Objective In patients with asthma and chronic obstructive pulmonary disease (COPD), disease control is still suboptimal—incorrect inhalation technique and medication non‐adherence are two important reasons for this outcome. Pharmacists' interventions have been shown to have a positive effect on the clinical outcomes of asthma and COPD. Quantitative assessment of the efficacy of pharmacist‐led interventions, mainly on inhalation techniques and medication adherence, is needed. Evidence for different interventions is not totally conclusive, and no results of theory‐based adherence promotion interventions for asthma and COPD have been published. The objective of our study is to evaluate the effect of pharmacist‐led interventions on asthma and COPD management, focusing mainly on inhalation technique and medication adherence, and whether the content of interventions (categorized based on Information‐Motivation‐Behavioural skills (IMB) model) affects the effectiveness and whether the IMB model is worthy of clinical promotion and application in adults with asthma or COPD. Methods The PubMed, EMBASE, The Cochrane Library, Web of Science and http://ClinicalTrials.gov databases were searched for randomized controlled trials that involved pharmacist‐led interventions among patients with asthma or COPD. We used database‐specific vocabulary (eg, Medical Subject Headings) and free text terms expanding from ‘asthma’, ‘COPD’ and ‘pharmacist’ to identify relevant articles. Two reviewers independently selected the studies, assessed the risk of bias and extracted the data. The meta‐analysis was performed in Review Manager 5.3 provided by the Cochrane Collaboration. PROSPERO registration number: CRD42019144793. Results and discussion Thirteen studies were eligible for qualitative analysis, and 12 studies were included in the meta‐analysis. Pharmacist‐led interventions showed a positive effect on medication adherence (1.34 [95% CI 1.18‐1.53], P < .0001) and inhalation technique (1.85 [95% CI 1.57‐2.17], P < .00001) in COPD and asthma patients. In the subgroup meta‐analysis, significant medication adherence improvement was found only in COPD patients (1.41 [1.24‐1.61], P < .0001). The subgroup meta‐analysis also noted that interventions that included all three Information‐Motivation‐Behavioural skills (IMB) constructs had a significant improvement in medication adherence (1.41 [1.24‐1.61], P < .0001). Subgroup meta‐analysis conducted between different diseases, different intervention contents, and different measure tools did not significantly change the heterogeneity. What is new and conclusion Pharmacist‐led interventions can improve inhalation technique in adult asthma and COPD patients. Significant improvement in medication adherence was found only in COPD patients. The effect among asthmatic patients requires further study. Interventions based on the IMB model may be worthy of clinical promotion and application. More future research is needed to establish solid evidence base for effective interventions and uniform measurem...
Background. The therapeutic mechanisms of cerebral ischemia treatment by acupuncture are yet not well addressed. Objective. We investigated the effects of electroacupuncture (EA) at GV26 observing the expression of autophagy-related proteins Beclin-1 and LC3B and proportion of apoptotic cells and Bcl-2 positive cells in MCAO/R model rats. Methods. Sprague-Dawley (SD) male rats were randomly assigned to 7 groups: model groups (M6h, M24h, and M72h), EA treatment groups (T6h, T24h, and T72h), and sham operation group (S). Neurological deficit and cerebral infarction volume were measured to assess the improvement effect, while the expression of Beclin-1 and LC3B and proportion of Tunel-positive and Bcl-2 positive cells were examined to explore EA effect on autophagy and apoptosis. Results. EA significantly decreased neurological deficit scores and the volume of cerebral infarction. Beclin-1 was significantly decreased in T24h, while LC3B-II/LC3B-I ratio markedly reduced in 6th hour. EA groups markedly reduced the number of Tunel positive cells, especially in T24h. Meanwhile, the number of Bcl-2 positive cells obviously increased after EA treatment, especially in T6h and T24h. Conclusions. The alleviation of inadequate autophagy and apoptosis may be a key mechanism involved in the reflex regulation of EA at GV26 to treat cerebral ischemia.
Our previous studies have demonstrated the efficacy of partition-herb moxibustion on ulcerative colitis (UC) rats. However, the mechanism of actions of partition-herb moxibustion is still unclear. Most Chinese acupuncturists believe that partition-herb improves the effect of moxibustion therapy. However, this argument lacks confirming experimental and clinical evidence. So, whether partition-herb does play a role in the mechanism of actions of partition-herb moxibustion was reported in this paper. A total of 123 patients were randomly divided into the partition-herb moxibustion group and the control group (partition-bran moxibustion group). Fourteen patients dropped out of the study. Finally, 109 patients finished the intervention. Sixty-one patients with UC received partition-herb moxibustion and 48 patients with UC received partition-bran moxibustion for 72 treatments, one treatment per day, every 12 treatments with an interval of 3 days. The expressions of interleukin-8 (IL-8) and intercellular adhesion molecule-1 (ICAM-1) in the colonic mucosa tissue in mild patients with UC were assayed by immunohistochemistry and RT-PCR. Histology of the colon also was observed at entry and after 72 treatments. Clinical therapeutic effect in partition-herb moxibustion was significantly better than those in partition-bran moxibustion (P < 0.05). Protein and mRNA expression of IL-8, ICAM-1 in the patients was inhibited by both partition-herb moxibustion and partition-bran moxibustion, of those the inhibition in the partition-herb moxibustion group was more obvious (P < 0.01). Partition-herb moxibustion was shown to significantly improve the histology of the colon, and partition-herb was shown to improve the therapeutic effect of moxibustion on treatment of UC patients.
Body acupuncture was effective in reducing stroke patients' depressive symptoms and had fewer side-effects. It should be considered as an option for neuropsychiatric sequelae of stroke.
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