Battlefield acupuncture appears to be an effective therapy for pain management

2021 ◽  
pp. 096452842110506
Author(s):  
Hyaehwan Kim ◽  
Ronald Markert ◽  
Kathryn Burtson
Keyword(s):  
Internal Medicine ◽  
Pain Management ◽  
Standard Care ◽  
Insertion Site ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Adjunct Therapy ◽  
Medical Treatment Facility

Introduction: The Department of Defense has been training primary care providers in battlefield acupuncture (BFA), a subtype of auricular acupuncture, as an adjunct therapy for pain management. Methods: The objective of this study was to evaluate the effectiveness and safety of BFA for pain management in an outpatient Internal Medicine clinic staffed by resident physicians. The target population for this single-center prospective cohort study were military beneficiaries at a medical treatment facility located at the Wright-Patterson Air Force Base. Participants who met inclusion criteria were treated with BFA in addition to routine standard care for pain (n = 69). The control group was composed of participants who received routine standard care only without BFA (n = 27). Pain was assessed by a self-reported pain scale (0–10) at the time of encounter, immediately after BFA (for the intervention group), then at 24 and 48 h afterwards. Results: Mean pain for the intervention group decreased from 5.45 before BFA to 3.29 immediately following BFA to 2.21 at 24 h and to 2.10 at 48 h (p < 0.001). Thus, at all three post-treatment time points, mean decrease in pain surpassed a two-point reduction, deemed to be a clinically important difference. The BFA group had a greater reduction in pain compared to the no intervention group at 24 h (3.14 vs 0.59, p < 0.001) and at 48 h (3.26 vs 0.96, p < 0.001). Four intervention group participants (6%) reported an adverse reaction (three with pain at the insertion site) or complication (one with superficial infection). Conclusion: BFA provided by Internal Medicine residents appears to be a safe and effective adjunct therapy for pain management in an outpatient setting, but requires further validation by randomized controlled trials.

scholarly journals Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain:

2020 ◽  
Vol 52 (3) ◽  
pp. 189-197
Author(s):  
Ann Marie Chiasson ◽  
Audrey J. Brooks ◽  
Mari Ricker ◽  
Patricia Lebensohn ◽  
Mei-Kuang Chen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Family Medicine ◽  
Self Efficacy ◽  
Medical Knowledge ◽  
Primary Care Providers ◽  
Control Group ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Patients

Background and Objectives: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. Methods: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. Results: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P&lt;.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). Conclusions: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.

Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial

2018 ◽  
Vol 26 (1-2) ◽  
pp. 21-27 ◽  
Author(s):  
Linda H Eaton ◽  
Daniel S Godfrey ◽  
Dale J Langford ◽  
Tessa Rue ◽  
David J Tauben ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Controlled Trial ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Perceived Competence ◽  
Control Group ◽  
Care Providers ◽  
Knowledge And Attitudes ◽  
Randomised Controlled

Introduction Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management. Methods The study design was a cluster randomised controlled trial. Primary care clinics that were part of the University of Washington Medicine Telehealth network were the unit of randomization. Primary care providers comprised the intervention group ( n = 23) and the control group ( n = 18). Providers in the intervention group attended telementoring sessions through the TelePain programme and presented patient cases at the beginning and end of their enrolled patients’ 12-week study period. TelePain sessions included a didactic presentation and telementoring for specific patient cases by a panel of pain specialists from the disciplines of pain medicine, internal medicine, anaesthesiology, rehabilitation medicine, psychiatry, addiction medicine, nursing and complementary and integrative pain management. Providers’ baseline and end-of-study knowledge and perceived competence in managing chronic pain were assessed by three questionnaires: Knowledge and Attitudes Survey Regarding Pain, the KnowPain-12 and the Perceived Competence Scale. Results Knowledge (Z = –0.34, p = 0.97 (Knowledge and Attitudes Survey Regarding Pain) and Z = 0.49, p = 0.62 (KnowPain-12)) and perceived competence (Z = –0.74, p = 0.46) did not increase for providers in the intervention group compared with providers in the control group. These providers attended on average 12.5 sessions (range 0–31) while participating in the study. Discussion Further research is recommended to establish the effectiveness of this telementoring intervention.

scholarly journals Patient Discomfort and Resident Confidence After Knee Intra-articular Injection Simulation Training: A Randomized Control Trial Study

2018 ◽  
Vol 11 ◽  
pp. 117954411878290 ◽  
Author(s):  
Adae O Amoako ◽  
George GA Pujalte ◽  
Neha Kaushik ◽  
Timothy Riley
Keyword(s):  
Primary Care ◽  
Simulation Training ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Control Group ◽  
P Value ◽  
Care Providers ◽  
Patient Discomfort ◽  
The Mean

Teaching primary care providers how to perform musculoskeletal procedures has become increasingly important as more and more patients with orthopedic conditions present in primary care clinics. This study aims to evaluate whether targeted simulation model training in residency can increase residents’ comfort level in performing intra-articular knee injections and decrease the pain of the procedure, as reported by patients injected. Residents were randomized into intervention and control groups. The comfort level of the residents as well as the pain levels from the procedures, as reported by patients, was recorded. The mean comfort level for the intervention group was 1.2, compared with that in the control group, which was 2.13; P value was .047. The mean pain level in the intervention group was 1.8, whereas in the control group was 3.63; P value was .156. Simulation training may boost residents’ comfort level, but not necessarily decrease patient discomfort during intra-articular knee injections.

Results of a randomized controlled study of personalized care plans in breast cancer survivors from a single institution.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 109-109 ◽  
Author(s):  
Rashida Haq ◽  
Christine Brezden-Masley ◽  
Ronita Lee ◽  
Suzanne Richter ◽  
Ralph L. George ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Qualitative Analysis ◽  
Cancer Survivors ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Controlled Study ◽  
Control Group ◽  
Care Providers ◽  
Post Intervention ◽  
Care Plans

109 Background: In 2006, Institute of Medicine recommended care plans for coordination of care of cancer survivors. Our pilot study of multifaceted care plans met information and communication needs of breast cancer (BC) survivors and their primary care providers (PCP). In this study, a Personalized Multifaceted Care Plan (PMCP) was developed, implemented and evaluated. Methods: This was a randomized study with mixed methods design. Upon REB approval, 78 women diagnosed with invasive BC for adjuvant treatments were recruited from the breast clinic from June 2013 to March 2015. After informed consent, participants were randomized to the control or the intervention group and stratified to chemotherapy (CT) vs. endocrine therapy (ET). The intervention group received a PMCP (paper based treatment and care plans (TP & CP) with information on breast pathology, treatment sequence, supportive care and follow-up guidelines with access to a website). CT arm patients received a TP at the start of therapy and a CP at completion. ET patients received the CP upfront. Quantitative outcomes were assessed by 3 standardized questionnaires at baseline and following treatment. Within-group baseline and post-intervention scores were compared using paired t-tests. The post-intervention control group and intervention group’s scores were compared using unpaired t-tests. In the intervention group, qualitative analysis was done through focus groups of BC survivors & PCP interviews. Results: Baseline scores in the mean intervention and control groups were similar. In the CT arm of the intervention group, post-intervention scores on Communication and Efficacy Scale showed statistically significant increase (p < 0.05, 95% CI). Results in the control group and in the intervention group of patients on ET were not significantly different. Focus group participants commented that the PMCP helped them feel ‘educated’ and engaged in their cancer treatment and their PCPs found the PMCP contained useful, concise medical summaries. Conclusions: Upfront PMCP improves self-efficacy scores in patients on CT. Qualitative analysis substantiates the benefits of PMCP. PMCP should be standard of care in BC survivors receiving CT.

Abstract 167: An Innovative mHealth-based Care Model for Improving Hypertension Control in Stroke Survivors

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kamakshi Lakshminarayan ◽  
Sarah Westberg ◽  
Mustapha Ezzeddine ◽  
Stuart Speedie ◽  
Candace Fuller ◽  
...  
Keyword(s):  
Usual Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Primary Care Providers ◽  
System Level ◽  
Control Group ◽  
Stroke Survivors ◽  
Care Providers ◽  
Care Model ◽  
Survey Question

Background: Hypertension (HTN) is the most important modifiable risk factor for stroke prevention. Unfortunately, HTN is considerably under-treated in stroke survivors. Purpose: Our AHRQ funded study (R21 HS021794) examined the usability and feasibility of a mHealth (mobile health technology) based care model for improving HTN control rates in stroke survivors. Methods: Design was a 2 group randomized controlled trial. Total study duration was 120 days. HTN control was defined as Systolic BP (SBP) less than 140 mm Hg based on the AHA stroke guidelines. HTN control was evaluated in participants at study enrollment and completion. Intervention Group: Patients used a smart phone and wireless BP monitor to measure their BP. Patients were requested to measure their BP daily which was transmitted automatically to the study database. Study investigators (Physician + PharmD) reviewed BP weekly and, made needed medication adjustments bi-weekly. Primary care providers (PCP) were involved in the decision making via the electronic medical record. Control Group: Patients received a digital BP monitor and were educated on the importance of HTN control and asked to follow up with their PCP as usual (usual care). Intervention patients completed a Marshfield System Usablity Survey. Possible responses to usability questions were 1=strongly disagree, 2=agree, 3=neither agree or disagree, 4=agree, 5=strongly agree. Results: Total 50 patients completed the study (Table). Intervention patients transmitted BP a total of 92% of observation days and, rated mHealth as highly usable, Mean Marshfield System Usability Survey question response “I thought the system was easy to use” was 4.7. HTN control was significantly more effective in the intervention group (Table). Conclusion: A mHealth based model of HTN care was highly feasible and clinically more effective than usual care in stroke survivors. We propose that this care model be evaluated at a health system level.

scholarly journals 43 Addressing Polypharmacy in the Frail Older Person - the WIDE (Wholistic, Integrated, Deprescribing, Evaluation) Review

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Clare Kinahan ◽  
Nazir Soomro ◽  
Florrie Daniels ◽  
Wafaa Hussain ◽  
Helen Heery
Keyword(s):  
Medication Review ◽  
Hospital Pharmacist ◽  
Intervention Group ◽  
Cost Savings ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Start Criteria ◽  
The Impact ◽  
Medication Appropriateness

Abstract Background People are living longer, with more chronic conditions and are prescribed more medications according to disease specific guidelines. The WIDE Review is an innovative model of comprehensive medication review devised to treat the whole patient. Frail patients are twice as likely to be prescribed inappropriate medications and are more vulnerable to their harmful effects. Use of the STOPP/START criteria and the Medication Appropriateness Index (MAI) have been shown to improve patient outcomes. This study examined the impact and cost effectiveness of pharmacist led WIDE Reviews. Methods This quantitative prospective cohort study was conducted over 8 weeks in a Model 3 hospital. Inclusion criteria: inpatients age > 65 years; prescribed > 6 regular medications and screened positive for frailty (PRISMA 7 score >3). Critically ill patients were excluded. Eligible patients were randomly allocated to intervention or control group. The intervention group received a pharmacist led WIDE Review: Wholistic (establishing patients' priorities), Integrated (collaborating with primary care providers), Deprescribing Evaluation of medication harms versus benefits. Medications were screened using the STOPP/START criteria and the MAI was calculated. In conjunction with the patients and their consultants, deprescribing plans were devised and communicated to their GPs and community pharmacists Results A total of 20 intervention and 20 control group patients were enrolled. Patient characteristics (age, sex and length of stay) were similar for both groups. 65% of STOPP and 62% of START criteria were addressed in the intervention group versus 12% and 5% respectively in the control group. In the intervention group 83 medications were stopped, 23 dose reduced and the total MAI score was reduced by 64%. Cost savings to the annual drug budget alone represented a 9:1 return on investment of hospital pharmacist time. Conclusion Pharmacists performing WIDE Reviews significantly improved medication appropriateness and realised compelling cost savings. A larger scale study of this innovative approach to medication review is planned.

scholarly journals The effects of Enhanced Primary Healthcare interventions on primary care providers’ job satisfaction

2020 ◽  
Author(s):  
Wen Jun Wong ◽  
Aisyah Mohd Norzi ◽  
Swee Hung Ang ◽  
Chee Lee Chan ◽  
Faeiz Syezri Adzmin Jaafar ◽  
...  
Keyword(s):  
Primary Care ◽  
Job Satisfaction ◽  
Primary Healthcare ◽  
Healthcare Delivery ◽  
Intervention Group ◽  
Well Being ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Post Intervention

Abstract Background: In response to the rising burden of cardiovascular risk factors, the Malaysian government has implemented Enhanced Primary Healthcare (EnPHC) interventions in July 2017 at public clinic level to improve management and clinical outcomes of type 2 diabetes and hypertensive patients. Healthcare providers (HCPs) play crucial roles in healthcare service delivery and health system reform can influence HCPs’ job satisfaction. However, studies evaluating HCPs’ job satisfaction following primary care transformation remain scarce in low- and middle-income countries. This study aims to evaluate the effects of EnPHC interventions on HCPs’ job satisfaction. Methods: This is a quasi-experimental study conducted in 20 intervention and 20 matched control clinics. We surveyed all HCPs who were directly involved in patient management. A self-administered questionnaire which included six questions on job satisfaction were assessed on a scale of 1-4 at baseline (April and May 2017) and post-intervention phase (March and April 2019). Unadjusted intervention effect was calculated based on absolute differences in mean scores between intervention and control groups after implementation. Difference-in-differences analysis was used in the multivariable linear regression model and adjusted for providers and clinics characteristics to detect changes in job satisfaction following EnPHC interventions. A negative estimate indicates relative decrease in job satisfaction in the intervention group compared with control group. Results: A total of 1042 and 1215 HCPs responded at baseline and post-intervention respectively. At post-intervention, the intervention group reported higher level of stress with adjusted differences of -0.139 (95% CI -0.266,-0.012; p=0.032). Nurses, being the largest workforce in public clinics were the only group experiencing dissatisfaction at post-intervention. In subgroup analysis, nurses from intervention group experienced increase in work stress following EnPHC interventions with adjusted differences of -0.223 (95% CI -0.419,-0.026; p=0.026). Additionally, the same group were less likely to perceive their profession as well-respected at post-intervention (β= -0.175; 95% CI -0.331,-0.019; p=0.027]). Conclusions: Our findings suggest that EnPHC interventions had resulted in some untoward effect on HCPs’ job satisfaction. Job dissatisfaction can have detrimental effects on the organisation and healthcare system. Therefore, provider experience and well-being should be considered before introducing healthcare delivery reforms to avoid overburdening of HCPs.

scholarly journals Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 463
Author(s):  
Mar Gomis-Pastor ◽  
Sonia Mirabet Perez ◽  
Eulalia Roig Minguell ◽  
Vicenç Brossa Loidi ◽  
Laura Lopez Lopez ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Experience ◽  
Mobile Application ◽  
Standard Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Adherence Score

Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

Efficacy of adjuvant phosphatidylcholine in the management of egyptian patients with non alcoholic fatty liver disease (NAFLD)

2021 ◽  
Vol 6 (8) ◽  
Keyword(s):  
Liver Disease ◽  
Fatty Liver Disease ◽  
Standard Care ◽  
Intervention Group ◽  
Control Group ◽  
Fibrosis Score ◽  
Alcoholic Fatty Liver ◽  
Nafld Fibrosis Score ◽  
Egyptian Patients ◽  
Alcoholic Fatty Liver Disease

Background and Aim: Non-Alcoholic Fatty Liver Disease (NAFLD) has become the most common liver disorder with increased liver related and non-related complications and mortality as a result of increasing obesity, type 2 diabetes and metabolic syndrome (MetS). The current study aims to evaluate the efficacy of adjuvant phosphatidylcholine in treating patients with NAFLD. Methods: This interventional randomized controlled study recruited 100 patients with NAFLD and MetS randomized into: a control group (n=50) that received standard care of life style modifications and an intervention group (n=50) that received phosphatidylcholine (2100 gm/day) plus standard care. Both groups received health education through clinical pharmacist for achieving sustainable weight loss for 6 months. Body mass index (BMI), waist and hip circumference, liver function, lipid profile, homeostasis model of assessment-insulin resistance (HOMA-IR) score, NAFLD-fibrosis score, steatosis score and liver stiffness measurement by transient elastography were recorded at baseline, 3 and 6 months. Results: Intervention group showed significantly (p<0.05) higher number with normalized; alanine aminotransferase, total cholesterol and low density lipoprotein at midpoint and endpoint, aspartate amiontransferase at midpoint and high density lipoproteins and malondaldehyde at endpoint. Intervention group showed a significantly higher participants’ number who shifted to more favorable category of NAFLD-fibrosis score (p=0.02), radiological fibrosis stage (p=0.015) at endpoint, radiological steatosis grades and HOMA-IR score at midpoint and endpoint (p<0.05). Additionally, significant number of participants in intervention group (34%) lost MetS components compared to (10%) in control group at endpoint (p=0.004). Conclusion: Adjuvant phosphatidylcholine has shown laboratory, radiological and clinical benefits in the management of Egyptian patients with NAFLD and ameliorate MetS parameters.

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