General information of participants
Seventy-one patients were enrolled in this study (mean age, 35.11±18.11 years, 38% males, 62% females). General information about the patients is provided in Table 1. The most common diseases among these patients receiving A-AHT were asthma (15/71, 21.1%), atopic dermatitis (10/71, 14.1%), acne (11/71, 15.5%) and rhinitis (9/71, 12.7%) The remaining diseases presented were urticaria (8.5%), chronic obstructive pulmonary disease (4.2%), and other diseases (23.9%). 42 patients(59.2%) had treatment between three to seven times, and 29 patients(40.8%) received treatment more than or equal to seven times. Treatments lasted an average of 1-4 weeks(38%) followed by 5-12 weeks(26.8%), and 1 week (12.7%). The most common injection site was limbs followed by the trunk (34.1%), neck (12.7%), and head and face (11.9%).
Seventy-six HPs, including 64 physicians and 12 nurses, were enrolled in this study. The most common professional title was chief physician (26, 40.6%), and deputy chief nurse (6, 50.0%). The majority of physicians (26, 55.5%) were from the department of internal medicine of TCM, and the majority of the nurses (7, 58.3%) were from the department of respiratory medicine. They had each spent an average of 14.02±9.45 years in the field of healthcare (physicians: 14.65±9.78 years, nurses: 10.69±6.88 years; p=0.11). Seventy-one (93.4%) of the HPs (physicians: 60, 84.5%, nurses: 11, 15.5 %) had experience with A-AHT treatment (for more than one year). There was no significant difference in the included physicians' and nurses' A-AHT experiences (p=0.79). Overall, the HPs from 30 cities and regions participating in this study reported 114863 patients treated with A-AHT as of May 25, 2022 (Figure 2). The mean number of patients reported was 1453.14±6941.05 (physicians: 1706.88±7545.66, nurses: 99.92±145.77; p=0.73) (Table 2). The majority of patients reported by HPs were from Guangdong, Guizhou and Shanxi, whereas the HPs from Hunan and Shanghai only reported 10 and 3 patients received A-AHT, respectively (Figure 1).
Table 1. General information of patients enrolled (n=71)
Variable
|
Data (n=71)
|
Age (yr)
|
35.11±18.11
|
Sex
|
|
Male
|
27 (38.0%)
|
Female
|
44 (62.0%)
|
Disease
|
|
Asthma
|
15 (21.1%)
|
Rhinitis
|
9 (12.7%)
|
Acne
|
11 (15.5%)
|
AD
|
10 (14.1%)
|
Urticaria
|
6 (8.5%)
|
COPD
|
3 (4.2%)
|
Others
|
17 (23.9%)
|
Treatment times
|
|
3-7
|
42 (59.2%)
|
≥7
|
29 (40.8%)
|
Treatment duration (wk)
|
|
<1
|
9 (12.7%)
|
1-4
|
27 (38.0%)
|
5-12
|
19 (26.8%)
|
13-24
|
8 (11.3%)
|
25-48
|
1 (1.4%)
|
>48
|
7 (9.9%)
|
Injection sites during the treatment
|
|
Head & face
|
15 (11.9%)
|
Neck
|
16 (12.7%)
|
Trunk
|
43 (34.1%)
|
Limbs
|
52 (41.3%)
|
Values are presented as mean± standard deviation or number (%)
COPD: Chronic obstructive pulmonary disease; AD: Atopic dermatitis
Table 2. Healthcare professional data (n=76)
Variable
|
AlI
(n=76)
|
Physicians
(n=64)
|
Nurses
(n=12)
|
p value
|
Professional title
|
|
|
|
|
Chief physician
|
11 (14.5)
|
11 (17.2)
|
-
|
|
Associate chief physician
|
14 (18.4)
|
14 (21.9)
|
-
|
|
Physician in charge
|
26 (34.2)
|
26 (40.6)
|
-
|
|
Resident physician
|
13 (17.1)
|
13 (20.3)
|
-
|
|
Deputy chief nurse
|
6 (7.9)
|
-
|
6 (50.0)
|
|
Junior nurse
|
4 (5.3)
|
-
|
4 (33.3)
|
|
Primary nurse
|
2 (2.6)
|
-
|
2 (16.7)
|
|
Department
|
|
|
|
|
Internal medicine of TCM
|
27 (35.5)
|
26 (55.5)
|
1 (8.3)
|
|
Acupuncture and moxibustion
|
12 (15.8)
|
11 (24.7)
|
1 (8.3)
|
|
Respiratory medicine
|
26 (34.2)
|
19 (53.5)
|
7 (58.3)
|
|
Dermatology
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
|
Pediatrics
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
|
Gynaecology
|
1 (1.3)
|
1 (2.1)
|
0 (0.0)
|
|
Other
|
10 (13.2)
|
7 (20.6)
|
3 (25.0)
|
|
Duration of career in healthcare (yr)
|
14.02±9.45
|
14.65±9.78
|
10.69±6.88
|
0.11*
|
Experience of acupoint autohemotherapy
|
|
|
|
|
Experienced
|
71 (93.4)
|
60 (84.5)
|
11 (15.5)
|
0.79#
|
In-experienced
|
5 (6.6)
|
4 (80.0)
|
1 (20.0)
|
|
Numbers of treating patients with acupoint autohemotherapy
|
1453.14±6941.05
|
1706.88±
7545.66
|
99.92±
145.77
|
0.73*
|
Values are presented as mean ± standard deviation or number (%).
Experienced HPs, using A-AHT for ≥1 year, or more than 200 cases; In-experienced, using A-AHT for <1 year, or less than 200 cases.
*Student's t-test, # chi-square test.
Questionnaire Results
The questionnaire results for the patients, HPs and the experienced/inexperienced staff are shown in Table 3, respectively.
Patients vs. HPs
In response to PQ1's questions, 55 patients (77.4%) and 75 HPs (98.6%) responded "extremely effective" or "effective," respectively. No patients or HPs responded "ineffective" or "extremely ineffective" on the HPQ1 (p<0.001). Fifty-nine patients (83.1%) responded “extremely safe” or “safe” to PQ2, whereas all of the HPs responded “extremely safe” or “safe” to HPQ2 (p<0.001). A total of 74 (97.4%) HPs responded “extremely satisfied” or “satisfied” to PQ3, compared to 29 (40.8%) and 33 (46.5%) patients responded “extremely satisfied” and “satisfied”, respectively (p=0.02). Sixty-six (93.0%) patients responded “strongly agree” or “slightly agree” to PQ4, whereas 71 (93.4%) HPs responded “strongly agree” or “slightly agree” to HPQ4 (p=0.46) (Table 3).
Patients vs. experienced group
From the experienced group, 55 (77.4%) patients and 70 (98.6%) HPs responded “extremely effective” or “effective” to HPSQ1 (p<0.001). From the experienced group, 59 patients (83.1%) and 71(100.0%) HPs responded “extremely safe” or “safe” to HPSQ2 (p<0.001). In response to PQ3, 29 (40.8%) and 33 (46.5%) patients responded “extremely satisfied” and “satisfied”, respectively. In the experienced group, 22 (31.0%) responded “extremely satisfied” and 47(66.2%) responded “satisfied” to the equivalent question (p=0.046). In response to PQ4, 23 (32.4%) and 43 (60.6%) patients responded “strongly agree” and “slightly agree”. In the experienced group, 26 (36.6 %) and 40 (56.3%) HPs responded “strongly agree” and “slightly agree”, respectively, to HPSQ4(p=0.425) (Table 3).
Patients vs. inexperienced group
In response to HPSQ1, 55 (77.4%) patients and all of HPs from the inexperienced group responded “extremely effective” or “effective” (p=0.143). In response to HPQ2, 59 patients (83.1%) and all (100.0%) HPs from the inexperienced group responded “extremely safe” or “safe” (p=0.158). In response to PQ3, 29 (40.8%) and 33 (46.5%) patients responded “extremely satisfied” and “satisfied”, respectively. In the inexperienced group, none of the HPs responded “extremely satisfied”, and all of them responded “satisfied” to the equivalent question (p=0.148). In response to PQ4, 23 (32.4%) and 43 (60.6%) patients responded “strongly agree” and “slightly agree”, respectively. In the inexperienced group, none and all of the HPs responded “strongly agree” and “slightly agree”, respectively to HPQ4 (p=0.373) (Table 3).
Results regarding acupoint autohemotherapy-related problems
Figure 3A-G shows the percentages for each A-AHT-related problem that was answered separately by patients and HPs, patients receiving treatment for 3~7 times and more than 7 times, experienced HPS and inexperienced HPs, patients receiving A-AHT with injection sits at head & face, neck, trunk and limbs, and HPS using AWB alone, AWB mixed with western medicine, and AWB mixed with TCM injection as injectant.
The most common responses to PQ4 were local pain (34, 47.9%) and no problem (34, 47.9.0%), closely followed by local swelling (15, 21.1%) and ecchymosis (15, 21.1%). The A-AHT-related problems that made the patients most anxious were local pain (46, 60.5%), ecchymosis (45, 59.2%), and local swelling (34, 44.7%). In addition, 21 HPs (27.6%) listed no problem and 15 listed fainting during treatment as the problem. The most common responses to PQ5 were as follows: none (30, 42.3%), local pain (22, 31.0%), ecchymosis (14, 19.7%), and local swelling (9, 12.7%). Local pain (48, 63.2%), ecchymosis (31,40.8%), local swelling (21, 27.6%) and fainting during treatment (21, 27.6%) were the issues that caused the HPs the greatest anxiety (Figure 3A).
Patients who received treatment three to seven times typically complained about "local pain" (24,57.1%). It is not unexpected that patients who received therapy more than seven times had no problems with PQ4 and PQ5, respectively, with 62.1% and 48.3% of them reporting no complications. Specifically, patients who had received treatment three to seven times did not report suffering from excitation or insomnia, fainting during treatment, secondary infection, nerve damage, symptom aggravation, and bleeding (>2ml) (Figure 3B).
The most common complications, according to experienced HPs, were “local pain”(44,62.0%) and “ecchymosis” (44,62.0%). Problems with “allergy” did not correlate with experienced HPS-reported AEs. Inexperienced HPS did not report the issues “allergy”, “excitation or insomnia”, “fainting during treatment”, “secondary infection”, “feeble”, “nerve damage”, “symptom aggravation” and bleeding (>2ml) (Figure 3C).
Both local pain and ecchymosis have been reported as problems by 60% of the patients receiving A-AHT in the head & face, also local pain was complained by 50% of the patients receiving A-AHT at the neck, whereas no problem was reported by 56.3%, 50% and 48.8% of the patients receiving A-AHT at the neck, limbs and trunk, respectively(Figure3D、E). In general, the group using the trunk and limbs as injection sites had more reported patients and patient-reported AE items than the other groups, particularly in the group using the limbs. One or three of the 43 patients getting A-AHT at the trunk reported having allergies or feeling weak, while one of the 52 patients receiving A-AHT in the limbs mentioned having excitement or insomnia(Figure2).
Out of the 76 surveyed HPs, 61 HPs using acupoint injection of AWB alone developed local pain (40, 65.6%) and ecchymosis (39, 63.9%) as the most common responses to HPQ4. Local pain (6, 46.2%), ecchymosis (6, 46.2%) and local swelling (6, 46.2%) were all the most common responses to HPQ4 by 13 HPS using acupoint injection of western medicine combined with AWB. Allergy (1,50%) and no problem (1,50%) were the most common responses to HPQ4 by HPs using acupoint injection of traditional Chinese medicine combined with AWB, whereas local swelling and no problem were the most common response to HPQ5 that made them most anxious (Figure 3F、G).
Correlation analysis results
The correlation coefficients (R) for the relationships between the patients’ efficacy (PQ1) scores and their safety (PQ2), satisfaction (PQ3), problems 1 (PQ4), problems 2 (PQ5), and necessity (PQ6) scores were 0.61, 0.649, 0.102, 0.017 and 0.481, respectively. The correlation coefficients (R) for the relationships between the patients’ safety scores and their satisfaction, problems 1, problems 2, and necessity scores were 0.61, -0.149, -0.184 and 0.442, respectively. The correlation coefficients (R) for the relationships between the patients’ satisfaction scores and their problems 1, problems 2, and necessity scores were 0.11, 0.102 and 0.627, respectively. The correlation coefficients (R) for the relationships between the patients’ problems 1 score and their problems 2, and necessity scores were 0.444 and 0.226, respectively. The correlation coefficient (R) for the relationships between the patients’ problem 2 scores and their necessity scores was 0.042 (Figure 4).