Acupuncture

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This article is a study based on a bibliographic reference, systematized on the importance of acupuncture and other Complementary Integrative Practices (PICs) in the treatment of mental and emotional disorders that has been growing in recent years, with a noticeable increase in times of pandemics of Covid 19. This study sought to analyze and describe the importance of applying these PICs combined with conventional treatment described by several authors. An electronic search was carried out in the bibliographic indexes: LILACS and Scielo and the following descriptors: Acupuncture and depression were used. Acupuncture and Anxiety/Stress and Acupuncture and Emotional Disorders.(2008-20021). Of the 30 references selected, 14 references were analyzed that dealt with the subject with greater clarity and objectivity. A greater effectiveness of acupuncture was observed in relation to other PICs, which demonstrates that acupuncture is an ancient therapy that contributes to the improvement of quality of life in all aspects, especially in people with emotional disorders.

Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can ®nd adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.

Complementary treatments are often used by HIV-infected individuals. Yet little is known about their effectiveness. The aim of this systematic review was therefore to summarize the published evidence for or against the effectiveness of complementary therapies in HIV-positive people. A comprehensive literature search was conducted to locate all randomized clinical trials (RCTs) of complementary therapies. Data were extracted in a standardized fashion and evaluated critically. Fourteen studies met our pre-de® ned inclusion/exclusion criteria; 2 of herbal treatments, 5 of vitamins and other supplements, 5 of stress management, one of massage therapy, and one of acupuncture. They fall into 2 broad categories of ‘cure’ and ‘care’. While the former category yields few encouraging results, the latter group of studies is more promising. In particular, stress management may prove to be an effective way to increase the quality of life. It is concluded that few rigorous trials of complementary...

Acupuncture is widely used in both Eastern and Western countries as a complementary or alternative treatment modality for various diseases. Experimental, but also clinical studies have recently provided evidence that it can be effective in treating multiple sclerosis patients, since it seems to improve motor, as well as, sensory disturbances. It is safe and can have a long-lasting effect, even in patients resistant to conventional treatment.

This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomized trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved nighttime sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.

Objectives: The purpose of this study was to systematically review the literature for, and critically appraise, randomized controlled trials of any type of complementary and alternative therapies for labor pain. Study design: Six electronic databases were searched from their inception until July 2003. The inclusion criteria were that they were prospective, randomized controlled trials, involved healthy pregnant women at term, and contained outcome measures of labor pain. Results: Our search strategy found 18 trials. Six of these did not meet our inclusion criteria. The remaining 12 trials involved acupuncture (2), biofeedback (1), hypnosis (2), intracutaneous sterile water injections (4), massage (2), and respiratory autogenic training (1). Conclusion: There is insufficient evidence for the efficacy of any of the complementary and alternative therapies for labor pain, with the exception of intracutaneous sterile water injections. For all the other treatments described it is impossible to make any definitive conclusions regarding effectiveness in labor pain control. Ó 2004 Elsevier Inc. All rights reserved.

Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy. We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received standard medication only. The standardized pain therapy after tonsillectomy was orally administered nonsteroidal anti-inflammatory drugs (NSAID) (diclofenac 3 × 50 mg oral). The patients (n = 123) treated with NSAID were asked about their acute pain after taking a sip of water between the first and fifth postoperative day. Participants’ pain was assessed using visual analog (VAS) [zero (0) for no pain up to ten (10) for the acute reported outset pain] before and 20 min, 1, 2 and 3 h after acupuncture treatment or standard pain medication, respectively. The functional assessment of diagnosis and treatment point-combination occurred by means of the “Heidelberg Model” of Traditional Chinese Medicine (TCM). Verum acupuncture lead to a significant additional pain relief. In comparison to the acupuncture, they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID. This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy. It may particularly serve as an alternative pain treatment in case of NSAID intolerances.

Un point de vue «absolu» prétendant décrire « l'essence » de la médecine chinoise n'a que peu de sens. On ne peut qu'adopter des points de vue relatifs adaptés à des objectifs qui sont 1) soit professionnels et disciplinaires (les disciplines médicales et les professionnels de santé d'un côté, les disciplines des sciences humaines et sociales de l'autre), 2) soit idéologiques (instrumentalisation de la médecine chinoise au profit d'intérêts extra-médicaux). En fonction des objectifs se construisent des images très différentes de la médecine chinoise. Les médecins ont donc à définir leur point de vue professionnel. Cet abord médical se doit 1) d'être dégagé des idéologies et 2) en cohérence avec le cadre de référence collectivement admis de la médecine.
Summary: An «absolute» viewpoint claiming to describe the «essence» of Chinese Medicine is of little meaning. On Chinese Medicine we can only describe relative viewpoints tailored to objectives that are 1) professional and disciplinary (medical disciplines and healthcare professionals on one hand, disciplines of Humanities and Social Sciences of the other), 2) or ideological (instrumentalization of Chinese Medicine in favor of extra-medical interest). Depending on the objectives are built very different images of Chinese medicine. Physicians therefore have to define their professional perspective. This medical viewpoint must 1) be free from ideologies and 2) consistent with the collectively agreed framework of medicine.

Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.

This review examines the educational accreditation standards of four licensed complementary and alternative medicine (CAM) disciplines (naturopathic medicine, chiropractic health care, acupuncture and oriental medicine, and massage therapy), and identifies public health and other competencies found in those standards that contribute to cooperation and collaboration among the health care professions. These competencies may form a foundation for interprofessional education. The agencies that accredit the educational programs for each of these disciplines are individually recognized by the United States Department (Secretary) of Education. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide them the knowledge and skills to work with practitioners from other fields and disciplines. Educational accreditation standards provide a framework for the delivery of these competencies. Requiring these competencies through accreditation standards ensures that practitioners are trained to optimally function in integrative clinical care settings.

Studies suggest that between 30% and 50% of the adult population in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-related problems. A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more prominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Six studies were excluded owing to their methodological limitations. Across surveys, acupuncture had the highest rate of physician referral (43%) among the 5 CAM therapies, followed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a high of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while f...

Comparative total impedance measurements for normal skin and acupuncture points are presented. The behavior of the impedance and admittance with the frequency for active points and indifferent skin is analyzed. It is indicated the optimum frequency domain for the detection of the acupuncture points.

In this review we provide the updates on last years' advancements in basic science, imaging methods, efficacy, and safety of dry needling of myofascial trigger points (MTrPs). The latest studies confirmed that dry needling is an effective and safe method for the treatment of MTrPs when provided by adequately trained physicians or physical therapists. Recent basic studies have confirmed that at the site of an active MTrP there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response. Two new modalities, sonoelastography and magnetic resonance elastography, were recently introduced allowing noninvasive imaging of MTrPs. MTrP dry needling, at least partially, involves supraspinal pain control via midbrain periaqueductal gray matter activation. A recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. Therefore, in a patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling.

BACKGROUND Biomedical Perspective Complaints of neck, shoulder and upper back pain are common reasons patients visit acupuncture clinics. Among the total work injuries in the US in 2010, 7.3% were neck and shoulder related, as compared to 19.9% related to the spine and spinal cord [1]. The pain greatly impacts a patient's ability to work, quality of life and emotional well-being. In one study, chronic neck pain involved a state of anxiety in 68.4% cases, while depression was prevalent in 55.7% [2].

A fluorescence stereomicroscope system was developed in order to observe in situ the distribution of nuclei in intravascular Bong-Han ducts and corpuscle tissues by injecting acridine orange, which stained specifically nuclei. Intravascular Bong-Han corpuscles, connected with Bong-Han ducts could be detected in the aortas of rats, mice, and rabbits.

Acupuncture as a complex therapeutic system has been used to treat a variety of diseases and pathological conditions. Although the exact mechanism(s) of acupuncture remains unknown, some evidence suggests a mechanism initially involving signal transduction through connective tissue, with secondary involvement of other systems including the nervous system. Acupuncture has become increasingly popular in the Western countries as a therapy for pain and several chronic disorders difficult to manage with conventional treatments. Acupuncture and acupuncture-like somatic nerve stimulation have been used in different kidney diseases and several complications related to them. The effect of acupuncture techniques in some kidney diseases is reviewed on the basis of clinical reports as well as mechanisms that may possibly explain the beneficial effects mediated by acupressure/acupuncture. The potential effect of acupressure techniques in renal inflammation and whether these effects could be mediated through the newly identified cholinergic anti-inflammatory pathway are discussed.

In the present study, the effects of acupuncture on the behavioral and physiological responses induced by chronic mild stress (CMS) were evaluated. Sprague–Dawley rats were exposed to a variety of chronic unpredictable, mild stressors for 8 weeks. The effects of acupuncture on stress-induced anxiety and anhedonia were investigated using the elevated plus maze (EPM) and sucrose intake test. In addition,

The mechanism of Cupping therapy action is not clear. Cupping may increase local blood circulation, and has an immune-modulation effect. Researches reported some local and systemic effects of cupping therapy. Genetic expression is a physiological process that regulates body functions. Genetic modulation is a reported acupuncture effect. In this presentation, the authors try to suggest genetic modulation as one of the possible mechanisms of action

En la ciudad de Puerto Montt a 24 de Abril del 2015, comparecen, por una parte, a nombre y en representación de quien se indica, don MANUEL CORTES RIVERA, Jefe de Personal del INSTITUTO DE SEGURIDAD DEL TRABAJO, Corporación Administradora del Seguro Social Obligatorio contra el Riesgo de Accidentes del Trabajo y Enfermedades Profesionales de la Ley 16.744, cédula de identidad número 10637820-7, con domicilio para estos efectos en (Ciudad) y, por otra parte doña ISABEL VARGAS OLIVOS, ENFERMERA Cédula de Identidad número 16.858.850-k del mismo domicilio, quienes declaran lo siguiente:

Background: The 'layering method', a clinical reasoning model for Western acupuncture, is a theoretical framework based on pain and tissue mechanisms. This focus on the mechanics of disability is a limitation of the original model. From a holistic viewpoint, the psychological status of an individual should be considered in clinical reasoning models. Objectives: The first objective was to summarize the original layering model. The second was to determine mechanisms underlying integration of sensations and emotions in the human brain and their effect on the body via output transfer systems of the autonomic, immune, and endocrine systems. The third objective was to determine whether acupuncture can modulate similar regions in the brain and to formulate appropriate clinical reasoning questions. Major findings: Interoceptive sensory stimuli and emotions are integrated in limbic and frontal brain regions to allow emotional responses to feedback from the body and provide the individual with a 'sense of self'. A strong connection with brainstem nuclei modulating output transfer systems allows emotions to regulate homeostatic balance. Acupuncture may be interpreted as an interoceptive stimulus by the brain. Neuroscience research has shown that acupuncture can modulate neural activity in similar brain regions to those processing emotional responses to sensory inputs. Conclusions: Acupuncture may influence emotional responses and their impact on the neurobiology of the human body. A biopsychosocial clinical reasoning model based on the modulation of emotional processing in the brain is proposed. This suggests that acupuncture may be used as an adjuvant to other therapies in disorders with a biopsychosocial component.

With more and more families presenting with two or more children with autism, this revolutionary treatment method in autism is transforming the lives of these autistic children and their families. Not only that, this approach is healing the lives of the entire family, thus being the FIRST, scientifically proven healing approach in autism that is truly (W) Holistic in every sense of the term. This is a win-win situation for all, as one can see the RESULTS of this path-breaking treatment in autism, right from Day ONE. The Problem While it is known that there is a " risk " of another child with autism being born in a family where the parents already have one child with autism, the actual statistics for the same is lacking. This article is inspired by my experience in healing children with autism in families with more than one child with autism. Autism Treatment Approach The healing method that was applied was Intent Healing™ that is based on Applied Energy Medicine and Applied Intentional Epigenetics. One can know more details about the same by perusing these articles on the scientific basis of the same and the case reports of successfully healed cases here: https://www.intenthealing.com/blog/ and in this online course on 'The Energy Basis of Autism and the Solution' , where the Testimonials and the Evidence of successfully healed cases of Autism, in line with EBM (Evidence Based Medicine) applying Intent Healing™ is available here: https://authenticautismsolutions.usefedora.com The treatment method applied was as follows: 1. Energy assessments of both parents and the autistic children: The energy patterns of the parents and the children were assessed over two days and two nights and the reports shared with the parents. This helps in understanding the underlying specific causes for the symptoms of autism seen in each child with autism, which was unique to each child. 2. Individual healing sessions with each parent: These sessions were done over skype and as Remote Healing sessions timed according to the time zones where the parents lived. Intent Healing™ energies were channeled in the sessions and the individual parents' energies were realigned first. 3. Individual sessions for each child: These sessions were done as Remote Healing sessions while each child was sleeping in bed at different times of the night. In some cases the sessions were done for one child and once the symptoms disappeared in that child the ISSN 2379-7150 sessions were done for the other child who had autism and then the third child after that. In some cases with two children with autism the sessions were done on the same day at different timings and improvements in the symptoms in both the children with each session were noted and documented till complete disappearance of all the symptoms was achieved. Results 1. In all the cases improvements of the symptoms in the children were seen right from the very FIRST session. 2. With consecutive sessions, PROGRESSIVE improvements in the symptoms were seen and documented in both the children with autism in the cases where the families had two children with autism and those families with more than two children with autism, the improvements were seen in ALL the autistic children. 3. In ALL the cases of families with two or more than two children with autism, 70-80% of the limiting symptoms of autism in each child disappeared over a span of 20-30 days were the sessions were done on consecutive days with no break in between. In families where the sessions were done for each child one after the other (doing the sessions for one child only first till the symptoms disappeared and then moving on to the next child and so on), the time period for recovery was correspondingly longer due to the logistics involved. 4. The ENTIRE FAMILY including the parents got healed in the process. By this I mean the physical well-being of the parents improved and they had more energy to devote to their individual creative pursuits and careers and were able to see progress in ALL aspects of their lives individually, as well as collectively, as a family.

As an increasingly informed public becomes more and more disillusioned with the failure of scientific medicine to live up to its promises and to fulfill popular expectations, attention has been turning to 'holistic,' 'traditional,' 'alternative' or 'complementary' medicine. Forms of medical treatment such as acupuncture, homeopathy, and ayurvedic medicine have infrequently been rigorously evaluated. This paper reviews the traditional structures of clinical and economic evaluation of health care, and then describes a particular set of specific problems that would be encountered in applying these techniques to 'holistic' medicine under the headings 'reductionism' (bias from excluding certain categories of effects).

Background. Acupuncture is a popular complementary therapy choice for depression in the UK but the evidence base lags behind its usage. Further effectiveness trials are required; however, these need based on appropriate design for a complex intervention on a heterogeneous group of people. Aim. To identify subgroups of patients with depression who could be the focus of effectiveness trials. Methods. Qualitative research using in-depth interviews in UK primary care. In-depth interviews with 30 participants from three stakeholder groups: 10 acupuncture patients and 10 acupuncturiststo examine the reasons why acupuncture is used for depression and 10 physicians-to elicit who would be acceptable to refer into a trial of acupuncture for depression. Interviews were transcribed and analysed using a Framework approach. Results. The data have highlighted that the acceptability of particular treatments for depression is influenced by the individuals' illness career within their social context. In addition, the plausibility and associated acceptability of depression treatments are also closely tied to an individuals' explanatory model of their condition. Seven patient subgroups were identified who could potentially find acupuncture of particular interest and on which effectiveness trials could be focused. Conclusions. We have identified the main reasons why people seek acupuncture for depression and the circumstances in which physicians would be willing to refer for depression were it to prove effective. We have also set out a number of potential patient subgroups who may be particularly interested participating in a randomized controlled trail of acupuncture for depression.

Over 250 patients from three complementary medicine practicesacupuncture, osteopathy and homoeopathy-completed a questionnaire rating 20 potential reasons for seeking complementary treatment. The reasons that were most strongly endorsed were 'because I value the emphasis on treating the whole person'; 'because I believe complementary therapy will be more effective for my problem than orthodox medicine'; 'because I believe that complementary medicine will enable me to take a more active part in maintaining my health'; and 'because orthodox treatment was not effective for my particular problem'.

Objective: To investigate acupuncture practitioners' experience and perceptions of supporting patients presenting with fertility issues. Design: Questionnaire survey. Setting: British Acupuncture Council. Patient(s): British Acupuncture Council acupuncture practitioners. Intervention(s): Questionnaire designed for the study, by post and online. Main Outcome Measure(s): Questions on education and training, size and nature of practice, liaison with conventional care, and perceptions about use of acupuncture for fertility issues.

Objective: The purpose of this study was to evaluate the efficacy of acupressure at the P6 point for the in-patient treatment of severe nausea and vomiting in early pregnancy. Study design: This was a prospective single-blind randomized control trial that involved 80 patients with nausea and vomiting plus ketonuria before 14 weeks of gestation. Results: There was no difference between length of stay, amount of medication, or fluid required between the acupressure and placebo groups, although acupressure reduced the number of patients who stayed R4 nights in the hospital. Acupressure was well tolerated and not associated with an increase in perinatal morbidity or death. Conclusion: The use of acupressure at the P6 point does not reduce the amount of antiemetic medication that is required, the requirement for intravenous fluid, and median duration of inpatient stay more than the use of placebo. A small reduction was seen in the number of women who required R4 days in the hospital.

Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementaryalternative medicine was frequently inadequate. Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence. (J Allergy Clin Immunol 2006;117:1054-62.)

growth that could have weakened the membranes leading to premature rupture. We would propose that any future use of precipitated egg white as a sealant would include sterilization of the agent as well as addition of a preservative. We share the conclusion that different dynamic factors could affect the action of a mechanical plug or sealant to close an iatrogenic defect in the fetal membranes. Ovomucin, the active ingredient in our precipitate, is the protein responsible for the gelatinous nature of the egg white and has intrinsic adhesive characteristics. 1 The search for the ultimate sealant has led some investigators to consider a tissue engineering approach while others have tested various synthetic hydrogels. 2,3 The final successful method will require a stable initial adhesion in an aqueous environment, lack of entry into the fetal respiratory and gastrointestinal tracts from efflux of the agent into the amniotic fluid, and elastic properties to account for growth and stretching of the amniotic membranes with advancing gestational age. All fetal interventionists await the results of these approaches in animal models before a human application can occur.

This article reviews the usual methods used to treat amyotrophic lateral sclerosis (ALS) in the West, then discusses some alternative treatments that are being used by practitioners of Traditional Chinese Medicine (TCM). The paper concludes by suggesting that some TCM methods, such as tai chi and qigong, should be considered for the treatment of ALS in conjunction with the current Western methods.

Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. A number of nonpharmacological therapies have been investigated, including nonnutritive sucking, with and without sucrose use, swaddling or facilitated tucking, kangaroo care, music therapy, and multi-sensorial stimulation. Although the efficacy of these approaches is clearly evident, they cannot provide analgesia for moderate or severe pain in the neonate. Further, some of these therapies cannot be effectively applied to all populations of critically ill neonates. Acupuncture, an ancient practice in Chinese medicine, has gained increasing popularity for symptom control among adults and older children. Acupuncture may provide an effective nonpharmacological approach for the treatment of pain in neonates, even moderate or severe pain, and should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management. Semin Perinatol 31:318-322

CJOM, VOLUME 18 NO. 1 • SPRING/SUMMER 2007

The following article is abstracted from Lonny’s new book in progress The Absolute Practice of Medicine.
The only true medicine is consciousness awakening to its self. What a surprise when we discover that what is seeking is what’s being sought for.

Purpose: To complete a systematic review, with trial quality assessment, of published research about behavioral, cognitive, and related treatments for developmental stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence about stuttering treatment for preschoolers, school-age children, adolescents, and adults. Method: Multiple readers reviewed 162 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. Results: Analyses found 39 articles that met at least 4 of the 5 methodological criteria and were considered to have met a trial quality inclusion criterion for the purposes of this review. Analysis of those articles identified a range of stuttering treatments that met speech-related and/or social, emotional, or cognitive outcomes criteria. Conclusions: Review of studies that met the trial quality inclusion criterion established for this review suggested that response-contingent principles are the predominant feature of the most powerful treatment procedures for young children who stutter. The most powerful treatments for adults, with respect to both speech outcomes and social, emotional, or cognitive outcomes, appear to combine variants of prolonged speech, self-management, response contingencies, and other infrastructural variables. Other specific clinical recommendations for each age group are provided, as are suggestions for future research.

Background Developers of health information websites aimed at consumers need methods to assess whether their website is of “high quality.” Due to the nature of complementary medicine, website information is diverse and may be of poor quality. Various methods have been used to assess the quality of websites, the two main approaches being (1) to compare the content against some gold standard, and (2) to rate various aspects of the site using an assessment tool.Objective We aimed to review available evaluation instruments to assess their performance when used by a researcher to evaluate websites containing information on complementary medicine and breast cancer. In particular, we wanted to see if instruments used the same criteria, agreed on the ranking of websites, were easy to use by a researcher, and if use of a single tool was sufficient to assess website quality.Methods Bibliographic databases, search engines, and citation searches were used to identify evaluation instruments. Instruments were included that enabled users with no subject knowledge to make an objective assessment of a website containing health information. The elements of each instrument were compared to nine main criteria defined by a previous study. Google was used to search for complementary medicine and breast cancer sites. The first six results and a purposive six from different origins (charities, sponsored, commercial) were chosen. Each website was assessed using each tool, and the percentage of criteria successfully met was recorded. The ranking of the websites by each tool was compared. The use of the instruments by others was estimated by citation analysis and Google searching.Results A total of 39 instruments were identified, 12 of which met the inclusion criteria; the instruments contained between 4 and 43 questions. When applied to 12 websites, there was agreement of the rank order of the sites with 10 of the instruments. Instruments varied in the range of criteria they assessed and in their ease of use.Conclusions Comparing the content of websites against a gold standard is time consuming and only feasible for very specific advice. Evaluation instruments offer gateway providers a method to assess websites. The checklist approach has face validity when results are compared to the actual content of “good” and “bad” websites. Although instruments differed in the range of items assessed, there was fair agreement between most available instruments. Some were easier to use than others, but these were not necessarily the instruments most widely used to date. Combining some of the better features of instruments to provide fewer, easy-to-use methods would be beneficial to gateway providers.