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Rupp TL, Amoako M, Johnson K, Rojas W, Highland KB. Massage Therapy Utilization in the Military Health System. Mil Med 2024:usae299. [PMID: 38861401 DOI: 10.1093/milmed/usae299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/06/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Massage therapy is an evidence-based approach for pain management. Information regarding its utilization in the Military Health System (MHS) is lacking. The goal of this study is to evaluate massage therapy utilization patterns across the MHS to include who receives (patient characteristics and diagnoses) and provides (e.g., massage therapists) massage therapy and where (e.g., clinic type). MATERIALS AND METHODS Medical record data of adult TRICARE Prime enrollees receiving outpatient massage therapy (Current Procedural Terminology codes: 97124 and 97140) from June 1, 2021, to May 31, 2023, were extracted from the MHS Data Repository. After identifying the index massage therapy visit, records for 6 months pre- and post-index were included. Descriptive statistics described massage therapy utilization patterns overall. Bivariate analysis compared patients who received massage therapy from massage therapists versus nonmassage therapist clinicians. RESULTS Of patients who received massage therapy (n = 179,215), the median number of visits was 2 (interquartile range 1 to 4), the median age was 32 years (interquartile range 25 to 40), they were mostly assigned male (72%), White (53%), Senior Enlisted (51%), with a musculoskeletal diagnosis (90%), and recent non-steroidal anti-inflammatory drug (NSAID) prescription (58%). Massage therapy was primarily delivered by physical therapists (49%) in physical therapy clinics (74%). Massage therapists provided 0.2% of massage therapy. Patients who received massage therapy from massage therapists versus nonmassage therapists significantly varied across several patient and care characteristics. CONCLUSIONS While massage therapy codes are documented frequently, massage therapists do not commonly provide massage therapy relative to nonmassage therapist providers. Access to massage therapists may be stymied by both lack of massage therapists and need for tertiary pain management referrals to access massage therapist-delivered care. Future research will leverage a health equity framework to (1) evaluate accessibility to massage therapy provided by massage therapists and (2) evaluate real-world evidence of massage therapy effectiveness.
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Affiliation(s)
- Tracy L Rupp
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD 20817, USA
| | - Maxwell Amoako
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD 20817, USA
- Enterprise Intelligence and Data Solutions (EIDS) program office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS), Arlington, VA 22209, USA
| | - Kevin Johnson
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD 20817, USA
| | - Winifred Rojas
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD 20817, USA
| | - Krista B Highland
- Department of Anesthesiology, School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Bayes J, Palencia J, Wardle J. Complementary and Integrative Medicine Prevalence and Utilization in International Military and Veteran Settings and Communities: A Systematic Review. Mil Med 2024; 189:e1318-e1335. [PMID: 37847545 DOI: 10.1093/milmed/usad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Active duty military personnel and veterans have unique and complex health needs, with the high demands of military life often leading to chronic physical and mental health conditions. Complementary and integrative medicine (CIM) could be a possible solution to this problem. Some military health systems have started integrating CIM into health care delivery. However, there has been no systematic evaluation of the prevalence and utilization of CIM in military and veteran populations globally. MATERIALS AND METHODS A Preferred Reporting Items For Systematic Reviews and Meta-Analysis Protocols protocol was used to systematically search for original research assessing the prevalence and utilization of CIM among active serving military or veterans. CINAHL, MEDLINE, Scopus, and AMED databases were searched up to February 3, 2023. RESULTS A total of 27 studies met the inclusion criteria and were included in this review. The overall quality of evidence was high with a low risk of bias. Utilization of CIM varied. The lowest utilization demonstrated that only 1.9% of services delivered by military health system were CIM. The majority of studies found utilization rates between 30% and 80%, with some studies reporting use as high as 90%. The most commonly used CIM therapies included chiropractic care, massage, mindfulness/meditation, and acupuncture. Utilization of CIM products was high and ranged from 32% to 87%. The most frequently used products were dietary supplements, particularly multivitamins and minerals and protein supplements/amino acids. The use of herbal products was high among veterans ranging from 10% to 79%. CONCLUSIONS The high demand for CIM by military personnel and veterans has important implications for policy, funding allocation, and integration of these services into clinical practice, particularly by countries not currently doing so. Further research is needed to assess the implementation of CIM into real-world settings to explore barriers and facilitators for their use in clinical practice and, by extension, their integration into the wider health care system.
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Affiliation(s)
- Jessica Bayes
- National Centre for Naturopathic Medicine (NCNM), Faculty of Health, Southern Cross University, East Lismore, NSW 2480, Australia
| | - John Palencia
- National Centre for Naturopathic Medicine (NCNM), Faculty of Health, Southern Cross University, East Lismore, NSW 2480, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine (NCNM), Faculty of Health, Southern Cross University, East Lismore, NSW 2480, Australia
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Wen PS, Vora A, Mortera M, Sasson N, Reed WR, Ehsanian R, Galantino ML, Erb M, Hu X, Kim S. Perceptions and use of complementary and integrative health practices among rehabilitation professionals: a survey. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hershaw JN, Hill-Pearson CA. Changes in EEG Activity Following Live Z-Score Training Predict Changes in Persistent Post-concussive Symptoms: An Exploratory Analysis. Front Neurol 2022; 13:714913. [PMID: 35392637 PMCID: PMC8979790 DOI: 10.3389/fneur.2022.714913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
A specific variant of neurofeedback therapy (NFT), Live Z-Score Training (LZT), can be configured to not target specific EEG frequencies, networks, or regions of the brain, thereby permitting implicit and flexible modulation of EEG activity. In this exploratory analysis, the relationship between post-LZT changes in EEG activity and self-reported symptom reduction is evaluated in a sample of patients with persistent post-concussive symptoms (PPCS). Penalized regressions were used to identify EEG metrics associated with changes in physical, cognitive, and affective symptoms; the predictive capacity of EEG variables selected by the penalized regressions were subsequently validated using linear regression models. Post-treatment changes in theta/alpha ratio predicted reduction in pain intensity and cognitive symptoms and changes in beta-related power metrics predicted improvements in affective symptoms. No EEG changes were associated with changes in a majority of physical symptoms. These data highlight the potential for NFT to target specific EEG patterns to provide greater treatment precision for PPCS patients. This exploratory analysis is intended to promote the refinement of NFT treatment protocols to improve outcomes for patients with PPCS.
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Affiliation(s)
- Jamie N. Hershaw
- Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence, Fort Carson, CO, United States
- General Dynamics Information Technology, Falls Church, VA, United States
- *Correspondence: Jamie N. Hershaw
| | - Candace A. Hill-Pearson
- Defense Health Agency (DHA) Traumatic Brain Injury Center of Excellence, Fort Carson, CO, United States
- General Dynamics Information Technology, Falls Church, VA, United States
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Banaag A, Korona-Bailey J, Koehlmoos TP. Intrepid Spirit Centers: Considerations for Active Duty, National Guard, Reserves, and Retirees. Mil Med 2022; 188:usac051. [PMID: 35284918 DOI: 10.1093/milmed/usac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant concern to the military health system (MHS) and a signature wound of America's current conflict. To address the influx of patients with military-related TBI, the Department of Defense has partnered with the Fisher Foundation and the Intrepid Fallen Heroes Fund to establish the National Intrepid Center of Excellence and satellite network of Intrepid Spirit Centers. The purpose of this study is to review the prevalence of disease and geographic density of TBI among active duty, National Guard, reservist, and retired military populations in order to inform decision-making around the development of additional Intrepid Spirit Centers. METHODS We used the MHS Data Repository to perform a cross-sectional examination to assess the prevalence of TBI among active duty, National Guard, reservist, and retired military personnel from fiscal years (FY) 2016 to 2019. Statistical analyses included descriptive statistics on patient demographics and the prevalence of TBI. RESULTS We identified a total of 3,221,682 active duty, National Guard, reservists, and retired military personnel in the U.S. Army, Air Force, Navy, and Marine Corps during FY 2016 to 2019; 59.5% were active duty personnel, 23.1% were Retirees, and 17.4% were National Guard and reservists. A total of 72,002 were found to have a TBI-related diagnosis. Texas, North Carolina, and California had the highest case counts for TBI. High prevalence of TBI was found in Bexar County, TX, Muscogee County, GA, Okaloosa County, FL, San Diego County, CA, and Virginia Beach City, VA. CONCLUSIONS Additional Intrepid Spirit Centers are warranted to better meet the needs of active duty, active and inactive National Guard and reservists, and retired military personnel in locations including San Antonio, TX, and Columbus, GA. These locations currently have the medical infrastructure necessary to facilitate the care of wounded warriors and return to duty ensuring the health of the Nation's fighting force and veterans.
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Affiliation(s)
- Amanda Banaag
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Jessica Korona-Bailey
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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Beltrán-Dussán EH. ¿Qué es la medicina alternativa, complementaria e integrativa? REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n4.91413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El concepto de medicina alternativa fue creado por la medicina occidental para identificar prácticas médicas diferentes a la medicina convencional, tales como la medicina tradicional china y acupuntura, homeopatía, terapia neural, medicina osteopática y quiropráctica, medicina ayurveda y la medicina tradicional indígena, que también tienen fundamentos filosóficos, científicos y terapéuticos. Desafortunadamente, con el tiempo se estableció la creencia de que la medicina alternativa comprende todas las prácticas médicas que no son parte de la medicina convencional, lo que ha causado muchas inexactitudes y controversias.
La medicina surgió como necesidad de auto preservación del ser humano y que considera a la salud como bienestar completo y a la enfermedad, como pérdida de esta condición. A lo largo de su evolución han emergido diversas racionalidades y algunas de ellas se han convertido en sistemas médicos. La medicina convencional se estructuró en Occidente, fundamentada en racionalidades médicas existentes para la época y enfocada en modificar la enfermedad, lo que resultó en marcadas diferencias conceptuales con sistemas de tratamiento ya existentes que se centraban en el individuo y en modificar los procesos de la enfermedad.
Todos los sistemas médicos han generado un impacto en diversos campos sociales. Asimismo, han surgido tendencias y estrategias de integración de la medicina convencional con otros sistemas médicos comoLa electroacupuntura de Voll, la homotoxicología, el balance polar electromagnético, la antroposofía, la sintergética y la biofotónica. Actualmente se considera que el objetivo de la medicina es integrar y complementar conocimientos de diferentes racionalidades médicas dentro del concepto de una sola medicina. Teniendo en cuenta lo anterior, el objetivo del presente artículo es clarificar los conceptos de las diferentes formas de medicina, plantear algunas definiciones al respecto, y proponer una definición de medicina alternativa, complementaria e integrativa.
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Green BN, Dunn AS. An Essential Guide to Chiropractic in the United States Military Health System and Veterans Health Administration. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:35-48. [PMID: 35002576 PMCID: PMC8720651 DOI: 10.1016/j.echu.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an essential overview of chiropractic services in United States military and veterans' health care systems. METHODS We reviewed literature, legislation, and policies from 1936 through September 2021 pertaining to chiropractic services in the United States military and veterans' health systems. Using these sources and our combined experience in these systems, we identified fundamental themes in the delivery of chiropractic care in the health care systems of the Department of Defense (providing health care for active duty service members) and the Department of Veterans Affairs (providing health care for veterans) in main topic areas. RESULTS We identified 7 main topic areas relevant to the 2 systems: populations served by chiropractors; health care systems; integration; utilization and supply of chiropractic care; vetting of chiropractors; roles and evaluation of chiropractors; and oversight and leadership. Key information about chiropractic care in these systems was synthesized into the main topic areas. Benefits of high-quality within-system chiropractic care to active-duty service members and veterans are presented. The assets that within-system chiropractors bring to the Department of Defense and Department of Veterans Affairs health care systems are discussed for each main topic area. CONCLUSION This article contains an essential overview of chiropractic services in the Department of Defense and the Department of Veterans Affairs. It offers clarity regarding the integration of chiropractic services into these health care systems and includes a 1-page brief of talking points that may help better inform ongoing discussions of chiropractic services in these 2 different but intertwined environments.
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Affiliation(s)
- Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Andrew S. Dunn
- Chiropractic Department, VA Western New York Healthcare System, Buffalo, New York
- Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca Falls, New York
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Risk Factors Associated With the Prescription of Opioids Among Service Members Following a First Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:345-353. [PMID: 34489385 DOI: 10.1097/htr.0000000000000711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate factors impacting opioid receipt among active-duty service members (SMs) following a first mild traumatic brain injury (mTBI). SETTING Active-duty SMs receiving care within the Military Health System. PARTICIPANTS In total, 14 757 SMs who have sustained an initial mTBI, as documented within electronic health records (EHRs), between 2016 and 2017. DESIGN A retrospective analysis of EHR metadata. MAIN MEASURES Multivariable logistic regression assessed factors impacting opioid receipt and initiation. Factors include demographics, military characteristics, and preexisting clinical conditions, including prior opioid prescription. RESULTS Of the sample population, 33.4% (n = 4927) were prescribed opioids after their initial mTBI, of which, 60.6% (n = 2985) received opioids for the first time following injury. Significant risk factors associated with the increased probability of opioid receipt included age, gender, and preexisting behavioral health and musculoskeletal conditions. Military characteristics also exhibited changes in the probability of opioid receipt, both among initiation and new prescription. No changes were observed among race, nor among those with preexisting headaches or migraines. CONCLUSION Despite concerns about the negative impact on recovery, the prescribing of opioids is common in this population of active-duty SMs first diagnosed with an mTBI. As several demographic and preexisting health conditions are factors in the receipt of opioids post-mTBI, the entire medical history of these patients should be considered prior to prescription. Understanding these factors may further inform policy for opioid use in the Military Health System.
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Ameli R, Skeath P, Abraham PA, Panahi S, Kazman JB, Foote F, Deuster PA, Ahmad N, Berger A. A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study. PeerJ 2021; 9:e10519. [PMID: 33505785 PMCID: PMC7789867 DOI: 10.7717/peerj.10519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022] Open
Abstract
We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.
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Affiliation(s)
- Rezvan Ameli
- NIMH representative to the Clinical Center, National Institutes of Health, Bethesda, MD, United States of America.,Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Perry Skeath
- Human Performance Partners Corp, Alexandria, VA, United States of America
| | - Preetha A Abraham
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Samin Panahi
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Josh B Kazman
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Frederick Foote
- Institute for Integrative Health, Baltimore, MD, United States of America
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America
| | - Niha Ahmad
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Ann Berger
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
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Yang J, Bauer BA, Wahner-Roedler DL, Chon TY, Xiao L. The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? J Pain Res 2020; 13:411-417. [PMID: 32110089 PMCID: PMC7038776 DOI: 10.2147/jpr.s244173] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION From 1986, the World Health Organization (WHO) analgesic ladder has been used as the simple and valuable pain-relieving guidance in the pharmaceutical pain management, however, with the development of medical history, notions about pain physiology and pain management have already updated. Is the analgesic ladder still appropriate for chronic non-cancer pain (CNCP) patients? This study aims to analyse the current usage of the analgesic ladder in patients with CNCP by evaluating previously published pertinent studies. METHODS Literature published in English from January 1980 to April 2019 and cited on PubMed database was included. Analysis on the analgesic ladder, current status of CNCP management, and a new revised ladder model were developed based on relevant literature. RESULTS The WHO analgesic ladder for cancer pain is not appropriate for current CNCP management. It is revised into a four-step ladder: the integrative therapies being adopted at each step for reducing or even stopping the use of opioid analgesics; interventional therapies being considered as step 3 before upgrading to strong opioids if non-opioids and weak opioids failed in CNCP management. DISCUSSION A simple and valuable guideline in past years, the WHO analgesic ladder is inappropriate for the current use of CNCP control. A revised four-step analgesic ladder aligned with integrative medicine principles and minimally invasive interventions is recommended for control of CNCP.
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Affiliation(s)
- Juan Yang
- Department of Pain Medicine, Shenzhen Nanshan People’s Hospital, Shenzhen518052, People’s Republic of China
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | | | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN55905, USA
| | - Lizu Xiao
- Department of Pain Medicine, Shenzhen Nanshan People’s Hospital, Shenzhen518052, People’s Republic of China
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Frisch NC, Rabinowitsch D. What’s in a Definition?Holistic Nursing, Integrative Health Care, andIntegrative Nursing: Report of an Integrated Literature Review. J Holist Nurs 2019; 37:260-272. [DOI: 10.1177/0898010119860685] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer-reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes “whole person care” often acknowledging body–mind–spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disciplines or distinct approaches to care. Both terms, integrative and holistic, are associated with alternative/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth.
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Kim M, Moss D, Crawford P. Battlefield acupuncture for post-partum pain: A randomized controlled trial. Explore (NY) 2019; 15:409-414. [PMID: 31186202 DOI: 10.1016/j.explore.2019.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Postpartum pain affects quality of life. Clinicians are increasingly using acupuncture for management of pain. Evidence based strategies that incorporate acupuncture for postpartum pain are lacking. METHODS We performed an exploratory, randomized clinical trial of Battlefield Auricular Acupuncture (BFA) plus standard analgesia versus standard analgesia alone for reduction of pain in the immediate postpartum period. RESULTS The mean time to 50% sustained reduction of initial pain in the standard analgesia group (n = 33) was 6 days compared to 5 days in the standard analgesia plus BFA (n = 37) group (p = 0.35). The mean total morphine equivalent units (MEUs) in the standard group compared to standard plus BFA group were 88 mg and 82 mg respectively (p = 0.45). CONCLUSIONS This exploratory comparison suggests that BFA may not provide additional benefit to standard analgesia for immediate postpartum pain; however, the trend toward faster reduction in pain indicates that a larger definitive study may be required.
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Affiliation(s)
- Michael Kim
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States; 375th MDG, Scott Air Force Base, Illinois 62225, United States
| | - David Moss
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States
| | - Paul Crawford
- 99th MDG, Nellis Air Force Base, Nevada 89191, United States.
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Abstract
Post-traumatic stress disorder (PTSD) affects about 20% of US military veterans and is a major cause of mortality in these men and women. The incidence of PTSD has persisted over the last decade with the Iraq and Afghanistan wars, yet treatment and adherence remain inadequate in part due to clinician lack of knowledge about cognitive processing therapy and prolonged exposure, the proven gold standards in treatment. This article reviews the most current and successful PTSD treatment options and identifies risk factors for patient nonadherence in hopes of reducing the rate of veteran suicide related to PTSD.
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Madsen C, Koehlmoos T. Acupuncture: Bridging the Gap Between the Military and Veterans' Health Systems. Med Acupunct 2018; 30:245-247. [PMID: 30377459 DOI: 10.1089/acu.2018.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This research brief describes the use of acupuncture as a mechanism for the development of crossagency knowledge translation and evidence-based practices in order to ensure the best possible care for the nation's veterans.
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Affiliation(s)
- Cathaleen Madsen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Tracey Koehlmoos
- Uniformed Services University of the Health Sciences, Bethesda, MD
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Abstract
PURPOSE OF REVIEW We review the published literature over the last 24 months in the treatment of PTSD for our military men and women. We examined the updated clinical practice guidelines published in June 2017 by the Veteran's administration and Department of Defense and contrasted the guidelines with the most recent literature. We also discuss new directions in PTSD research. RECENT FINDINGS Psychotherapy remains one of the most effective treatments for PTSD; unfortunately, few participants remain in treatment to completion. Many of the emerging therapies target NMDA receptor antagonists, cannabinoid receptor modulators, glucocorticoid receptor agonists, non-SSRI antidepressants, and opioid receptor agonists. The newer therapies fall into the drug classes of anti-hypertensives, glutamate modulators, oxytocin, and medication targeting insomnia/hyperarousal. PTSD symptoms are often chronic in our veteran population. While current treatments are helpful, there are often significant residual symptoms. We reviewed the most recent improvements in treatment and discuss therapies that are in the research phase.
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Affiliation(s)
- Durga Bestha
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA
| | - Layla Soliman
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA
| | | | - James Rachal
- Department of Psychiatry, Atrium Health, Charlotte, NC, USA.
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Madsen C, Patel A, Vaughan M, Koehlmoos T. Use of Acupuncture in the United States Military Healthcare System. Med Acupunct 2018; 30:33-38. [PMID: 29410719 DOI: 10.1089/acu.2017.1260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: The Military Healthcare System (MHS) shows increasing interest in acupuncture as an alternative to opioids for pain control. However, specific factors associated with this procedure in the MHS are not well-described in literature. This study examines usage within the MHS to determine patterns among the diagnoses, provider types, and facilities associated with acupuncture. Materials and Methods: Acupuncture-treated patients were identified from TRICARE claims data in the MHS Data Repository as having at least one acupuncture treatment in fiscal year (FY) 2014. Bivariate analysis was performed to determine demographics, diagnoses, and number of visits, for both active-duty and nonactive-duty personnel. Descriptive statistics were used to show associated provider and facility types. Results: A total of 15,761 people received acupuncture in the MHS in FY 2014. Use of acupuncture was greater for Army service, white race, and senior enlisted rank overall, and for males ages 26-35 among active-duty and females ages 46-64 among nonactive-duty beneficiaries. A cumulative 76% of diagnoses were for musculoskeletal or nerve and system issues. Approximately 60% of patients received acupuncture from physicians, 16% from physical therapists or chiropractors, and 9.7% from physician extenders. Specific acupuncture techniques (traditional, auricular, etc.) could not be determined from the data set. Conclusions: The most common diagnoses associated with acupuncture are consistent with pain management. However, full analysis is hampered by inconsistent coding and lack of granularity regarding specific techniques. Given the popularity of acupuncture in the MHS, further research is necessary to explore the full scope of this intervention.
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Affiliation(s)
- Cathaleen Madsen
- Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Avni Patel
- Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Megan Vaughan
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.,Defense and Veterans Center for Integrative Pain Management, Rockville, MD
| | - Tracey Koehlmoos
- Uniformed Services University of the Health Sciences, Bethesda, MD
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