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Lumiere K, Zhang R, Lesnik I, Bayer S, Metcalf C, Gordon DB. Integration of Doctor of Acupuncture and Oriental Medicine Students in a Trauma Center's Acute Pain Service: In-Person and Remote Training and Patient Care. Med Acupunct 2021; 34:88-95. [PMID: 35509879 PMCID: PMC9057894 DOI: 10.1089/acu.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective Evidence of effectiveness and demand for acupuncture to treat acute pain conditions is growing, as is the need for acupuncturists trained to deliver patient care in a hospital setting. This articles describes collaboration between Bastyr University and Harborview Medical Center to incorporate Doctor of Acupuncture and Oriental Medicine (DAOM) students into a trauma hospital setting. Materials and Methods A model was developed to integrate DAOM students into an Anesthesiology Acute Pain Service to provide acupuncture to postoperative inpatients. That in-person model pivoted to remote student education and patient self-care education during the COVID 19 outbreak. A review was conducted of 323 consecutive patients who received acupuncture while they were hospitalized. Results The review of 323 consecutive patients who received acupuncture for pain during their hospital admission indicated that as few as one acupuncture treatment resulted in clinically significant benefits. No serious complications or safety concerns were reported. Conclusions Collaboration between academic and clinical programs can provide the structure to integrate acupuncture into hospital settings safely and with benefit to patients and students.
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Affiliation(s)
- Kathleen Lumiere
- Acupuncture and East Asian Medicine, Bastyr University/Bastyr Center for Natural Health, Seattle, WA, USA
| | - Raymond Zhang
- Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Ivan Lesnik
- Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Sara Bayer
- Acupuncture and East Asian Medicine, Bastyr University/Bastyr Center for Natural Health, Seattle, WA, USA
| | - Carol Metcalf
- Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Debra B. Gordon
- Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, Seattle, WA, USA
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Roth I, Highfield L, Cuccaro P, Wells R, Misra S, Engebretson J. Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital. J Altern Complement Med 2019; 25:S95-S105. [PMID: 30870018 PMCID: PMC6446163 DOI: 10.1089/acm.2018.0369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. METHODS An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected. FINDINGS Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking. CONCLUSION Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.
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Affiliation(s)
- Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Linda Highfield
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Sanghamitra Misra
- Department of Academic General Pediatrics, Baylor College of Medicine, Houston, TX
| | - Joan Engebretson
- Department of Family Health, University of Texas Health Science Center Cizik School of Nursing (UTHealth), Houston, TX
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Stock-Schröer B, Huber R, Joos S, Klose P. Evaluation of the current status of Rehabilitation, Physical Medicine and Naturopathy education 10 years after the reform of the Medical Licensure Act - a nationwide survey of German Medical Universities. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc3. [PMID: 28293670 PMCID: PMC5327655 DOI: 10.3205/zma001080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
Introduction: After the reform of the German Medical Licensure Act of 2003, Rehabilitation, Naturopathy and Physical Medicine were integrated into one discipline to be taught in Medical University. The aim of this survey is to determine the outcome of this change by evaluating the current status of education of these three disciplines based on the experience and satisfaction reported by lecturers responsible for teaching these subjects to medical students. Methods: A questionnaire-based survey. A paper version of the questionnaire for each discipline was posted to each Medical University in Germany. The first part asked about the current status of teaching; the second part asked about facilities and requirements; the third part asked respondents to give information on their career and teaching experience in this subject Results: The response rate was 51.5% for Rehabilitation, 48.5% for Physical Medicine and 60.6% for Naturopathy. A vast range of people and faculties were involved in the curricula. The percentage of each discipline taught was unevenly distributed: the major proportion being rehabilitation (38%), then naturopathy 34% lastly physical medicine with less than a third (28%). The main delivery of these disciplines was through lectures in plenary sessions. Modern teaching methods were not in evidence. Lecturers were generally pleased to be working with the combination of the three disciplines. Conclusion: Future medical education should improve upon teaching coordination and aim towards a common curriculum for these three disciplines. Expected future changes to medical curricula will provide opportunities to improve the implementation of Rehabilitation, Physical Medicine and Naturopathy in teaching and research.
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Affiliation(s)
| | - Roman Huber
- University Medical Centre Freiburg, Centre for Complementary Medicine, Institute for Environmental Health Sciences and Infection Control, Freiburg, Germany
| | - Stefanie Joos
- University of Tuebingen, Medical Faculty, Tübingen, Germany
- University Hospital Tuebingen, Institute for General Practice, Tübingen, Germany
| | - Petra Klose
- University of Duisburg-Essen, Faculty of Medicine, Essen, Germany
- Kliniken Essen-Mitte, Department of Internal and Integrative Medicine, Essen, Germany
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Olchowska-Kotala A, Barański J. Polish physicians’ attitudes to complementary and alternative medicine. Complement Ther Med 2016; 27:51-7. [PMID: 27515876 DOI: 10.1016/j.ctim.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022] Open
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Witt CM, Pérard M, Berman B, Berman S, Birdsall TC, Defren H, Kümmel S, Deng G, Dobos G, Drexler A, Holmberg C, Horneber M, Jütte R, Knutson L, Kummer C, Volpers S, Schweiger D. Using the framework of corporate culture in "mergers" to support the development of a cultural basis for integrative medicine - guidance for building an integrative medicine department or service. Patient Prefer Adherence 2015; 9:113-20. [PMID: 25632226 PMCID: PMC4304533 DOI: 10.2147/ppa.s66778] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. PURPOSE The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. METHODS A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service. RESULTS Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). CONCLUSION The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.
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Affiliation(s)
- Claudia M Witt
- University Hospital Zurich, Institute for Complementary and Integrative Medicine, Zurich, Switzerland
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, USA
- Correspondence: Claudia M Witt, Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich Sonneggstr 6, CH-8091 Zurich, Switzerland, Tel +41 44 255 2396, Email
| | - Marion Pérard
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany
| | - Brian Berman
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, USA
- The Institute for Integrative Health, Baltimore, USA
| | - Susan Berman
- The Institute for Integrative Health, Baltimore, USA
| | | | - Horst Defren
- Kliniken Essen Mitte, Evang, Huyssen-Stiftung/Knappschaft GmbH Patientenmanagement, Essen, Germany
| | - Sherko Kümmel
- Department of Senology, Breast Center, Kliniken Essen-Mitte, Evang. Huyssens Stiftung, Knappschaft GmbH, Essen, Germany
| | - Gary Deng
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Germany
| | - Atje Drexler
- Robert Bosch Foundation GmbH, Stuttgart, Germany
| | - Christine Holmberg
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany
| | - Markus Horneber
- Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nürnberg, Germany
| | - Robert Jütte
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Germany
| | - Lori Knutson
- Integrative Healthcare Solutions, Minneapolis, Minnesota, USA
| | - Christopher Kummer
- Institute of Mergers, Acquisitions and Alliances (IMAA), Zurich, Switzerland
| | | | - David Schweiger
- Schweiger, Schweiger & Associates, Hilton Head Island, South Carolina, USA
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Mittring N, Pérard M, Witt CM. Corporate culture assessments in integrative oncology: a qualitative case study of two integrative oncology centers. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:316950. [PMID: 23818923 PMCID: PMC3683441 DOI: 10.1155/2013/316950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/19/2013] [Indexed: 11/17/2022]
Abstract
The offer of "integrative oncology" is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type ("best of both worlds" and "linking"). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.
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Affiliation(s)
- Nadine Mittring
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstraße 57, 10117 Berlin, Germany
| | - Marion Pérard
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstraße 57, 10117 Berlin, Germany
| | - Claudia M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstraße 57, 10117 Berlin, Germany
- Center for Integrative Medicine, University of Maryland School of Medicine, 520 W. Lombard Street, Baltimore, MD 21201, USA
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Holmberg C, Brinkhaus B, Witt C. Experts' opinions on terminology for complementary and integrative medicine - a qualitative study with leading experts. Altern Ther Health Med 2012; 12:218. [PMID: 23151006 PMCID: PMC3522550 DOI: 10.1186/1472-6882-12-218] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/09/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term "integrative medicine" with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a "conventional framework of thinking". The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general. METHODS We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda. RESULTS Overall the current terminology was seen as a problem, although most experts agreed that the term "integrative medicine" (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine. CONCLUSION The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.
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