from the 2012 National Health Interview Survey', HEADACHE, vol. 57, no. 8, pp. 1228-1242.View/Download from: UTS OPUS or Publisher's site
Cramer, H & Chung, VCH 2016, 'Meta-analysis in systematic reviews of complementary and integrative medicine trials', Advances in Integrative Medicine, vol. 3, no. 3, pp. 114-120.View/Download from: UTS OPUS or Publisher's site
© 2017 Elsevier Ltd In evidence-based medicine, meta-analyses are often considered to provide an exceptionally high level of evidence. Beyond other systematic review formats, meta-analyses allow for statistically pooling results of original research. This approach allows us to increase statistical power, improve precision, investigate heterogeneity, and settle controversies across different clinical trials. However, meta-analysis requires rigour in methodology, in order to avoid 'mixing apples and oranges'. Study design, participants, interventions, comparators, and outcomes need to be clearly defined, and statistical methods need to be applied precisely. For researchers in specialized fields such as integrative medicine, additional considerations on the unique features of therapies need to be applied. This article describes practical and academic insights into preparing a meta-analysis for publication.
Chung, VCH, Wu, X, Lu, P, Hui, EP, Zhang, Y, Zhang, AL, Lau, AYL, Zhao, J, Fan, M, Ziea, ETC, Ng, BFL, Wong, SYS & Wu, JCY 2016, 'Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis', MEDICINE, vol. 95, no. 7.View/Download from: UTS OPUS or Publisher's site