Tuesday, November 30, 2010

Acupuncture for Chronic Fatigue Syndrome

Acupuncture for Chronic Fatigue Syndrome


By Adrienne Dwllwo

Research Brief

A small but growing body of evidence suggests that acupuncture may be an effective treatment for chronic fatigue syndrome.

A recent Chinese study showed that 2 treatments from Traditional Chinese Medicine (TCM) were effective -- acupuncture and Shenmai injection (which is composed of 2 common TCM herbs.) However, researchers say acupuncture was the far more effective treatment.

Specifically, researchers say the treatments made participants less fatigued and eased fatigue-related symptoms, such as brain function.

Last April, a separate study also out of China found that circadian rhythm (your internal "body clock") was abnormal in people with chronic fatigue syndrome, and that treatment with electroacupuncture was able to regulate the circadian rhythm and improve daytime cognitive function.

The term "electroacupuncture" has 2 different meanings. In TCM, it means using electricity in conjunction with needles to provide higher levels of stimulation. In the U.S., it's often used to describe treatment with low-voltage electricity instead of needles. The abstract didn't specify which form was used, and I can't read the article because it's in Chinese. However, since this was a Chinese study published in a Chinese journal, my assumption is that they used the TCM definition.

In Dec. 2009, another Chinese research group published a meta analysis of 28 published studies on acupuncture for chronic fatigue syndrome. It concluded that acupuncture does appear effective but that more high-quality studies need to be done before we know for sure.

If you're interested in trying acupuncture, it might help to print out the first two studies, linked above, so your acupuncturist knows which sites the researchers used.

http://chronicfatigue.about.com/b/2010/11/04/acupuncture-for-chronic-fatigue-syndrome.htm
www.awcsandiego.com

Tuesday, November 23, 2010

Fresh tips for surviving holiday stress





Fresh tips for surviving holiday stress

By Diane Suchetka

Old wounds reopen, new insults are hurled and the longest-running tradition is the family fight that started in 1962.

You can sidestep those land mines and come out at the other end of the holidays unscathed if you follow these experts' suggestions.

Start with the advice from Jeffrey Janata, a psychologist at University Hospitals Case Medical Center. He says to take steps before the holidays are in full swing. "Start by sitting down and thinking historically, what have the problems been?" he says. "Where does your stress come from? How do you avoid the pitfalls? Do your own inventory."

Having trouble with that? Talk to a friend who can finish this sentence, "Every year, I complain about ... " One or two things will pop out.

"Then you can create a strategy that makes sense for you," Janata says.

"You can only change your response to them."And there's a long list of strategies that can help. But always remember this: "In the end, you're not really going to change people," says Dr. Christine Alexander interim chairman of the Department of Family Medicine at MetroHealth Medical Center.

Become an anthropologist, or a comedian

Pretend your family is some strange tribe you've just discovered in the jungle, says Cleveland Clinic psychologist Michael McKee.

If anger or arguments develop, watch who instigates them, who responds and how.

turkey1.jpg

"Stand back and be the observer," McKee says. "Instead of reacting emotionally, you're really learning something about what the different patterns are."

Even better -- pretend you are in a "Seinfeld" episode.

After all, that's what Jerry was, a contemporary American anthropologist with a sense of humor.

A great deal of comedy is based on annoying events that occur when families get together, says James Overholser, a psychology professor at Case Western Reserve University.

"Remember how many 'Seinfeld' episodes were about that?" he says. "So step back and appreciate the humor. So much comedy is based on what happens in family situations."

Here's the best part of all. "You'll be even better prepared next year," says McKee, "because you'll know what to expect."

holidays-emotions-escape-plan-motorcycle.jpgView full size

Create an escape plan

If somebody is about to punch your hot button, hit "Eject" instead.

Changing the subject is a great way to do that, says family physician Alexander.

It works best, says the doctor, if you have topics lined up for all family members, things you know they like to talk about and don't lead to arguments: their gardens, the Browns, the kids, the books they're reading.

"Just find common ground you can engage in," Alexander says.

And if changing the subject doesn't work?

Leave.

"Say, 'I have to go to the bathroom' or 'I have to check on the kids' or 'I think I hear the kids calling.' "

Take a little time away, Alexander says, and by the time you get back, your antagonist will have moved on.

Read this book

Before you have to drag yourself through 15,739 seconds with the one relative who pushes all your buttons, pick up a copy of "The Four Agreements."

That's a recommendation from Deborah Ross, a Mayfield Heights therapist who gives presentations on how to deal with difficult people.

The book, she promises, will help.

turkey3.jpg

"I'm a psychologist, so I look at everybody in terms of how they got to be the way they are," Ross says. "And the more you understand someone, the more you can sympathize with them. The more you sympathize with them, the more you don't take it so personally. And if you don't take it so personally and realize it's not about you, it doesn't sting as much."

"Don't take anything personally" is Agreement No. 2, one of four rules that author Don Miguel Ruiz says will reduce suffering, guilt and shame and bring joy, freedom and love.

Brushing up on the other three agreements for the holidays can't hurt either:

"Be impeccable with your word." That means only saying "yes" to those things you really want to do.

"Don't make assumptions." Even if you think you know what someone's trying to say, ask to avoid misunderstandings and the drama that comes with them.

"Always do your best." Do that and you won't have any regrets.

Skip the gossip

"So often in a family, two people will get together and gossip about another," says Ross. It makes the gossips feel better about themselves.

"But, really, what good does it bring? It divides the family up into camps and it doesn't promote good relationships.

"It might make you feel better at the moment but, ultimately, it's very destructive."

Overholser says it's easier to control our behavior than our emotions. Not gossiping is a great way to do that, he says.

"Once you are in this downward spiral of negatives," says psychiatrist Dr. Sara Stein, "it's very hard to get out of -- so it's best to avoid getting into it from the start.

"Just interrupt your thoughts and get off that hamster wheel," says Stein, who works for Kaiser Permanente. "Keep telling yourself, 'I don't want to think that way right now' even if you have to say it to yourself 400 times."

It's worth remembering, Stein says, "that you can't turn someone who isn't a nice person into one, but what you can control is how much time you spend with her and how you react to her."

Get real

"You don't need an A+ in entertaining and cooking and cleaning and the indulgence of everyone else but yourself," says McKee. "Get real in the sense that it's not going to be perfect.

"And get away from the expectation that other people are going to change."

As Alexander says, "Many, many, many people have family stressors. It's not like anybody escapes this. There is no perfect family out there."

Janata agrees. "Sometimes our expectations are driven by these idyllic scenes in our minds of home and hearth and family, or the perfect Christmas you think you had when you were a kid -- or what you think you see when you look through other people's windows."

And expectations, as the saying goes, are premeditated resentments. So release them, and stay with "what is," not "what if."

Leave things undone

Decide upfront that you don't have to do everything, McKee says. Then hand out assignments.

"It keeps people busy, gives them something to do," says McKee. "And it gives them a feeling of helping, which people like. Ideally, you're working on how to cooperate."

Here's the other good thing about delegation: If there's a troublemaker in the crowd, you can get rid of him for a while.

"If Uncle Joe's going to start an argument," McKee says, "send him out for ice. And make sure that there's none close by."

Establish some rules

No politics and no religion at the dinner table are rules many of us already follow. But feel free to create a few more, tailoring them to your family, Alexander says.

turkey2.jpg

"And if you need to, talk to other family members. Say 'Here's what the game rules are going to be. We're not going to talk about that fight we had last year.'

"Now is not the time to be solving all of the family problems. There are better times and better venues for that."

Skip the togetherness

"Families always idealize having everyone together," says Ross, "and that's not always the best thing to do. Sometimes smaller groups are easier for people to handle."

Her suggestion? Have some family over on Christmas Eve, some on Christmas Day, especially if you have a couple of relatives with a history of not getting along.

Even if there's no family dispute, big parties aren't everybody's cup of eggnog. So if the combination of 40 people, kids running around and a blaring TV is too much for you, it's OK to skip the large gathering.

Cut yourself some slack

Especially if you've lost a loved one in the past year, the holidays can be difficult.

"The first holiday is the worst of all," McKee says.

"Maybe you're feeling sad. It's OK. No matter what you do, you have to expect that some sadness is pretty appropriate. But don't make it worse by turning it into a catastrophe."

Stein tells people that grief is a full-time job. "Understand that you will be exhausted, drained and depressed," she says.

So be gentle with yourself and know that you are fragile.

Also, Stein says, it's important not to overdo with alcohol or sweets. "It's not going to take that much to plummet your mood further," she says.

Sure, you can have a cookie or two, or an eggnog.

"But overdoing it with alcohol and carbs will make you feel much worse."

And don't feel as though you've got to join in the fun.

"What makes the holidays so difficult is forced cheerfulness," Stein says. "So let's remember that that is not what holidays are about. They are intensely spiritual, and can give you a chance to focus on your inner world, the relationships with people around you, or your relationship with your community and the greater world.

"Seek out what is for you the deepest, most satisfying meaning of the holiday."

holidays-change-traditions.jpgView full size

Change the traditions

Loss isn't just about the death of a loved one. People might be feeling pain from different kinds of losses: the loss of a home or job, a separation from someone because of work or military service, the loss of a lifestyle you used to have but can't afford anymore, says Stein.

And, Alexander says, "Sometimes doing the same ritual can be too painful. Sometimes it sets off a trigger of sadness."

It's the perfect opportunity to help someone else, says Overholser -- volunteer at a shelter or visit a nursing home, for example. Make the effort -- it might sound like a cliche, but it really works: Helping someone else makes you feel better, he says.

"It also reminds you that other people are struggling, and it gives you a shift of perspective that lightens your burden."

Phone a friend

Of course you need a lifeline during the holidays. We all do.

Alexander suggests figuring out what your emotional needs are going to be beforehand.

Have you just gone through a divorce and need a good listener? Then make a mental note of the best listener in your circle of family and friends.

"That's the person you should be spending more of your time with," Alexander says.

"Look out for yourself.

"But as a family member, you also have a responsibility to the group. Think about who you have to look out for."

Reaching out is especially important if you're alone at the holidays, says McKee.

Loneliness, he explains, sets off the fight-or-flight response because in the early history of man, it was dangerous to be by yourself.

"People needed to band together to protect themselves from the fierce animals that were around," McKee says.

"So the instinctive response to being lonely is to feel stress.

"And getting out and being with other people helps with that."

Socializing, he explains, is Mother Nature's antidepressant.

If you can't visit, then call or e-mail, anything to get in touch with people you love. >

http://www.cleveland.com/healthfit/index.ssf/2010/11/try_these_tips_for_surviving_t.html
www.awcsandiego.com

Acupuncture help for hayfever sufferers








Acupuncture help for hayfever sufferers
Not to be sneezed at...
Stephanie Bedo

GRIFFITH University School of Medicine study is hoping to help hay-fever sufferers with the prick of a needle.

John McDonald, a Southport acupuncturist of 40 years, and his research team are planning to reveal how acupuncture can treat irritating and chronic allergies via changes to the immune system.

Hay fever was more prevalent on the Gold Coast, where the allergy season was up to five times longer than the average two-month period of Melbourne, he said. This was because the Coast's pollen season was longer.

About 15 per cent of Australians suffer from hay fever, commonly caused by grass pollen and dust mite.

Mr McDonald said the figure could be even higher on the Coast and he is calling on 60 locals to participate in the free study.

Runaway Bay man John Black has already taken part in the study and said he had noticed massive improvements in his condition.

''I'm a lot better now and I can do a lot more things now I couldn't do before,'' he said.

''Even just sitting around the house and things that would come through the window would be a problem.''

Mr Black, who has been battling hay fever for 10 years, said he previously used a pack of tissues a day and took antihistimines but now did not use either.

The 24-year-old is part of 72 people aged between 18 and 45 who have already completed the study. Mr McDonald said the findings would be of great importance to allergy specialists throughout the world.

''The information should be able to be used for developing new treatments outside of acupuncture because once you know what needs to be done it's just a question of figuring out how to do it,'' he said.

http://www.goldcoast.com.au/article/2010/11/24/272835_gold-coast-news.html

www.awcsandiego.com

http://www.cnn.com/video/#/video/health/2010/11/18/sgmd.gupta.acupuncture.cnn?hpt=Sbin

Thursday, November 18, 2010

Vegetarian Comfort Food at Thanksgiving

Vegetarian Comfort Food at Thanksgiving


The traditional Thanksgiving table is filled with comfort foods like cheesy casseroles, creamy potatoes and marshmallow-topped sweet potatoes. But the cookbook authorsBruce Weinstein and Mark Scarbrough offer a new spin on traditional comfort foods by packing them with fall vegetables.

Bruce Weinstein and Mark Scarbrough

“Our goal lately is more vegetables in every spoonful,” says Mr. Scarbrough, whose latest book with Mr. Weinstein is “Real Food Has Curves: How to Get Off Processed Food, Lose Weight and Love What You Eat.’’

Although the duo isn’t planning to go vegetarian this Thanksgiving, they do want to amp up the vegetables in the side dishes they serve. “I would prefer my plate not be a huge slab of turkey and a tablespoon of this and that around it,” said Mr. Scarbrough. “I’d rather it be the other way around. People get more creative at Thanksgiving, and that’s the stuff that I want to eat.”

For the Eat Well Vegetarian Thanksgiving series, Mr. Weinstein and Mr. Scarbrough have offered four of their favorite comfort foods from three of their cookbooks. Included are recipes for crisp zucchini cakes, a veggie-laden skillet macaroni, a garden vegetable gratin and a winter squash pizza that Mr. Scarbrough suggests be served as a pre-meal snack.

“I think kids would be thrilled to have pizza show up at a Thanksgiving table,” Mr. Scarbrough notes. “And in my house, we tend to eat at 2 or 3 o’clock in the afternoon, and there’s always the need for a snack from about 11 to noon. It would be nice to have this out, cut into little squares in the hours before the meal.”

Zucchini Cakes (Adapted from “Real Food Has Curves”)

These savory patties are delicious on their own or with a little mustard slathered on the side. They are also a great after-Thanksgiving leftover, recrisped in the oven and served for breakfast or in whole-wheat pita pockets for lunch.

4 medium zucchini
1 teaspoon kosher salt
1 small yellow onion, peeled
1/2 cup low-fat ricotta
5 tablespoons whole-wheat flour
1 large egg, beaten with a fork in a small bowl
1/2 teaspoon mild paprika
1/2 teaspoon dried dill
1/2 teaspoon freshly ground black pepper
1 tablespoon olive oil

1. Trim the ends off the zucchini, then shred them into a colander, using the large holes of a box grater. (You’ll need about 4 cups shredded zucchini.)

2. Sprinkle the zucchini shreds with salt, toss well and set in the sink for 15 minutes to drain.

3. Rinse the zucchini shreds under cool water in the colander. Then pick up handfuls and squeeze them over the sink to get rid of almost all of the moisture. Set the shreds in a large bowl.

4. Grate the onion into the bowl using the large holes of the box grater.

5. Stir in the ricotta, whole-wheat flour, egg, paprika, dill and pepper, just until the mixture is uniform and there are no streaks of dry flour anywhere.

6. Heat a large skillet over medium heat. Swirl in the oil, then use a 1/2-cup measuring cup to scoop up the zucchini mixture and plop it into the skillet, scraping out any mixture left in the cup. Flatten the mixture into a thick cake with the bottom of the cup and continue making more.

7. Cook until lightly browned, about 4 minutes, then turn them with a large spatula and continue cooking until lightly browned on the other side and a little firm to the touch, about 4 more minutes. If you can’t fit all six into your skillet, you’ll need a little more oil for the second batch.

Yield: Serves 6.

Skillet Macaroni and Broccoli and Mushrooms and Cheese (Adapted from “Real Food Has Curves”)

This skillet-supper version of the classic is quicker and easier to make. This hearty comfort food easily functions as the main dish for vegetarians.

4 ounces grated Cheddar
2 ounces finely grated Parmigiano-Reggiano or other hard cheese
1 tablespoon unsalted butter
1 small yellow onion, chopped
6 ounces cremini or white button mushrooms, sliced
3 tablespoons unbleached all-purpose flour
3 cups low-fat or fat-free milk
1 tablespoon Dijon mustard
1 tablespoon minced tarragon leaves or 2 teaspoons dried tarragon
1/2 teaspoon salt
1/2 teaspoon freshly ground black pepper
8 ounces dried whole-wheat pasta shells (not the large ones for stuffing), cooked and drained according to the package instructions
4 cups small broccoli florets, cooked in boiling water for 1 minute (broccoli can be added to the pasta during the last minute of cooking, then drained with the pasta in a colander)

1. Mix the Cheddar and Parmigiano-Reggiano in a medium bowl. Set aside.

2. Melt the butter in a large, high-sided, oven-safe skillet. Add the onion and cook, stirring often, until softened, about 3 minutes.

3. Add the mushrooms and cook until they release their liquid and it comes to a simmer, and then reduces by about two-thirds, about 5 minutes.

4. Sprinkle the flour over the vegetables in the skillet. Stir well to coat.

5. Whisk in the milk in a steady, thin stream until creamy. Then whisk in the mustard, tarragon, salt and pepper. Continue whisking until the mixture starts to bubble and the liquid thickens, about 3 minutes.

6. Remove the skillet from the heat. Stir in three-quarters of the mixed cheeses until smooth. Then stir in the cooked pasta and broccoli.

7. Preheat the broiler after setting the rack 4 to 6 inches from the heat source. Meanwhile, sprinkle the remaining cheese over the ingredients in the skillet. Set the skillet on the rack and broil until light browned and bubbling, about 5 minutes. (If your skillet has a plastic or wooden handle, make sure it sticks outside the oven, out from under the broiler, so the handle doesn’t melt.) Cool for 5 to 10 minutes before dishing up.

Yield: Makes six side-dish servings.

Garden Vegetable Gratin (Adapted from “Cooking Know-How”)

A layered potato casserole, a gratin (pronounced grah-TAN) is a French dish named for both the technique and the dish it’s baked in: a fairly shallow, oval, oven-safe baking dish. Nonetheless, you can make it in a standard 9-by-13-inch baking dish, more in keeping with standard American cookware. Here’s a perfect version for your holiday table: a side dish that just may even conquer the main course!

3 pounds russet potatoes, peeled
2 tablespoons unsalted butter
4 ounces shallots, diced
1 medium carrot, diced
1 small zucchini, diced
1 cup frozen peas, thawed
2 cloves garlic, minced
2 tablespoons stemmed thyme
1 teaspoon salt
1/2 teaspoon freshly ground black pepper
1/4 teaspoon grated or ground mace
3 cups reduced-sodium vegetable broth
1 cup low-fat or fat-free cream

1. Position the rack in the center of the oven and preheat the oven to 350 degrees Fahrenheit. Peel and thinly slice the potatoes. Place the slices in a bowl, cover with cool water and set aside.

2. Melt the butter in a large skillet over medium heat.

3. Add the shallots, carrot, zucchini and peas. Cook, stirring often, until softened, about 3 minutes.

4. Add the garlic, thyme, salt, pepper and mace. Stir well to warm through. Remove from the heat.

5. Layer the potatoes and vegetable mixture in a 10-cup gratin or 9-by-13-inch baking dish by first blotting some potato slices on a paper towel, then layering them across the bottom of the dish. Add some of the vegetable mixture, spread it over the slices, then blot dry more slices and add them as another layer. Keep layering the casserole, like a lasagna, ending with a layer of potato slices.

6. Whisk the broth and cream in a large bowl. Pour it over the contents of the baking dish.

7. Bake, uncovered, basting occasionally, until it is golden and most of the liquid has been absorbed, about 2 hours.

Yield: Makes about eight side-dish servings.

Winter Squash, Onion and Pine Nut Pizza (Adapted from “Pizza: Grill It, Bake It, Love It!”)

This flavorful autumnal pie uses winter squash purée as the pizza topping; the purée is spread like a sauce on the crust. You can find puréed winter squash (sometimes labeled as “puréed acorn squash” or “puréed butternut squash”) in the freezer section of most markets — thaw according to the package instructions before using.

Yellow cornmeal to dust the pizza stone (or nonstick spray to grease the baking sheet)
1 pound fresh dough (from a pizza shop) or a frozen dough, thawed; or prebaked pizza crust
2 tablespoons olive oil
2 medium yellow onions, halved through the stem, then thinly sliced
3/4 cup frozen winter squash purée, thawed
2 teaspoons minced sage leaves or 1 teaspoon rubbed sage
1/4 teaspoon grated or ground nutmeg
1/4 teaspoon salt
1/4 teaspoon freshly ground black pepper
1 1/2 ounces Parmigiano-Reggiano or Grana Padano or pecorino or other hard cheese, finely grated
1 tablespoon pine nuts

1. Preheat pizza stone or oven. If using a pizza stone, preheat it in the oven at 450 degrees Fahrenheit for 30 to 45 minutes; if using a pizza tray or a large baking sheet, preheat the oven to 450 degrees.

2. Prepare the crust. If you’re using fresh dough on a pizza stone, dust a pizza peel lightly with cornmeal. Add the dough and form it into a large circle by dimpling it with your fingertips. Pick it up and shape it by slowly turning it by its edge, stretching that edge all the while, until the circle is about 14 inches in diameter. Set it cornmeal side down on the peel.

To use fresh dough on a pizza tray or a large baking sheet, grease the tray or baking sheet lightly with nonstick spray. Lay the dough on the baking sheet and dimple it with your fingertips — then pull and press it until it forms a circle about 14 inches in diameter on the pizza tray or a 12-by-7-inch, somewhat irregular rectangle on the baking sheet. If you’re using a prebaked crust, place it on a cornmeal-dusted pizza peel or on a greased pizza tray or a large baking sheet.

3. Heat a large skillet over medium heat, then swirl in the oil. Add the onion slices, reduce the heat to very low, and cook, stirring often, until soft, golden and very sweet, 20 to 25 minutes.

4. Meanwhile, stir the squash purée, sage, nutmeg, salt and pepper in a medium bowl until uniform. Spread this mixture evenly over the prepared crust, leaving a 1/2-inch border at its edge.

5. Top with the caramelized onions, then sprinkle the finely grated cheese and pine nuts over the pie. Slide the pizza from the peel to the very hot stone, or place the pie on its tray or baking sheet with the pie either in the oven or on the section of the grill grate that’s not right over the heat source.

6. Bake or grill with the lid closed until the crust is golden and somewhat firm to the touch, perhaps even a little darkened on its bottom, 16 to 18 minutes. Check fresh dough occasionally to prick any air bubbles that may arise so you’ll have an even crust on the pie. Slip the peel back under the pie to get it off the stone, or set the pie on its tray or baking sheet with its pie on a wire rack. Cool for 5 minutes before slicing. If you want to make sure the crust stays crunchy, consider transferring the pie directly to the wire rack after a minute or so.

http://well.blogs.nytimes.com/2010/11/02/vegetarian-comfort-food-at-thanksgiving/

www.awcsandiego.com

Tuesday, November 16, 2010

Acupuncture for dry eye

Acupuncture for dry eye: a multicentre randomised controlled trial with active comparison intervention (artificial tear drop) using a mixed method approach protocol

Previous studies of acupuncture show favourable results for both subjective and objective outcomes of dry eye. However, firm conclusions could not be drawn from these studies because the quality of the trials was too low to establish concrete evidence.

Therefore, this study was designed both to avoid the flaws of the existing trials and to assess the effectiveness, cost-effectiveness and qualitative characteristics of acupuncture treatment for dry eye.

Methods: One hundred fifty participants with dry eye will be recruited into three independent hospitals from different areas: Korea Institute of Oriental Medicine, DongGuk University Ilsan Oriental Hospital and Dongshin University Gwangju Oriental Hospital. The number of participants required was calculated from the data of a previous, relevant study.

These patients will be randomly allocated into acupuncture treatment or artificial tear groups. Either 17 acupuncture points (bilateral BL2, GB14, TE 23, Ex1, ST1, GB20, LI4, LI11 and single GV23) will be used 3 times a week or disposable artificial tear drops (Refresh Plus(R), ALLERGAN) will be provided for use at least once a day for 4 weeks.

The ocular surface disease index (OSDI), tear film break-up time (TFBUT), Schirmer test, visual analogue scale (VAS) for self-assessment of ocular discomfort, general assessment (by both acupuncture practitioners and participants) and quality of life (QOL) through the Measure Yourself Medical Outcome Profile-2 (MYMOP-2) will be assessed for approximately 3-months for each study participant. In addition, qualitative study and cost-effectiveness study of acupuncture treatment will be conducted.Trial registration: ClinicalTrials.gov (Identifier: NCT01105221).

Author: Tae-Hun KimJung Won KangKun Hyung KimKyung-Won KangMi-Suk ShinSo-Young JungAe-Ran KimHee-Jung JungSeung-Deok LeeJin-Bong ChoiSun-Mi Choi
Credits/Source: Trials 2010, 11:107





http://7thspace.com/headlines/363773/acupuncture_for_dry_eye_a_multicentre_randomised_controlled_trial_with_active_comparison_intervention_artificial_tear_drop_using_a_mixed_method_approach_protocol.html