Faculty Bibliography

OBJECTIVE: The objective of this study was to assess clinical effects and logistical feasibility of acupuncture given during labor and delivery in a U.S. hospital setting. DESIGN: A case-control pilot study was conducted with 45 parturients receiving acupuncture during labor and delivery alongside standard care. Primary outcome endpoints were incidence of cesarean section, amount of parenteral opioids used, use of epidural anesthesia, and duration of labor. Secondary endpoints included patient satisfaction and nursing staff acceptance as assessed by postpartum questionnaire, maximum flow rate of oxytocin, incidence of instrumental delivery, Apgar score, and incidence of adverse event. RESULTS: Forty-five (45) patients receiving acupuncture were compared to 127 historical controls matched for maternal age, gestational age, parity, and use of oxytocin (augmentation and induction were matched separately). Acupuncture patients underwent significantly fewer cesarean sections (7% versus 20%, p = 0.004). No significant differences were noted in other clinical endpoints. Seventy-eight percent (78%) of nurses reported a subjective perception of improvement in patients' comfort with acupuncture, while 83% reported that the acupuncturists' presence never interfered with their work. Eighty-seven percent (87%) of patients reported that acupuncture had helped them. CONCLUSIONS: Acupuncture during labor and delivery is well tolerated by patients and medical staff. It should be further evaluated for its promise in potentially reducing the incidence of cesarean section.

BACKGROUND: Oriental medicine (OM) is widely practiced internationally and embraces many schools of thought. Western medical research is currently struggling to understand OM in purely biomedical terms, with limited success. OBJECTIVE: We propose a research model for applying Western research methodologies to OM in a way that respects its theory and modes of clinical application. This would facilitate systematic investigations of OM's specific assumptions and make explicit the way OM studies could build on each other. METHODS: To develop this model, the authors extracted key assumptions of Western research methodology germane to clinical research, put them in a developmentally logical sequence, and related them to the diagnostic and clinical processes of OM. RESULTS: The model categorizes studies into seven levels. Foundation studies (level one) establish the conceptual basis for OM research by establishing the internal validity of its basic "truth statements." Measurement studies (level two) determine how OM identifies and measures diagnostic indicators, treatment outcomes, and other basic aspects of health. Group studies (level three) describe populations in ways meaningful to their health. Pattern/diagnosis studies (level four) identify and define OM patterns of disharmony. Treatment technique studies (level five) describe particular techniques or principles of treatment, their indications, and rationale. Treatment effectiveness studies (level six) evaluate techniques of treatment, often by comparing the results of one technique with those of another in similar patients. Systematic reviews (level seven) draw together studies on the same topic to see if conclusions are thereby strengthened. CONCLUSION: The levels can be used to establish relationships between already published studies, determine if sufficient background research has been done to enable a study idea to be carried out, and generate ideas for future studies.