HRS 4570 Quiz 1 (Everything)
Role of NCCIH
Conduct and support research and provide information about complementary health products and practices; committed to studying promising health approaches already in use by American public; integrative health care, which can be defined as combining complementary approaches into conventional treatment plans, has grown within care settings across the nation, including hospitals, hospices, and military health facilities
Era 1-Formation
-1960s-1980 -Choice in health care brought more time with provider, less technological interference, and a personal-relationship based approach to care -HMO Act (1973) passed by Nixon focused on health maintenance rather than a fee-for-service payment model -Biopsychosocial model emerged in primary care and desire for more quality care -WHO (1978) began pursuing goal of attaining primary care for all
Era 1-Formation
-1960s-1980 -Influence of values of the 1960s -Congressional briefing (1979) led by Charles Bezold, PhD international futurist, that a new trend was taking place: alternative medicine -Role of technology (viewed as driving wedge between patients and providers) -Professions coming into focus -Environmentalism
Era 2-Advancing the Silos
-1980-1995 -Lack of support -Lack of government support -Lack of philanthropic support (major foundations did not provide grants) -Professions developed via sweat equity and volunteerism -Focus was finding community for these providers -Health Freedom Movement: patient access to non-traditional medicine
Era 2-Advancing the silos
-1980-1995 -Separate campaign to mature fields and organizations -Period characterized by challenges related to identity and form -Providers interacting, each modality had their own campaign, challenges in organizations finding their identity
Era 3-Non-integrated integration
-1995-2001 -Professional building activities left one gap that leaders of conventional medicine identified as a problem: research -New England Journal of Medicine (1993) publication by Eisenberg changed perception of CAM use. This was evidence they were craving! Consumers were making choices that the dominant force of medicine was in the dark. (Insurers began making plans including CAM, hospitals included CAM) -Large medical delivery systems were becoming more like competitive businesses -Medical centers empowered to open integrative clinics
Era 4-Acting Through Consortia and Collaboratives
-2001-2010 -Development of many professional organization -JAMA article (1998) fueled understanding that even more patients were using CAM and therefore spending more money out of pocket. -Led to creation of new multi-player and multi-stakeholder interprofessional vehicles for action -IHPC-Integrative Health Care Policy Consortium -ACIMH-Academic Consortium for Integrative Medicine and Health -ACIH-Academic Collaborative for Integrative Health -Academy of Integrative Health and Medicine
Era 5-Convergence in Health Creation
-2010-? -ACA reform meant to shift incentives of medical industry from production on services to actual focus on health via Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs); more legitimacy as they serve in the US -Convergence resulted in ACIMH leading the Joint Commission, the organization that accredits the nation's medical delivery organizations, to substantially change its pain guidelines to include acupuncture therapy, chiropractic therapy, massage therapy, osteopathic manipulation (least invasive, non pharmacological approah) -Other organizations follow suite: American Public Health Association, US Health and Human Services National Plan Strategy, American College of Physicians
Academic Collaborative for Integrative Health (ACIH)
-Became voice of integrative professions -Important actions: -Education, Research, and Clinical working groups -Creation of CEDR _Primary Care Needs: Roles of DCs and NDs -IPE at National Academy of Medicine
Integrative Health Policy Consortium (IHPC)
-Grew out of informal collaboration efforts mid-1990s through Senator Harkin (D. Iowa) that if Cam interests could speak as one voice, they would have more impact federally. -Helped provide justification for creation of NCCAM -Placed integrative content in ACA (2010) -Formed state-to-state CovermyCare campaign to support action of Section 2706 of ACA (nondiscrimination in healthcare)--> could not discriminate against licensed professions in integrative medicine -Create formal responses to federal initiatives
Academic Consortium for Integrative Medicine and Health (ACIMH)
-Grew out of leaders at University of Maryland, Arizona, Harvard. Minnesota and other health centers. -Simultaneously, a group of philanthropists interested in IM decided to collaborate with focus on elevating field of IHM--funding -Important actions: regular research conferences, influence Joint Commission to clarify management standard (2014) -Ohio State is a member
Systematic Review
-High-level overview of primary research on a focused question that identifies, selects, synthesizes and appraises all high quality research evidence relevant to that question -Answers a focused clinical question and eliminates bias -Clearly defined and answerable clinical question; recommend using PICO as a guide -Components are pre-specified eligibility criteria, systematic search strategy, assessment of the validity of findings, interpretation and presentation of results, reference list -Three or more authors -Timeline is months to years; average eighteen months -Requirements are thorough knowledge of topic, perform searches of all relevant databases, statistical analysis resources (for meta-analysis) -Connects practicing clinicians to high quality evidence; supports evidence-based practice
Academy of Integrative Health and Medicine (AIHM)
-Physician level practitioners with an interest in IHM/CAM many of several groups -Important actions: Interprofessional conference, professional development and fellowship in IM Partner with other orgs (IHPC, ACIMH)
Literature Review
-Qualitatively summarizes evidence on a topic using informal or subjective methods to collect and interpret studies -Provides summary or overview of topic -Can be a general topic or a specific question -Components are introduction, methods, discussion, conclusion, reference list -One or more authors -Timeline is weeks to months -Requirements are understanding of the topic and perform searches of one or more databases -Value is that it provides summary of literature on a topic
NCCIH definition of IHM
Medicine that combines treatments from conventional medicine and complementary & alternative medicine (CAM) for which there is evidence of effectiveness and safety.
Tenets of biomedicine/technocratic medicine
Mind body separation The body as machine The patient as object Alienation of practitioner from patient Diagnosis and treatment from outside in Hierarchical organization and standardization of care Authority and responsibility inherent in practitioner, not patient Supervaluation of science and technology Aggressive intervention with emphasis on short-term results Death as defeat A profit-driven system Intolerance of other modalities
whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, energy medicine
National Center for Complementary and Integrative Medicine (NCCIM) funds scientific research in 5 domains:
Dr. Dean Ornish has found that comprehensive lifestyle changes can reverse?
heart disease
Fact about James Gordon
1. Developed the first national program for runaway and homeless youth 2. Founded and managed The Center for Mind-Body Medicine in 1991
What are the five values of IHM?
1. Using least invasive methods first 2. Partnering with others 3. Patient-centered or person-centered care 4. Promoting self-care 5. Creating health rather than treating disease
Herbert Benson
A cardiologist and professor at Harvard Medical School. Conducted research using monkeys that linked stress to physical health and the effects of Transcendental Meditation on blood pressure. Benson and Wallace found that subjects who practiced TM, and who were able to change thought patterns, experienced decreases in their metabolism, rate of breathing, and heart rate, and had slower brain waves. They believed the technique was useful for treating conditions such as insomnia, anxiety, hypertension, and chronic pain.
References
A list of the works cited by the author (s)
to fund and conduct research about complementary health approaches
According to SnL, what is the main mission of the National Center for Complementary and Alternative Medicine (now called, the National Center for Complementary and Integrative Medicine (NCCIH)?
Relevance
Sources that pertain to your research question; does the title have anything to do with your research question? is the publication date within your parameters; look at abstract to identify the question the article addresses; do the sources in the bibliography pertain to your research?
David Eisenberg
Was the first U.S. medical exchange student to the People's Republic of China. Currently, Dr. Eisenberg is the director of Harvard Medical School's Osher Research Center and is the program director of Integrative Medicine at Brigham and Women's Hospital in Boston, Massachusetts
ACIH (academic collaborative for integrative health) ACIMH (academic consortium for integrative medicine and health) AIHM (academy of integrative health and medicine) IHPC (integrative health policy consortium)
What are the 4 professional organizations?
Background information/expert opinion; case-controlled studies/case studies/case reports; cohort studies; randomized controlled trials (RCTs); meta-analysis & systematic review
What are the components of the evidence from the bottom to the top (strength of evidence increases from bottom up)?
Era 1-Formation (1960s-1980) Era 2-Advancing the Silos (1980-1995) Era 3-Non-integrated integration (1995-2001) Era 4- Acting through Consortia and Collaboratives (2001-2010) Era 5- Convergence in Health Creation (2010-?)
What are the five eras of IHM?
Results
Where the author(s) talk about what they found in their research study
Conclusion/discussion
Where the authors summarize what they found, why they think their research is significant, etc.
Authority
Credibility; who is providing the information in the article? Who is the author? What else has the author written?
Date
Currency; how new or current the information is; high priority for data to be published in the last 5 years; when was the source first published? what version or edition of the source are you consulting? are there differences in editions? when was the publication last updated? what has changed in the field of study since the publication date? are there any published reviews, responses or rebuttals?
What does DRAMA stand for?
D- Date R- Relevancy A- Accuracy M- Motivation A- Authority
Accuracy
Do the authors cite their sources? Or are there other means to verify the reliability of their claims? Are the authors affiliated with any of the authors they cite? Did they appropriately cite ideas that were not their own?
Motivation
Do the authors have an incentive to be biased or a reason to tell you something other than the truth? Unbiased resources include statements that are supported by evidence and documentation. Biased sources have little information and documentation presented. Unbiased sources have pro and con viewpoints, biased sources present one version of the truth. Why was this source created? Is it meant to be persuasive? What research questions does it attempt to answer?
Deepak Chopra
Dr. Chopra is an Indian-trained biomedical physician. Dr. Chopra gives workshops utilizing Ayurveda medicine modalities and practical tools of mind-body healing such as energy healing, guided meditation, visualization, and writing exercises. He is the author of more than 50 books and more than 100 audio, video, and CD-ROM titles.
Andrew Weil
He is the program director for the Arizona Center for Integrative Medicine, the founder of the Foundation for Integrative Medicine, and a national voice on CAM therapies and integrative medicine.
Bernard Siegel
He spent much of his life teaching techniques to help cancer patients use their own body energy to help in the healing process, techniques such as meditation and positive imagery. He also believes in using humor as a healing technique. He valued Patients' self-healing power and he founded ECaP (Exceptional Cancer Patients) a type of individual and group therapy support that uses drawings, dreams, positive imagery.
Office of Alternative Medicine
Helped legitimize integrative professions; justifications for its creation: 1) congressional concern over spiraling health costs for regular, high-tech medicine 2) public demand to learn more about these therapies Purpose: info for patients, practitioners, and policy makers to make informed decisions about integrative medicine Budget to evaluate CAM therapies Committee of scientists, doctors, and CAM practitioners were given task of evaluating CAM therapies Biomedical scientists pushed for RTCs, but CAM resisted because these treatments were part of a larger system of healing that can't be reduced to biological components.
for purification ceremonies
In Native American culture, the sweat lodge was used:
Name of Pioneer
James Gordon
Integration (1990s to present)
Key actions: Congress reduced FDA's control over herbal medicine by making dietary supplements "exempt" from FDA regulation (FDA could not keep up with amount of herbal supplements) Rise of evidence-based medicine movement to determine if CAM therapies were or were not valid Office for the Study of Unconventional Medical Practices promoted approach to studying CAM
Introduction
Often provides the thesis or hypothesis, as well as the literature review.
Tenets of Holistic Medicine
Oneness of body-mind-spirit The body as an energy system interlinked with other energy systems Healing the whole person in whole-life context Essential unity of practitioner and client Diagnosis and healing from inside out Networking organizational structure facilitates individualization of care Authority and responsibility inherent in each individual Science and technology placed at the service of the individual A long-term focus on creating and maintaining health and well-being Death as a step in the process Healing is the focus Embrace of other modalities
What does PICO stand for?
P- Patient, problem or population of interest I - Intervention of interest C - Comparison/control of interest O - Outcome
Era 2-Advancing the silos
Professional building-help establish legitimacy in the US -creating schools and colleges -creating councils of colleges to set educational standards -building an accrediting agency and gaining federal recognition through US Department of Education -developing nationally standardized exams -forming coalitions with patient advocate to expand licensing from state to state -making case to malpractice insurers to cover providers in the field -fending off attacks from those who benefited from a lack of standards or who operated with lower standards
Abstract
Provides a concise summary of the research including its purpose, significant results, etc.
A study by Benson and Wallace found that subjects who practiced Transcendental Meditation and were able to change thought patterns, experienced?
Slower heart rates
Methodology
Tells you how the author(s) went about doing their research.
nonvitamin, nonmineral dietary supplements
The National Health Interview Survey of adults ages 18 and over found that the most commonly used CAM were:
What is the definition of mindfulness according to JKZ?
The awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally
NCCIH
The main mission/role is to fund and conduct research about complementary health approaches.
Dr. Bernard Siegel spent much of his life helping cancer patients learn how to use _____ to help in the healing process.
Their own body energy
Phase 1: Condemnation
Time: 1960s-1970s Tone: Negative, hostile, quackery Focus: Disapproval of therapies Cultural impact: American Medical Association (AMA) influence; Wilk vs. AMA (chiropractic medicine considered a threat to monopoly of medicine) (late 1960s-1970s) Tone 1- mocking carried underlying theme of danger and need to protect the public; "quackery"; chiropractic medicine considered a hazard to JAMA, threats like cigarettes Tone 2- warnings to public Cultural impact- political action where AMA persuaded Congress to order US Department of Health, Education and Welfare to investigate Chiropractic (wanted to withdraw licensure and remove from medicare); Wilk vs. AMA (1976) anti-trust lawsuit, judge found that AMA intentionally wanted to harm chiropractic profession; chiropractic survived but acupuncture did not (reserved for MDS)
Phase 2: Reassessment
Time: 1970s-early 1990a Tone: Introspective Focus: curious about IHM use and quality of patient-provider relationships Cultural impact: health care crisis; shortcomings of conventional medicine (more attention on patient satisfaction; "whole" patient--> holism, shift in focus to psychological healing; realization that medicine cannot solve everything)
Phase 3: Integration
Time: mid-1990s to present Tone: largely objective, without caustic tone Focus: publication reported results that almost uniformly disparaged CAM treatments; growing awareness of use Cultural impact: greater need for training on IHM, creation of NCCAM, supplements and FDA, legitimacy Financial implication and impact-more use and out of pocket expense (more on unconventional than conventional) More utilization studies Reluctance to discuss CAM use with physicians (because of how they were regarded in previous decades) Shift away from most threatening CAM modalities to broader discussion of CAM in general Need for training for medical professionals on CAM/IHM
According to SnL, what is the main mission of the National Center for Complementary and Alternative Medicine (now called, the National Center for Complementary and Integrative Medicine (NCCIH)?
To fund and conduct research about complementary health approaches
