User:VCastanov/sandbox

Acupuncture has been suggested as a method to treat people who have PTSD. Weak evidence suggests that acupuncture may improve functional status and improve PTSD symptoms. There is also weak evidence to suggest that a therapeutic approach that includes a combination of acupuncture and moxibustion or with cognitive behavioural therapy (CBT) may improve PTSD symptoms. Overall, acupuncture is a promising option to be used to treat individuals with PTSD, however, more research is needed to recommend it an evidence-based treatment option for PTSD.

Comments
Thanks for posting this. I commented directly on the article talk page. Please read the full text of ref #2 as well to determine the strength of the evidence. Ref 1 is very weak evidence for the use of acupuncture (see my quote on the article talk page from the source). If you have any questions please let me know. Thanks! JenOttawa (talk) 21:04, 5 November 2018 (UTC) : Can you please confirm that you have noted these comments. It would be helpful to discuss this prior to the 13th when you are improving the article. JenOttawa (talk) 21:04, 9 November 2018 (UTC)
 * @JenOttawa thank you! I read the comments and will be addressing them prior to adding them to the article. @JenOttawa thank you again for your suggestions. I've made edits to include the quality of evidence. Please let me know if more changes are recommended, and if I should proceed with the editing of the article. "Thanks for responding and for the email. I made some edits to the text, modifying to reflect the weak evidence. We can't include the last sentence as this does not have a source and there is no strong evidence to say that it is promising. We can try to post this on the talk page and see what kind of comments it generates over the next 24 hours. Does this sound good to you? Thanks for your patience here! JenOttawa (talk) 21:04, 5 November 2018 (UTC)"

Comment from your in-class tutor
I am sharing this (personal info removed) information that was provided from your tutor. Please adjust your edit before you edit live in Wikipedia. If you need help with wording (wiki style) please do not hesitate to reach out. Thanks!JenOttawa (talk) 18:04, 12 November 2018 (UTC)

Based on the feedback provided by me at our last session, I think it’s imperative that we include the quality of the evidence in making the recommendation for acupuncture as a treatment option in PTSD. The two studies you referenced both indicate that the quality of evidence for recommending acupuncture is very week and the outcomes when compared to standard treatments such as CBT or SSRI of poor significance. As detailed in the papers the only conclusion is that acupuncture as a potential treatment option would warrant further study and at this time based on the limited evidence cannot be recommended as evidence based treatment option for PTSD. I have highlighted sections from the papers you referenced to support this conclusion. I also included at the end, a paragraph from the Canadian Anxiety disorders guidelines where they have a very limited section on alternative therapies for PTSD for your perusal. Send any questions my way!

Reference 1. We identified very low quality of the body of evidence (QoE) indicating significant differences favoring acupuncture (versus any comparator) at post-intervention on PTSD symptoms, and low QoE at longer follow-up on PTSD and depressive symptoms. No significant differences were observed between acupuncture and comparators at post-intervention for depressive symptoms, anxiety symptoms, and sleep quality. Safety data (7 RCTs) suggest little risk of serious adverse events, though some participants experienced minor/moderate pain, superficial bleeding, and hematoma at needle insertion sites. To increase confidence in findings, sufficiently powered replication trials are needed that measure all relevant clinical outcomes and dedicate study resources to minimizing participant attrition.

Reference 2. Four randomized controlled trials (RCTs) and 2 uncontrolled clinical trials (UCTs) out of 136 articles inTotal were systematically reviewed. One high-quality RCT reported that acupuncture was superior to waitlist control and therapeutic effects of acupuncture and cognitive-behavioral therapy (CBT) were similar based on the effect sizes. One RCT showed no statistical difference between acupuncture and selective serotonin reuptake inhibitors (SSRIs). One RCT reported a favorable effect of acupoint stimulation plus CBT against CBT alone. A meta-analysis of acupuncture plus moxibustion versus SSRI favored acupuncture plus moxibustion in three outcomes. This systematic review and meta-analysis suggest that the evidence of effectiveness of acupuncture for PTSD is encouraging but not cogent. Further qualified trials are needed to confirm whether acupuncture is effective for PTSD. Types of Studies-heterogeneous. We included RCTs and nonrandomized controlled trials that compared acupuncture or its variants with a control or control groups. We also included uncontrolled clinical trials (UCTs) of acupuncture for PTSD One RCT originated from the USA, while all the others were from China. Risk of Bias in Included RCTs Based on Cochrane Criteria. The risk of bias was low in one RCT whereasone trial had a moderate risk of bias and two trials had a high risk of bias in most categories In all, the four included RCTs had an unclear risk of bias in terms of selective reporting and other sources of bias. This systematic review has several limitations. First, although we made strong efforts to retrieve all RCTs on the subject, the evidence reviewed is potentially incomplete because only one rigorous study was included. These very different designs across studies prevented us from abstracting a firm conclusion. Furthermore, the paucity of included trials and the suboptimal methodological quality of the primary data overall, except for one high-quality trial, are also important vulnerabilities of this review.

3. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders Alternative therapies: In a RCT, acupuncture was more effective than a wait-list control and as effective as group CBT (Level 2) [1083]. Adjunctive use of symptom-oriented hypnotherapy [1059] or mantra repetition [1084] (both Level 2) improved PTSD symptoms in small trials; and in a small case series, patients with PTSD benefited from transcendental meditation (Level 4) [1085]. Patients who do not respond to multiple courses of therapy are considered to have treatment- refractory illness. In such patients it is important to reassess the diagnosis and consider comorbid medical and psychiatric conditions that may be affecting response to therapy. Third-line agents, adjunctive therapies, as well as biological and alternative therapies may be useful when patients fail to respond to an optimal treatment trial of first- and second-line therapies used alone and in combination. Katzman et al. BMC Psychiatry 2014, 14(Suppl 1):S1 http://www.biomedcentral.com/1471-244X/14/S1/S1