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A Vickers

Publications and source records attributed to A Vickers.

At least 55 records · Page 3Linked to original sources
PubMed1999

Guidelines for authors of books and papers on complementary medicine.

Writing about complementary medicine, whether intended for book or journal publication, has often suffered from three flaws: inadequate attention to the origin and nature of knowledge claims; careless use of problematic concepts such as 'holistic' or 'natural' and poor application of basic principles of good scholarship. In this paper I present guidelines to promote better writing. With respect to knowledge claims, authors need to be explicit about the origin of the claim; that is, the reasons why they believe it to be true. Many books and papers on complementary medicine are flawed because their authors avoided explaining why they have made particular claims. Claims can be justified by using personal experience or by quoting scientific research. When using personal experience, authors need to: describe the practitioners concerned; use generalities about practitioners with care and be wary when referring to 'classical' or 'traditional' practitioners. When quoting scientific research, authors should: cite references and use these sparingly and specifically; avoid 'secondary sourcing', reliance on abstracts and the referencing of authorities; use 'weasel words' ('may' or 'can') with extreme care; think carefully about causal inferences and take care with laboratory-based research. Many of the concepts found in books and papers on complementary medicine are used rather carelessly. Concepts such as holism or 'natural' medicine, or even the concept of 'complementary' and 'conventional' medicine, are often taken to have simple and obvious meanings. Yet these concepts are extremely slippery and open to differing interpretations, especially if they are used with insufficient care. Authors should apply basic principles of good scholarship by displaying thoroughness and attention to detail; reflecting on the validity of each point made; reflecting on the limitations of their arguments and maintaining a level of disinterestedness. However, authors should avoid trying to sound academic for the sake of it: the use of long words, obscure jargon and dense and lengthy prose does not make a work scholarly.

Authorship↗
PubMed1999

Acupuncture for migraine and headache in primary care: a protocol for a pragmatic, randomized trial.

UNLABELLED: This paper presents the protocol for a randomized trial of acupuncture for migraine and headache. SUBJECTS: Four hundred patients with migraine or headache will be recruited from GP practices. INCLUSION CRITERIA: Eighteen to 65 years old, contractable by telephone, onset at least 1 year prior at age less than 50, two headaches per month in the previous 6 months, adequate data completion and headache severity during pre-randomization baseline. EXCLUSION CRITERIA: Pregnancy or malignancy, cluster headache, serious pathological aetiology, cranial neuralgia, acupuncture treatment in the past year. DESIGN: Following a 4-week baseline, patients will be allocated to acupuncture or control by minimized randomization. Up to 12 acupuncture treatments will be provided by advanced members of the Acupuncture Association of Chartered Physiotherapists. The type of acupuncture given will be recorded. STUDY MEASURES: Outcome will be assessed by headache diary, medication diary and SF36 at 3 months and 1 year. Resource use and days off sick will be assessed by quarterly questionnaire. Adverse events will be monitored by self-report. The primary outcome measure will be the change in mean daily headache score between baseline and the 1 year follow-up. An economic evaluation will also be undertaken.

Acupuncture Therapy↗
PubMed1999

A randomized comparison of homoeopathic and standard care for the treatment of glue ear in children.

OBJECTIVE: To pilot a model for determining whether homoeopathic treatment of children suffering from glue ear is more effective than standard GP care at producing a return to normal hearing (a hearing loss of less than 20 dB) within 12 months. DESIGN: Non-blind, randomized controlled trial. SETTING: General practice in two locations in southern England. SUBJECTS: Thirty-three children aged 18 months to 8 years with otitis media with effusion, hearing loss > 20 dB and an abnormal tympanogram. OUTCOME MEASURES: Hearing loss, tympanogram, referrals to specialists and number of courses of antibiotics at 12 month follow-up. RESULTS: A higher proportion of children receiving homoeopathic care had a hearing loss less then 20 dB at follow-up (64 vs 56%), though this difference did not reach statistical significance (95% confidence interval for the difference between means of -25 and 42%). More homoeopathy patients than controls had a normal tympanogram (75 vs 31%, P = 0.015). Referrals to specialists and antibiotic consumption was lower in the homoeopathy group, though differences between groups did not reach statistical significance. CONCLUSION: Further research comparing homoeopathy to standard care is warranted. Assuming recovery rates of 50 and 30% in homoeopathy and standard care groups respectively, 270 patients would be needed for a definitive trial.

Acoustic Impedance Tests↗
PubMed1999

Vitamin E-TPGS increases absorption flux of an HIV protease inhibitor by enhancing its solubility and permeability.

PURPOSE: To investigate the effect of vitamin E-TPGS, d-alpha-tocopheryl polyethylene glycol 1000 succinate, on the solubility and permeability of amprenavir, a potent HIV protease inhibitor. METHODS: The aqueous solubility of amprenavir was measured as a function of vitamin E-TPGS concentration. Directional transport through Caco-2 cell monolayers was determined in the presence and absence of vitamin E-TPGS and P-glycoprotein inhibitors. Absorption flux was estimated from Caco-2 cell permeability and aqueous solubility. RESULTS: The solubility of amprenavir in a pH 7 buffer at 37 degrees C was 0.036+/-0.007 mg/mL. The solubility linearly increased with increasing vitamin E-TPGS concentration (above 0.2 mg/mL). Polarized transport was demonstrated in the basolateral to apical direction, exceeding apical to basolateral transport by a factor of 6. The active efflux system was inhibited by vitamin E-TPGS and known P-glycoprotein inhibitors verapamil and GF120918. CONCLUSIONS: The solubility of amprenavir was improved in the presence of vitamin E-TPGS through micelle solubilization. Vitamin E-TPGS inhibits the efflux system and enhances the permeability of amprenavir. Overall, vitamin E-TPGS enhanced the absorption flux of amprenavir by increasing its solubility and permeability. The enhancement is essential to the development of the novel soft gelatin capsule formulation of amprenavir for use in the clinic.

Algorithms↗
PubMed1999

Acupuncture for recurrent headaches: a systematic review of randomized controlled trials.

OBJECTIVE: To assess whether there is evidence that acupuncture is effective in the treatment of recurrent headaches. DESIGN: Systematic review. STUDY SELECTION: Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of recurrent headaches. DATA SOURCES: Electronic databases (Medline, Embase, Cochrane Field for Complementary Medicine, Cochrane Controlled Trials Register), personal communications and bibliographies. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, methods, and results were extracted by at least two independent reviewers using a pretested form. A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group) was calculated as a crude indicator of trial results as meta-analysis of more specific outcome data was impossible due to heterogeneity and insufficient reporting. RESULTS: Twenty-two trials, including a total of 1042 patients (median 36, range 10-150), met the inclusion criteria. Fifteen trials were in migraine patients, six in tension-headache patients, and in one trial patients with various headaches were included. The majority of the 14 trials comparing true and sham acupuncture showed at least a trend in favor of true acupuncture. The pooled responder rate ratio was 1.53 (95% confidence interval 1.11 to 2.11). The eight trials comparing acupuncture and other treatment forms had contradictory results. CONCLUSIONS: Overall, the existing evidence suggests that acupuncture has a role in the treatment of recurrent headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of acupuncture under real life conditions.

Acupuncture Therapy↗
PubMed1998

Do certain countries produce only positive results? A systematic review of controlled trials.

OBJECTIVE: To determine whether clinical trials originating in certain countries always have positive results. DATA SOURCES: Abstracts of trials from Medline (January 1966-June 1995). STUDY SELECTION: Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. DATA EXTRACTION: Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin. DATA SYNTHESIS: In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective. CONCLUSIONS: Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.

Humans↗
PubMed1998

Unreliability of IgE/IgG4 antibody testing as a diagnostic tool in food intolerance.

BACKGROUND: Some clinicians link chronic disease in certain patients to 'food intolerance'. This is currently diagnosed by exclusion dieting, a time-consuming and tedious technique. It has been claimed that IgE/IgG4 antibody testing is a rapid and valid method of determining food intolerance. OBJECTIVE: To determine the test/retest reliability of IgE/IgG4 antibody testing as a diagnostic tool. METHODS: Blinded testing of duplicate blood samples from nine patients with suspected food intolerance was undertaken by tertiary referral centre using the services of a commercial laboratory. The proportions of consistent and inconsistent results for tests of 95 different foods were analysed. RESULTS: Test/retest reliability was low. Even though the study method systematically overestimated kappa, this value never exceeded 0.51, regardless of the statistical model used. All but one patient had a greater number of inconsistent results than had been prespecified as an unacceptable level of disagreement. In one case, 50 out of 95 test results were inconsistent on retest. CONCLUSIONS: We found no evidence that IgE/IgG4 antibody testing as performed by this laboratory is a reliable diagnostic tool.

Allergens↗
PubMed1997

Yes, but how do we know it's true? Knowledge claims in massage and aromatherapy.

While there is evidence that both massage and aromatherapy can be of benefit, practitioners make a great number of claims about the clinical effects of their treatments. These are presented in literature as simple statements of fact, often with no attempt to explain the basis upon which the claim is made. Though authors do occasionally make reference to the scientific literature, they often do so inadequately and in many cases the cited papers do not support the claims being made. Some authors have been explicit in giving personal experience as the source of their knowledge. However, there are several reasons why it can be difficult to make general statements based on individual experience. The many inconsistencies found in massage and aromatherapy literature--such as different properties being given to the same oil--provide further evidence that the knowledge base of these therapies is unreliable. Practitioners need to develop a critical discourse by which they can evaluate knowledge claims.

Aromatherapy↗
PubMed1997

How should we research unconventional therapies? A panel report from the Conference on Complementary and Alternative Medicine Research Methodology, National Institutes of Health.

Research in unconventional medicine requires a number of different questions to build up a "mosaic" of evidence. Choice of research design depends on the question being asked and is independent of the therapy under investigation. Despite the doubts of some practitioners, randomized trials are of value for determining certain questions in alternative medicine.

Complementary Therapies↗
PubMed1997

A proposal for teaching critical thinking to students and practitioners of complementary medicine.

It can be argued that it is only possible to promote research in complementary and alternative medicine once the importance of critical thinking is understood. Critical thinking can be defined as (1) the adoption of a cautious approach to beliefs and claims, and (2) the process of analyzing beliefs to see whether they are valid and useful. The Research Council for Complementary Medicine has considerable experience teaching critical thinking to students and practitioners of complementary and alternative medicine. We use several tactics to ensure that such teaching has maximum impact: stressing that criticism does not pose a threat, using an interactive approach, avoiding abstract or esoteric discussions, giving examples from conventional medicine and from everyday life, and so on. The actual structure of a class involves a series of logical steps: stating the reasons for critical thinking, linking beliefs to belief-forming processes, linking beliefs about health to personal experience, explaining why personal experience can be unreliable, completing the "skeptical argument" that many health beliefs are unreliable, discussing the implications for practice, etc. Learning about critical thinking in such a manner can be an important prerequisite for undertaking or using the results of research.

Complementary Therapies↗
PubMed1996

Methodological issues in complementary and alternative medicine research: a personal reflection on 10 years of debate in the United Kingdom.

There are certain immediate and obvious problems in using conventional research techniques for the evaluation of complementary and alternative medicine (CAM). These have led some to argue that alternative medicine requires alternative methodologies. The experience in the United Kingdom has been that existing methodologies can be adapted and do not have to be discarded wholesale. Conventional research has developed a set of powerful techniques for generating reliable knowledge and these have been used with considerable success in a variety of different settings. In retrospect, the call for new methodologies appears to have been a reaction against the perceived dominance of the randomized controlled trial (RCT). This stemmed from the misperception that the RCT inevitably involves features, such as placebo controls or double-blinding, which are not feasible in many CAM therapies. There was also a desire to ask questions about medicine, the answers to which, it was felt, could not be decided by the RCT. A variety of different research designs need to be used to answer the variety of questions important in CAM. However, research designs do not have to be reinvented: appropriate methodologies can normally be found in one or another of the diverse branches of medical research. Successful research has been conducted in CAM using conventional research techniques and this refutes the claims that such techniques are inappropriate for CAM. Solving methodological problems in CAM is a matter of following simple guidelines, not the creation of complex and esoteric research designs.

Complementary Therapies↗