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Li H, Darby JE, Akpotu I, Schlaeger JM, Patil CL, Danciu O, Boyd AD, Burke L, Ezenwa MO, Knisely MR, Lee TY, Mandernach MW, de Martelly VA, Molokie RE, Shah N, Wilkie DJ, Doorenbos AZ. Barriers and Facilitators to Integrating Acupuncture into the U.S. Health Care System: A Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39093944 DOI: 10.1089/jicm.2023.0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.
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Affiliation(s)
- Hongjin Li
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Juanita E Darby
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Ivy Akpotu
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Crystal L Patil
- School of Nursing, University of Michigan, Ann Arbo, MI, USA
| | - Oana Danciu
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Andrew D Boyd
- College of Applied Health Science, University of Illinois Chicago, Chicago, IL, USA
| | - Larisa Burke
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Miriam O Ezenwa
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Ta-Ya Lee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
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Allen SJ, Conboy L, Wasserman TL, Graca S, Mager A, Howlett B, Graziano M, Teo L, Schlaeger JM. 2021 American Society of Acupuncturists Survey on Acupuncturists' Backgrounds, Interests, and Attitudes toward Conducting Research. Med Acupunct 2024; 36:215-226. [PMID: 39309622 PMCID: PMC11411272 DOI: 10.1089/acu.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Background It has been previously reported that acupuncturists internationally can be reluctant to engage in acupuncture research. Purpose Assess the beliefs and attitudes of acupuncturists in the United States toward research, along with exploring their backgrounds and interests regarding conducting acupuncture research. We aimed to capture any previous experiences in conducting research, applying research findings in their clinical practice, and their ideas on how research could be used to promote the profession. Methods Using the SurveyMonkey© online platform, a 21-item survey was developed by the American Society of Acupuncturists Research Committee in 2021. Areas of research background and research interests, attitudes toward research, and demographics were queried. Close- and open-ended questions were used. Statistical analyses were conducted and presented in simple tabulations with confidence intervals for central tendency, along with relevant verbatim responses presented to highlight meaningful insights from the participants. Results Seven hundred and eighteen respondents completed the survey. Respondents were: 1) overwhelmingly positive concerning their beliefs and attitudes toward conducting research, 2) wanting to receive resources from the professional organization regarding all queried aspects of research ranging from interpretation of research articles, conducting research, and how to obtain research funding, and 3) concerned that acupuncture and traditional Chinese medicine could be usurped by biomedicine, in effect losing its rich theoretical grounding. Conclusion Acupuncture professional organizations should develop resources including lectures and seminars to educate and support their members on how to: 1) interpret research articles, 2) design acupuncture studies, and 3) obtain research funding.
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Affiliation(s)
- Samantha J. Allen
- New England School of Acupuncture at MCPHS, Worcester, Massachusetts, USA
| | - Lisa Conboy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tuesday L. Wasserman
- New England School of Acupuncture at MCPHS, Boulder Community Health (BCH) in Center for Integrative Care (CIC), Worcester, Massachusetts, USA
| | - Sandro Graca
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
- Northern College of Acupuncture, York, United Kingdom
| | - Amy Mager
- Wellness House, Northampton, Massachusetts, USA
| | - Beth Howlett
- AOMA Graduate School of Integrative Medicine, Austin, Texas, USA
| | | | - Lynn Teo
- Teo Research Consulting, Portland, Maine, USA
| | - Judith M. Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Huemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Assessing the role and impact of research in clinical practice among acupuncturists in western countries: a multinational cross-sectional survey. Front Med (Lausanne) 2024; 11:1331184. [PMID: 39144669 PMCID: PMC11322080 DOI: 10.3389/fmed.2024.1331184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Evidence-informed practice is crucial to perform safe and efficient health interventions. In recent years, the evidence base of acupuncture continuously increased leading to the integration of acupuncture into clinical guidelines by various leading medical associations worldwide. At the same time, recent studies showed that licensed acupuncturists are rarely utilizing scientific research to inform their practice. Methods This descriptive study using an online survey assessed the role of evidence-informed practice of acupuncturists in Austria, Germany, the United States of America, Australia, and New Zealand and aimed to determine critical factors relevant for promoting research literacy including demographical data, data about the clinical practice patterns, and the role and value of different information sources of traditional, complementary and integrative medicine (TCIM) practitioners. Results In total, 404 acupuncturists completed the online survey that included questions about demographic characteristics, the role and value of research in clinical practice, and details about the amount and type of continuing professional education. Univariate and multivariate analysis was used to determine significant predictors of the outcome variable "importance of research in clinical practice" (numerical rating scale, 0 to 100). The results showed that the majority of acupuncturists use certified courses as primary source of continuing professional education and value experts' opinions as the most reliable source of information. Multivariate analysis showed that the importance of research is dependent on the interest in research, an interdisciplinary learning environment, and positive experiences with research including if an acupuncture study ever changed the clinical practice of practitioners. Conclusion Future educational programs should therefore focus on an interactive format aiming to promote skills to critically assess the value and practical use of research studies to improve the general practice of acupuncture.
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Affiliation(s)
- Matthias Huemer
- Department of Internal Medicine, Division of Oncology, Palliative Care Unit, Medical University of Graz, Graz, Austria
| | - Sandro Graca
- Northern College of Acupuncture, York, United Kingdom
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Sarah Bitsche
- Department of Internal Medicine, Division of Oncology, Palliative Care Unit, Medical University of Graz, Graz, Austria
| | - Guenter Hofmann
- Department of Internal Medicine, Division of Oncology, Palliative Care Unit, Medical University of Graz, Graz, Austria
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Martin Pichler
- Department of Internal Medicine, Division of Oncology, Palliative Care Unit, Medical University of Graz, Graz, Austria
- Translational Oncology, University Hospital of Augsburg, Augsburg, Germany
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Mycyk MB, Seaman L, Yurasek F. Emergency Department Acupuncture Is a Promising Option That Deserves an Open Mind and Continued Rigor. Ann Emerg Med 2024:S0196-0644(24)00291-9. [PMID: 38888532 DOI: 10.1016/j.annemergmed.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Mark B Mycyk
- Department of Emergency Medicine, Cook County Health, Chicago, IL.
| | - Lisa Seaman
- Department of Anesthesiology and Pain Management, Cook County Health, Chicago, IL
| | - Frank Yurasek
- Department of Anesthesiology and Pain Management, Cook County Health, Chicago, IL
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Smith CL, Mulcahy M. The Impact of Inpatient Acupuncture on a Mixed Hospital Floor: A Pragmatic 3-Month Cost-Effectiveness Retrospective Evaluation. Med Acupunct 2024; 36:27-33. [PMID: 38380172 PMCID: PMC10874818 DOI: 10.1089/acu.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Objective Viability of inpatient acupuncture is limited by current hospital reimbursement structuring. Research has primarily focused on length of stay (LOS) instead of cost of stay (COS). This study evaluated acupuncture as an option for inpatient pain control, determined if acupuncture influenced patient satisfaction during hospitalization, and examined any effects on LOS and COS. Materials and Methods In a quasiexperimental pilot research study, acupuncture was offered free of charge for 3 months on a single floor of an urban medical center. Pre- and postintervention scores, number of treatments, and diagnosis related groups (DRGs) of patients receiving acupuncture were tracked and then compared to a nonintervention, DRGs-matched group with overlapping hospital-floor and admission dates. LOS, COS, and patient satisfaction scores during the months of intervention were compared to the months before and after the intervention. Results Patients' pain significantly decreased each time they were treated. Consumer Assessment of Healthcare Providers and Systems scores increased to 85, 99, and 97 during the months of intervention and then returned to the lower, preacupuncture levels after acupuncture was no longer available. LOS was higher in the intervention group (+7.8 days), but acupuncture saved the hospital an anticipated $125,770 in the projected COS during that 3-month time alone. Conclusions Acupuncture was a potent pain-relief alternative for hospitalized patients, providing more satisfaction. Acupuncture resulted in longer LOS, but the aggregate COS was 86% less than expected. Acupuncture may be a financially viable, clinically impactful adjunct to hospital care.
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Affiliation(s)
- Clasina Leslie Smith
- Chicago Healing Center and University of Illinois, College of Medicine, Chicago, IL, USA
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Huemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:64-71. [PMID: 38199884 DOI: 10.1016/j.joim.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Many cancer patients seek adjunctive therapies to biomedical cancer treatments at some point of their disease trajectory. While acupuncture is increasingly recommended by leading oncological associations, limited evidence exists concerning the evidence-informed practice and adherence to current guidelines of traditional complementary and integrative medicine (TCIM) practitioners treating cancer patients. METHODS An international online-survey assessed the demographical data, clinical practice, and sources of information used by TCIM practitioners in Austria, Germany, United States of America, Australia, and New Zealand. RESULTS In total, 404 respondents completed the survey, of which 254 (62.9%) treated cancer patients. Most practitioners were acupuncturists and herbalists (57.1%), had (16.8 ± 9.9) years of clinical experience and see a median of 2 (1, 4) cancer patients per week. Breast cancer (61.8%) is the most common cancer type seen in TCIM clinics. Adjunctive TCIM treatments are frequently concurrent with the patient's cancer specific treatment (39.9%), which is also reflected by the main goal of a TCIM treatment to alleviate side effects (52.4%). However, only 28.0% of the respondents are in contact with the treating oncologist. According to the respondents, pain is most effectively treated using acupuncture, while herbal medicine is best for cancer-related fatigue. TCIM practitioners mostly use certified courses (33.1%) or online databases (28.3%) but often believe that experts are more reliable to inform their practice (37.0%) than research publications (32.7%). CONCLUSION Acupuncturists and herbalists commonly treat cancer patients. Most practitioners use TCIM as an adjunct to biomedicine as supportive care and use it largely in accordance with current oncological guidelines. PLEASE CITE THIS ARTICLE AS Huemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey. J Integr Med. 2024; 22(1): 64-71.
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Affiliation(s)
- Matthias Huemer
- Palliative Care Unit, Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Sandro Graca
- Northern College of Acupuncture, York YO1 6LJ, United Kingdom; School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, United Kingdom
| | - Sarah Bitsche
- Palliative Care Unit, Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Guenter Hofmann
- Palliative Care Unit, Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Mike Armour
- National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia; Medical Research Institute of New Zealand, Wellington 6021, New Zealand
| | - Martin Pichler
- Palliative Care Unit, Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; Translational Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
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Miao H, Li R, Li W, Wu F, Li H, Luo H. Electroacupuncture attenuates ketamine-induced neuronal injury in the locus coeruleus of rats through modulation of the CAMK II/CREB pathway. Brain Res Bull 2023; 202:110724. [PMID: 37543295 DOI: 10.1016/j.brainresbull.2023.110724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/02/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Ketamine, despite its efficacy in treating depression, raises concerns regarding safety due to potential abuse, cognitive impairment, and bladder toxicity. Ketamine can affect the locus coeruleus (LC) norepinephrine and attention networks. This study explored the protective effects of electroacupuncture (EA) on the LC of rats exposed to repeated administration of ketamine while investigating the potential role of the Calcium CaM-dependent protein kinase II (CAMK II)/ cAMP response element binding protein (CREB) pathway in mediating EA's impact on ketamine-induced neuronal injury in LC. METHODS Rats were repeatedly injected intraperitoneally with ketamine hydrochloride (50 mg/kg) once daily for seven days. Subsequently, EA was performed at the acupoints "Zusanli" (ST36) and "Sanyinjiao" (SP-6) once daily following ketamine administration. The Morris water maze test was employed to assess behavioral changes in the rats. Neuronal injury was examined using Nissl staining, and the expression of CAMK II, CREB, and phospho-CREB (p-CREB) was evaluated through immunohistochemistry and western blotting. RESULTS EA mitigated the cognitive and exploratory impairments and attenuated neuronal injury in the LC induced by repeated administration of ketamine. The expression of CAMK II and p-CREB proteins in the LC increased following 7 days of ketamine administration. However, EA treatment led to a downregulation of CAMK II and p-CREB expression. CONCLUSION Repeated administration of ketamine in male rats can lead to neuronal injury and neurobehavioral dysfunction. However, EA was found to ameliorate neurodegeneration in the LC and enhance neurobehavioral symptoms. This therapeutic effect of EA may be attributed to its modulation of the CAMKII/CREB pathway, thereby mitigating the aforementioned adverse effects.
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Affiliation(s)
- Huachun Miao
- Department of Human Anatomy, Wannan Medical College, Wuhu, Anhui Province 241002, China
| | - Runzhi Li
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province 310053, China
| | - Wenjuan Li
- Department of Human Anatomy, Wannan Medical College, Wuhu, Anhui Province 241002, China
| | - Feng Wu
- Department of Human Anatomy, Wannan Medical College, Wuhu, Anhui Province 241002, China
| | - Huaibin Li
- Department of Human Anatomy, Wannan Medical College, Wuhu, Anhui Province 241002, China.
| | - Hong Luo
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, Zhejiang Province 311121, China.
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Anderson BJ, Zappa M, Leininger BD, Taylor-Swanson L. Cross-Sectional Survey of Acupuncturists in the United States Who Prescribed Chinese Herbal Medicine for Patients with Symptoms Likely Related to COVID-19. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:510-517. [PMID: 36893307 PMCID: PMC10457619 DOI: 10.1089/jicm.2022.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Objective: The objective of this study was to examine the prescribing of Chinese herbal medicine (CHM) by licensed acupuncturists in the United States during the COVID-19 pandemic. Methods: A 28-question survey with nine branching questions was disseminated through collegial networks, paid advertisements, and a study website in April-July 2021. Participants indicated that they were licensed acupuncturists who treated more than five patients for symptoms likely related to COVID-19 to gain entry to the full survey. Surveys were undertaken electronically through the Research Electronic Data Capture (REDCap) system. Results: The survey was undertaken by 103 participants representing all US geographic regions and had an average of 17 years in practice. Sixty-five percent received or intended to receive the COVID-19 vaccine. Phone and videoconference were the predominant methods of patient contact; granules and pill forms of CHM were the most prescribed. A wide variety of information sources were used in devising patient treatments inclusive of anecdotal, observational, and scientific sources. Most patients were not receiving biomedical treatment. Ninety-seven percent of participants reported that they had no patients die of COVID-19, and the majority reported that <25% of their patients developed long hauler syndrome (post-acute sequelae SARS-CoV-2 infection). Conclusions: This study demonstrates that licensed acupuncturists were treating COVID-19 infected individuals in the United States during the early stages of the pandemic, and for many such patients this was the only therapeutic intervention they had access to from a licensed health care provider. Information disseminated from China through collegial networks, along with published sources including scientific studies, informed the approach to treatment. This study provides insight into an unusual circumstance in which clinicians needed to establish evidence-based approaches to the treatment of a new disease during a public health emergency.
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Affiliation(s)
- Belinda J. Anderson
- College of Health Professions, Pace University, New York, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa Zappa
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Brent D. Leininger
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, Minnesota, USA
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Anastasi JK, Capili B, Neumaier J, Hackett L. Delivery of acupuncture in clinical trials: Research acupuncturists’ perspectives. JOURNAL OF INTEGRATIVE MEDICINE 2023:S2095-4964(23)00027-4. [PMID: 37117088 DOI: 10.1016/j.joim.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/20/2022] [Indexed: 03/31/2023]
Abstract
Delivery of acupuncture in the setting of a clinical trial is a unique practice that diverges significantly from the delivery of acupuncture in a real-world clinical setting. Research acupuncturists, particularly those trained in traditional Chinese medicine (TCM), are often required to set aside valued precepts of traditional care, including diagnosing imbalances, individualizing treatment, and forging a therapeutic relationship with patients. TCM-trained acupuncturists express mixed feelings about participating in clinical trials. Many are eager to play a vital role in the advancement of acupuncture science and appreciate the need for strict protocol adherence to minimize bias. However, the acupuncturist(s) may also have concerns about clinical trial methodology, including but not limited to the delivery of a control condition, e.g., sham acupuncture. Investigators should anticipate certain questions and even a level of resistance to the requirements of research among acupuncturists and be prepared to address them. This manuscript presents a brief review of the subjective experience of the research acupuncturist within the available scientific literature as it pertains to the delivery of active and sham clinical research protocols. Our goals are to better understand the perspectives of acupuncturists who may participate in clinical research, so that their concerns may be addressed in study design and methodology. To that end, we suggest the creation of a novel training program specifically for clinical trial acupuncturists, intended for qualified TCM- and Western-trained practitioners, that would help to standardize the research acupuncturist's role and help to strengthen the design and execution of acupuncture studies.
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Chung VC, Ho FF, Lao L, Liu J, Lee MS, Chan KW, Nilsen P. Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 109:154591. [PMID: 36610171 DOI: 10.1016/j.phymed.2022.154591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits. PURPOSE The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective. METHODS Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach. RESULTS Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice. CONCLUSION Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.
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Affiliation(s)
- Vincent Ch Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fai Fai Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, United States
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kam Wa Chan
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Kwon CY, Lee B. The efficacy of acupuncture on suicidal behavior: A protocol for systematic review and meta-analysis. AIMS Public Health 2022; 9:651-660. [PMID: 36636152 PMCID: PMC9807412 DOI: 10.3934/publichealth.2022046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/16/2023] Open
Abstract
Background One of the leading causes of death worldwide is suicide. Acupuncture has been reported to be related to clinical improvement of some risk factors for suicide including depression. Moreover, practitioner-patient communication is an important component of the acupuncture procedure, which may contribute to suicide risk reduction as a social contact. This systematic review was performed to evaluate the effectiveness and safety of acupuncture for suicidal behavior. Methods A comprehensive search will be conducted in electronic medical databases including MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, PsycARTICLES, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang data, VIP Chinese Science and Technology Periodicals, Citation Information by NII, Koreanstudies Information Service System, Korea Citation Index, Research Information Sharing Service, Oriental Medicine Advanced Searching Integrated System, and Korean Medical database. Interventional studies regardless of its design to assess the role of acupuncture on suicide prevention will be included. The validated measure of suicidal ideation including Beck scale for suicidal ideation will be considered as a primary outcome. The validated tools will be used to assess methodological quality of included studies according to its design (e.g., Cochrane Collaboration's risk of bias tool-2). If sufficient homogeneous data from controlled clinical trials exist, a quantitative synthesis will be performed. According to the heterogeneity of included studies, either a random-effects or fixed-effects model will be used. Discussion The findings of this systematic review and meta-analysis will help to address the emerging major public health problem, suicide, in terms of evidence-based medicine.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, 52–57, Yangjeong-ro, Busanjin-gu, Busan, Republic of Korea,* Correspondence: ; Tel: +82518508808; Fax: +82518675162
| | - Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon, Republic of Korea
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Acupuncture for polycystic ovary syndrome – A cross-sectional survey of clinical practice amongst acupuncturists trained in reproductive medicine. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Graca S, Citkovitz C. From Bench to Bedside and Back Again: Developments in the Evidence-Informed Practice (and Practice-Informed Research) of Acupuncture. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:613-617. [PMID: 35862030 DOI: 10.1089/jicm.2022.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sandro Graca
- Department of Research, Northern College of Acupuncture, York, United Kingdom
| | - Claudia Citkovitz
- Massachusetts College of Pharmacy and Health Sciences, New England College of Acupuncture, Worcester, MA, USA
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Citkovitz C, Taylor-Swanson LJ, Davis R, Harris RE, Kligler B, Kong JT, Lao L, Mao J, Moré AOO, Napadow V, Rubin LH, Schnyer R, Wayne PD, Witt CM. Turning Point: A Review of Key Research and Engagement in 2021. J Altern Complement Med 2021; 27:1018-1022. [PMID: 34842451 DOI: 10.1089/acm.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Robert Davis
- Acupuncture Vermont Oriental Medical Clinic, South Burlington, VT, USA
| | - Richard E Harris
- Division of Rheumatology, Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Jiang-Ti Kong
- Department of Anesthesiology Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, USA
| | - Jun Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Vitaly Napadow
- Center for Integrative Pain Neuroimaging, Harvard Medical School, Boston, MA, USA
| | | | - Rosa Schnyer
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Peter D Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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