Improved arthritic knee health in a pilot RCT of phytotherapy

Although practitioner-prescribed 'western' herbal medicine (phytotherapy) is a popular complementary therapy in the UK, no clinical studies have been reported on patient-orientated outcomes. The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee. A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome, published in the Journal of the American Medical Association,(1) acted as a model in the development of the protocol of this investigation. Twenty adults, previously diagnosed with osteoarthritis of the knee, were recruited from two Inner London GP practices into this randomized, double-blind, placebo-controlled, pilot study carried out in a primary-care setting. All subjects were seen in consultation three times by a herbal practitioner who was blinded to the randomization coding. Each subject was prescribed treatment and given lifestyle advice according to usual practice: continuation of conventional medication where applicable, healthy-eating advice and nutrient supplementation, Individualized herbal medicine was prescribed for each patient, but only dispensed for those randomized to active treatment - the remainder were supplied with a placebo. At baseline and outcome (after ten weeks of treatment), subjects completed a food frequency questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee health and Measure Yourself Outcome Profile (MYMOP) wellbeing questionnaires. Subjects completing the study per protocol (n = 14) reported an increased intake of wholegrain foods (p = 0.045) and oily fish (p = 0.039) compared to baseline, but no increase in fruit and vegetables and dairy products intakes. There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response (baseline-week 10) in WOMAC score between the two treatment groups. However, there was, compared with baseline, improvement in the active group (n = 9) for the mean WOMAC stiffness sub-score at week 5 (p = 0.035) and week 10 (p = 0.060) but not in the placebo group (n = 5). Furthermore, for the active, but not the placebo group, the mean WOMAC total and sub-scores all showed clinically significant improvement (>= 20%) in knee symptoms at weeks 5 and 10 compared with baseline. Moreover, the mean MYMOP symptom 2 sub-score, mostly relating to osteoarthritis (OA), showed significant improvement at week 5 (p = 0.02) and week 10 (p = 0.008) compared with baseline for the active, but not for the placebo group. This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner resulted in improvement of symptoms of OA of the knee.

Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study

Background: Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studies suggest that bromelain, a pineapple extract, may be a safer alternative/adjunctive treatment for knee OA than current conventional treatment. Aim: To assess the efficacy of bromelain in treating OA of the knee. Design: Randomized, double-blind placebo-controlled trial. Methods: Subjects (n=47) with a confirmed diagnosis of moderate to severe knee OA were randomized to 12 weeks of bromelain 800 mg/day or placebo, with a 4-week follow-up. Knee (pain, stiffness and function) and quality-of-life symptoms were reported monthly in the WOMAC and SF36 questionnaires, respectively. Adverse events were also recorded. The primary outcome measure was the change in total WOMAC score from baseline to the end of treatment at week 12. Longitudinal models were used to evaluate outcome. Results: Thirty-one patients completed the trial (14 bromelain, 17 placebo). No statistically significant differences were observed between groups for the primary outcome (coefficient 11.16, p=0.27, 95%CI-8.86 to 31.18), nor the WOMAC subscales or SF36. Both treatment groups showed clinically relevant improvement in the WOMAC disability subscale only. Adverse events were generally mild in nature. Discussion: This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study.

Articulation of stakeholders requirements for complex e-government systems development

Requirements analysis focuses on stakeholders concerns and their influence towards e-government systems. Some characteristics of stakeholders concerns clearly show the complexity and conflicts. This imposes a number of questions in the requirements analysis, such as how are they relevant to stakeholders? What are their needs? How conflicts among the different stakeholders can be resolved? And what coherent requirements can be methodologically produced? This paper describes the problem articulation method in organizational semiotics which can be used to conduct such complex requirements analysis. The outcomes of the analysis enable e-government systems development and management to meet userspsila needs. A case study of Yantai Citizen Card is chosen to illustrate a process of analysing stakeholders in the lifecycle of requirements analysis.

Articulation of information requirements for personalised knowledge and construction

The quality of information provision influences considerably knowledge construction driven by individual users’ needs. In the design of information systems for e-learning, personal information requirements should be incorporated to determine a selection of suitable learning content, instructive sequencing for learning content, and effective presentation of learning content. This is considered as an important part of instructional design for a personalised information package. The current research reveals that there is a lack of means by which individual users’ information requirements can be effectively incorporated to support personal knowledge construction. This paper presents a method which enables an articulation of users’ requirements based on the rooted learning theories and requirements engineering paradigms. The user’s information requirements can be systematically encapsulated in a user profile (i.e. user requirements space), and further transformed onto instructional design specifications (i.e. information space). These two spaces allow the discovering of information requirements patterns for self-maintaining and self-adapting personalisation that enhance experience in the knowledge construction process.

Manipulation and articulation: population statistics in 19th century France and England

The article presents an essay that deals with the study conducted by Donald MacKenzie and the case studies comparing the use of population statistics in France and Great Britain in the periods of 1825 and 1885. It analyzes Donald MacKenzie's study on the ways professional and political commitments informed the choice of statistical indexes in the British statistical community. Furthermore, the author is interested in knowing how this influenced the development of mathematical statistics in Great Britain. The author concludes that the differences in the debates over population statistics are accounted to the differences in the social and epistemological logics of population statistics.