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      Interrater Reliability of Chinese Medicine Diagnosis in People with Prediabetes

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          Abstract

          Background. Achieving reproducibility in research design is challenging when patient cohorts under study are inconsistently defined. Traditional Chinese medicine (TCM) diagnosis is one example where inconsistency between practitioners has been found. We hypothesise that the use of a validated instrument may improve consistency. Biochemical biomarkers may also be used enhance reliability. Methods. Twenty-seven participants with prediabetes were assessed by two TCM practitioners using a validated instrument (TEAMSI-TCM). Inter-rater reliability was summarised using percentage agreement and the kappa coefficient. One-way ANOVA and Tukey's post hoc test were used to test links between TCM diagnosis and biomarkers. Results. The two practitioners agreed on primary diagnosis of 70% of participants. kappa = 0.56 ( P < 0.001). The three predominant TCM diagnostic patterns for people with prediabetes were Yin deficiency, Qi and Yin deficiency and Spleen qi deficiency. The Spleen Qi deficiency with Damp cohort had statistically significant higher fasting glucose, higher insulin, higher insulin resistance, higher HbA1c and lower HDL than those with Qi and Yin deficiency. Conclusions. Using the TEAMSI-TCM resulted in moderate interrater reliability between TCM practitioners. This study provides initial evidence of variation in the biomarkers of people with prediabetes according to the different TCM patterns which may suggest a route to further improving interrater reliability.

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          Most cited references61

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          Statistical methods for assessing observer variability in clinical measures.

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            Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial.

            Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment. To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS. Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997. Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics. A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS. Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group. Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients. Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.
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              Review of randomised controlled trials of traditional Chinese medicine.

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                Author and article information

                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi Publishing Corporation
                1741-427X
                1741-4288
                2013
                9 May 2013
                9 May 2013
                : 2013
                : 710892
                Affiliations
                1CompleMED, School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
                2School of Nursing, University of Texas, 1710 Red River Street, 5.188, Austin, TX 78701, USA
                3School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
                Author notes
                *Suzanne J. Grant: s.grant@ 123456uws.edu.au

                Academic Editor: Zhaoxiang Bian

                Article
                10.1155/2013/710892
                3665184
                23762155
                7e864e5f-faf3-4b53-b9d1-11d22ddb5d89
                Copyright © 2013 Suzanne J. Grant et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 January 2013
                : 8 April 2013
                : 9 April 2013
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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