Objectives: An important task facing hospitals is improving pain management without raising costs. Integrative medicine (IM), a promising nonpharmacologic pain management strategy, is yet ...

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Cost Savings from Reducing Pain Through the Delivery of Integrative Medicine Program to Hospitalized Patients.

To lead an organization in the 21st century, GEN (Retired) Stanley McChrystal argues, requires a change in both mindset and organizational structure. McChrystal and his fellow authors recount the struggles of the Joint Special Operations Command (JSOC) in the early stages of the war in Iraq and explain how the task force changed in order to meet those challenges. They sell the point that efficient, complicated organizations that dominated the 20th century are inappropriate for the 21st century.

Team of Teams: New Rules of Engagement for a Complex World

An Australian case series study demonstrated the effectiveness of the REsilience and Activities for every DaY for people with multiple sclerosis (READY for MS), a resilience group training program based on Acceptance and Commitment Therapy, in improving quality of life in people with MS. This study aimed to evaluate the feasibility and acceptability of the Italian READY for MS program, and to preliminary assess its efficacy when compared to an active control intervention (group relaxation). Single-blind phase II randomized controlled trial (RCT) and nested qualitative study (ISRCTN registration number: 38971970). Health-related quality of life (primary study outcome), mood, resilience, psychological flexibility and its protective factors were measured at baseline, after seven, 12 and 24 weeks. READY participants completed the purpose-built satisfaction questionnaire after 12 weeks. After trial completion, the control group also received READY. One-to-one participant interviews were conducted within three months of finishing the READY groups. Four intervention groups were conducted with 39 participants (20 READY, 19 relaxation). Two patients (READY) withdrew before beginning the intervention due to unexpected work commitments. Feasibility and acceptability of READY were good, with high participant engagement and satisfaction. No statistical effects of READY were detected vs relaxation. Thirty participants were interviewed (18 READY; 12 relaxation + READY). Content data analysis revealed seven overarching themes: "Attitudes towards participation"; "Perceptions of program composition"; "Program impacts on life domains"; "Program active elements"; "Program improvement trajectories"; "Program differences and similarities"; "Suggested READY improvements". READY was well accepted by MS patients with varied socio-demographic and clinical characteristics. Qualitative (but not quantitative) data provided evidence in favour of READY. Our findings will inform methodological and intervention refinements for the multi-centre RCT that will follow.

/pdf/a-resilience-group-training-program-for-people-with-multiple-2mkxh1k2kb.pdf

A resilience group training program for people with multiple sclerosis: Results of a pilot single-blind randomized controlled trial and nested qualitative study.

Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations.

/pdf/the-effectiveness-of-integrative-medicine-interventions-on-4lqnad1nqu.pdf

The effectiveness of integrative medicine interventions on pain and anxiety in cardiovascular inpatients: a practice-based research evaluation

Objective . To evaluate acceptability and clinical outcomes of acupuncture on patient-reported pain and anxiety in an emergency department (ED).

Design . Observational, retrospective pilot study.

Setting . Abbott Northwestern Hospital ED, Minneapolis, MN.

Methods. Retrospective data was used to identify patients receiving acupuncture in addition to standard medical care in the ED between 11/1/13 and 12/31/14. Feasibility was measured by quantifying the utilization of acupuncture in a novel setting and performing limited tests of its efficacy. Patient-reported pain and anxiety scores were collected by the acupuncturist using an 11-point (0–10) numeric rating scale before (pre) and immediately after (post) acupuncture. Efficacy outcomes were change in pain and anxiety scores.

Results . During the study period, 436 patients were referred for acupuncture, 279 of whom were approached by the acupuncturist during their ED visit. Consent for acupuncture was obtained from 89% (248/279). A total of 182 patients, who had a pre-pain score >0 and non-missing anxiety scores, were included in analyses. Of the 52% (94/182) who did not have analgesics before or during the acupuncture session, the average decrease of 2.37 points (95% CI: 1.92, 2.83) was not different (p > 0.05) than the mean decrease of 2.68 points for those receiving analgesics (95% CI 2.21, 3.15). The average pre-anxiety score was 4.73 points (SD = 3.43) and the mean decrease was 2.27 points (95% CI: 1.89, 2.66).

Conclusions . Results from this observational trial indicate that acupuncture was acceptable and effective for pain and anxiety reduction, in conjunction with standard medical care. These results will inform future randomized trials.

http://kstp.com/kstpImages/repository/cs/files/Reinstein%20et%20al%202016%20Pain%20Medicine(1).pdf

Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study.

Background: Optimal inpatient pain management remains a major institutional and therapeutic challenge. Nontoxic, nonpharmacological approaches to treating pain show promise but have not been widely implemented, nor has their effectiveness been evaluated. Aims: To evaluate the effectiveness of an inpatient integrative medicine consult service for pain management in 6 settings across an entire tertiary care hospital. Design: Retrospective, observational study. Setting Abbott Northwestern Hospital, a 629-bed tertiary-care hospital in Minneapolis, Minn, that is part of Allina Hospitals & Clinics. Participants: Approximately 1837 patients hospitalized between January 1, 2008, and June 30, 2009. Measurements: Pretreatment and posttreatment pain scores on a verbal scale of 0 to 10. Results: Most patients (66%) had never previously received integrative services. Provision of integrative services had immediate and beneficial effects on pain scores. The average reduction in pain scores was 1.9 points (on a 10-point scale), and the average percentage in pain reduction was approximately 55%. Conclusions: The formal provision of inpatient integrative medicine had a significant impact on pain scores for hospitalized patients, reducing self-reported pain by more than 50%, without placing patients at increased risk of adverse effects. This was true in all 6 settings. Age, previous use of complementary therapies, and sex did not affect results. Future research must define the appropriate dose of the intervention, the duration of the relief, and the identification of patients most likely to respond to these nonpharmacological treatments. Additionally, future research using the electronic health record will allow quantification of any reduction in total costs, pain medication usage, and adverse events.

The impact of integrative medicine on pain management in a tertiary care hospital.

Evaluation of an 8-Week Resilience Training Program in Moderate to Severely Depressed Patients

Developing the new paradigm of integrative nursing through community.

Those of us who have been in the integrative health field know that health is much more than a symptom, disease, illness, or disability. These are the physical manifestations of the world around us and the world within us. The science of epigenetics now validates much of what we have observed and experienced as integrative health providers and practitioners, and as informed human beings. Our new scientific discoveries in health and medicine, our evolving knowledge of the environment, the growing diversity of people, and the political and economic landscape are the separate parts of a dynamic and complicated whole that many say is on the verge of crisis. Integrative leaders have an opportunity to impact all of these social and human components. Whether society moves in the direction of wholeness or fragmentation and disease will be determined by the wholeness of those who lead. It requires a dramatically different way of “being” in those who lead. I believe now is the time for integrative leadership—it is our social imperative.

Integrative Leadership: An Embodied Practice.

Holistic nursing model for hospital-based integrative care.

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