1
|
Lessens DM, Rakel D. The DASH Diet. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
2
|
|
3
|
Hampton A, Rakel D. Journaling for Health. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Rakel D, Fortney L. The Healing Encounter. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
5
|
Rakel D, Rindfleisch JA, Gaudet T. The Whole Health Process. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Rakel D. Benign Prostatic Hyperplasia. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Atwood KA, Shamblen SR, Gaudet T, Rindfleisch A, Collins DA, Milovani C, Greenfield R, Kiefer D, Rakel D. Impact of a Clinical Educational Effort in Driving Transformation in Health Care. Fam Med 2016; 48:711-719. [PMID: 27740671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to assess whether a 2.5 day clinical education course focused on integrative medicine (IM), complementary health (CH), and patient-centered care strategies delivered to staff at Veteran Health Administration (VHA) facilities resulted in changes in attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies. The study also assessed whether there were differential impacts by participant characteristics. METHODS The study used a pre-post intervention group-only design with participants who completed self-report pre, post, and 2-month follow-up surveys. The course was delivered to 15 VHA facilities, reaching a total of 655 participants with 407 participants completing the 2-month follow-up survey (65% response rate). RESULTS Findings suggest that the clinical course was associated with changes in all outcomes at the 2-month follow-up, including attitudes, self-efficacy to engage in IM strategies, institutional support, perceived preparedness to discuss non-pharmaceutical approaches to care, intentions to engage in IM strategies, and greater engagement in IM behaviors during clinical encounters. Differential impacts were found for younger participants, longer tenured staff, non-nursing compared to nursing staff, and among those who volunteered as opposed to those who were required to attend. DISCUSSION AND CONCLUSIONS The study found significant positive changes in all outcomes measured at the 2-month follow-up. Positive impacts were found across a variety of participant characteristics. Findings suggest that this brief experiential course, designed to be a foundational strategy in driving transformation is effective in shifting attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies.
Collapse
|
8
|
Luchterhand C, Rakel D, Haq C, Grant L, Byars-Winston A, Tyska S, Engles K. Creating a Culture of Mindfulness in Medicine. WMJ 2015; 114:105-109. [PMID: 27073828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Well-documented challenges faced by primary care clinicians have brought growing awareness to the issues of physician wellness and burnout and the potential subsequent impact on patients. Research has identified mindfulness as a tool to increase clinician well-being and enhance clinician characteristics associated with a more patient-centered orientation to clinical care. OBJECTIVE The overall goal of our intervention was to promote the cultivation of mindful awareness throughout our health system, creating a culture of mindfulness in medicine. METHODS We developed a systems-level strategy to promote health and resilience for clinicians and patients by preparing a group of clinician leaders to serve as catalysts to practice and teach mindfulness. The strategy involved 3 steps: (1) select 5 primary care leaders to help foster mindfulness within both health care delivery and education; (2) provide funds for these leaders to attend advanced mindfulness training designed specifically for clinicians; and (3) foster mindfulness within our health system and beyond via collaborative planning meetings and seed money for implementation of projects. RESULTS All 5 leaders endorsed the personal value of the mindfulness training, with some describing it as life-changing. Within 8 months, 4 of the leaders fostered a wide variety of mindfulness activities benefitting colleagues, medical students, and patients across our state and beyond. CONCLUSION We found that the value received from our investment in mindfulness far exceeded our relatively low cost, although further evaluation is needed to prove this.
Collapse
|
9
|
Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med 2013; 11:412-20. [PMID: 24019272 PMCID: PMC3767709 DOI: 10.1370/afm.1511] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians. METHODS A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures. RESULTS Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales-Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale. CONCLUSIONS In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.
Collapse
|
10
|
Rakel D, Mundt M, Ewers T, Fortney L, Zgierska A, Gassman M, Barrett B. Value associated with mindfulness meditation and moderate exercise intervention in acute respiratory infection: the MEPARI Study. Fam Pract 2013; 30:390-7. [PMID: 23515373 PMCID: PMC3722506 DOI: 10.1093/fampra/cmt008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute respiratory infection (ARI) is among the most common, debilitating and expensive human illnesses. The purpose of this study was to assess ARI-related costs and determine if mindfulness meditation or exercise can add value. METHODS One hundred and fifty-four adults ≥50 years from Madison, WI for the 2009-10 cold/flu season were randomized to (i) wait-list control (ii) meditation or (iii) moderate intensity exercise. ARI-related costs were assessed through self-reported medication use, number of missed work days and medical visits. Costs per subject were based on cost of generic medications, missed work days ($126.20) and clinic visits ($78.70). Monte Carlo bootstrap methods evaluated reduced costs of ARI episodes. RESULTS The total cost per subject for the control group was $214 (95% CI: $105-$358), exercise $136 (95% CI: $64-$232) and meditation $65 (95% CI: $34-$104). The majority of cost savings was through a reduction in missed days of work. Exercise had the highest medication costs at $16.60 compared with $5.90 for meditation (P = 0.004) and $7.20 for control (P = 0.046). Combining these cost benefits with the improved outcomes in incidence, duration and severity seen with the Meditation or Exercise for Preventing Acute Respiratory Infection study, meditation and exercise add value for ARI. Compared with control, meditation had the greatest cost benefit. This savings is offset by the cost of the intervention ($450/subject) that would negate the short-term but perhaps not long-term savings. CONCLUSIONS Meditation and exercise add value to ARI-associated health-related costs with improved outcomes. Further research is needed to confirm results and inform policies on adding value to medical spending.
Collapse
Affiliation(s)
- David Rakel
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53715, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. 05. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study. Glob Adv Health Med 2013. [PMCID: PMC3875079 DOI: 10.7453/gahmj.2013.097cp.s05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Focus Area: Integrative Algorithms of Care
Collapse
Affiliation(s)
| | - Charlene Luchterhand
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Larissa Zakletskaia
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Aleksandra Zgierska
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Rakel
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
12
|
Barrett B, Hayney MS, Muller D, Rakel D, Ward A, Obasi CN, Brown R, Zhang Z, Zgierska A, Gern J, West R, Ewers T, Barlow S, Gassman M, Coe CL. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Ann Fam Med 2012; 10:337-46. [PMID: 22778122 PMCID: PMC3392293 DOI: 10.1370/afm.1376] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 11/11/2011] [Accepted: 12/19/2011] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study was designed to evaluate potential preventive effects of meditation or exercise on incidence, duration, and severity of acute respiratory infection (ARI) illness. METHODS Community-recruited adults aged 50 years and older were randomized to 1 of 3 study groups: 8-week training in mindfulness meditation, matched 8-week training in moderate-intensity sustained exercise, or observational control. The primary outcome was area-under-the-curve global illness severity during a single cold and influenza season, using the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) to assess severity. Health care visits and days of missed work were counted. Nasal wash collected during ARI illness was assayed for neutrophils, interleukin-8, and viral nucleic acid. RESULTS Of 154 adults randomized into the study, 149 completed the trial (82% female, 94% white, mean age 59.3 ± 6.6 years). There were 27 ARI episodes and 257 days of ARI illness in the meditation group (n = 51), 26 episodes and 241 illness days in the exercise group (n = 47), and 40 episodes and 453 days in the control group (n = 51). Mean global severity was 144 for meditation, 248 for exercise, and 358 for control. Compared with control, global severity was significantly lower for meditation (P = .004). Both global severity and total days of illness (duration) trended toward being lower for the exercise group (P=.16 and P=.032, respectively), as did illness duration for the meditation group (P=.034). Adjusting for covariates using zero-inflated multivariate regression models gave similar results. There were 67 ARI-related days of-work missed in the control group, 32 in the exercise group (P = .041), and 16 in the meditation group (P <.001). Health care visits did not differ significantly. Viruses were identified in 54% of samples from meditation, 42% from exercise, and 54% from control groups. Neutrophil count and interleukin-8 levels were similar among intervention groups. CONCLUSIONS Training in meditation or exercise may be effective in reducing ARI illness burden.
Collapse
Affiliation(s)
- Bruce Barrett
- Department of Family Medicine, University of Wisconsin - Madison, 1100 Delaplaine Ct, Madison, WI 53715, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Barrett B, Rakel D, Hayney M, Muller D, Zgierska A, Obasi C, Ewers T, West R, Brown R, Zhang Z, Gassman M, Barlow S, Coe C. P02.36. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. BMC Complement Altern Med 2012. [PMCID: PMC3373942 DOI: 10.1186/1472-6882-12-s1-p92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
14
|
Rakel D. Laboratory Testing Resources in Integrative Medicine. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
|
16
|
|
17
|
Rakel D, Jonas W. Creating Optimal Healing Environments. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
18
|
Abel R, Ali A, Ammon P, Barrett B, Bell IR, Bergquist PE, Bodemer AA, Bonakdar RA, Capra JM, Coeytaux RR, Dahmer SM, Dandurand DE, Dattner AM, Degenhardt B, Desai AD, Desai GJ, Devries S, Dowling DJ, Dusek J, Earl CJ, Earley B, Eichenseher J, Figurski AC, Fortney L, Gagné L, Galland L, Gardiner P, Gordon A, Grassmann J, Greenfield RH, Gurgevich S, Hameed FA, Hanaway PJ, Harvie J, Hernke MT, Hewitt MJ, Hirekatur RS, Horwitz RJ, Humphreys C, Ivker RS, Jernberg J, Jonas W, Kaufman AJ, Kemper KJ, Khalsa DS, Khan SK, Kiefer D, Kligler B, Kohatsu W, Kuphal GJ, Lee RA, Lessens DM, Linkner E(L, Onna Lo YM, Locke AB, Lovett EA, Dog TL, Lumpkin M, Lupiani JH, Maizes V, Maker-Clark G, Mallory DJ, Mann JD, Marchand LR, Mark JD, Massey PB, McBride PE, McClure MW, Temple LM, Mertz MJ, Michelfelder AJ, Muller D, Mumber MP, Myers H, Nahas R, Naiman R, Najm WI, Newmark SC, Nicolai JP, Olshansky B, Pai ST, Park D, Perlman AI, Pierce S, Platt J, Plotnikoff GA, Podein RJ, Rabago D, Rakel D, Reed G, Rhode R, Rindfleisch JA, Ring M, Rosen LD, Rosenberger L, Rossman ML, Saper RB, Schneider C, Schubiner H, Selfridge NJ, Sethi T, Silverman H, Simmons AD, Smith C, Smith PW, St. John TM, Stanton A, Stevans JM, Stoler L, Sudak NL, Teitelbaum J, Underbakke G, Utzinger-Wheeler ML, Warne D, Warshowsky A, Weil A, Weydert JA, Wilhite M, Wissink T, Wolf AJ, Wu J, Zager SH, Zgierska A. Contributors. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
19
|
Lumpkin M, Rakel D. Relaxation Techniques. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, Scheder J. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns 2011; 85:390-7. [PMID: 21300514 PMCID: PMC3107395 DOI: 10.1016/j.pec.2011.01.009] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold. METHODS We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, "standard" interaction or an "enhanced" interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 h later. RESULTS Patients' perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p=0.04) and duration (perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count (perfect: 49, sub-perfect: 12, p=0.09). CONCLUSIONS When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change. PRACTICE IMPLICATIONS This study helps us to understand the importance of the perception of empathy in a therapeutic encounter.
Collapse
Affiliation(s)
- David Rakel
- Department of Family Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
|
23
|
Rakel D. Show health the money. WMJ 2009; 108:295. [PMID: 19813496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- David Rakel
- Dept. of Family Medicine, University of Wisconsin Integrative Medicine, University of Wisconsin School of Medicine and Public Health, 595 Science Dr. Madison, WI 53711, USA.
| |
Collapse
|
24
|
Kligler B, Lebensohn P, Koithan M, Schneider C, Rakel D, Cook P, Kohatsu W, Maizes V. Measuring the "whole system" outcomes of an educational innovation: experience from the integrative family medicine program. Fam Med 2009; 41:342-349. [PMID: 19418283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Six family medicine residency programs in the United States collaborated on the development and implementation of an integrative family medicine (IFM) program, which is a postgraduate training model that combines family medicine residency training with an integrative medicine fellowship. This paper reports on effects of IFM on residency programs and clinical systems in which it was implemented. METHODS We used the Integrative Medicine Attitudes Questionnaire (IMAQ) to assess participants' attitudes toward integrative medicine before and after the program was implemented. We assessed residency program recruitment success before and after the program was implemented. We conducted interviews with key informants at each program to evaluate the effects of the IFM on the six participating residency programs. RESULTS IMAQ scores demonstrated a significant increase in the acceptance of integrative medicine after implementation of IFM. Recruiting data showed that participating programs filled at a rate consistently above the national average both before and after implementation. Analysis of interview data showed that programs became more open to an integrative medicine (IM) approach and offered a wider range of clinical services to patients. CONCLUSIONS Our mixed-methods strategy for evaluation of IFM showed that implementing the program increased acceptance of IM, did not affect residency fill rates, and increased use of IM in clinical practice. The combination of quantitative and qualitative methods was an effective strategy for documenting the "systems level" effects of a new educational program.
Collapse
Affiliation(s)
- Benjamin Kligler
- Arizona Center for Integrative Medicine/Beth Israel Residency in Urban Family Practice.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Rakel D. A new model of care. Acad Med 2009; 84:289-290. [PMID: 19240425 DOI: 10.1097/acm.0b013e318197259b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
26
|
Abstract
Irritable bowel syndrome (IBS) is one of the most common conditions seen in primary care settings. Despite this, there is no consensus as to the pathogenesis of this disorder or a consistently effective therapeutic regimen for many patients. This has encouraged the use of various alternative therapies from behavioral or complementary medicine. This review will address the evidence for alternative therapies, including the following: cognitive behavior therapy, hypnosis, elimination diets based on food antibody testing, nutrition supplements (such as fiber, probiotics, and prebiotics), and, finally, peppermint, l-glutamine, zinc, and cromolyn sodium. The review also explores the evidence for and the therapeutic ramifications of the hypothesis that increased intestinal permeability underlies the symptoms of IBS in many patients, and how a therapeutic plan that addresses nutrition, elimination diets, and nutrition supplements may be useful in restoring the integrity of the gut immune barrier.
Collapse
Affiliation(s)
- Arnold Wald
- Section of GI and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | | |
Collapse
|
27
|
Abstract
Primary care in America is in need of a rescue. Clinicians are asked to see more patients in a day that only allows time to focus on a physical symptom or disease process. They do not have time or space to use their humanism to develop insight toward what the patient needs for the symptom to resolve, and they are often forced to suppress it with technology. This results in a very expensive medical system that leads to frustration for a clinician who realizes that this is not the way toward facilitating health. This clinically focused paper proposes the incorporation of a healing-oriented session into the delivery of primary care to bring focus toward the creation of health (salutogenesis). A salutogenesis-oriented session (SOS) honors relationship-centered care and will provide a unit that can then be studied to see if it has a positive influence on cost, quality of care, and provider satisfaction.
Collapse
Affiliation(s)
- David Rakel
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|
28
|
Elder W, Rakel D, Heitkemper M, Hustedde C, Harazduk N, Gerik S, Haramati A. Using complementary and alternative medicine curricular elements to foster medical student self-awareness. Acad Med 2007; 82:951-5. [PMID: 17895654 DOI: 10.1097/acm.0b013e318149e411] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To determine the value that the National Center for Complementary and Alternative Medicine (NCCAM)-funded Education Project leaders placed on self-awareness objectives among their curricular activities, to identify projects' rationales for inclusion of self-awareness activities, and to describe curricular elements used to teach self-awareness. METHOD A survey was distributed to the NCCAM Education Project grantees in October 2006. Survey items sought to identify project directors' perceived importance of self-awareness activities in complementary and alternative medicine (CAM) curricula, rationales for inclusion of self-awareness activities, and activities to foster self-awareness. Invited reports described in more depth the specific activities in three of the projects. RESULTS Fourteen of 15 reporting NCCAM educational projects rated activities to promote self-awareness as highly or very highly valued components, and all projects incorporated numerous strategies to enhance self-awareness. Learning objectives ranged from basic knowledge about mind-body relationships and psychoneuroimmunology, to evidence and indications for mind-body interventions, to training in self-application, to training for intervention with patients. Specific strategies that increase students' self-awareness included evidence-based CAM activities to help students recognize personal biases that may impair critical thinking; personal health experiences to expand definition of health beliefs; and mind-body medicine skills groups to personally integrate the use of mind-body techniques for wellness and stress management. CONCLUSIONS Incorporating some of these CAM curricular activities, didactically or experientially, may be a unique way to foster student self-awareness and personal growth.
Collapse
Affiliation(s)
- Willam Elder
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0284, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Rakel D, Riley M. Recurrent Aphthous Ulceration. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
30
|
|
31
|
Rakel D, Mercado MA. Breathing Exercises. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Rakel D, Rindfleisch JA. The Anti-Inflammatory Diet. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
Sierpina V, Kreitzer MJ, Rakel D, Shelley B, Hedgecock J, Prasad A. Innovations in integrative healthcare education: the AMSA CAM education projects and the University of New Mexico Integrative Medicine Program. Explore (NY) 2006; 2:368-70. [PMID: 16846829 DOI: 10.1016/j.explore.2006.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
34
|
Kreitzer MJ, Sierpina V, Rakel D, Bauer B. Innovations in integrative healthcare education: consortium expands with the addition of the University of Wisconsin and the Mayo Medical Center. Explore (NY) 2006; 2:457-8. [PMID: 16979114 DOI: 10.1016/j.explore.2006.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Maizes V, Silverman H, Lebensohn P, Koithan M, Kligler B, Rakel D, Schneider C, Kohatsu W, Hayes M, Weil A. The integrative family medicine program: an innovation in residency education. Acad Med 2006; 81:583-9. [PMID: 16728816 DOI: 10.1097/01.acm.0000225225.35399.e4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The Integrative Family Medicine (IFM) Program is a four-year combined family medicine residency program and integrative medicine fellowship. It was created in 2003 to address the needs of four constituencies: patients who desire care from well trained integrative physicians, physicians who seek such training, the health care system which lacks a conventional integrative medicine training route, and educational leaders in family medicine who are seeking new strategies to reverse the declining interest in family medicine amongst U.S. graduates. The program was designed jointly by the University of Arizona Program in Integrative Medicine (PIM) and family medicine residency programs at Beth Israel/Albert Einstein College of Medicine (AECOM), Maine Medical Center, Middlesex Hospital, Oregon Health & Science University, and the Universities of Arizona and Wisconsin. One or two residents from each of these institutions may apply, and when selected, commit to extending their training by a fourth year. They complete their family medicine residencies at their home sites, enroll in the distributed learning associate fellowship at PIM, and are mentored by local faculty members who have training in integrative medicine. To date three classes totaling twenty residents have entered the program. Evaluation is performed jointly: PIM evaluates the residents during residential weeks and through online modules and residency faculty members perform direct observation of care and review treatment plans. Preliminary data suggest that the program enhances interest amongst graduating medical students in family medicine training. The Accreditation Council of Graduate Medical Education Family Medicine residency review committee has awarded the pilot experimental status.
Collapse
Affiliation(s)
- Victoria Maizes
- Program in Integrative Medicine, University of Arizona, Tucson, Arizona 85724, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Placebos are boon and bane to medical theory and clinical practice. On the one hand, randomized controlled trials employ concealed allocations of placebo to control for effects not due to specific pharmacological mechanisms. As a result, nearly all of evidence-based medicine derives from principles and practices based on placebo. On the other hand, medical researchers and physicians have tended to ignore, minimize, or deride placebos and placebo effects, perhaps due to values emphasizing scientific understanding of mechanistic pathways. We argue that intention, expectation, culture, and meaning are central to placebo-effect phenomena and are substantive determinants of health. We introduce three dualities that are integral to placebo/meaning phenomena: body-mind, subconscious-conscious, and passive-active. These placebo-related dualities should be acknowledged, explored with research, and incorporated in theory. While we view consideration of placebo and meaning effects as essential to any adequate understanding of human health, we feel that lessons from this area of inquiry may already provide practical tools for astute clinicians. Toward this end, we list eight specific clinical actions: speak positively about treatments, provide encouragement, develop trust, provide reassurance, support relationships, respect uniqueness, explore values, and create ceremony. These clinical actions can empower patients to seek greater health and may provide a healthful sense of being cared for.
Collapse
Affiliation(s)
- Bruce Barrett
- Department of Family Medicine, University of Wisconsin-Madison, 777 South Mills, 53715, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Rakel D, Rindfleisch A. Optimal Healers: Igniting the Spark and Fanning the Flame. Training Academic Medical Faculty in Optimal Healing. J Altern Complement Med 2004. [DOI: 10.1089/acm.2004.10.s-113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Rakel
- Department of Family Medicine, University of Wisconsin Medical School, Fitchburg, WI
| | - Adam Rindfleisch
- Department of Family Medicine, University of Wisconson Medical School, Madison, WI
| |
Collapse
|
38
|
Rakel D, Rindfleisch A. Optimal Healers: Igniting the Spark and Fanning the Flame. Training Academic Medical Faculty in Optimal Healing. J Altern Complement Med 2004; 10 Suppl 1:S113-20. [PMID: 15630828 DOI: 10.1089/1075553042245827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Optimal healing environments (OHEs) require optimal healers to keep them flourishing. Academic medical faculty are in a unique position, through their involvement in education, research, and leadership, to create and perpetuate OHEs. Means by which they might do so using a motivational interviewing model as a framework are discussed. A four-part process to facilitate faculty involvement is described: (1) means of assessing interest in creating OHEs; (2) methods for moving interested individuals beyond a merely intellectual interest to a deeper level of commitment; (3) ways of providing optimal healers with the tools they will need to successfully create OHEs; and (4) perpetuation of OHEs through support networks and educational methods. Resources and examples which can guide the creation of an optimal healing curriculum are provided.
Collapse
Affiliation(s)
- David Rakel
- Department of Family Medicine, University of Wisconsin Medical School, Fitchburg, WI 53711, USA.
| | | |
Collapse
|
39
|
Barrett B, Marchand L, Scheder J, Plane MB, Maberry R, Appelbaum D, Rakel D, Rabago D. Themes of holism, empowerment, access, and legitimacy define complementary, alternative, and integrative medicine in relation to conventional biomedicine. J Altern Complement Med 2004; 9:937-47. [PMID: 14736364 DOI: 10.1089/107555303771952271] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Complementary and alternative medicine (CAM) has been defined largely in relation to conventional biomedicine. CAM therapies that are used instead of conventional medicine are termed "alternative." CAM therapies used alongside conventional medicine are said to be "complementary." "Integrative medicine" results from the thoughtful incorporation of concepts, values, and practices from alternative, complementary, and conventional medicines. The evolving process of integration between CAM and conventional medicine evokes new conceptual frameworks, as well as new terminology. Interview-based qualitative research at the University of Wisconsin-Madison seeks to probe and develop this theoretical structure. Interviews with users and practitioners of CAM therapies have revealed four primary themes: holism, empowerment, access, and legitimacy (HEAL). These themes characterize CAM and contrast it with conventional medicine. CAM is said to be more holistic and empowering yet less legitimate than conventional medicine. CAM is more intuitive; conventional is more deductive. While CAM is perhaps more psychologically accessible to many patients in that it better reflects commonly held values, it is often less financially and institutionally accessible, at least for those with conventional health insurance and limited income. Substantive barriers--including economic, organizational and scientific differences, as well as an apparent widespread lack of understanding--continue to thwart attempts at integration. More and better evidence is needed if CAM therapies are to be accepted by mainstream medicine. State-of-the-art research methods developed by conventional science will be needed to test CAM therapies. Conventional medicine, however, has much to learn from CAM. By incorporating a more holistic, empowering and accessible therapeutic approach, conventional medicine could build on its present legitimacy, and thereby enhance its power to "HEAL."
Collapse
Affiliation(s)
- Bruce Barrett
- Department of Family Medicine, University of Wisconsin Medical School, 777 South Mills, Madison, WI 53715, USA.
| | | | | | | | | | | | | | | |
Collapse
|