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Medical Research
Cause of Asthma –could relate to culture and emotion?
01-07-2011
Angela ning zhang
Science answer for asthma
Asthma is a common disease which negatively affects many New Zealand people daily lives. Can we ask what the reason & cause for asthma is?
If you go to Google & search many sciences’ studies have plenty of answers for it .Most found the answer in physical level or environment. You can have a long list of reasons. Like genes allergies, weather colder or dampness or lack of exercise, poor diet environment dust mites , high pollen season , smoking and more..
The interesting thing is the highest asthma country number one is Britain,. The number two is New Zealand.
If we believe all asthma research the reason for asthma is true. Then we need to ask next question: UK , New Zealand, have the worst environment for dust mite? They are worst people for excise? They have worst diet in the world? They highest smoking rate internationally?
Or these two countries are very damp or most cold place or have the highest pollen density nature environment?
I think we can answer it: no.
British and New Zealand culture
Then we need to ask the next question: Why only these two countries in the world have highest rate of asthma? What is in common between these two countries?
My answer is culture. Britain is the mother country for New Zealand. British culture is mother culture for New Zealand culture..
UK and New Zealand people have similar culture, attitude and behaviour patterns , our attitude, behaviour is based on culture and belief systems. Our emotions are based on attitude and behaviour and interactions
We all can understand and accept that: the stress or negative emotion could trigger physical suffering or health problems.
Can we ask the next question: what negative emotion actually causes asthma and what negative emotion possibly UK and kiwi have in common to cause asthma?
In Chinese medicine every organs have emotion energy and physical energy at the same time.
For example: The heart is in charge of blood circulation also the emotion of heart energy is love and joy.
The lung is in charge of breathing and the emotion energy is connection. If the lung energy is weak you can’t breathe properly also you are feel separated and lonely and sad.
And they are work in both ways. If you are lacking in connection to people, feel sad and alone that will be your reflected in your weak your lungs function. You will easy get asthma, bronchitis or other lung system infections.
From western medicine and physical point of view, Asthma is lung dysfunctions .
From Chinese medicine point of view: your physical body and your emotion body are one they are never been separated .
If your lungs function are not physically healthy, your lungs emotions impossible to be healthy.
The true answer is if you have lung dysfunction problems such as asthma that indicate you have certain level of loneliness or sadness and feel disconnected with work or life or people.
Statistics show UK and New Zealand has highest asthma rate in the world. That indicate emotionally these two countries have highest population of people feel lonely, separated and missing connection.
The real cause for asthma cant only count genes, food, exercise, dust mite, smoking, and cold or damp weather ,behind all of that is the negative emotions.
What is the negative side of British culture and New Zealand culture?
Classified, judgemental, you must do certain things in certain ways you don’t want to look silly. You need to behave in certain ways.
Are you familiar with these kind of ideas:
You shouldn’t talk to strangers.
You need to wait for other person to talk to you first.
You never say how good you are, that is too showy you never tell other people how good they are , that could be too shallow.
You never ask things about other people because that is private;
you never tell other people what you do for life, Maybe they don’t want to know maybe they will think you are showing off.
Maybe you should keep for yourself for your privacy.
You need be subtle, you need be lay back, and you need be private.
You can’t be too open, too friendly, and too showy.
You don’t want to look silly you need to be nice.
You don’t want to be different, you want to blend with people, you don’t want they think you are better than anyone else.
We are all the same.
So we do the same things, we talk same ideas, we walk in same pace.
We lost the individual selves we were ,we forget who we are. We are so inside ourselves we just can’t breathe.
How familiar are you with the experience – when you go to a party, you found everyone only talked to the people they know, after a party you almost know no body. If you are lucky maybe the people you meet they talk to you about weather or food. Nothing really meaningful, after a night out, you didn’t feel connected or up lifting. And you didn’t have new friends.
You need to wear right clothing to the right place, right colour, and right style say the right thing and have the right manners.
Do you notice In New Zealand at any business meeting you go to, that 90% of professional woman wear black coloured cloth? Why black? Because you not stand out and you can’t be go wrong.
You need to go to right school, talk to the right people, and be in the right job. You learn to know many boundaries, Many expectations. All this stuff, has been written in your mind, or invisibly written in your environment, in the air your breath.
Because when you walk in a room you can sense the judgemental energy and You are so restrained and it becomes part of your nature, you never know this is not natural , how you can you be free to talk ,free to act, free to be who you are ?
You find it hard to breath inside your body, you have asthma.
New Zealand is a interesting place: the most green country in the planet, one of the best places to live in the world.
New Zealand People have interesting characters: most innovative, most love charity work .most sporty people in the world and have the highest Olympic winners. From the surface New Zealand friendly you can see people say hi to others in street vertically when walking with your dog in a park.
The challenge question is why we have highest asthma rate in the world?
Why we have highest suicide teen’s rate in the world?
IS There a emotional link between asthma and suicide?
Have we ever thought that our culture and attitude have something to do with our characters and that could affect our emotions and breathing and health?
My journey of discovery
I have been work at medical field since I was 17 years old.
I have over more than 30 years of work experience.
I have been treating people focus on physical level for all most that entire time. I always love to learn new techniques, new therapies. I have my own clinic since 1995.
Regardless that I have much success in healing people. I always felt something missing in my work. I can’t fully understand why for some patients: they are eating healthy food, do excise, and come for treatments still I can’t help them to getting to be healthier.
I want to see good results in every patient I treat. I am looking for answers.
This Last year was a break though. I attended two revolutionary training course that has inspired me. These eye opening moments has changed my practise for ever.
At May last year I attending a French course “Nutrinpunctur”. This therapy use Trace elements as supplements to treat patients. They believe the body sickness come from the unbalanced emotions because unbalanced body energy functions.
They use a well structured system to indentify the organs and emotions relationships. That was based on ancient Chinese medicine theories :
Like the heart emotion is love and joy.
The lung is connections.
The stomach is respect and thought and action.
The liver is wisdom and flexible.
The kidney is self acknowledgement and ambitions.
This idea was written in the ancient Chinese medical book for many thousands of years. I have studied many times and also many years ago.
But in the real world, a school teacher never teach you to heal patients emotions and when patients come to me I only work on the physical body never really ask question about emotional health.
If I sense they have emotional problems I just ignore it because that was not my job to touch these areas.
Every day in the class room I was so fascinated by the teaching and almost can’t sleep. Suddenly I realised for the first time I now fully understand the physical body and emotion body as one soI need to positively treat both then I can restore the patients health. also I am shocked by this therapy developed by a French doctor who is not Chinese .
In ancient Chinese text book the emotion relating to organs only in one sentence for each organ.
But in the French course they are based on the ancient principle has been devolved to very detailed big body charts of Encyclopedia.
I studied and felt like this French doctor has been using ancient text interpreted to modem language and add latest discovery of universal truth of mind & body connection.
And few months later I attended a American course and developed by a American doctor- Emotion code.
The principle is actually same to “nutrient- puncture” .the theories is all health issues could partly be relating to trapped emotions embedding in your body organs and tissues.
Work at the 5 inner organs and relating to 5 group of negative emotions .To learn this technique was a next level of revolution.
To remove these negative motions you don’t need any complicated medical equipment…..
Since then treat patient emotional health become part of my work. An example is:
Nuky is a 30 years old young lady who lives in east Europe. Her sister got married two weeks ago and she came to New Zealand to join the wedding ,
Because the sister and husband have benefited from Chinerchi therapy . after the wedding very next day Nuky come with sister to clinic to have consultation she had suffered from blocked nose for more than 10 years. She is a business owner and conscious of healthy living. She can’t understand why she have the problems.
My answer is every physical pain is behind emotional pain. Nose is widower of the lungs. Lung energy is relating to connection or sadness and loneliness. To healing the block nose need to give the body energy ,use energy therapy also need to find out emotion reason behind this. I designed a package treatment with two energy therapy ,one implant acupuncture and two emotion code and one hypnosis.
At first emotion code session I find out Nuky blocked nose was relating to she has a heart wall for self protection and separate her from others and she have trapped emotion of loneliness .Nuky mum died when she is only 17 year old. She think she was over that sadness but reality is she is not.
But after the first treatment Nuky nose was 60 % better, the sister said she is a transformed person. She is more happy and open. After second emotion code and hypnosis therapy Nuky felt the nose is free from blocking, amazingly feel light and happy.
To be a good healer and to understand how the body and mind works that will be a life time challenge for me and for all people who work in these fields. This is a exciting journey and full of mysteries waiting for us to explore and find answers and to contribute to humility.
References
1. July, 3, 2011.from http://www.nytimes.com/1995/
Developing a research proposal
A random trial to evaluate the effectiveness of Electronic acupuncture treating school age children with asthma.
A pilot study
By Angela Ning Zhang
Complete Date: 4th July 2010
Contents page
1. Title of research project
2. Investigators
3. Abstract
4. Statement of the problem being investigated & significance of the project
5. A literature review and background of the topic
6. Aims and objectives of the project
7. Research plan
8. Assumptions and definitions
9. Ethical issues
10. Dissemination of the findings
11. Problems and limitations of the study
12. Proposed time frame
13. The estimated budget
14. References
15. Appendices: Patient information, informed consent and asthma diary
Title
A randomized trial to evaluate the effectiveness of Electronic acupuncture treating school age children with asthma.
A pilot study
Key words: Electronic acupuncture asthma children inhaler peak flow
Investigators
This study will involve the following people: Lead researcher,two acupuncturists a research assistant and a statistician.These people will work as a team and have independent responsibilities to avoid bias and support each other to accomplish the study.
Two acupuncturists
The acupuncturists should be a qualified and registered acupuncturist with at least 5 years experience working as acupuncturist. They should have some experience in treating asthma.
Two acupuncturists will be needed. Two will administer treatments. Two are needed because of the large work load caused by the frequent treatments and large sample size. The role of the two acupuncturists’ will be to:
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Administer acupuncture to patients.
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Record the treatments and patients reaction toward treatments.
One research assistant:
The research assistant should be responsible for:
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Testing and recording peak flow.
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Investigate and record inhaler usage twice a week, during their visit for treatment.
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Collect the asthma diaries completed by the participants.
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Discuss overall quality of life of participants.
This person should be a qualified Pediatricnurse and have 5 years experience with asthma children. They will need to have these qualifications because they are administering the peak flow tests. A third person will be employed for this job because they are asking qualitative questions regarding the quality of life.
Lead researcher:
The lead researcher will provide guidance on the research processes including methodology and data analysis. This role will be filled by the author who has experience in acupuncture and research knowledge.
This role will involve:
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Assistance in the development of research methodology, protocols and outcome measures.
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Apply for ethical approval.
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Develop and manage the research team.
Statistician:
The person should be qualified in statistics. Their role will involve:
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Analyzing the data collected.
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Drawing conclusions about the data.
Abstract
The purpose of this paper is to present a single blind electronic acupuncture trial to answer the question: Does electronic acupuncture improve peak-flow, lung functions and reduce inhaler usage in children with asthma?
Participants:
This research will involve 60 children affected by asthma. Children will be defined as being aged 6-12. Being affected by asthma will be defined as being diagnosed as having mild or moderate asthma by their GP. Also the condition should have persisted for at least one year and having to use an inhaler daily for at least the last six months. Participants will be randomly assigned to the control or experimental group.
It was decided that 60 participants will be recruited so that even after natural attrition there should still be a sufficient sample size. An attrition rate of 20% would be considered a worst case scenario leaving a sample size of 48. Comparing this with Stockert, K., Schneider, B., (2007), study which used only 18 participants in total.
In order to recruit these participants an advertisement will be taken out in an asthma magazine produced by the asthma foundation and local news papers. This advertisement will ask for any parents who would like their children to take part to contact the researcher.
Method:
The participants will be randomly allocated to one of three groups. The A experimental group will receive electronic acupuncture two times a week for four weeks. The B group referred to as the sham group will receive sham acupuncture in order to control placebo effects. The C Group is a control group and will receive no treatment from the clinic. All treatment will be conducted at a Chinese therapy clinic. (See reference)
All the three groups will continue to take medication treatment as usual and will be asked to visit the clinic two times a week in order to have their peak flow measured and to answer questions about their inhaler usage.
Results:
Peak flow results and lung function test will be analyzed through an ANOVA method to determine whether or not there is a significant difference between group means. A Chi square test will be used to analyze inhaler usage. This will determine whether or not there is a significant difference between inhaler usages between groups.
Statement of the problem being investigated and significance the project
One in four New Zealand children are estimated to have asthma (Asthma foundation, 2010)This gives New Zealand these condhighest prevalence of asthma in the world after the UK(Asthma foundation, 2010). It's the most common cause of hospital admission among New Zealand children (asthma foundation, 2010).
The economic costs of asthma in New Zealand have been conservatively estimated to be around $825 million per year. This is made up of $125 million in direct medical costs and $700 million in indirect medical costs such as the cost of having time off work.(Beasley , Holt, 2002.)
After looking at these statistics it can be concluded that asthma is affecting New Zealand on an individual and national level. It is affecting our children and it is costing us money. Therefore it is essential that a more effective treatment method is developed. Electronic acupuncture may be able to provide this much needed alternative.
Western medicine has successfully developed many effective medical drugs to treat asthma. Inhalers are an important part of asthma treatment (Asthma foundation, 2010). If this research is successful it will offer an alternative to this treatment.
Traditional Chinese medicine (TCM) including both Chinese herbal medicine and acupuncture has been widely accepted. This can be seen with ACC and a number of insurance companies accepting it as a funded treatment method. But there are a number of limitations. These include the fact that the taste of herbal medicine can be unpleasant, which many people do not like. Also the fear of needles can hinder treatment. This limitation is especially important to this research because children in particular have a fear of needles.
Electronic acupuncture is a development of TCM acupuncture. It is based on the same principles as acupuncture but with the benefit of not relying on the use of needles.
A major reason for conducting this research is that the author runs a clinic in which she has found positive results in this area. Although results are documented, the measurement was dependent on patients reports – life quality improvement and reduced use of inhaler but no peak flow and lung functions test were conducted. There was also a lack of follow up. There seems to be enough evidence to warrant further investigation. The author has treated 18 children using this method and has found that the majority (15 out of 18) report positive results in which their quality of life is improved with reduced use of inhaler.
Because these results were developed from a small sample size it is essential that they are tested on a larger scale. This will give the treatment a better scientific standing. There are also a number of bias’s to take into consideration including experimental bias, extraneous variables and possible placebo effects.
In addition two unique advantages have been found. Firstly, because no needles are used the children feel more comfortable and are more accepting of it. Secondly, because no medications or supplements are involved there is little stress on the stomach.
This study not only tests a possible alternative to current treatment methods, it also will pave the way for future research to be conducted surrounding electronic acupuncture.
The benefit will be many asthma children could reduce the use of an inhaler, have a better quality of lifeand ensure a more healthy adult future. Also to establish an effective asthma treatment will improve public health and reduce the cost to the health care system
Economic benefits both nationally and internationally will be obtained.
Literature review and background of the topic
In order to determine whether or not this topic has been studied previously and to see what other research had to contribute to this topic a literature review was completed. This literature review aimed to answer the questions: How well can acupuncture treat childhood asthma? And how well can electronic acupuncture treat childhood asthma?
A search of ‘Pubmed’ used the keywords: electronic, acupuncture, asthma, children and pediatric. This search provided 11 articles relating to this topic (see references). No research has been conducted which employs the same methods as suggested for this research.. There are two important differences compared with other studies:
A: Use multiple electronic acupuncture machines and use multiple acupuncture points.
B: Have a concentrated treatment plan .Each treatment lasts 30 minutes at a time and is conducted twice a week for a period of 4 weeks.
Relevant articles are discussed further below, including their findings and how they differ from the proposed research.
Two studies used alternative electronic machines to treat asthma, their results were as follows:
Zhong, Z.,, Xi Y., Jie H.,& Za Zhi.,(1992), conducted a study using an electronic machine to work on body airways to treat asthma patients. They found that this treatment was safe and effective. The difference between this study and the one proposed is that this study did not involve acupuncture points. It could be expected that more efficient results would be obtained if specific acupuncture points were used as proposed in this study.
Ngai, S.P., Jones, A.Y., Hui-Chan, C.W., Ko, F.W., & Hui, D.S., (2009), also used an electronic machine to treat asthma. They used electrical stimulation over acupuncture points and found that this treatment improved lung functions.. The main difference between this study and the proposed study is that this study does not focus on treating asthma specifically but rather attempts to increase lung functions in order to allow patients to exercise longer. Also this research was done in a gym setting and not in a hospital or clinic.
Four studies used laser acupuncture, which is very similar to electronic acupuncture. Three of these focused on children, the fourth used a mixed age group. Their results were as follows:
Stockert, K., Schneider, B., Porenta, G., Rath, R., Nissel, H., & Eichler, I., (2007), found that laser acupuncture was successful in preventing acute respiratory exacerbations in 6-12 year olds. The difference between this study and the proposed study is that not only is laser acupuncture used rather than electronic acupuncture but also this research also used probiotics, whereas the proposed research suggests that electronic acupuncture could be used on its own.
Nedeljković, M., Ljustina-Pribić, R., & Savić, K., (2008), also used laser acupuncture to treat asthma in 7-17 year olds. The study produced positive results. The difference with this study is that they used acupuncture points on the participant’s hands and feet. The proposed study will use acupuncture points around the whole body.
Milojević, M.,& Kuruc V,. (2003), conducted a study using a low powered laser treatment. They found that the younger participants showed more improvement than the older participants. This study did not focus on children; they focused on a mix age group. An important point to note is that they found the most positive results in younger participants.
Gruber, W., Eber, E., Malle-Scheid, D., Pfleger, A., Weinhandl, E., Dorfer, L., & Zach, M.S., (2002), conducted a study using laser acupuncture to treat exercise induced asthma in children. This study failed to show any positive results. However, a possible reason for this is the fact that they only used one acupuncture point and only used two treatments. More acupuncture points and more treatments are likely to show better results, as shown by other articles discussed.
Two studies where found where rats were used to determine the effect of electronic acupuncture on asthma. The studies results and differences were as follows:
Carneiro , E.R., Carneiro, C.R., Castro, M.A., Yamamura, Y., &Silveira, V.L., (2005), found that electronic acupuncture had positive results in treating asthma in rats. It also found that the specific acupuncture points used had an impact on results.
Carneiro, E.R., Xavier, R.A., De Castro, M.A., Do Nascimento, C.M., & Silveira, V.L., (2010), found that the anti-inflammatory benefits of electronic acupuncture means it could be a possible complementary treatment for asthma.
These studies show that electronic acupuncture has positive results in treating asthma rats which may be able to be reproduced in humans.
Three studies used traditional acupuncture needles to treat asthma. Their results were as follows:
Maa, S.H., Sun, M.F., Hsu, K.H., Hung, T.J., Chen, H.C., Yu, C.T., Wang, C.H., & Lin, H.C., (2003), found that the supplementation of acupuncture or acupressure can significantly improve quality of life in asthma patients.
Chu, K.A., Wu, Y.C., Ting ,Y.M., Wang, H.C., & Lu, J.Y.,(2007), found that acupuncture produced positive results in treating asthma, however, results showed less improvement than that from inhalation bronchodilator.
Zhang, Z.L., Ji, X.Q., Xue, L., & Yu, S.H.,(2005), found similar results to Chu et al (2007) in that acupuncture can be a positive supplementary treatment for asthma.
After looking at all these studies it can be concluded that although no research has been conducted similar to the proposed research, research surrounding acupuncture in the treatment of asthma shows positive results. Similar forms of acupuncture such as laser and traditional acupuncture have shown positive results and electronic acupuncture in the treatment of rats has shown positive results.
After reviewing the literature we can be more positive in our predictions for the use of multiple point electronic acupuncture in the treatment of children with asthma.
There are two important differences compared with other studies:
A: Use multiple electronic acupuncture machines and use multiple acupuncture points.
B: Have a concentrated treatment plan .Each treatment lasts 30 minutes at a time and is conducted twice a week for a period of 4 weeks.
That will be the first time research has been conducted by this method.
Purpose and objective of the project
The purpose of this study is to evaluate the effectiveness of electronic acupuncture in treating school age children with asthma.
The objective of this study is to develop data to support or stop the use of electronic acupuncture as a pain free and drug free treatment for school age children with asthma. Another objective will be to open the door for future study on electronic acupuncture in the treatment of other chronic health problems.
The benefit will be many asthma children could reduce the use of an inhaler, have a better quality of life, and ensure a more healthy adult future. Also to establish an effective asthma treatment will improve public health and reduce the cost to the health care system and help our nation economically and also the world
Research plan
Participants will be recruited through an advertisement in an asthma magazine produced by the New Zealand Asthma foundation and local news papers. It will ask for parents of children aged between 6 and 12 years old who have mild or moderate asthma, as diagnosed by their GP. They should require an inhaler daily and have been affected for at least one year. Also they are needed to have used the same medication for the last 3 months. When you enroll for this study you must not be using any other form of natural therapy that includes acupuncture or supplements.
Participants will be excluded from the study if their asthma is classified as acute as diagnosed by a GP. Participants must not be receiving any other type of acupuncture during the research period and they must speak English fluently in order to effectively communicate with the researchers. The patients must also not have any metal implants which could be dangerous in combination with the electronic acupuncture. The participants should not have been admitted to hospital for their asthma in the last six months. This is to ensure that participants selected have a stable condition.
60 participants will be recruited, 20 randomly allocated to a control group, 20 will be randomly allocated to the ‘sham’ group and 20 to the experimental group. The large sample size will allow for good results even if drop out occurs.
Participants in this study require their guardian’s consent as well as the child’s consent. This is because guidelines suggest that any participants who are under the age of 16 needed to have parental consent.
Once a participant has voiced their interest in the study, and it has been determined that they meet the criteria for participating, a meeting will be set up where the parents, the child and the acupuncturist will discuss the study in further detail. They will be told a rough outline of the study including what they will be asked to do and how much time they are expected to commit, they will also be given a information and consent form (appendix 1) to sign if they are still willing to take part. These will be asked to be posted back within two weeks with a prepaid envelope which will be provided. They will also be given instructions on how to record an exercise and inhaler usage diary. (Appendix 2). This diary will be given to the research assistant each meeting.
Once written consent has been received, the research assistant will record the patient’s name, sex, date of birth and previous experience of any natural therapy including acupuncture. Each patient will be assigned a code number.
Methodology
A single blind method will be employed for this study.
Treatment will be administered by a member of the New Zealand Register of Acupuncturists (NZRA), with a minimum of five years experience. The Treatment will be given twice a week with each session lasting 30 minutes. This will occur over four weeks so that participants in both the experimental and sham groups will receive 8 treatments in total.
At this study all patients will continue to take the same medication they were taking before the study.
Treatments will be identical for the sham and experimental group except the sham group will not receive any electrical stimulation. The same acupuncture points will be used and treatments will have the same treatment time.
The acupuncture points that will be used are:
Yongquan, both sides. Zusanli, both sides. zhongwen, guanyuan.
Feishu both sides, shenshu both sides
This is a total of 10 acupuncture points.
Experimental A group:
Patients will be given real electronic acupuncture treatment on the points stated above. The acupuncturist will need to complete treatment records for each patient, documenting the power level given. These records will be used to determine how much should be given in the next treatment.
The participant will be asked by the research assistant how they felt about the last treatment. The research assistant can then inform the acupuncturist if the participant was unhappy with the treatment or had any negative side effects so that the acupuncturist can alter the treatment to reduce this. A research assistant should do this rather than the acupuncturist to avoid social desirability bias.
Sham treatments B Control group:
The control group will receive sham acupuncture on the same points as used in the experimental group. It will last the same length of time. The only difference will be that electricity stimulation will not be used; however, they will still feel a warm sensation.
No treatment C Control group:
For the three groups of participants all need to visit clinic twice a week. For peak flow test and asthma dairy hand over research assistant, also answer question relating inhaler usage and excises.
Variables:
The independent variable is the treatment which participants received. The dependant variable will be measured through lung functioning, peak-flow results and inhaler usage.
Possible extraneous variable could be experimenter bias and social desirability bias. These have been controlled by employing a third person to record results. An extraneous variable that has not been controlled for is the fact that some participants may live in damp dusty houses which could increase asthma symptoms. Also some participants will be not been able to control for exposure to passive smoking from other household members.
Another extraneous variable that has not been controlled for is the fact that the participants will all have different diets. Some diets may increase asthma symptoms more than others.
Data collection:
The measurement of the research will be:
A Lung function test three times:
1, before treatment starts,
2, after 8 treatments
3 after a three month follow up.
The lung function test will be done with a local GP
B During the study the peak flow tests are conducted twice a week for four weeks and after a 3 month follow up test.
C Asthma patients or their caregivers complete a diary at every visit to the clinic and a nurse assistant records the research questioner including the inhaler usage and daily activities.
Before every treatment meeting the participants will be required to complete an interview with the research assistant. This will involve the research assistant asking questions about the last treatment, in order to make any changes for the next treatment. They will collect the inhaler diaries and have their peak-flow tested. The research assistant will conduct this interview to ensure that experimenter bias and social desirability bias do not occur.
Data analysis:
A statistician will be employed to analyze the data. They will use a Chi square test to determine the significance of the difference in inhaler usage between groups. An ANOVA method should be used to determine the significance of Lung function and peak-flow change. For both of these tests a 0.05 significant level should be used.
Assumptions and definitions
All professionals involved should remain neutral throughout the process. They should not expect any particular results as this will cause them to interpret results in a particular way.
It is assumed that participants will adhere to the guidelines including the fact that they should not alter their current treatment plan in another way other than the addition of acupuncture treatment provided by the study.
Being affected by asthma will be defined as being diagnosed as having mild or moderate asthma by their GP. Also the condition should have persisted for at least one year and having to use an inhaler daily for at least the last six months.
Children will be defined as being aged 6-12.
Electronic acupuncture: is an electronic stimulating machine working on acupuncture points in place of traditional needles.
Peak flow Test: a peak flow meter is a small plastic tube with a measuring gauge along the side, which measures how fast you can blow air out of your lungs.
The speed and force you can blow air out of your lungs depends on how open your
breathing tubes are. If you are well the breathing tubes are open and your peak flow is
high .If the tubes are tight (when your asthma is playing up) your peak flow will fall. Asthmadundation/Peak flow monitoring2010)
Lung function Test: Spirometry is the most basic objective measurement of lung function. The results of well performed spirometry give an indication of whether airflow and lung volume are within normal limits for a patients age, sex and height. It will indicate whether a person has significant airflow obstruction (e.g. asthma or COPD) or significant lung volume reduction (e.g. a restrictive lung disease). However, poorly performed spirometry is often worse than no spirometry at all! Good quality spirometry requires a trained and experienced operator. (asthma foundation/ Spirometry Courses for Health Professionals2010)
Ethical issues
This study will follow standard ethical guidelines. This includes informed consent, confidentiality and the right to withdraw. Because this study is dealing with participants under the age of 16 there are ethical issues suggesting that parents also need to be consulted throughout the process. These have all been taken into account when designing this study.
Dissemination of the findings
This report will be submitted to journals that deal with asthma treatment, journals that deal with complementary treatments, journals that deal with acupuncture treatments and general medical journals.
This way this information should reach acupuncturists’, those interested in asthma treatment, those interested in complementary therapies and those interested in general medical research. By targeting all these areas it ensures that maximum exposure of the research occurs.
Periodical Names
General
BMC Complementary and Alternative Medicine Journal
http://www.biomedcentral.com/bmccomplementalternmed/
World Health Organization (WHO) documents and publications on traditional medicine
http://www.who.int/topics/traditional_medicine/en/
New Zealand
Ngä Tipu Whakaoranga: information on traditional uses of New Zealand native plants
http://www.lawsite.co.nz/landcare/index.cfm?option=searchtemplat
United Kingdom
CAMEOL - Complementary and Alternative Medicine Evidence Online database
Bandolier Library of Complementary and Alternative Therapies
http://www.jr2.ox.ac.uk/bandolier/booth/booths/alt
Problems and limitations of the study
There are a number of limitations involved with this study. They are discussed below.
The first limitation will be: The author, who will be involved in the study, runs a clinic in which similar treatment programs have been successful. Not only will this cause the author to expect specific results and so interpret results favorably but also it creates a conflict of interest.
Because each participant requires 1 hour of treatment per week there is a limit to how many participants can be involved. This caused the sample size to be relatively small with only 20 participants in each group. This sample should provide accurate results; however, a larger sample size would be more desirable.
Estimated time period
|
Time (In weeks) |
Task |
|
0-4 |
Advertising for participants |
|
5-7 |
Meet participants and get consent forms signed. |
|
8-9 |
Allocate groups and treatment times |
|
10-14 |
Treatment period |
|
15-27 |
Follow up |
|
28-29 |
Follow up data collection |
|
30-31 |
Analyze data and draw conclusions. |
|
32-36 |
Write report and inform participants of findings. |
|
In total we need a period of |
9 months
|
Estimated budget
Table 1
|
Time (In weeks) |
Task |
|
Staff Investigator |
Advertising for participants answering the phone for questions 3 hours a week for 4 weeks 12 hours 1-4th weeks |
|
Investigator |
Meet participants and get consent forms signed. We need 60 participants could interview 90 puritanical participant take about 45 -55 minute for each participant need about 85 hours of work. 5-7th week
|
|
Investigator Research expert |
Allocate groups and treatment times Research expert Allocate groups work for 4 hours Investigator to contact participants and organize the time to meet for a first assessment and to give a time table for the whole period of treatment. Total work 80 hours 8-10th week
|
|
Acupuncturist Nurse assistant Investigator
|
Treatment period Two Acupuncturist 40 hours a week for 4 weeks 320 hours Nurse assistant 40 hours a week for 4 weeks 160 hours Investigator 40 hours a week for 160 hours
11-15th week |
|
Nurse assistant |
Three month Follow up 15-27th week Once a month email contact. If email is not available then a phone call asking participants to send back the asthma diary by post: 6 hours work 15-27th week |
|
Nurse assistant |
Follow up data collection Nurse assistant Sending 60 participants a phone call or email Conduct peak flow test: 30 hour work 28-29th week
60 participants need to go to a local GP for a lung function test 3 times First test -before study Second test -after study Third test- three month later Lung function test $75 each 180 times $13,500
28-29th week |
|
Research expert |
Analyze data and draw conclusions. Research expert 30-31th week 10 hours |
|
Investigator
|
Write report and inform participants of findings. 32-36th weeks About 80 hours |
Table 2
|
The teamwages Investigator 417 hours $60 per hour $25,020 Acupuncturist 320 hours $40 per hour $12,800 Nurse assistant 196 hours $60 per hour $11,760 Research expert 14 hours $60 per hour $840
|
Total $ 50,420 |
|
The lung function test in local News paper $500 for each Ad for 4weeks AD Need
|
$13,500 $2,000 |
|
320 treatments cast Treatment use clinic equipment $10 each treatment, $10 Fresh clean sheet for each time treatment bed. $20 per treat 4o participates each need 2 treatments a week. Study deals with 80 treatments a week for 4 weeks. The research takes 9 months from beginning to end
Chinese energy therapy clinic needs 12 weeks fully occupied with research The phone and internet connection bill $120 Includes Land phone $40 Mobile $40 Internet $40
Rent clinic space $600 per week 12 weeks
All research relating to forms design and print $500 Clinic office paper , pen $200 Total paper costs
|
$6,400
.$ 7,200
$700 |
|
Total
|
$14,420 |
|
All 60 participants will be offered $20 a week for travel costs, for 5 weeks visits to clinic $100 each
|
$6,000 |
|
Research team $ 50,420 Lung function test $13,500
Advertising costs $2,000 Clinic cost $14,420 travel $6,000
|
Total $ 86,340 |
References
Asthma foundation (2010), retrieved from: http://www.asthmafoundation.org.nz/_asthmabasics.phpon June 26th 2010
Asthma foundation (2010), retrieved from: http://www.asthmafoundation.org.nz/in_new_zealand.php on June 26th 2010
Asthma foundation (2010), retrieved from: http://www.asthmafoundation.org.nz/understanding_your_inhalers.php on June 26th 2010
Asthma foundation (2010), retrieved from: http://www.asthmafoundation.org.nz/in_new_zealand.php on June 27th 2010
Holt S, & Beasley R.(2001) The Burden of Asthma in New Zealand. Report produced for the Asthma and Respiratory Foundation of New Zealand.
Carneiro , E.R., Carneiro, C.R., Castro, M.A., Yamamura, Y., &Silveira, V.L., (2005), Effect of electroacupuncture on bronchial asthma induced by ovalbumin in rats. J Altern Complement Med, 11(1):127-34.
Carneiro, E.R., Xavier, R.A., De Castro, M.A., Do Nascimento, C.M., & Silveira, V.L., (2010), Electroacupuncture promotes a decrease in inflammatory response associated with Th1/Th2 cytokines, nitric oxide and leukotriene B4 modulation in experimental asthma. Cytokine, 50(3):335-40.
Chu, K.A., Wu, Y.C., Ting ,Y.M., Wang, H.C., & Lu, J.Y.,(2007), Acupuncture therapy results in immediate bronchodilating effect in asthma patients. J Chin Med Assoc, 70(7):265-8.
Gruber, W., Eber, E., Malle-Scheid, D., Pfleger, A., Weinhandl, E., Dorfer, L., & Zach, M.S., (2002), Laser acupuncture in children and adolescents with exercise induced asthma. Thorax, 57(3):222-5.
Maa, S.H., Sun, M.F., Hsu, K.H., Hung, T.J., Chen, H.C., Yu, C.T., Wang, C.H., & Lin, H.C., (2003), Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. J Altern Complement Med, 9(5):659-70.
Milojević, M.,& Kuruc V,. (2003), Low power laser biostimulation in the treatment of bronchial asthma. Med Pregl, 56(9-10):413-8
Nedeljković, M., Ljustina-Pribić, R., & Savić, K., (2008), Innovative approach to laser acupuncture therapy of acute obstruction in asthmatic children. Med Pregl, 61(3-4):123-30.
Ngai, S.P., Jones, A.Y., Hui-Chan, C.W., Ko, F.W., & Hui, D.S., (2009), Effect of Acu-TENS on post-exercise expiratory lung volume in subjects with asthma-A randomized controlled trial, Respir Physiol Neurobiol, 167(3):348-53.
Stockert, K., Schneider, B., Porenta, G., Rath, R., Nissel, H., & Eichler, I., (2007), Laser acupuncture and probiotics in school age children with asthma: a randomized, placebo-controlled pilot study of therapy guided by principles of Traditional Chinese Medicine. Pediatr Allergy Immunol, 18(2):160-6.
Zhang, Z.L., Ji, X.Q., Xue, L., & Yu, S.H.,(2005), Clinical observation on acupuncture for treatment of bronchial asthma at acute stage. Zhongguo Zhen Jiu, 25(3):158-60.
Zhong, Z.,, Xi Y., Jie H.,& Za Zhi.,(1992), Influence of application-impulse stimulation treatment on airway's reactivity with asthma, Title, 12(2):86-7.
Chinese energy therapy clinic started 1995. Practice the unique Chinese energy therapy.
Chinese energy therapy is use traditional Chinese medicine principles combining modern
Electronic therapeutic machines to treat chronic health problems, instead of traditional needles and herbals.www.energytherapy.co.nz
APENDIX 1: Participant information sheet and informed consent form
This information has been provided to you to ensure that you understand what will be expected of you and your child during the course of this study and to give a brief outline about what you should expect. After reading this information feel free to contact the researcher to ask any questions you may have or enquire about taking part.
Contact details of lead researcher:
Name: Angela Ning Zhang
Email: info@energytherapy.co.nz
Phone: (09) 4825318
Note: because this study is using participants who are under the age of 16 years old a legal guardian is required to also complete a consent form. Please ensure both the child and guardian understand the following information. Feel free to ask any questions by contacting the researcher through one of the above methods.
Purpose of research:
You and your child are invited to take part in a research study which is seeking to suggest an alternative, more natural, treatment for asthma. This study is focusing on the use of electronic acupuncture in reducing inhaler usage in children with mild to moderate asthma.
Your participation in this study is entirely voluntary and you will be able to withdraw from the study at any point with no questions asked.
Confidentiality
Any information you provide will be kept confidential. Including the diaries provided and contact information. You and your child will not be identifiable in any way through the research report.
What the study will involve
If you choose to participate your child will be randomly assigned to one of three groups, the experimental which will receive electronic acupuncture, a sham group which will receive a placebo acupuncture treatment and a control group which will continue treatment as usual. You will not be able to select which group you are assigned to nor will you be told which group you have been assigned to.
All groups will still use their current treatment plan. Only the experimental and sham groups will have the additional treatment. You will be required to not alter this current treatment and not employ any other natural treatments during the period of the study.
You will be asked to complete a diary about your child’s diet, exercise, inhaler usage and sleeping patterns. You will give these to a member of the research team twice a week when you will be expected to visit a Chinese energy clinic in Birkenhead. During this meeting you will also be given treatment if you are allocated to the sham or experimental group, this will last roughly 30 minutes. You will also be required to take part in an interview which will last no more than 15 minutes. You will be provided with more detailed information depending on your assigned group once you have been assigned to a group.
Time duration of the study.
The treatment period will last four weeks and a follow up period of three months, a total of four months.
Information regarding what will be expected of you during the study period
You will be expected to not change your child’s current treatment program other than the addition of the acupuncture treatment as provided by this study. This includes the addition of a drug or herbal medicine or the removal of a drug or herbal medicine
You will be expected to complete a diary about your child’s asthma including questions about wheezing, diet, sleeping habits and their exercise levels.
You will be expected to attend the clinic in Birkenhead two times per week for treatment and a brief interview. The treatment period will last roughly 30 minutes and the interview period will last roughly 15 minutes.
What you should expect from the study
We aim to provide valuable information about your child’s condition. Once the research has been completed you will be provided with the findings. If any positive treatments are found, you will be offered a course of these at no cost. We will also reimburse your travelling costs.
Risks associated with the treatment
No adverse reactions to electronic acupuncture have been documented apart from occasional minor skin irritation.
Electronic acupuncture is a non-invasive treatment and as such has no danger of infection.
Patients with metal implants should not take part in this study.
Your rights as a participant in research
You have the right to be fully informed about the research. This includes information about the nature and process of the study.
You have the right to withdraw from the study at any point if you do not wish to continue to participate for any reason.
You have the right to decide to participate, this means you should not be convinced or manipulated into participating by any person.
You have the right to ask any questions you may have, this can be done at anytime by contacting the researcher using the above information.
Guardian consent form.
I the legal guardian of give permission for my child to take part in this research project regarding electronic acupuncture in the treatment of childhood asthma. I have read the information provided and understand it. I know what is expected of me and agree to do what is being asked of me. I have explained to my child what will happen and they are happy to take part. I have not been talked into taking part against my will by any person, likewise I have not convinced my child to take part against their will.
Signed
Date
Participant consent form.
I am happy to take part in this study about electronic acupuncture as a way of treating childhood asthma. I have talked about the information with my Mum or Dad and understand what will happen during the study. I have not been made to take part by any person.
Signed
Date
APENDIX 2: Asthma dairy
|
Name: |
|
Doctor: Phone: |
|
Preventer: |
|
Reliever (blue inhaler): |
Refer to your Asthma plan for more details on what action to take
0=Well −−−−→ 1=Asthma Mild −−−→ 2=Asthma Worse −−−−→ Asthma emergency
If you are frightened at any stage call 111
|
Date |
Day |
Night time cough or wheezing 0-2 |
Day time cough or wheezing 0-2 |
Activity or behavior altered 0-2 |
Number of reliever doses given |
Number of preventer doses given |
Other medicine given |
Comments e.g. developing a cold, blocked or runny nose, possible triggers |
B-breakfast L-lunch D-dinner |
Sleep B-bed time U-up time
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