Global advances in integrative medicine and health最新文献

There are many known drivers of burnout and distress among physicians and other healthcare providers. Current conversations have not fully characterized the significant impact of workload increases alongside staffing shortages as drivers of moral distress and subsequent burnout. Together these factors pose a significant systemic threat to the workforce, and a personal threat to the individuals within it. Physicians are at high risk for moral distress because of work ethic and culture. The drive to do the right thing for the patient limits an ability to set boundaries around work. Moral distress is experienced when the needs of patients can't be met; this drives us to work even harder. Culturally, there has been limited opportunity to acknowledge this distress, so we haven't been able to deal with it outright. Financial pressures continue pressure health systems to drive productivity. Additional patient encounters drive more after visit work that requires time and attention. Simultaneously, the remaining physicians are further stretched as people burnout and leave. There are few groups of workers more mission-driven than primary care physicians. We are committed to doing the right thing for patients and our teams. If we can acknowledge and talk about moral distress as an indicator that we need to change the way we do things, we can use it as a tool to optimize patient care. The physician voice may help us move beyond the learned helplessness and shift to engagement in solutions. We propose three solutions: 1) acknowledge the presence of routinized stress injury that occurs in healthcare 2) leverage data on physician wellbeing to understand how to optimize care, and 3) foster connection and community. Fundamentally, when our healthcare workers feel seen, heard, and valued, they are healthier themselves, and better able to support the missions of the medical system.

Background: While specific elements of naturopathic medicine, such as botanical medicines and lifestyle interventions, have supporting evidence, there is limited quantitative data confirming its effectiveness as a comprehensive, whole-person medical approach for patients with metastatic colorectal cancer (CRC).

Objective: This study aims to retrospectively evaluate the integration of naturopathic modalities, including modulated electrohyperthermia (mEHT), into the standard of care for metastatic CRC. We compare survival outcomes between patients at the Integrated Health Clinic (IHC) and a matched control group from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database, a de-identified, publicly available cancer registry in the United States.

Methods: A retrospective chart review was conducted for 131 IHC patients diagnosed with stage IV CRC and treated with mEHT between 2010 and 2021. These patients were matched with 262 controls from the SEER database using propensity score matching. The primary outcome was overall survival, with time zero defined as the first IHC treatment date (with controls assigned the time zero of their matched IHC patient) to account for immortal time bias. Survival analysis was conducted using a Kaplan-Meier curve, log-rank test, and Cox proportional-hazards model.

Results: The overall survival analysis did not achieve a statistically significant difference (HR = .76; 95% CI: .57-1.01) between the IHC (median survival time: 29 month) and SEER groups (median survival time: 18 months). Incorporating time-varying effects, the hazard ratio (HR) for the IHC group compared to the SEER group was .63 (95% CI: .46-.86) for survival <36 months, indicating a lower hazard of early mortality in the IHC group. Moreover, IHC patients who initiated treatment within 90 days of diagnosis had significantly improved survival compared to their matched controls (HR = .45; 95% CI: .28-.70).

Conclusion: This study provides evidence that integrative naturopathic treatment, including mEHT, can significantly improve survival outcomes for CRC patients in the first 36 months post-treatment and when initiated within 90 days of diagnosis.

Background: Several biomarkers, including C-reactive protein (CRP), ferritin, D-dimer, and Interleukin-6 (IL-6), are established predictors of disease severity and respiratory failure in patients with COVID-19.

Objective: In this randomised clinical study, we evaluated the efficiency of the combination of 2 variants' AFO-202 and N-163 strains of Aureobasidium pullulans produced 1,3-1,6 β-glucans in comparison with the control arm on these biomarkers in COVID-19 patients.

Methods: Forty RT-PCR positive COVID-19 patients were divided into 2 groups: control (n = 22) and standard treatment; ii. (n = 18) - Standard treatment + combination of AFO-202 and N-163 beta glucans for 15 days.

Results: IL-6 levels significantly decreased in the treatment group on day 7 (P = 0.03) but not by day 15 (P = 0.30). CRP levels in the treatment group decreased at day 7 (5.53 ± 8.21 mg/L) compared to baseline but showed no significant difference from the control group (4.91 ± 12.54 mg/L, P = 0.98). At day 15, CRP levels remained lower in the treatment group (5.42 ± 10.41 mg/L) but increased in the control group (14.0 ± 37.16 mg/L), with no significant difference (P = 0.52). Ferritin levels dropped significantly in the treatment group by day 15 (from 560.58 ± 537.30 ng/mL to 127.51 ± 215.91 ng/mL) but increased in the control (P = 0.98). D-dimer levels decreased in the treatment group by day 15 but were not significantly different from controls (P = 0.56).

Conclusion: These results indicate that while co-supplementation with AFO-202 and N-163 beta-glucans led to improvement in CRP, ferritin, and IL-6 levels in COVID-19 patients, only the reduction in IL-6 levels on day 7 reached statistical significance. Further long-term multicentric clinical research is warranted to validate the potential of these supplements as treatment adjuncts, for addressing inflammation in COVID-19, especially in vulnerable populations infected with emerging SARS-CoV-2 variants.

Background: Healthcare workers face an elevated risk of chronic stress and burnout, for which resiliency interventions are needed.

Methods: The Stress Management and Resiliency Training Program (SMART-3RP; 8 weekly 90-minute sessions) was offered to 254 hospital employees between 2/2021 and 1/2024. Participants were surveyed pre- and post-intervention for measures of resiliency, stress coping, positive affect, perceived stress, anxiety, and depression.

Results: The baseline sample was 84% female, 89.5% non-Hispanic, 71.3% White, and averaged 45 years of age (SD = 14.25). Baseline and follow-up survey completion rates were 71.3% (N = 181) and 35.8% (N = 91), respectively. Significant improvements were seen pre-post intervention for all measures (all ps <.001): resiliency (d = 0.57), stress coping (d = 1.1), positive affect (d = 0.83), perceived stress (d = -0.88), anxiety (d = -0.74), and depression (d = -0.43).

Conclusions: Alleviating employee stress is crucial for improving individual, clinical, and systems-level outcomes in hospitals. The SMART-3RP is a promising program that provides healthcare workers with resiliency and stress coping skills.

Background: More than 1 in 5 US adults live with mental illness. Novel therapies as complements to standard therapies are needed to improve patient well-being. Reiki is a biofield therapy that may improve well-being in mental health.

Objective: The primary aim of this study was to evaluate the feasibility of providing Reiki at a behavioral health clinic serving a low-income population. The secondary aim was to evaluate outcomes in terms of patients' symptoms, emotions, and feelings before and after Reiki.

Methods: This was a mixed-methods, feasibility pilot study with a pre-post experimental design. Reiki was offered to adult outpatients at a community behavioral health center in Rochester, Minnesota. Patients with a stable mental health diagnosis seen between July 22, 2021, and May 18, 2023, completed surveys before and after the Reiki intervention and provided qualitative feedback. Patients were asked to report their ratings of pain, anxiety, fatigue, and feelings (eg, happy, calm) on 0- to 10-point numeric rating scales. Data were analyzed with Wilcoxon signed rank tests.

Results: Among 91 patients who completed a Reiki session during the study period, 74 (81%) were women. Major depressive disorder (71%), posttraumatic stress disorder (47%), and generalized anxiety disorder (43%) were the most common diagnoses. The study was feasible in terms of recruitment, retention, data quality, acceptability, and fidelity of the intervention. Patient ratings of pain, fatigue, anxiety, stress, sadness, and agitation were significantly lower, and ratings of happiness, energy levels, relaxation, and calmness were significantly higher after a single Reiki session.

Conclusion: The results of this study suggest that Reiki is feasible and could be fit into the flow of clinical care in an outpatient behavioral health clinic. It improved positive emotions and feelings and decreased negative measures. Implementing Reiki in clinical practice should be further explored to improve mental health and well-being.

Background: "Natural products" (NPs), including dietary supplements, are widely used, yet little is known about NP use for chronic pain and related conditions.

Objective: To develop a new NP survey to better understand reasons for NP use, beliefs, concerns, medication substitution, and provider disclosure.

Methods: Based on similar surveys and input from veteran focus groups and subject matter experts, a new brief NP survey was developed. The survey was piloted among 52 veterans with chronic pain enrolled in Veterans Health Administration (VA) primary care who endorsed NP use at baseline in a pragmatic trial comparing non-drug pain management approaches. Survey data was enriched with sociodemographic and clinical data from a parent trial. Descriptive frequencies and means were calculated.

Results: Of 55 surveys, 52 were completed (response rate, 94.5%). Respondents' mean age was 57.6 (SD+/-12.5); 42% were women, 21% identified as Black/African American, and 10% Hispanic/Latinx ethnicity. All had chronic pain; 80% experienced disabling pain daily; 67% were prescribed non-opioid pain medication; 15% were prescribed opioids. In the prior 3 months, the mean number of NPs used was 4.6 (SD+/-3.2); 90% reported daily use. Most frequently used NPs were vitamins/minerals (94%), herbals/botanicals (60%); and cannabis (40%); one-third reported substituting NPs for pain medications. The majority endorsed safety concerns about interactions of NPs either with pain medications (55%) or other NPs (52%). Nearly all (98%) believed providers should discuss NP use with their patients, though only 52% had disclosed NP use to their providers.

Conclusions: Among veterans with chronic pain in VA primary care enrolled in a pragmatic trial, a new NP survey revealed prevalent use of multiple NPs concurrently, and in some cases, as substitutes for prescribed medications. Most veterans expressed safety concerns, yet a significant proportion reported not discussing NP use with their providers.

Background: As global climate change accelerates, the crisis of species survival invites holistic ways of knowing. There is a resurgence of engagement in Indigenous spiritual wellbeing systems as part of anti-colonial liberation movements. Green collective wellbeing systems (GreenCoWell) offer opportunities to heal both people and the planet, addressing the notion of separation between life forms.

Objective: We plan to study and elaborate upon 6 BIPOC health practices based on interconnection, including family constellation healing (Zulu nation, Southern Africa), fa (Ghana), yoga (India), shinrinyoku (Japan), Danza Azteca (Central America), and one practice to be identified in the course of the study. From a feminist, anti-racism and decolonial lens, our work aims to support ways of knowing which originate from the Global South and Indigenous communities.

Methods: Applying a participatory action research approach, we will blend qualitative and arts-based methods to portray 6 global GreenCoWell. Healers from each tradition will be interviewed separately and will engage in a collective dialogue on the desire, need, and methods for proliferating GreenCoWell systems.

Results: The results of this project will be a film, poems, stories, academic products, social media messages, and a manifesto emanating from the collective dialogue.

Conclusion: This mixed methods arts-based, feminist, anti-racism, and decolonial project brings together healers from 6 traditions, representing a novel approach to addressing climate change. Those who practice GreenCoWell engage in environmental conservation. Our long term aspiration is for more people to experience mental, physical, and spiritual wellbeing through these and related GreenCoWell and take action for climate justice.

Background: The COVID-19 pandemic exacerbated pain care inequities for low-income people. The Telehealth Integrative Pain Management Program (t-IPMP) was developed to provide pain management services for patients in public health clinics of the San Francisco Health Network (SFHN). Adapted from an existing program, t-IPMP delivered multimodal pain treatment via telehealth groups when in-person healthcare was restricted.

Objective: This mixed-methods study evaluates the feasibility and acceptability of t-IPMP.

Methods: We conducted a single-arm evaluation of three cohorts of t-IPMP, comprising 12 two-hour weekly online sessions on pain education, mindfulness, therapeutic movement, and self-acupressure. Participants were adults with chronic pain referred by SFHN primary care providers. We conducted baseline surveys, three-month surveys, and qualitative interviews (n = 15); participant observation of three sessions per cohort; and 3 focus groups (n = 20). Mixed-methods analysis included descriptive statistics, pre/post comparisons using t-tests, and codebook thematic analysis.

Results: The t-IPMP received 107 referrals from 52 providers at 11 clinics, and 35% of referrals enrolled. Participants (n = 37) attended an average of 6 sessions. Participants who completed surveys (n = 15) were majority cisgender women (67%) with below-average wealth (87%) from diverse racial and ethnic identities. Qualitative data highlighted that t-IPMP created a supportive environment which fostered social connection and reduced social isolation. Social support encouraged use of new mind-body practices for pain. Telehealth was well received, though some participants preferred in-person interaction. From baseline to three-month follow up, average scores increased on measures of physical function (mean = 1.9, 95% CI 0.2-3.6); global quality of life (mean = 3.8, 95% CI 1.6-6.0); and pain self-efficacy (mean = 5.3, 95% CI 0.9-9.7).

Conclusion: Integrative, multimodal pain management delivered through telehealth groups is feasible among primary care safety net patients, however, may not be optimal for all. Findings indicate that offering options for participating either online or in-person may best address patient needs and preferences.

Background: Chronic pain is a global problem affecting approximately 20% of adults. The prevalence of opioid use for chronic pain has contributed to a widespread crisis of addiction and inadequately managed pain. Though national and international guidelines recommend nonpharmacological, integrative, multi-modal therapies for chronic pain, numerous systemic barriers limit access to these services for those with the highest need and fewest resources.

Objective: This paper describes the development and testing of an innovative "Heals on Wheels" (HoW) community engagement and Group Medical Visit (GMV) program for underserved communities experiencing chronic pain in Hennepin County, Minnesota.

Methods: The HoW program's curriculum was collaboratively adapted from pre-existing Hennepin Health care GMV programs for chronic pain. Free community-based "Appetizer" workshops were developed alongside an 8-week "Full Meal" GMV program titled Easing Pain Holistically (EPH). Three pain-affinity variations of EPH were created (the "Body", "Head", and "Heart") and delivered to 6 cohorts (2 cohorts of each variation). Feasibility was measured by attendance, demographics, and insurance provider information. To evaluate program acceptability, thematic analysis of patients post-GMV weekly progress sheets was performed.

Results: The curriculum for the HoW program included experiential training and education in evidence-based integrative pain management strategies. Fourteen community appetizer workshops (n = 142) were offered in partnership with organizations representing underserved populations. Fifty-five patients completed EPH from 2022 to 2024 with the greatest number of patients in the Heart (n = 23), followed by the Body (n = 19), and the Head (n = 13). Feasibility for the GMV program was demonstrated with average attendance across 6 cohorts at 75.1%. Thematic analysis of qualitative data revealed themes highlighting appreciation for group connection ("sharing") and the EPH program content.

Conclusion: The HoW program shows promise as a feasible and acceptable model of community outreach and engagement to improve access to evidence-based integrative pain care.