Transcript West Yorshire BranchSCP2014

IS SEEING
BELIEVING?
Anecdote Versus Evidence for Complementary
Medicine Use Within Podiatry
JANE E GREENWOOD
MSC DPODM MCHS
Podiatrist
Huddersfield
West Yorkshire
[at]JaneGreenwood JaneGreenwood[at]hotmail.com
W E S T YO R K S H I R E B R A N C H O F
THE SOCIETY OF
C H I RO P O D I S T S A N D
P O D I AT R I S T S ( S C P )
Kaberry Lecture Theatre
Leeds General Infirmary
Wednesday 24th September 2014, 19:30
AIM 1
We will support professional development and interaction
between Chiropodists/Podiatrists across West Yorkshire.
We will foster their skills to meet their clients' needs for
the provision of high quality podiatric care and to
maintain the high standards of practice advocated by
The Society of Chiropodists and Podiatrists
(West Yorkshire Branch
SCP Newsletter June 2014, penultimate paragraph)
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AIM 2
Through the activities of the Society and College, the
following advances in podiatry will have been made:
- robust systems will be in place to measure continuously
and consistently the costs and outcomes of treatment, to
demonstrate clinical and cost effectiveness (SCP. (n.d). Our Vision.
Retreived from http://www.scpod.org/society/our-vision/)
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MSC IN PODIATRY
DISSERTATION 2014
Alice’s Adventures in
Wonderland
JANE
 1984 - 1987 Huddersfield School of Chiropody - possible
use of acupuncture in chiropody
 1987 - 2012 25 years NHS Specialist Podiatrist in LongTerm Conditions and DESMOND educator
 2001 - 2013 Faculty of Homeopathy - DFHom(Pod)
 2011 - 2014 MSc in Podiatry, University of Huddersfield
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ALICE
Intense curiosity
Adventurous
Large imagination
Trustful
Very polite
Walt Disney (Producer). Geronimi, C.,
Jackson, W., Hamilton, L. (Directors). Alice
in Wonderland [Motion picture]..
London:RKO Radio Pictures
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British Humanists Association. (2014). Homeopathy. Retreived from https://humanism.org.uk/campaigns/ethical-andscientific-issues/homeopathy/
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The Nightingale Collaboration. (2014). Homeopathy toes the line. Retreived from http://www.nightingalecollaboration.org/news/122-homeopathy-clinic-toes-the-line.html
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MORE CHALLENGING…
These successes have all been through complaints to the ASA. But we have
also been using the medicines regulator, the MHRA, and the HCPC (the
regulator of podiatrists and chiropodists and other healthcare professions) to
ensure that the unlicensed Marigold Therapy products are only used and
advertised by those legally entitled to do so. Since most podiatrists and
chiropodists are not permitted to supply unlicensed medicines, we
reported 39 websites advertising Marigold Therapy to the HCPC and we will
report more on this part of the campaign in a future newsletter (The Nightingale
Collaboration. (2014). Herbalism on the NHS: complaint upheld. Retreived from http://www.nightingalecollaboration.org/news/154-herbalism-on-the-nhs-complaint-upheld.html)
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A WO N D E R L A ND R E S P O N S E
I see!' said the Queen,
who had meanwhile
been examining the
roses. 'Off with their
heads! (Carroll, L. (2011). Alice’s Adventures
in Wonderland.. Retreived from
http://www.gutenberg.org/ebooks/11)
Kids Colouring pages. (2014). Alice in Wonderland Colouring
Pages. Retreived from .http://www.icoolpages.com/alice-inwonderland-coloring-pages-alice-in-wonderland-coloringpages-disney-kids-games.html
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H E A LT H & C A R E P RO F E S S I O N S
COUNCIL (HCPC)
 HCPC standards of conduct, performance and ethics. Practice safe
and effectively in best interest of service user
HCPC. (2012). Standards of performance conduct and ethics. Retrieved from http://www.hpcuk.org/publications/standards/index.asp?id=38
 HCPC standards of proficiency for podiatrists. Reflect on and
systematically review practice. Modify practice in the light of the
outcome
HCPC. (2013). Standards of proficiency-Chiropodists/podiatrists. Retrieved from http://www.hpcuk.org/publications/standards/index.asp?id=41
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NOTTINGHAM UNIVERSITY
2008
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SEEING IS BELIEVING
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FOOTHEALTH 2010
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PATIENT REPORTED
OUTCOMES
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ANOTHER ANECDOTE
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BEST INTEREST OF
SERVICE USER
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Faculty of Homeopathy. (n.d.). Systematic Review of randomised controlled trials in homeopathy. Retreived from
http://www.facultyofhomeopathy.org/research/systematic-reviews-of-rcts-in-homeopathy/
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MADNESS
But I don't want to go among mad people,'
Alice remarked.
'Oh, you can't help that,' said the Cat:
'we're all mad here. I'm mad. You're mad.'
'How do you know I'm mad?' said
Alice.
'You must be,' said the Cat, 'or you
wouldn't have come here (Carroll,
2011).
HelloKids. (2006). How to draw the Cheshire Cat from Alice
in Wonderland how-to draw lesson. Retreived from
http://www.hellokids.com/c_26348/drawing-forkids/drawing-tutorials-step-by-step/disney/how-todraw-the-cheshire-cat-from-alice-in-wonderland
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Ghana Homeopathy Project. (2014). Volunteering in Ghana 29th August to 18th September 2010. Retreived from
http://ghanahomeopathy.org/2012/11/volunteering-in-ghana-29th-august-to-18th-september-2012/#comment-38534
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DILEMMA
Cheshire Puss,' she began, rather timidly, as she did not at all know whether it
would like the name: however, it only grinned a little wider. 'Come, it's pleased so
far,' thought Alice, and she went on. 'Would you tell me, please, which way I
ought to go from here?'
'That depends a good deal on where you want to get to,' said the Cat.
'I don't much care where—' said Alice.
'Then it doesn't matter which way you go,' said the Cat.
'—so long as I get SOMEWHERE,' Alice added as an explanation.
'Oh, you're sure to do that,' said the Cat, 'if you only walk long enough
(Carroll, 2011)
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Sense about science. (n.d.). People. Retreived from http://www.senseaboutscience.org/pages/people.html
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All Trials. (2014). All Trials Registered/All Results Reported. Retreived from http://www.alltrials.net/
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Sense About Science. (n.d.). Ask for Evidence. Retreived from http://www.senseaboutscience.org/pages/a4e.html
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Sense About Science. (n. d.). Subjects. Retreived from http://www.senseaboutscience.org/subjects.php
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The Skeptic. (n.d.). Welcometo The Skeptic magazine (UK). Retreived from http://www.skeptic.org.uk/
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WHAT RESEARCH EXISTS
TO SUPPORT MY PRACTICE?
Exploring the characteristics of the current peer
reviewed published research of complementary and
alternative interventions within podiatry related
literature in the developed world: a systematic
integrative review.
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AIM
…to determine the safety, effectiveness,
feasibility, and appropriateness of
complementary and alternative medicine
(CAM) use in podiatry
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OBJECTIVES
 1. Identify which CAM is safe and effective for what podiatric
problem.
 2. Evaluate critically the quality of the peer reviewed published
podiatric related CAM research.
 3. Explore the podiatry patient’s views on CAM use.
 4. Explore the podiatric practitioner’s views on CAM use.
 5. Present a professional academic report of the research undertaken
for the MSc Podiatry project module.
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CHARACTERISTICS
Participants, demographics, homeopathy,
acupuncture, herbal, other CAM, experimental, nonexperimental, benefits, risks, cost, level of
practitioner training in CAM, and ethical
considerations.
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PEER-REVIEWED PUBLISHED
R E S E A R C H L I T E R AT U R E
Printed or other form of peer-reviewed work, as
identified by SCOPUS (Elsevier. (2014). Content overview SCOPUS. Retrieved
from http://www.elsevier.com/online-tools/scopus/content-overview
and EBSCOHost (EBSCOHost. (2014). Title Lists. Retrieved from
), which contains a methodology
http://www.ebscohost.com/title-lists
that elicits new knowledge and informs future work
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CAM
any non-traditional therapy that is not considered
mainstream in podiatry and for the review it was
defined as homeopathy (topical and oral), herbal
(topical), acupuncture, and other CAM
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P O D I AT RY ( A L S O K N OW N A S
C H I RO P O DY I N U K A N D C A N A DA )
any research concerned with the care and disorders of the feet,
including but not limited to; neurological, cardiovascular,
biomechanical, dermatological, diabetes mellitus, rheumatoid
arthritis and other arthropathies, infections, renal, development
disorders of the foot, malignancy, local analgesia, and
pharmacology (HCPC. (2013). Standards of proficiency-Chiropodists/podiatrists. Retrieved from http://www.hpcuk.org/publications/standards/index.asp?id=41HCPC), 2013).
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INCLUSION/EXCLUSION
CRITERIA
English language, USA, Canada, UK, Europe,
Australia, New Zealand, excluding acute injuries and
generalised systemic disease not specific to the foot,
anecdotes and reviews, and no statement of ethical
approval
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TOOLS
Study appraisal: MMAT Tool (Pluye et al., 2011), CONSORT
with extension for pragmatic Randomised Controlled
Trials (RCTs) (Zwarenstein et al., 2008) and recommendations for
herbal (Gagnier et al., 2006) , STROBE (University of Bern, 2009). Synthesis
methods: ESRC (Popay et al., 2006) method for narrative
synthesis conduct
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FURTHER REFERENCES
Gagnier, J. J., Boon, H., Rochon, P., Moher, D., Barnes, J., & Bombardier, C. (2006). Recommendations for reporting
randomized controlled trials of herbal interventions: explanation and elaboration. Journal of clinical epidemiology, 59(11),
1134-1149. doi:10.1016/j.jclinepi.2005.12.020
Pluye, P., Robert, E., Cargo, M., Bartlett, G., O’Cathain, A., Griffiths, F., Boardman, F., Gagnon, M.P., & Rousseau, M.C.
(2011). Proposal: A mixed methods appraisal tool for systematic mixed studies reviews. Retrieved from
http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/24607821/FrontPage
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., Britten, N., Roen, K. & Duffy, S. (2006).
Guidance on the Conduct of narrative Synthesis. ESRC methods programme.
University of Bern. (2009). STROBE Statement. Retrieved from http://www.strobe-statement.org/
Zwarenstein, M., Treweek, S., Gagnier, J. J., Altman, D. G., Tunis, S., Haynes, B., Oxman, A. D., & Moher, D. (2008).
Improving the reporting of pragmatic trials: An extension of the CONSORT statement. BMJ, 337(7680), 1223-1226. doi:
10.1136/bmj.a2390
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CURIOUSER AND CURIOUSER!'
…cried Alice (she was so much surprised, that for the
moment she quite forgot how to speak good English); 'now
I'm opening out like the largest telescope that ever was!
Good-bye, feet!' (for when she looked down at her feet,
they seemed to be almost out of sight, they were
getting so far off.) (Carroll, 2011)
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Dean, M. E., Coulter, M.K., Fisher,
P., Jobst, K., Walach, H. (2007).
Reporting data on homeopathic
treatments (RedHot): a supplement to
CONSORT. Homeopathy, 96(1), 42 –
45. Doi: 10.1016/j.homp.2006.11.006
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Did you know homeopathy ? (n.d.). Did you know homeopathy? Retreived from http://www.redhot-homeopathy.info/
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METHODS
Protocol produced for project preparation module in 2012.
Data sources: Ten appropriate databases (CINHAL, LILACS, Medline, Pedro,
PsycInfo, Pubmed, Social Care Online (Beta Site), Scopus, Science Direct, and
Trip), Three SR registers: DARE, The Campbell Collaboration library, The
Joanna Briggs Institute. The International Clinical Trials Registry Platform
(WHO, 2014a) which includes the clinical trial databases: ANZCTR,
ClinicalTrials.gov, EU Clinical Trials Register, ISRCTN. Grey Literature: Open
Grey.
Searched 21 – 24 January 2014
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DECLARATIONS
Funding: SHA
Conflicts of Interest: None
SR registration number: Not registered
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LIMITATIONS
Sole novice researcher with limited access to
CAM databases, and restricted time to
contact individual researchers and hand
search journals
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RESULTS 1
 Five papers were reviewed
 Efficacy and effectiveness of podiatric CAM was lacking in higher
quality studies of honey for toenail surgery with phenolisation of
matrix, wheatgrass cream for plantar fasciitis, and limited in a poorer
quality study of 25%, and 50% tea tree oil for interdigital tinea pedis
 No studies for homeopathy or other CAM met the inclusion criteria;
however, an RCT in acupuncture for plantar fasciitis is pending
publication
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RESULTS 2
 Safety issues are evident, as is an awareness of the legislation and
economic values of podiatric CAM use
 There is evidence of high use of CAM within Australian podiatry
patients’ and podiatrists’ armamentarium and a suggestion it
forms part of the elderly long-term condition sufferer’s selfmanagement repertory
 The source of knowledge of CAM often emanates from non-
scientific derivations
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CONCLUSION
 High quality pragmatic RCTs following registered
study proposals are required to support podiatric
CAM use
 Safety, legality, and economic definitions are
essential
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IMPLICATION OF KEY
FINDINGS
 Practitioners using and contemplating training in
podiatric CAM are advised to seek advice regarding safety,
legislation and existing evidence of effectiveness for the
CAM intervention
 Professional podiatry bodies are recommended to
develop guidelines for their membership regarding CAM
use and the system for approving CAM training courses
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BACK TO THE BEGINNING
 support professional development and interaction between
Chiropodists/Podiatrists
 foster their skills to meet their clients' needs for the provision of high
quality podiatric care
 maintain the high standards of practice advocated by The Society of
Chiropodists and Podiatrists.
 measure continuously and consistently the costs and outcomes of
treatment, to demonstrate clinical and cost effectiveness (West Yorkshire Branch SCP,
2014)
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IS BELIEVING SEEING?
Critical thinking
Risks versus benefits versus no
intervention
 Shared decision making
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ANY QUESTIONS?
…but it's no use
going back to
yesterday, because I
was a different person
then (Carroll, 2011)
Elfman, D. (2010). Alice’s Theme. On Alice In Wonderland. [CD]. Burbank: Wonderland
Music Company. Inc.
Early Moments. (2014). Free Alice In
Wonderland Colouring Pages. Retreived from
https://www.earlymoments.com/disney/
List-of-Disney-Books/Alice-inWonderland/coloring-pages/
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THE END
Thank-you for
listening…
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