Integrative Medicine – Samueli Institute Blog http://samueliinstituteblog.org Mon, 12 Dec 2016 18:35:08 +0000 en-US hourly 1 https://wordpress.org/?v=4.6.1 On Human Flourishing is the official podcast for Samueli Institute, a Washington, D.C. based research center that focuses on the science of healing. The show features interviews with thought leaders in the areas of medicine, research, military and veteran care, integrative medicine and other spheres of focus that contribute to a flourishing society. Integrative Medicine – Samueli Institute Blog clean Integrative Medicine – Samueli Institute Blog communications@siib.org communications@siib.org (Integrative Medicine – Samueli Institute Blog) Samueli Institute Integrative Medicine – Samueli Institute Blog http://samueliinstituteblog.org/wp-content/uploads/powerpress/OHF_icon.jpg http://samueliinstituteblog.org/category/im/ Celebrating 15 Years Exploring the Science of Healing http://samueliinstituteblog.org/celebrating-15-years-exploring-science-healing/ http://samueliinstituteblog.org/celebrating-15-years-exploring-science-healing/#respond Mon, 12 Dec 2016 18:09:22 +0000 http://samueliinstituteblog.org/?p=2136 To celebrate its 15-year anniversary, Samueli Institute invited guests to gather and share stories of the positive impact the Institute’s research has had in helping patients, policymakers, service members and veterans find evidence-based alternative, complementary and integrative treatments for chronic pain and illness.

In 2001, Henry & Susan Samueli launched Samueli Institute to explore the science of healing and expand the evidence base for complementary and integrative medicine. In the ensuing decade and a half, Institute researchers published more than 700 peer-reviewed articles and hosted scientific conferences of global experts, developed programs for pain, stress and performance for the military and supported healthy communities across the United States.

 

Now, after 15 years of service to the integrative health, healthcare, and military communities, Samueli Institute will cease research and programmatic operations in 2017.

 

“I am enormously proud of the work that Samueli Institute and all of its staff, fellows and grantees have accomplished. And I am grateful to Henry and Susan Samueli for their investment in time, money and expertise in supporting the work of the Institute,” said Wayne Jonas, MD, Samueli Institute President & CEO.

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State of the Evidence on Training Programs for Self-Management of Emotional Stress http://samueliinstituteblog.org/state-evidence-training-programs-self-management-emotional-stress/ http://samueliinstituteblog.org/state-evidence-training-programs-self-management-emotional-stress/#respond Tue, 04 Oct 2016 14:38:25 +0000 http://samueliinstituteblog.org/?p=2121 Limiting the stressors in our lives is not always possible; however, managing HOW we deal with the stress can be within our control. Nearly half of Americans report that their stress levels have increased in the last five years making effective treatments to decrease psychological distress in demand. Even more so, are mind-body programs that provide individuals the opportunity to have greater control over their own health. This focus on the self-management of health is a global phenomenon with increasing usage of complementary and integrative health practices being reported in the United States, United Kingdom, Canada and Europe.

 

In 2008, 19% of U.S. adults (more than 55 million people) reported using at least one mind-body therapy during the previous 12 months and in 2012, deep-breathing exercises, meditation, yoga, tai chi and qi gong were among the most frequently used techniques. These therapies are based on the biopsychosocial model, a perspective that acknowledges that biological, psychological (e.g., thoughts, emotions, and behaviors), and social factors all play a significant role in human functioning in the context of wellness and illness. It is often used to describe the concept of the “mind–body connection.”

 

In 2008, 19% of U.S. adults (more than 55 million people) reported using at least one mind-body therapy during the previous 12 months.

NEW REPORT PUBLISHED

A recent Samueli Institute report evaluated the existing body of randomized controlled trials on biopsychosocial training programs for the self-management of emotional stress. The report is especially impactful for researchers, clinicians and policy-makers as they develop new programs and assess the utility of existing ones.

 

“This evidence helps us to focus on the programs that work, and retire those that don’t,” said Wayne B. Jonas, MD, President and CEO of Samueli Institute. “By allowing the evidence to guide our decisions, we empower patients to gain control over the stress in their lives.”

 

A full copy of the report including an evidence breakdown, complete methodology and analysis is available for download, but read on for a short summary of some of the findings.

EXPLORING WHAT WORKS

In the pool of well-studied, effective programs were Mindfulness-based Stress Reduction and Cognitive Behavioral Stress Management. Both are well-established programs that require a substantial amount of training before the learned skills can become self-management skills. Multi-modal yoga-based studies were of good quality and found to be effective for stress reduction. There is reasonably sound evidence for program directors to incorporate these practices into their programs.

 

There were mixed results for relaxation-based techniques, both in terms of research quality and effectiveness. Autogenic Training studies showed moderately good quality, yet mixed effectiveness.

 

Limited evidence existed for many other programs including Easwaran’s Eight Program of Passage Meditation, dialectical behavioral therapy, FRIENDS program and several others. Researchers should focus on expanding the body of evidence for these programs to determine their efficacy.

SELF-MANAGEMENT EMPOWERS

The self-care programs described in the report have potential benefits for both clinical and healthy populations experiencing emotional distress. These self-management skills can help to empower individuals, since they can be practiced in virtually any environment, with minimal time required and at low cost.  This may be especially helpful for individuals who are likely to refuse, delay or feel stigmatized by seeking conventional therapies.

 

Such self-management programs are cost-effective strategies to prevent or manage stressors and because they are multi-modal, they may also offer greater appeal than single-modal programs. There are very few to no adverse effects when these self-management skills are properly learned and practiced.

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What Works for PTSD? Research is Key http://samueliinstituteblog.org/works-ptsd-research-key/ http://samueliinstituteblog.org/works-ptsd-research-key/#respond Tue, 27 Sep 2016 06:00:26 +0000 http://samueliinstituteblog.org/?p=2106 A recent article in the New York Times on alternative treatments for post-traumatic stress disorder (PTSD) highlights a key question: how do we know what alternative therapies work to treat our veterans suffering from PTSD?

Dr. Barbara Rothbaum is a psychologist at Emory University who runs an intensive two-week PTSD treatment program that includes complementary and alternative treatments. While compiling a National Academy of Sciences report on therapies for PTSD, she encountered a key issue: “We met a lot of well-meaning clinicians around the country creating programs with equine therapy or wilderness therapy or whatever, and there was no way to know if any of it worked,” said. “Because of that, we couldn’t recommend it.”

This is not to say that the programs do not work—but the evidence base is not strong enough yet. Part of that is a question of research funding. Drug companies have a vested interest in funding multi-million dollar clinical trials. However, many of the organizations running these alternative programs barely have enough funding to carry out the programs, and therefore do not have the extra funding available for the evaluation of these programs—creating a cyclical problem.

“We need to get what doesn’t work OUT and what DOES work IN the regular treatment for PTSD,” said Wayne B. Jonas, MD. “But we can’t do that unless we build evaluation into each program.”

Two recent projects of Samueli Institute are helping to build the evidence base for complementary and alternative treatments for pain, stress and health.

  1. Stress Management – A new report by Samueli Institute boils down more than a decade of research on stress management. It builds upon an earlier study that focused on military-related programs.
  2. Massage– Samueli Institute recently published a systematic reviews and meta-analysis series that is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life for pain, cancer and surgical patients.

In his article entitled The Evidence of Enough, Dr. Jonas explains the challenge and the imperative of managing and evaluating the growing body of evidence: “A more rigorous management of the judgment processes for evidence is needed. Lives, money and the mitigation of suffering depend on it.” Read more.

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Study Clarifies Traumatic Brain Injuries and Headache Connections http://samueliinstituteblog.org/study-clarifies-traumatic-brain-injuries-headache-connections/ http://samueliinstituteblog.org/study-clarifies-traumatic-brain-injuries-headache-connections/#respond Fri, 19 Aug 2016 18:30:00 +0000 http://samueliinstituteblog.org/?p=1919 A recent study confirmed the link between traumatic brain injury and headaches or migraines.

The article published in the July 2016 Medical Surveillance Monthly Report also shows how the prevalence of headaches for service members with TBI increases with the severity of the injury.

“Compared to service members without TBI, those who sustained a mild TBI were 3.99 times more likely to have a headache or migraine, and those with a moderate/severe TBI were 8.89 times more likely.”[i] – Vincent P. Beswick-Escanlar, MD, MPH et al. (July 2016, MSMR)

Source: Medical Surveillance Monthly Report

Source: Medical Surveillance Monthly Report

This highlights the importance of finding sustainable treatment options for service members experiencing headache due to mild to moderate TBI. Another study also published this year provided evidence that acupuncture should be a standard form of treatment for chronic headaches due to TBI. Researchers discovered that both Traditional Chinese Acupuncture (TCA) and Auricular Acupuncture (AA) were more effective for reducing pain and improving headache-related quality of life than usual care without acupuncture.

Learn more about the Samueli institute study on acupuncture for headache here.


[i] Increasing Severity of Traumatic Brain Injury Is Associated with an Increased Risk of Subsequent Headache or Migraine: A Retrospective Cohort Study of U.S. Active Duty Service Members, 2006–2015

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Meditation and the Relaxation Response http://samueliinstituteblog.org/meditation-relaxation-response/ http://samueliinstituteblog.org/meditation-relaxation-response/#respond Wed, 01 Jun 2016 12:30:20 +0000 http://samueliinstituteblog.org/?p=1797 In our current healthcare system, a person’s overall health is balanced by pharmaceuticals, surgery, and self-care, according to Herbert Benson, MD, author of “The Relaxation Response.” As a result of this healthcare model, between 60-90% of healthcare visits are for conditions likely caused by chronic stress. It is his professional belief, that through meditation and eliciting the relaxation response, the harmful effects of chronic stress can be reduced or even eliminated.

The Relaxation Response

The Relaxation Response is defined as the state of deep rest that alters one’s emotional and physical responses to stress.

“The train of our everyday thought is broken when two basic steps that elicit the relaxation response are followed.” Dr. Benson

The two steps, to which Dr. Benson refers, begin the process of transporting a person into this place of deep rest. They are:

  1. The repetition of a word, sound, prayer, thought, phrase or muscular activity.
  2. The passive return to the repetition when other thoughts intrude.

There is no single way to meditate, and no form of meditation is better than the other. Meditation can be a calm or a state of activity. It all depends on the person. What is most important, however, is the healing mechanism in meditation, which is known to relieve stress and cure stress-related illnesses.

How Meditation Helps

It is believed that meditation as a method for relaxation leads to a physical response. In many cases, that physical response initiates a healing process. Meditation can be applied to anyone’s life and has come to be recognized as a helpful therapy for the following illnesses:

  • Chronic Stress
  • Hypertension
  • Cardiac Arrhythmia
  • Chronic Pain
  • Insomnia
  • Anxiety
  • Hostility
  • Depression
  • Premenstrual Syndrome
  • Infertility
  • and more…

How To Meditate

The goal of meditation is not to empty your thoughts, as is the common misconception; the goal is actually to focus on one particular thought repetitively. To begin, Dr. Benson recommends following these first five steps (see all), which lead to the relaxation response:

  1. Sit quietly in a comfortable position
  2. Close your eyes
  3. Relax all the muscles in your body
  4. Breathe through your nose
  5. Continue for 10 to 20 minutes

Overtime life’s changes become more profound and as stress increases so does the potential for poor health. Meditation can be the key to wellbeing for families and in work environments. Practitioners like Dr. Benson are recommending meditation even to children, who during their adolescent years have a hard time managing stress.


Samueli Institute recently launched brainmindhealing.org to bring together the evidence behind integrative medicine, explore the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

 

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Creating Healing Spaces for Service Members and Veterans with Dr. Joseph Bobrow http://samueliinstituteblog.org/creating-healing-spaces-military-veterans-dr-joseph-bobrow/ http://samueliinstituteblog.org/creating-healing-spaces-military-veterans-dr-joseph-bobrow/#respond Wed, 25 May 2016 13:00:44 +0000 http://samueliinstituteblog.org/?p=1764 Waking Up From War Joseph Bobrow

In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans.

A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Director of Training of the Department of Psychiatry at Kaiser Hospital and Medical Center in South San Francisco. He is also a Zen Master and served on the Board of Directors of the Interfaith Center at the Presidio of San Francisco, located at the Main Post Chapel. Joseph teaches and writes on the interplay of Western psychology, Buddhism, and the beloved community in transforming human suffering, including war-related trauma. Dr. Bobrow’s latest book “Waking Up From War,” is the story behind his non-profit organization, the Coming Home Project.

The research was featured by the DCoE in its review of reintegration programs and was the only program with a research evidence base.


Bio Credit: Coming Home Project 


On Human Flourishing is the official bi-weekly podcast of Samueli Institute, hosted by Wayne B. Jonas, MD. Subscribe to our podcast on iTunes.

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http://samueliinstituteblog.org/creating-healing-spaces-military-veterans-dr-joseph-bobrow/feed/ 0 In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans. A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Dir... In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans. A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Director of Training of the Department of Psychiatry at Kaiser Hospital and Medical Center in South San Francisco. He is also a Zen... Integrative Medicine – Samueli Institute Blog clean 19:23
The Healing Intention: Battling Habitual Behavior http://samueliinstituteblog.org/healing-intention-battling-habitual-behavior/ http://samueliinstituteblog.org/healing-intention-battling-habitual-behavior/#respond Wed, 25 May 2016 12:30:00 +0000 http://samueliinstituteblog.org/?p=1783 Let’s face it—we all do things that we know are not healthy. What is important is that these behaviors don’t become habits that negatively affect our wellbeing.

“Habits play an important role in our health. Understanding the biology of how we develop routines and embrace new ones, could help us changes our lifestyles and adopt healthier behaviors.” –Nora Volkow, MD, National Institutes of Health

Forming Habits

In many cases, habits are formed from repetition or routine. There are certain activities that we do so often, we begin to do them unconsciously. Once we lose consciousness, routines become habits that are very difficult to quit. But difficult does not mean impossible.

Good habits and bad habits in the brain would look surprisingly similar if we were to view them under a microscope.  But according to Dr. Russell Poldrack, a neurologist at the University of Texas-Austin, certain habits, like those that bring pleasure, require much more work to curb.

“There’s one important difference-If you do something over and over, and dopamine is there when you’re doing it, that strengthens the habit even more. When you’re not doing those things, dopamine creates the craving to do it again. This explains why some people crave drugs, even if the drug no longer makes them feel particularly good once they take it.”

Breaking Bad Habits

Bad habits, even those formed by pleasurable experiences, can be broken. This is achieved by developing a healing intention. This is a conscious mental choice to improve your health and it is accomplished through awareness, intention and reflection.

Awareness

Awareness is a component of your internal environment, which can dictate your behaviors and thereby prevent or end habits. Being aware means understanding your body and the signs it sends to you, as well as being able to interpret your thoughts and feelings. Ask yourself; why do I smoke? Why do I binge drink? Why do I over-eat? Once you have answers, you can begin to set goals that will get rid of your bad habits.

Intention

Getting in touch with your inner-self is a challenge, but it is the key to develop the intention to heal. Some do this by prayer, meditation or by sitting quietly and relaxing. By making this connection, it is possible to direct your intention to bring this sense of peace and healing to yourself and others in your life.

Reflection

Looking back at your experiences allows you to learn from them. A way to do this is to record your life’s events in a journal. Reflection on these past experiences, especially on occurrences that lead you to habits like addiction, can help you to understand who you are, what you believe in and what your place is in the world.

Experiencing Personal Wholeness

Personal wholeness is the sense of wellbeing that you feel when the mind, body and spirit are balanced. At this point, you will feel like you most authentic self and your consciousness is heightened, allowing you to prevent bad habits from reforming and live a healthier life.

 


You can learn more about habits and behavior in our book, Optimal Healing Environments: Your Healing Journey

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Planting Seeds for National Wellbeing with Senator Tom Harkin http://samueliinstituteblog.org/podcast-planting-seeds-national-wellbeing-senator-tom-harkin/ http://samueliinstituteblog.org/podcast-planting-seeds-national-wellbeing-senator-tom-harkin/#respond Wed, 04 May 2016 18:13:34 +0000 http://samueliinstituteblog.org/?p=1715 Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote wellness and prevent illness.

“Health is not just in the hospital and doctors offices; it’s in your workplace, school, family, community and even in your church.” -Harkin

As a man from a small farm in Iowa, Harkin grew up understanding that nutrition and exercise play a role in a person’s wellbeing. Serving in Congress from 1975 to 1985, then in the Senate, Harkin supported the notion that Americans had a greater chance at flourishing in a country with a better healthcare system and set out to help build that country.

Preventative Care

As one of the delegators of the Affordable Care Act, Harkin looked at the American health system as a complex institution that needed improvement. This is due, in part, to what Harkin calls “short-sightedness,” or a misconception that health care is about treating patients rather than preventing illness in the first place.

“We’re talking about keeping people healthy, keeping them well, in the first place.” –Sen. Harkin

When trying to put his vision into action, Congress members who, despite the evidence, could not see the benefits to funding preventative healthcare often stonewalled Harkin. In addition, lobbyists who represented pharmaceuticals companies, hospitals, and even medical schools halted his plans.

Our host Wayne B. Jonas, MD with Sen. Tom Harkin

Our host Wayne B. Jonas, MD with guest former Sen. Tom Harkin

Policy and Progress

Realizing that players in the healthcare industry had “their own agendas,” Sen. Harkin took his own agenda one step further by forming the National Prevention Council. This council is comprised of about 16 organizations from various industries that recognize that preventative healthcare will benefit the entire country.

The National Prevention Council monitors the Prevention Fund, and therefore has the power to influence that future of healthcare. Senator Harkin counts on this power, as he believes that the key to human flourishing is self-care and self-management that starts in the home and is also practiced in schools and in the community.


On Human Flourishing is the official bi-weekly podcast of Samueli Institute, hosted by Wayne B. Jonas, MD. Subscribe to our podcast on iTunes.

 

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http://samueliinstituteblog.org/podcast-planting-seeds-national-wellbeing-senator-tom-harkin/feed/ 0 Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote w... Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote wellness and prevent illness. “Health is not just in the hospital and doctors offices; it’s in your workplace, school, family, community... Integrative Medicine – Samueli Institute Blog clean 33:52
A Response to the CDC Opioid Guidline: Implementing Integrative Therapies into Chronic Pain Care http://samueliinstituteblog.org/response-cdc-opioid-guidline-implementing-integrative-therapies-chronic-pain-care/ http://samueliinstituteblog.org/response-cdc-opioid-guidline-implementing-integrative-therapies-chronic-pain-care/#respond Mon, 25 Apr 2016 13:00:11 +0000 http://samueliinstituteblog.org/?p=1682 A message from Wayne B. Jonas, MD President & CEO Samueli Institute

A message from Wayne B. Jonas, MD President & CEO Samueli Institute

Opioids are commonly prescribed for pain. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. But opioid pain medication use presents serious risks, including overdose and opioid use disorder. From 1999 to 2014, more than 165,000 people died from overdose related to opioid pain medication in the United States.

This increased risk for overdose and opioid use disorder drove the Center for Disease Control (CDC) to create a Guideline providing recommendations for safer prescribing practices for clinicians, including the conviction that patients should receive appropriate pain treatment based on a careful consideration of the benefits and risks of treatment options. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including non-opioid pain medications and non-pharmacologic treatments). Supporting the CDC, the Food and Drug Administration (FDA), has launched an action plan due to the concern of the growing opioid overuse, abuse, and overdose in the country.

“Patients with pain should receive treatment that provides the greatest benefit. Opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that non-opioid treatments, including non-opioid medications and non-pharmacological therapies can provide relief to those suffering from chronic pain, and are safer.” –Center for Disease Control and Prevention

The CDC guideline has also inspired conversation in the field of integrative medicine about providing alternatives to opioids for chronic pain care. Samueli Institute recently led a dialogue explaining the guideline and non-pharmacologic approaches to chronic pain care.

SI Webinar Looks Into New Approaches

In a webinar hosted to motivate discussion on the integrative, non-pharmacological approaches to chronic pain care, Samueli Institute (SI) and other experts shared the changes that need to occur in the area of pain care.

“What we really need to work towards is a cultural transformation that puts the patient at the center of a personalized, integrated, multi-disciplinary model that emphasizes self-care practices know to reduce pain.” –Bonnie Sakallaris, PhD, RN

The CDC is recommending practice transformation in three key areas:

1.     When to initiate or continue opioids
2.     How to select, determine dosage, choose duration, follow-up or discontinue
3.     How to assess risk and addressing harm

In each of these areas, the CDC recommends working with patients to understand their goal and educate them on the risks and benefits of the treatment proposed.  The recommendations emphasize the importance of non-pharmacologic therapy as a first line approach and in combination with pharmacological therapy.

In SI’s informational webinar, experts discussed not only the importance of the CDC’s opioid guideline but the implementation of the recommendations it provides.

“How would we change the processes in each of our clinics that would support implementation of these guidelines?” asked Diane Flynn, MPH, FAAFP

Additionally, Dr. Flynn suggested that clinics look at the whole person when treating pain. Considering that pain causes other medical issues and often stems from other medical issues, accessing the patient’s level of pain is only one step in treating them. Most importantly, it was decided that limiting the number of days in which a patient is medicated with opioids is best practice.

Dr. Diane Flynn noted that if symptoms of acute pain persisted following three or four days of opioid therapy, a deeper, underlying problem needed to be addressed. Non-pharmacologic therapies, including self-care therapies, allow pain patients to unmask core issues that lead to their pain symptoms; allowing them to heal.


Read Samueli institute’s pain management supplement on self-care; one of the references used to support the data in the CDC’s new guideline.

Samueli Institute’s Chronic Pain Breakthrough Collaborative is now seeking enrollment. Learn more.

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Shattering the Myth of Immutable Genes with Dr. Pamela Peeke http://samueliinstituteblog.org/podcast-dr-pamela-peeke-shattering-myth-immutable-genes/ http://samueliinstituteblog.org/podcast-dr-pamela-peeke-shattering-myth-immutable-genes/#respond Wed, 20 Apr 2016 14:00:42 +0000 http://samueliinstituteblog.org/?p=1659 For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. New scientific studies have shown that genes are not determinant of a person’s wellbeing. The lifestyle choices a person makes including exercise and eating habits can deactivate the genes that originally would have lead to disease.

Genetics Do Not Define Health

“You thought DNA was your destiny,” said Pamela Peeke, MD, MPH, FACP, FACSM. The science shows that lowering stress hormone levels through exercise and Cortisol levels through therapies like yoga, are the keys to tapping into your good genes. This comes first; everything else is epigenetics, according to Peeke.

The term Epigenetics refers to any process that alters the activity of a gene, without altering the DNA sequence to which that gene belongs.

 

“We found out that the mass majority of these genes actually have what I kind of call a dimmer switch. We can activate or deactivate the gene based upon our environment.” –Dr. Peeke

Changing Your Destiny

Referencing the genome project conducted by the National Institutes of Health (NIH), Dr. Peeke asserts that you can alter your destiny by accessing the methyl donors, which dampen genes. The methyl donors are accessed through repeated practices that work against bad genes. Failure to practice proper nutrition and exercise routines can apparently have the reverse effect:

“Genetics may load the gun, but epigenetics pulls the trigger.” –Dr Peeke

Because epigenetics can go two ways, Dr. Peeke tells the audience of On Human Flourishing to “assume the vertical,” when it comes to physical activity. And for complete wellness, people can use their minds to set the tone for their overall wellbeing. In closing, Dr. Peeke asks, “When’s the last time you checked in with yourself?”


(i) Epigentics: The Science of Change, Bob Weinhold. Environmental Health Perspectives 2006 Mar; 114 (3): A160-A167

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http://samueliinstituteblog.org/podcast-dr-pamela-peeke-shattering-myth-immutable-genes/feed/ 0 For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. New scientific studies have shown that genes are not determinant of a person’s wellbeing. The lifestyle choices a person makes including exercise and... Integrative Medicine – Samueli Institute Blog clean 45:09
Extended Consciousness: Going Beyond the Five Senses http://samueliinstituteblog.org/extended-consciousness-senses/ http://samueliinstituteblog.org/extended-consciousness-senses/#respond Mon, 18 Apr 2016 11:00:34 +0000 http://samueliinstituteblog.org/?p=1652 Consciousness is a state of being fully connected. The traditional form of consciousness includes connections with others and also to one’s own thoughts and feelings. But to understand extended consciousness, humans must study the unseen and the unknown.

Harnessing Extended Consciousness

In the real world, harnessing extended consciousness may help relieve pain and suffering from chronic illness through meditative stages and mantras. In other communities, like the military, the ability to tap into one’s extended consciousness could be the difference between life and death.

“A few moments of advance notice could help soldiers take cover before an explosion, help first responders make course corrections for vehicles, and benefit any life-or-death task where seconds count,” -Julia Mossbridge, PhD, Department of Psychology at Northwestern University. Mossbridge is the lead author of a groundbreaking study published in 2012 that showed that the human body can anticipate emotional future events as much as 10 seconds before they occur.

Consciousness is not among the popular mind-body practices, and is often thought of as an illusion or delusion within the medical population. This is despite the scientific research which shows that consciousness is a cognitive ability, accessible to all humans, and is magnified for some.

The Science Behind Consciousness

Science has provided evidence that consciousness includes abilities like anomalous cognition, giftedness, and the ability to change the direction and lapse of time. Though it may seem like a mysticism, research shows that not only do these abilities exist in humans, sometimes it is triggered, without them even knowing. The scientific research on extended consciousness is ongoing and is looking into the following theories:

  •  Quantum mechanics
  •  Ultraweak light emissions
  • Standard physics or cognitive neuroscience
  • New understandings about time
  • Artifact, error or bias

The Future of Extended Consciousness

Scientists believe that understanding extended consciousness and harnessing the ability, could be especially beneficial for the military population. If soldiers are able to tap into knowledge beyond the five senses, the theater of war could be forever changed.

 

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Samueli Institute recently launched brainmindhealing.org to bring together the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

 

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The Future of Resilience in the Military http://samueliinstituteblog.org/future-resilience-military-2/ http://samueliinstituteblog.org/future-resilience-military-2/#respond Fri, 15 Apr 2016 11:00:43 +0000 http://samueliinstituteblog.org/?p=1642 Resilience is all about being able to function at an appropriate level in any situation with which you are faced, says Geoffrey Ling, MD, PhD, DARPA Biological Technology Office. For the military, the idea of resilience differs from the civilian world, because a person’s community or support system is in a state of constant change. When in the theatre of war, a service member’s community is his or her unit, we members return home, their families become their beacon or focal point. Whether at home or in theatre, resilience can be built through preparation and training in mind, body and spirit– which is guiding the future of technology in military medical research.

Preparedness Leads to Resilience

Building resilience in the military requires service members to be prepared for all that they will face physically, spiritually and morally according to Dr. Ling. This mental preparedness is developed through training: the foundation of how service members learn within these various military communities.

“A prepared mind is really one of the most important things.” -Dr. Geoffrey Ling

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Geoffrey Ling - BMH

“There’s an old saying in the military…train like you fight; fight like you train.”

–Dr. Geoffrey Ling

Repetitive and consistent training leads to preparedness in combat. The same tactic can be applied to everyday life, because the more often a person encounters a certain situation, the more familiar they are with the outcomes and will know how to react to them in a way that is in line with their beliefs.

Morality and the Future of Technology and Military Medical Research

Dr. Ling believes that being prepared morally for the harsh conditions in the theatre of war helps service members when they come home. If service members are trained to stay true to their belief system,  it helps them to do their job in a way that honors themselves and which they can be proud of when they return home. Future technology training tools need to incorporate this facet to fully prepare service members.

“I’d say that’s the biggest gap area in research in technology right now: How do you put the things in it that we all value; the morality, the ethics, the belief system.”

 Training in Mind, Body, and Spirit

Understanding morality within the context of war and in the function of military life is a standing challenge. In efforts to help service members prepare for and heal from traumatic occurrences, the military is incorporating more mind-body therapies into its medical care and training. This can help with increasing performance and post-war difficulties like moral injury, which is caused by disconnect between actions of war and a person’s beliefs, causing a rift between their mind-body and spirit.

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Samueli Institute recently launched brainmindhealing.org to bring together the evidence behind integrative medicine, explore the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

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Resilience in the Community: How it Works http://samueliinstituteblog.org/resilience-community-samueli-institute-framework/ http://samueliinstituteblog.org/resilience-community-samueli-institute-framework/#respond Wed, 13 Apr 2016 11:00:40 +0000 http://samueliinstituteblog.org/?p=1570 In theory, community resiliency occurs when communities are taught useful steps, which guide them toward wellbeing. However, early into Samueli Institute’s Well-Community Project, it became clear that theory is only the beginning of the solution. To be useful, theory-based project models must be implemented by not only the efforts of governing bodies, organizations, and volunteers; but also by the community members themselves. Success means engaging the strengths of a community and allowing for dialogue across all stakeholders.

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BSakallaris Samueli Institute BMH

Putting Science into Action

After a decade of studying wellbeing in individuals, health systems, and the military; Samueli Institute (SI) experts applied that knowledge to communities, exploring: “What does a well community look like?” as part of a unique program to foster community wellness, the Well Community Project.

The program aimed to go beyond public health and medical care to understand what community wellness is, and how it is developed and sustained. Samueli Institute began by convening stakeholders from communities, as well as activists, academics, and policymakers to probe the process fostering wellness.

The working group adopted a framework first built for the military called Total Force Fitness to intensify their effort. In that initial meeting , participants learned that frameworks were not the core need nor at the heart of the process. Indeed, many frameworks had been developed and they usually left out some of the most important social and historical causes of illness and wellness. What was needed was a much more basic model of human flourishing. Even more important than any model was fostering a process in which the strengths of a community were tapped and a deep dialogue was created across all stakeholders.

Once this process was developed, the communities began to create their own wellness. Samueli Institute worked with three communities from around the country, drawn from locations with some of the worst health metrics. Each was offered an opportunity to receive assistance in a community wellness improvement project of their choice.

A Framework of Community Wellbeing

Experts found that community wellbeing must address the following six pillars to be a resilient and well community: psychological, physical, social, economic, environmental and cultural. A weakness in one of these areas limits the ability of the community members to achieve their full potential.

 

SI_communitywellness_web

When experts went to Indianola, MS, a town of 12,000 in the Mississippi Delta region, applied its theory for community wellbeing, those involved saw that the path to resilience could not begin until healing occurred to overcome generations of racism and segregation. This realization, according to Samueli Institute’s VP of Optimal Healing Environments, Bonnie Sakallaris, PhD, RN, changed SI’s approach to building resilience in communities. A group of community leaders met every month for three or four hours at a time to discuss big topics: health, economics, education and race. Through these facilitated conversations, healing began.

“We had to rethink and we had to redefine community wellness, in terms that provided communities with the ability to do their work and measure their work,” Bonnie Sakallaris, PhD, RN, Vice President, Samueli Institute.

Accountability

The role of community members is just as important and often even more important than that of governing bodies, officials, and activists. Accountability means that the members of the community recognize their part in the destruction or hindrance of their community, as well as the redevelopment and prosperity of their community. Without the input of the people most affected by poor health care services, social-economic injustice, and other factors that contribute to their state of wellbeing; it is impossible to move forward.

“Until the community expresses their needs and gets engaged in the work, the work doesn’t move forward.” Bonnie Sakallaris, PhD, RN

How We Helped

Combining Samueli Institute’s whole-systems research with the existing grassroots efforts within the community, a difference was made. Learning through the process, the Well Community Project became a step-by-step path to resiliency. The steps SI took were as follows:

Step 1: Breaking the Silence

Step 2: Reconciliation, Reparation, and Recovery

Step 3: Moving Forward Through Shared Purpose

Step 4:  Creating Authentic Partnerships

Step 5: Envisioning Possibilities

Step 6: Creating Integrated Networks

What’s Still Missing?

What we know is that resilience is a state of indefinite wellbeing. A resilience community is able to push through, even when times are difficult. In the United States, especially on the subject of healthcare, certain communities still lack the fundamental means to even begin their journey toward resilience. SI believes that understanding the unseen forces behind health and resilience can help.

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Samueli Institute recently launched a new website, brainmindhealing.org to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.

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Kevin Berry, MD on Resilience: “We Need to Look Beyond Bouncing Back.” http://samueliinstituteblog.org/resilience/ http://samueliinstituteblog.org/resilience/#respond Mon, 11 Apr 2016 11:00:33 +0000 http://samueliinstituteblog.org/?p=1560 Resilience means different things for individuals, for communities and for the military. Over the last 15 years, Samueli Institute and its expert partners have explored a wider understanding of resilience than was previously understood. During this exploration, it was discovered that resilience is indubitably more complex than its traditional definition of being able to recover from trauma. Real resilience involves preparedness –the ability to adjust to upcoming trauma and stress.

 “Often times people think of resilience as bouncing back, I think we need to think beyond bouncing back.” –Kevin Berry, MD of Samueli Institute

Resilience requires stages of evolution and preparation. It also requires the individuals or communities involved to make an overall transformation from their previous state to the state of well-being. Also, resilience is dependent upon a well environment and the perception of the individuals or communities involved. This is obviously more complex than the standard “bouncing back” theories of the past.

 

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Kevin Berry MD

 

Evolution

On the subject of resilience, experts have developed the term “resilience thinking,” which refers to the idea of eventually being able to transform. Evolution as a prerequisite for resilience suggests that the mind has more power during the path to wellbeing than most other factors. This is because, without the thought that one can prosper, their perception is perturbed, making resilience just a word, having nothing to do with the life of an individual or the state of community.

Preparation

Preparedness is a common theme in communities like the U.S. Military, but not as common in others. Being prepared for the positive changes that come with resilience is as simple as being aware of the past and present. For individuals, understanding the current and past states and learning from them, is preparation. For communities, understanding their past and present circumstances, what caused them and the role certain individuals may have played, allows the community to recognize when similar issues arise in the future.

Transformation

“The idea of being able to transform–about being able to pick up and move on,” as Dr.  Berry explains, is a sound example of resilience thinking. The process of transforming requires an alternate mindset, which motivates new actions for better outcomes.

Resilience works when all of the factors that contributed to the trauma or stress are understood and overcome; and when the individual or communities except that trauma and stress are almost impossible to avoid.

The most important component of resilience to understand is the future. Trauma or stress may re-occur, but true resilience leaves individuals or communities fully equipped to handle future circumstances.

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Samueli Institute recently launched a new website, brainmindhealing.org to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.


What role does leadership play in military resilience? Watch video of Dr. Kevin Berry at the 2016 Military and Veteran Resiliency Summit in San Deigo: WATCH

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PODCAST: An Interview with Henry Samueli, PhD http://samueliinstituteblog.org/podcast-interview-henry-samueli-phd/ http://samueliinstituteblog.org/podcast-interview-henry-samueli-phd/#respond Thu, 07 Apr 2016 11:00:19 +0000 http://samueliinstituteblog.org/?p=1549 Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Samueli sits with Wayne B. Jonas, MD, to discuss the long path of life, which later led him to dive into the world of integrative medicine.

Samueli’s journey in integrative health began on the home front, as he watched his wife, Susan, nurse their children to health using homeopathy, Chinese herbs, and nutrition. He admits that he found it mystical at first, but later, after watching his children flourish, he came to appreciate it.

“I’m a complete believer that these alternative therapies have a lot of efficacy.” –Henry  Samueli, PhD

 

Samueli’s successes in engineering allowed him to act philanthropically, investing in science education for young people. Much of his philanthropic work was executed through the Samueli Foundation, a charity organization started by his wife, Susan Samueli, PhD. The Samueli Foundation endeavors to create value within society by endowing innovation, entrepreneurial and sustainable ideas. Mr. and Mrs. Samueli later began investing in organizations and projects having to do with complementary and alternative medicine, the only thing missing according to Henry Samueli, was the science that supported this form of medical care.

“That became another area of interest for us; to try to develop some scientific evidence behind it.” -Henry Samueli

To unveil the science behind the esoteric world of integrative medicine, Henry and Susan Samueli first started a research center at University of California, Irvine. Later, the Samueli’s partnered with Dr. Jonas to start the Samueli Institute for Information Biology, now called Samueli Institute.

Jonas believes that Samueli has “a passionate drive to enhance human flourishing,” and there is much more in the future for the Samueli Foundation in the area of integrative health. Henry Samueli’s “primary motivation,” in starting Samueli Institute and pursuing his other philanthropic projects was to understand how integrative medicine works, just like the radio from his electric shop class. Today, he continues to transcend mere curiosity, by helping Samueli Institute in exploring the science of healing to create a flourishing society.


Subscribe to the podcast on iTunes to get automatic downloads of On Human Flourishing to your devices. Subscribe here.

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http://samueliinstituteblog.org/podcast-interview-henry-samueli-phd/feed/ 0 Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Samueli sits with Wayne B. Jonas, MD, to discuss the long path of life, which later led him to dive... Integrative Medicine – Samueli Institute Blog clean 27:18
Understanding Bioenergy Medicine with Dr. John Ives http://samueliinstituteblog.org/understanding-bioenergy-medicine-dr-john-ives/ http://samueliinstituteblog.org/understanding-bioenergy-medicine-dr-john-ives/#respond Mon, 04 Apr 2016 11:00:41 +0000 http://samueliinstituteblog.org/?p=1536 Thanks to Einstein, we know that all living matter is made up of energy. But there is a difference between traditional energy used in sound, light and magnetic therapies and the more ancient concept of subtle energy that may be behind the healing practices of therapeutics touch, healing touch, Reiki, and Qi Gong.

“All living things, all living cells-plants, animals, every living thing on this planet actually emits light. That light maybe carrying information.” –John Ives, PhD

Practitioners and patients are finding value in self-care practices with roots in bioenergy medicine. While once reserved for those interested in non-traditional or alternative forms of healing, bioenergy medicine is now working its way into more traditional medicine. Even the military has taken interest by adding Reiki and Tai Chi into its offerings.

Challenges of Bioenergy Medical Practice

In a medical system focused on pills and procedures, this shift to self-care can be challenging for patients. Beginning the healing process requires making a commitment to self-care according to our experts.

What’s perhaps more challenging for practitioners who promote bioenergy healing is backing up their practice with science. Though the knowledge of bioenergy itself has settled within the medical community, the idea of tapping into bioenergetics to actually treat and heal patients is fairly new. Samueli Institute’s Senior Director of Research, John Ives, PhD, believes that there is still much more information to be gathered on the topic.

“We’re still figuring out what the information is–what the Rosetta Stone would be.” –Dr. John Ives

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Dr John Ives on Bioenergy medicineThe questions that still exist about Bioenergy are questions that allow understanding of just how powerful human energy is. Can humans detect the heartbeats of other humans without medical machinery? This is a thought Dr. Ives has about Bioenergy, but to get to the answer, the field needs more time.

Understanding Bioenergy Medicine

In the military, the are therapies being used by service members and veterans to tap into their own bioenergetics. According to the science, these complementary, integrative medicine modalities have been proven to be a more of an efficient treatment form than prescription medications for chronic conditions like pain, depression, and sleep disturbances. These therapies include:

  • Art therapy
  • Music therapy
  • Reiki
  • Yoga therapy
  • Tai Chai
  • Qi gong
  • Other meditative modalities

The science behind bioenergy medicine is still developmental and therefore, a lack of understanding about how bioenergy medicine can improve practices in our healthcare system still exists. SI’s goal is to play a part by better understanding bioenergy as it relates to healing, which, according to Dr. Ives, is not a far-off goal.

In the next 10 years, Dr. Ives believes that the medical population will be able to define and measure bioenergy in a way that will be acceptable to the majority of the population. He argues that once bioenergy can be measured, it can then be implemented into normal medical practice.

“My prediction is that there will be interface between scientific understanding and the human experience of bioenergy.” – Dr. John Ives

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Samueli Institute recently launched the mind-body website brainmindhealing.org to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site

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Dr. James Gordon on the Future of Mind Body Medicine http://samueliinstituteblog.org/dr-james-gordon-future-mind-body-medicine/ http://samueliinstituteblog.org/dr-james-gordon-future-mind-body-medicine/#respond Mon, 28 Mar 2016 11:00:45 +0000 http://samueliinstituteblog.org/?p=1481 The modern challenges in health are closely associated with a disconnection between the mind and body. James S. Gordon, MD, founder of the Center for Mind-Body Medicine, professes a clear understanding of how the mind and body work together to create wellness within humans. According to Dr. Gordon, in order to know the future of mind-body medicine, it is best to look at the past and make note of the exact period in time where the science was lost.

“The problem is that we lost sight of it. We began to separate the mind from the body and to see and believe that they were different.” –Dr. James Gordon

Gordon puts the time around the 1960s, when the mind was thought to be one with the spirit and the body, a completely separate entity. This was when treating people became more difficult and was the beginning of an enormous dependence on prescription medication.

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James Gordon, MD Mind Body Medicine Samueli Institute

“The body became the concern of doctors and the mind and spirit was the concern of the priests and the clergy and different faiths.” –Dr. James Gordon

Leaning towards the future, Dr. Gordon finds that a focus on self-care can reverse the issues that come along with practitioner-administered care. Stating that, “we’ve been drugging the whole population,” Gordon believes that many of the prescription remedies are not helpful and cause other health problems. So for the future, Dr. Gordon wants the responsibility of care to move out of the hands of practitioners and into the hands of the patients themselves. Through mind-body therapies, self-care is rather simple for patients and limits the need for doctor visits.

“The next step for us as a society is to make self-care the true primary care.”

Promoting self-care doesn’t mean excluding practitioners altogether, but in the future, as seen through Dr. Gordon’s eyes, practitioners assist patients in practicing self-care. This form of doctoring is based on “the understanding that we have a very great capacity to do things on our own behalf.” Based on Dr. James Gordon’s insightful interview, the future of mind-body medicine is in your own hands.

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Samueli Institute recently launched the mind-body website brainmindhealing.org to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site

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Dr. Wayne B. Jonas Explains The Placebo Effect http://samueliinstituteblog.org/dr-wayne-b-jonas-explains-placebo-effect/ http://samueliinstituteblog.org/dr-wayne-b-jonas-explains-placebo-effect/#respond Mon, 21 Mar 2016 11:00:15 +0000 http://samueliinstituteblog.org/?p=1458 Since Medieval times, traces of placebo can be found in medical practice. It began as a way to ease symptoms, but over the years has been found to be a way to actually treat patients. According to Dr. Jonas, the placebo effect, is a form of healing that modern doctors should pay attention to and that healthcare system should begin assimilating into everyday practice.

Blog-Video-ButtonWayne B. Jonas, MD of Samueli Institute, Placebo Effect video

“The placebo effect tells us that there are some underlying processes around how we go about healing, that are separate from the what.”

What We Know About Placebo

In any healthcare setting, clinicians can maximize healing and the effects placebo has on the patient, has much to do with what Jonas refers to as the 80/20 rule.

Only 20 percent of healing comes from the medical treatment itself. The remaining 80 percent comes from how the treatment is given. In other words, giving a patient an herb alone, can only make them optimistic about the possibility of being treated, however telling the patient what the herb will do for them will enhance their healing experience. Experts suggest that four additional approaches bring about the placebo effect:

  1. Acupuncture
  2. Pill color
  3. Number of pills
  4. How and where patient is treated

Jonas calls the use of placebo in patient care, a ritual and encourages clinicians to perform the ritual in an ethical way as a standard practice.

“If we can optimize those rituals and minimize the negative components of those rituals, then we could reduce side effects and enhance healing.”

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Samueli Institute recently launched the mind-body website brainmindhealing.org to bring together the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

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Samueli Institute Launches Brain, Mind and Healing Website http://samueliinstituteblog.org/samueli-institute-launches-brain-mind-healing-webisite/ http://samueliinstituteblog.org/samueli-institute-launches-brain-mind-healing-webisite/#respond Thu, 17 Mar 2016 11:00:44 +0000 http://samueliinstituteblog.org/?p=1496 Samueli Institute has launched brainmindhealing.org, a website dedicated to exploring mind-body medicine and its unparalleled healing capacity. Modern medicine, with its many innovations, is still missing several components that if used, would heal patients and leave them with a more promising future.

The future of medicine, as Samueli Institute views it, is a future in which patients can tap into their body’s own healing capacity through self-care and with the assistance of practitioners who understand the importance of evidence-based treatments, patient-centered care, and resiliency.

 

A Thriving Nation

There are ways in which society can predict, track and improve resilience. Samueli Institute’s experts have researched the cases of trauma and stress that have been turned around through the implementation of mind-body practices in patient care. As one of the organizations helping with the integration of mind body medicine in the military, SI has looked into the factors that contribute to resilience, for the military community, and in the nation.

In life and in the military, trauma is unavoidable, therefore preparing for life in the military should include exercises that teach service members how to cope with what is happening around them. Geoffrey Ling, MD, PhD says “a prepared mind is really one the most important things.” Outside of the military, the path to flourishing requires more than just preparation, as sometimes, the state of a community is the result of issues occurring outside of that community. SI’s VP of Optimal Healing, Bonnie Sakallaris, PhD, RN asserts that the key to resiliency within a community is to understand the needs of the community and work from there. Learn more.

 

The Placebo Effect

The process of healing extends far beyond actual treatment, and through research, we’ve come to understand that the encounter between a patient and a practitioner is an important part of the healing process.

Salutogenesis begins when a healer makes the simplest of gestures. SI’s Wayne B. Jonas, MD explains that putting a positive spin on the patient’s situation, or informing them that the condition is likely to improve, all affect how the patient to begins to heal.

 

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Wayne B. Jonas, MD of Samueli Institute, Placebo Effect video

“The placebo effect tells us that there are some underlying process around how we go about healing, that are separate from the what.” -Dr. Wayne B. Jonas

 

Mindfulness/Mind Body Medicine

Mindfulness is a consciousness therapy, which leads to the mind-body connection. Science has discovered that 80% of all non-communicable disease is related to stress, therefore, most diseases are preventable through self-care.

It is as simple as breathing, and thinking; these are everyday tasks, which humans do mindlessly. But to consciously think, feel and breathe, is to fuse the mind and body and experience life as a whole person. Learn more.

 

Consciousness

Both science and religion describe a world in which humans have the inherent power to influence their lives through Extended Consciousness. How humans perceive the world, behave and interact with the world, all affect how their lives will play out; it’s all about connection.

Extended Consciousness involves forming a connection with oneself, with others and with the universe. Learn more about consciousness here.

 

Bioenergy Medicine

With a goal to help with the integration of mind-body medicine into standard care, Samueli Institute is exploring Bioenergy Medicine. With the expertise of SI researchers John Ives, Ph.D. and partner experts like Capt. George J. Ceremuga, DO, we have been able to skim the surface and predict what future exploration into the science of bioenergy can do for medicine. Learn more.

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Samueli Institute recently launched the mind-body website brainmindhealing.org to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.

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PODCAST: An Interview With Dr. James Gordon http://samueliinstituteblog.org/podcast-interview-dr-james-gordon/ http://samueliinstituteblog.org/podcast-interview-dr-james-gordon/#respond Tue, 15 Mar 2016 13:56:37 +0000 http://samueliinstituteblog.org/?p=1450 James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices for which they were trained. These doctors were helping patients heal themselves with mind-body therapies. In his interview with Samueli Institute’s President and CEO Wayne B. Jonas, MD, Dr. Gordon explains his vision for building his healing community:

“To make self-awareness, self-care, and group support central to all healthcare-the training of health professionals and the education of our children.”

 Mind Body Medicine vs. Conventional Medicine

The recognizable difference between healing through mind-body medicine and with conventional practices is the use of modern technologies and artificial remedies as opposed to plant-based medications and mind-body therapies. Not all doctors are healers, according to Gordon’s testimony of what lead him to his current role. In fact, healers are not limited to those who actually studied medicine, and self-care can sometimes be more effective in treating patients than practitioner evoked treatment.

What sets mind-body medicine apart from other practices, according to James Gordon, is establishing a name for it that speaks directly to its function within society. Mind-body medicine is meant to treat using traditional forms of healing; these are healing forms, which he considers “indigenous,” and efficient.

“By calling it mind-body medicine, we are saying that we are in line with the deepest understanding of how human beings function. And we’re also committed to those approaches and those techniques that make it possible for each person to experience that connection and have a positive effect on it.”

In the conventional world, practitioners, academics and others have compared mind-body medicine to standard methods and decided that it seemed, “soft,” but Dr. Gordon finds that the reputation of mind-body medicine doesn’t quite match the evidence from mind-body research or the patient results.

 The Challenge of Mind Body Medicine

In response to the way much of the Western world views mind-body medicine, Dr. Gordon has a wake- up call. According to the Dr. Gordon, “soft” is a poor word to describe mind-body medicine becomes “soft” does not mean effective. Instead he says it’s not the mechanisms for healing that are present in mind-body therapies but the people criticizing the treatments who need to change.

 “No matter how much research you and I and others produce, people look at them as soft. And it’s their minds that need to change.”


 

Samueli Institute recently launched a new website brainmindhealing.org to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site

 

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http://samueliinstituteblog.org/podcast-interview-dr-james-gordon/feed/ 0 James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices... James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices for which they were trained. These doctors were helping patients heal themselves with mind-body therapies. In his interview... Integrative Medicine – Samueli Institute Blog clean 43:48
Mind-Body for Performance and Resilience: Advice for Leaders http://samueliinstituteblog.org/mind-body-for-performance-resilience/ http://samueliinstituteblog.org/mind-body-for-performance-resilience/#respond Tue, 23 Feb 2016 14:41:43 +0000 http://samueliinstituteblog.org/?p=1416 We know mind-body practices improve performance. Mind-body techniques are based on recognizing the stress response and engaging in purposeful activities to stimulate the restorative relaxation response. These responses – stress on the one hand and relaxation on the other – are controlled by the autonomic nervous system, and can be regulated by the mind. Mind-body techniques can be mastered and leaders can help their teams learn when and how to use appropriately.

How can we as leaders make these tools more accessible to our teams? The barriers can seem overwhelming when trying to effect change. But by overcoming barriers of language and imagery; challenges of limited resources and making one degree of change at a time, leaders on all levels can improve the performance and resilience of their teams.

Overcome the Language Barrier

Not everyone connects with the typical language of mind-body practices. In fact, it alienates many who might benefit from it. To overcome this, leaders must normalize the language and make it un-mystical. By “de-mystifying” it, any religious or negative connotations associated with the mind-body connection are removed as barriers. We can use neutral language that relies on evidence and communicates to our teams in their language. This will drive policy change and increase utilization of beneficial mind-body tools.

 

It’s just training

"Soldier, take a knee."

“Soldier, take a knee.”

In the military, we don’t call it mind-body, we call it training. However, mind-body practices can be seen throughout training. Breath control is an essential component of marksmanship and weapons training. Team leaders often calm on-edge Service members by saying: “Soldier, take a knee.” This allows the Soldier to take a breath and relax thereby resetting their stress response.

 

Sports stars also use mind-body skills to achieve greatness. However, rather than calling the process “guided imagery,” sports stars call it “visualization” avoiding any spiritual or religious connotations. Athletes have long-relied on presence of mind to get through the most difficult physical challenges. Long-distance runners often rely on the mind-body connection to maximize the ability to perform under pressure.

Put it to work. Don’t wait for perfection.

How can you immediately get mind-body techniques into your clinic, your office, or your “squad” even with limited resources?

It only takes a moment. Leaders could teach all staff simple exercises to help center the patient and set intentions. An example is to teach staff language to encourage the patient to do a breath exercise when just before taking a blood pressure measurement. It’s as simple as saying: “We find that we get more valid readings if while you breathe, you think of a person or a situation that brings you joy.” Adding mind-body to well visits, vaccines, and other patient encounters is a small step within a leader’s control and requires no more time or resources.

The Bounce Back Project in Buffalo, Minnesota, takes a mind-body approach to help patients with anxiety and mood disorders. Patients were prescribed to do three good things and then report back. Their symptoms were more improved than those in treatment as usual.

And its not just in medical settings that Bounce Back is making an impression, it is also in the justice system. Police and judges are making a difference, too. A judge caught on to this idea and sentenced people to do three good things a day and journal it. These very real activities are mindfulness in action.

 

Aim High. Invest Now for Later

USUHS_Meditation1webHealth care leaders can make the most of their efforts by targeting residence training. By investing early in a young doctor or a nurse’s career, the payoff will include increased energy, optimized performance, decreased stress and improved health. Paying attention to the stress of their charges, leaders will help prevent stress from becoming burnt out. Military medical schools are working to provide this type of training to new health care professionals.

Leaders should consider incorporating mind-body training into daily meetings. Take a moment to set an intention and take a breath; this models the behavior for all present.

In 2012 CAPT Lori Laraway wrote in Proceedings, the official journal of the Naval Institute Press, about the “Navigating Operational Stress.” CAPT Laraway noted the pressures on active and reserve Service members and families due to the operating tempo of military operations such as wars in Afghanistan and Iraq, humanitarian and disaster relief deployments after the devastating earthquake in Haiti and the tsunami that hit Japan.

 

These pressures, whether due directly to dangers of war or difficulties related to frequent, lengthy deployments away from home and family, have significant costs that are manifested in multiple ways, including higher divorce rates, an uptick in DUI and alcohol-related incidents, increased illegal drug use, more frequent spouse or child abuse, and even, most regrettably, more suicides.”  CAPT Laraway

The solution, she says, required re-thinking about stress and recovery, moving away from the culture of believing a Sailor or Marine was either a “full up round” or “broken,” to embracing the idea that stress is normal affecting people differently. Navy operational stress management doctrine changed shifting more responsibility to leaders who needed more knowledge and skills identifying and managing adverse consequences of stress injuries and illness preventatively.

  • Read more: Samueli Institute studies have shown that emergency responders and Service members can learn to self-calm in the face of a crisis.

Leaders have a responsibility to incorporate mind-body practices into the everyday rituals of those under your command.


Watch video of Dr. Kevin Berry at the 2016 Military and Veteran Resiliency Summit in San Deigo: WATCH

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Team Approach Improves Chronic Pain Care in Oklahoma Clinic http://samueliinstituteblog.org/team-approach-to-chronic-pain-care-oklahoma-clinic/ http://samueliinstituteblog.org/team-approach-to-chronic-pain-care-oklahoma-clinic/#comments Mon, 22 Feb 2016 12:01:08 +0000 http://samueliinstituteblog.org/?p=1397 Providing chronic pain patients with seamless access to non-pharmacological therapies and self-care skills requires clinics to re-think business as usual. Dr. Vinny Francio, DC, MS, practices Integrative Spine Care and Integrative Pain Management for Essential Integrative Health in Oklahoma City, an integrative spine and pain management clinic, in collaboration with orthopedic spine surgeon and integrative physician Dr. Art Conley, MD.

Improving chronic pain care for his patients is especially important to Dr. Francio because the state of Oklahoma is one of the leading states in prescription drug overuse with nearly 800 deaths per year due to drug overdose according to the Center for Disease Control.

Earlier this month, Dr. Francio shared his story in a Virtual Congress as part of Samueli Institute’s Chronic Pain Breakthrough Collaborative.

“Our patients were tired of traditional pain management,” said Dr. Francio, whose team created a model of care that better serves his patients. This effort was part of Essential Integrative Health’s participation in the Chronic Pain Breakthrough Collaborative, a systematic approach to health care quality improvement.

Assessment Looks at the Bigger Picture of Chronic Pain

The first step of the chronic pain care model is an integrative treatment intake. The new intake includes a physical assessment, a medical assessment, a behavioral assessment and nutritional assessment.

“By the end of the treatment assessment, we sit down with the patient and explain our entire treatment protocol, including medication management strategies, physical medicine strategies, behavior, and nutrition,” said Dr. Francio.

 

Integrating the multidisciplinary assessments in a single visit helps to minimize patient burden and optimize reimbursement, in addition to facilitate the patient’s transition from a traditional pain management program to an integrative model.

“At the same time patients see us for medical treatment; they also get an adjunctive assessment with one of our other pillars—physical medicine, behavior, or nutritional medicine.” -Dr. Francio.

By developing this integrative assessment and making time for a weekly meeting to collaborate on administration and clinical needs, Dr. Francio found that his team was able to maximize their current resources to provide better chronic pain care to patients in the Oklahoma City and surrounding metro area.

Teamwork Benefits Patients and Providers

An integrative pain practitioner for over 20 years, Heather Tick MA, MD, believes that working in teams is important for both the patients and the providers.

“Patients with pain complaints are some of our most frequent and our most challenging patients. They’re very difficult in terms of the complexity that they present when it’s chronic pain, and this applies to every single specialty. So, when we feel inadequately prepared to deal with the complexity, and unsupported in the work, that adds to physician stress. Working in teams is a chance to mitigate the situation.” –Dr. Heather Tick

 

PainCollaborative-4

Dr. Tick guides discussion at the Chronic Pain Breakthrough Collaborative Learning Session

“Patients want seamless care,” said Dr. Tick. “They want to know that their team members speak to each other and collaborate, so that even when there are times when there are different team members who want to approach a problem differently, patients are fine with that as long as they know that there’s dialogue and that their wellbeing is at the center of the conversation.”

Dr. Tick serves as an integrative pain care subject matter expert as part of the Chronic Pain Breakthrough Collaborative faculty. Faculty guided participants through the components of team-based chronic pain care:

  • creating and strengthening interdisciplinary pain management teams;
  • promoting an understanding of self-care and non-pharmacologic treatment options, and
  • developing shared intake assessments and care planning processes that include the patient as an expert in their own care.
PainCollaborative-Mittman

Dr. Mittman, Chronic Pain Breakthrough Collaborative learning session

Like Dr. Francio, Paul Mittman, ND, of the Southwest College of Naturopathic Medicine Medical Center found that participating in the Chronic Pain Breakthrough Collaborative helped his team to become more integrated in their approach to care.

We took three people from very different backgrounds—an acupuncturist, a medical doctor and a naturopathic doctor and through this process really started to unite as a team,” said Dr. Mittman.

This increased integration of interdisciplinary care providers is part of the solution to decrease the number of patients relying solely on opioids for chronic pain. When providers are connected in meaningful ways to each other around patient care, it leads to more choices of disciplines and strategies available for the benefit of the patient.

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Increase Patient Power In Pain Care http://samueliinstituteblog.org/increase-patient-power-pain-care/ http://samueliinstituteblog.org/increase-patient-power-pain-care/#comments Mon, 08 Feb 2016 12:12:17 +0000 http://samueliinstituteblog.org/?p=1296 Problem-solving is a key skill at work, at home and in the classroom. But problem-solving is also important for patients when managing chronic pain.

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Samueli Institute’s Chronic Pain Breakthrough Collaborative teams met in January to celebrate and share what worked to increase the number of patients using non pharma and self-care therapies for chronic pain—one of the goals of the 2015 learning collaborative. Participants found that moving from a clinician-driven model of care to one that empowers patient’s self-management of chronic pain required a new outlook and skill set for both the providers and the patients.

Measures of Success in Chronic Pain Care: Empowering Patients with Self-Care Strategies

“Pain care doesn’t always involve providers,” explained Martha Menard, PhD, LMT, Executive Director of the Crocker Institute, and a faculty member for the 2015 Chronic Pain Breakthrough Collaborative.

In a recent study (published Jan 2016), Menard found a common characteristic of those living well with chronic pain was their perseverance and openness: “People were very open to trying new things and kept trying until they found what worked for them, putting together these highly individualized packages of care for themselves. They became skilled at noticing the connection between feeling stressed and making their pain worse, so they found lots of ways to incorporate self-care into their daily routine.”

According to Menard, these individuals looked for opportunities to take action to change the things in the daily life over which they did have control. These included eating a healthy diet, being more physically active, engaging in meaningful activities that gave them pleasure, and were often high users of integrative therapies like chiropractic, acupuncture, massage, and mind-body therapies like meditation or yoga.

Self-care in practice: Massage and Yoga

Pain clinics like Madigan Army Medical Center in Tacoma, Washington, employ self-care into their treatment programs to improve patient self-efficacy.

According to Diane Flynn, MD, MPH, FAAFP, the Primary Care Pain Management Advisor at Madigan Army Medical Center, a typical patient going through their three to six week pain program called IMPACT (Integrative Modalities Pain Care Team) received twice weekly acupuncture, chiropractic care, health psychology, physical therapy and occupational therapy, and once weekly foam roller massage instruction and yoga.

Foam roller massage is a type of self-massage using a dense foam roller device that can be taught to patients, and focuses on myofascial, or connective tissue pain.

Staying active is another important form of self-care, which is why the IMPACT program offers yoga.

The military and VA have recognized the value of yoga and are working to increase its availability. Outcomes studies show the potential benefits of yoga especially for chronic low back pain.

  • Learn more about Tai Chi, music therapy, and other self-care modalities in Samueli Institute’s Supplement to “Pain Medicine” summarizing the available evidence for self-care complementary modalities in chronic pain.

Developing Self-Efficacy Key to Positive Outcomes

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

According to Menard, one way to help patients develop a sense of self-efficacy is through social role modeling where people can learn from others’ experiences of success.

“People who may be struggling need to see models of living well with pain to know that it is possible. Seeing and hearing positive stories from other people who are living a satisfying and fulfilling life enhances their own belief that ‘Hey, maybe I could do this, too.’”

She encouraged engaging community stakeholders and local providers to collect individual success stories: “People who are living well with chronic pain are a largely untapped resource. They can serve as positive role models for people who are struggling in almost every community.”

Shared Tools to Help Patients Understand Chronic Pain

When dealing with chronic pain, it can be easy for patients to narrowly focus on the pain rather than zooming out to understand the human brain and its relationship with acute and chronic pain.

Collaborative participants shared resources, including a video explaining how to retrain the brain to heal and manage pain. The video explores the different components of pain including medical options; thoughts/ emotions; diet/lifestyle; personal history; physical activity and function.

Called “Understanding Pain”, the video was developed to provide individuals, family members, and clinicians with general strategies for managing acute and chronic pain. Based on an Australian concept for pain education, “Understanding Pain” is a product of the Department of Defense (DoD) – Veterans Health Administration (VHA) Joint Pain Education Project (JPEP).

At the final meeting of the 2015 Chronic Pain Breakthrough Collaborative, executive sponsor Bonnie Sakallaris, PhD, RN, expressed her satisfaction in the progress the teams made:

“The pain practitioners we work with share one common passion and that is for the relief of suffering and a passion to go beyond moving the needle on pain intensity scores to enable those suffering with chronic pain to manage their own health and fulfill their life’s goals. They are transforming chronic pain care through rapid cycle tests of change that lead to seamless, integrative, person-centered care.

Learn more about the process at SamueliInstitute.org/ChronicPain

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Podcast-An Interview With Dr. Robert Bonakdar http://samueliinstituteblog.org/podcast-an-interview-dr-robert-bonakdar/ http://samueliinstituteblog.org/podcast-an-interview-dr-robert-bonakdar/#respond Thu, 28 Jan 2016 12:00:17 +0000 http://samueliinstituteblog.org/?p=1239 Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain Management at the Scripps Center for Pain Management in California. When asked how he got started, Dr. Bonakdar explained that what Americans call alternative medicine, is not as foreign to him.

Born in Iran, Dr. Bonakdar learned of integrative medical practices like mind-body therapy and Tai Chi at a young age. In his homeland, these practices are primal and others like prescription medication are secondary and sometimes forbidden. His vision for pain management practice is to help make so-called alternative medicine, more prominent in the United States.

“We need a huge transformation. We need more individualized pain care, not just specifically what the guidelines say; and a lot more self-care.”

His current approach involves offering alternative pain management treatment as a first choice or after patients have exhausted all other forms of treatment, including medication. In his practice, he often finds that many patients are not healing from conventional practices because the root of their problem is not what it appears. Sometimes chronic pain comes from injuries and strain, but other times, it comes from stress. Dr. Bonakdar strives to look at the whole picture to heal his patients.

“How can condition ‘X’ fit the entire picture and how can you then approach this complex picture in a way that’s patient’s centered.”

Acknowledging that there has been considerable evidence that integrative medicine heals patients, Dr. Bonakdar is looking for ways to make some integrative treatments standard in healing patients with chronic pain.

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http://samueliinstituteblog.org/podcast-an-interview-dr-robert-bonakdar/feed/ 0 Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain ... Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain Management at the Scripps Center for Pain Management in California. When asked how he got started, Dr. Bonakdar explained that what... Integrative Medicine – Samueli Institute Blog clean 25:58
SI Experts And Partners Publish Article On SEaRCH Process For Evidence-Based Care http://samueliinstituteblog.org/search/ http://samueliinstituteblog.org/search/#respond Wed, 20 Jan 2016 18:37:46 +0000 http://samueliinstituteblog.org/?p=1176 On a quest to discover which healthcare practices are the most effective and nominal in cost, leaders from Samueli Institute’s Scientific Evaluation and Research of Claims in Healthcare SEaRCH™ Program have published an article on how to get evidence-based medical practices into mainstream care. We have found that expert panels from SI and partnered organizations are the best option to guide the research process.

Who’s Involved?

Samueli Institute’s SEaRCH™ program has several expert panels which include article co-authors Wayne Jonas, MD and Senior Psychologist, Pamela Elfenbaum. The Clinical Expert Panel (CEP), Research Expert Panel (REP), the (PoEP) which is designed for policy and the PaEP which is for patient experts. Partners of SI are also closely involved in streamlining evidence-based patient care:

National Institute of Health (NIH) Consensus Panels -Since 1977, the panel has been congregating on occasions to answer standing questions on how to resolve the controversies surrounding data management.

Institute of Medicine (IOM)- The IOM summarizes the medical evidence into reports to make the data more clear and more readily available to be used by practitioners.

RAND Expert Panel– RAND focuses on clinical experts rather than scientific experts to add diversity to the evidence. RAND’s Ian Coulter, PhD is working closely with SI’s SEaRCH™.

Consciousness and Healing Initiative (CHI)- Director of the initiative, Dr. Shamini Jain has partnered with SEaRCH™ for this article.

The article titled, SEaRCH™ expert panel process: streamlining the link between evidence and practice, is published in the journal BioMed Central.

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Faculty Announced For 2016 Chronic Pain Breakthrough Collaborative http://samueliinstituteblog.org/faculty-announced-2016-chronic-pain-breakthrough-collaborative/ http://samueliinstituteblog.org/faculty-announced-2016-chronic-pain-breakthrough-collaborative/#respond Wed, 20 Jan 2016 16:37:48 +0000 http://samueliinstituteblog.org/?p=1159 Last year, Samueli Institute launched the Chronic Pain Breakthrough Collaborative with a plan to assist the many Americans who suffer from chronic pain, and to support the health care leaders working to reverse the opioid epidemic.

With 46 deaths each day from opioid overdoses, it’s clear that providers need more options for their patients. Many of these options are already evidence-based, however, integrating them into practice remains a challenge.

In a special virtual congress on Chronic Pain [watch the recording here] President and CEO Wayne B. Jonas, MD, acknowledged that Samueli Institute plays a special role in the process.

“Samueli Institute’s Chronic Pain Collaborative does the important work so that the research doesn’t just sit on the shelf.”

To continue that work, Samueli Institute has brought together a group of experts to lead the collaborative.

Chronic Pain Collaborative Faculty are the following:

Adam Perlman, M.D., MPH, FACP, Chair

Executive Director, Duke Integrative Medicine

Chair (past) for the Consortium of Academic Health Centers for Integrative Medicine

Diane Flynn, MD, MPH, FAAFP

Primary Care Pain Management Advisor
U.S. Army, Madigan Army Medical Center

Vinny Francio, DC, MS

Essential Integrative Health

Doctor of Integrative Spine Care, Pain Management and Physical Medicine and Rehabilitation.

Heather Tick, M.A., M.D.

Clinical Associate Professor at the University of Washington, Departments of Family Medicine, Anesthesia and Pain Medicine

The learning collaborative is currently seeking participants to join the expert faculty to identify and implement innovative ways to reduce chronic pain and optimize quality of life through timely delivery of team-based, person-centered, integrative pain management.

If participating in a high-level, results-oriented learning collaborative on integrative pain management would be valuable to you and your organization, please contact us today at SamueliInstitute.org/chronicpain

 

Who Should Join?

The Collaborative is appropriate for pain practices within organizations and clinical sites that want to offer a more integrative approach to pain management. Typically these organizations are:

  • Health systems with integrative pain clinic sites
  • Hospitals with integrative pain clinic sites
  • Group pain management practices
  • Primary care organizations utilizing at least one integrative modality.

The first collaborative meeting will take place in Spring 2016. Learn more online or schedule a call: kengstrom@siib.org.

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3 Opportunities for Integrative Medicine http://samueliinstituteblog.org/3-opportunities-integrative-medicine/ http://samueliinstituteblog.org/3-opportunities-integrative-medicine/#respond Tue, 19 Jan 2016 14:39:55 +0000 http://samueliinstituteblog.org/?p=1145 headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

In his interview with the Natural Medicine Journal, an electronic peer-reviewed journal and open access website dedicated to the field of integrative medicine, Wayne B. Jonas, MD, describes three opportunities for the field of health and wellness and how Samueli Institute and others are working to make progress in these areas.

1. Establish an evidence base

Providers and patients are constantly faced with claims about therapeutic and healing practices. Trying to sort out what works and what does not is often done in a haphazard and unreliable manner—or the information is not available at all.

The evidence gap poses a challenge to health professionals, educators, funders and patients seeking to establish whether a health claim is supported by valid clinical evidence. Over the last decade Samueli Institute researchers have tackled the evidence gap for these and other topics:

  • Breast Cancer: A review uncovered specific interventions (i.e., pharmacological, behavioral, psychological, complementary and alternative medicine, multi-modal) aimed at mitigating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients and survivors.
  • Resilience in the Military: Samueli Institute rigorously assessed the quantity, quality, effectiveness, and safety concerns on multi-modal, biopsychosocial training programs used for the self-management of emotional stress.
  • Supplements: Samueli Institute’s reviews have uncovered how supplements can improve performance and sustain health for omega 3’s, melatonin for sleep, and others.

As more non-traditional health care treatments are accepted, this research becomes even more important to inform providers, guide policy and empower patients.

2.  Incorporate healing practices into large systems

hands_forblogMerely having the evidence is not enough. Most patients undergoing surgery still cannot access post-surgical acupuncture more than a decade after it was deemed effective. Ensuring that large hospital systems are successfully able to integrate these evidence-based practices into standard care is needed to move the field forward.

Complementary and integrative practices like acupuncture, massage, manipulative therapies, and education on diet, nutrition, and other self-care approaches are not very integrated, with conventional medicine or themselves. They are not part of normal medical training, are usually delivered in silos of practice, often aren’t found in the same place, are not part of a patient centered medical home, are not incorporated into national guidelines and are not paid for by insurance. Therefore, integrative practices tend to operate in isolation.

The need to improve quality of care is fueling Samueli Institute’s work in the Chronic Pain Breakthrough Collaborative. Health care systems and clinics receive consultative support in process improvement to integrate care which results in better outcomes for both patients and providers.

3. Show impact on the bottom line

Dr. Jonas discusses the need to demonstrate how complementary and integrative practices are cost effective within large health care systems.

Progress can only be achieved by knowing the return on investment of wellness behaviors and programs, and the success rates of traditional health interventions like medications and surgeries and how they compare with alternative treatments.

When Valley Hospital in Ridgewood, New Jersey decided to train their nursing staff in using holistic integrative care – for themselves and with their patients, a look at the operating margin of 9.64%, nine times the average for New Jersey confirmed that the decision to incorporate integrative, holistic care was clearly on target.

More success stories like this will provide a powerful financial driver for wellness.

Listen to the full interview to hear the biggest advances and future predictions for the field of Integrative Medicine.

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The Future of Integrative Medicine, an Interview with Dr. Jonas http://samueliinstituteblog.org/future-integrative-medicine-interview-dr-jonas/ http://samueliinstituteblog.org/future-integrative-medicine-interview-dr-jonas/#respond Wed, 06 Jan 2016 21:08:00 +0000 http://samueliinstituteblog.org/?p=1132 What does the future hold for health and wellness research? Wayne B. Jonas, MD, discusses this and more with the staff at the Natural Medicine Journal, an electronic peer-reviewed journal and open access website dedicated to the field of integrative medicine (IM).

Listen to the interview in Episode 6 of the
Integrative Medicine Research Series.

Mainstreaming of Healthy Values

In recent years it seems there is little “health” in the nation’s health care system. By its actions, the health care system showed its laser focus on disease and illness management rather than health promotion.

However, as we look ahead, we begin to see the wellness-focused values of those in the non-traditional wellness field appearing in the lexicon of the mainstream health care system.

Wellness, well-being, health and health promotion are becoming valued by the health care system in its efforts to improve patient care. As the focus shifts from disease-centered care to person-centered care, patients benefit and the nation becomes healthier.

Consumers Demand Health and Wellness

TK SAT-53webSeeing these values in action is as easy as entering the supermarket, where the demands for organic, hormone-free, antibiotic free products have surged. Health and wellness are part of the everyday quest for many consumers who are showing their interest with their wallets, purchasing healthier protein options such as bison, salmon and quinoa.

As these values of health and wellness become mainstream, they continue to have ripple effects as choices are not always an individual behavior, but influenced by the social and physical environments as well.[i]

Mainstreaming of Alternative Practices

The health care system cannot ignore the interest in promoting wellness. This leads to the next trend of mainstreaming practices that were once considered non-traditional by the health care industry.

Once on the fringes, massage and chiropractic care are now more accepted. Even the current administration is discussing how non-drug approaches to chronic pain might alleviate the opioid crisis in America.

BFA Acupuncture needlesThe connection between nutrition and brain function is a focus point of Samueli Institute’s work with the military. As is exploring the value of acupuncture and guided imagery for the signature wounds of the war in the Middle East—post-traumatic stress and traumatic brain injuries.

Researchers and practitioners must continue to show the value of these non-traditional practices for the health industry to adopt them.

But knowing that something works is merely part of the equation.

Knowing how to implement that knowledge within the current system of care is also critical. The term “integrative care” surfaces as a buzz word in the industry; however many health care systems struggle to provide care that combines the best of traditional and non-traditional medicine.

Improving the patient’s experience of care through a focus on integration is highlighted in Samueli Institute’s work in chronic pain care.

Listen to the full interview including the biggest advances and opportunities in the field of Integrative Medicine.


 

[i] http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-522

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Should You Go Under the Knife? A Review of Sham Surgery http://samueliinstituteblog.org/placebo-sham-surgery/ http://samueliinstituteblog.org/placebo-sham-surgery/#respond Tue, 15 Dec 2015 11:10:38 +0000 http://samueliinstituteblog.org/?p=1109 Patients dealing with chronic pain and obesity have a difficult decision to make when facing surgery or minimally invasive procedures. With the help of their doctors, patients weigh the risks of the procedure including infection, cost, and the side effects, including those of anesthesia. However, a recent study by researchers showed that in some cases, surgery is no better than placebo, and in other cases that doctors and patients may not have all the information they need to make proper decisions.

Some Procedures No Better than Placebo

Researchers from Samueli Institute, National Institutes of Health, Harvard Medical School, Houston Methodist Hospital, the University of Maryland and the University of Munich, Germany systematically reviewed 55 studies comparing patient outcomes from actual surgical procedures to outcomes after “sham” procedures. Sham procedures mimic the ritual and process of surgery without actually performing the procedure.

The review encompassed more than 3,500 patients and showed that outcomes for surgery were about the same as placebo in the included procedures for pain, and marginally better in cases of obesity.

The results of the systematic review, which was published this month in the journal BMJ Open, have implications for clinical research and practice by arguing against the continued use of ineffective, invasive procedures—especially in the field of chronic pain – until more rigorous research is done on these procedures.

Limited Information Available for Decision-Making

Minimally invasive surgical procedures have expanded for treating conditions such as low-back pain, arthritis, endometriosis, Parkinson’s disease, gastro-oesophageal reflux and obesity, but rarely are these procedures evaluated using rigorous research designs using randomized, placebo-controlled trials, the gold standard of medical research.

This limits the ability of doctors and patients to make proper evidence-based decisions when deciding whether the risks outweigh the benefits.

Wayne B. Jonas, MD, President and CEO of Samueli Institute and an author of this review, has been studying the effects of placebo for more than a decade. His research works to uncover the role of placebo, meaning and context in the healing process.

“We need to uncover how much of the healing is due to the specific treatment and how much can be attributed to other factors like the ritual, the setting, and the communication style of the provider,” says Dr. Jonas. “This understanding will help us to maximize the effective factors and limit the risk of invasive treatments.”

Read the full study here.


BMJ Open 2015;5:e009655 doi:10.1136/bmjopen-2015-009655:  To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. View article.

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Maximize the Power of Data in Pain Care http://samueliinstituteblog.org/maximize-power-data-pain-care/ http://samueliinstituteblog.org/maximize-power-data-pain-care/#respond Mon, 14 Dec 2015 12:16:32 +0000 http://samueliinstituteblog.org/?p=1107 When improving the quality of pain care, health care organizations can be tempted to start making changes, but having appropriate outcomes data ensures that the efforts are effective, sustainable and evidence-based.

LTG Eric Schoomaker (ret.)

LTG Eric Schoomaker (ret.)

“You need to have a handle on outcomes before you start changing processes,” noted former U.S. Army Surgeon General Eric Schoomaker, MD, PhD.

Improving chronic pain management requires using all the tools in our toolbox, including outcomes and measurement data. Overcoming challenges in data collection, focusing on patient-centered data, and using valid and consistent tools are three important components of the data picture.

These are just a few of the lessons being learned in Samueli Institute’s Chronic Pain Collaborative in which participants learn state of the art approaches to improve integrative pain management.

Challenge of Integrative Pain Management

Showing improvements in Integrative Pain Management is challenging. Integrative treatments are currently used as a treatment of last resort. As with other medical conditions, history has shown us that it is much better to prevent than to treat the condition. Therefore, those who are receiving the treatment are less likely to respond because they are further along in the pain continuum.

In the field of research, this is called a sampling bias. Sampling bias means that the participants being studied do not reflect the characteristics of the population which is being tested.

“We need to get our patients into integrative treatment earlier so we can see better outcomes. Including it early in treatment helps prevent the helplessness and hopelessness cycle that can prevent our patients from improving,” says Bonnie Sakallaris, RN, PhD, Vice President of Samueli Institute.

But it’s not just important TO collect data; it’s more WHAT data you collect.

Collecting Valid and Consistent Data

“Large amounts of valid and consistent data is very powerful in determining what works in the area of pain care. You can’t compare efficacy if you don’t have good data,” says Bonnie Sakallaris, PhD, RN, Vice President, Samueli Institute.

Consistent and valid data minimizes issues with evaluating success.

Several members of the Chronic Pain Collaborative implemented a validated assessment scale developed by the military called PASTOR[i].

PASTOR (Pain Assessment Screening Tool and Outcomes Registry) was developed by the military on the recommendation of the Army Pain Management Task Force to optimize quality of life for patients living with acute and chronic pain.

To develop this tool, the Pain Management Task Force leveraged the NIH’s investment in building the Patient-Reported Outcomes Measurement Information System (PROMIS®). PASTOR enhances the clinical encounter and provides data for comprehensive evaluations of treatment effectiveness. It’s available via REDCap, which is a secure web application for building and managing online surveys and databases.

Improving Patient Care through PASTOR

Madigan Army Medical Center’s Interdisciplinary Pain Management Center (IPMC) began piloting the online outcomes pain measurement tool earlier this year to improve their patient care. Patients either filled it out at home online or at kiosks in the pain clinic. It took 20 minutes the first time and filling it out every four weeks at follow-ups took about 16 minutes.

The provider then receives a three-page report with a visual dashboard and which looks at the whole person as it screens for post traumatic stress, depression, anxiety, sleep dysfunction, activity, mood, stress and alcohol usage.

In the short-term, providers found the tool to be effective and began using this holistic report as a way to talk with their patients about their pain goals, care and outcomes.

In the long-term, the clinic is excited to use the data to help determine their efficacy of care.

“By collecting this data, we can help understand what types of patients or which diagnoses are more likely to improve, which are less likely and who should we treat via different avenues,” said Diane Flynn, MD, Primary Care Pain Advisor for the Interdisciplinary Pain Management Clinic at the Madigan Army Medical Center (IPMC).

Learn more about her team’s efforts.

An Opportunity for Change

Another team noted that they, too, had an opportunity to improve their outcomes strategy to show the results of their work.

“We realized that we needed to show the effect of our work. We weren’t doing that enough before.” -Collaborative participant

Exploration uncovered that the batteries of tests were overlapping, repetitive and not very meaningful to their patients.

The team changed their measurement strategy; they added some and removed others. The new outcomes were still comprehensive, but less burdensome for patients –  decreasing the time taking assessments from 60 minutes to 25 minutes. They also saw the value of adding a one-on-one consultation to go over the assessment findings with the patients to help judge progress at several time-points along the treatment.

The team received advice and input from other groups participating in the collaborative as well as experts in the field of pain and research as part of the 9-month collaborative process.

Patient-Centered Data

Pain practitioners are trained to work towards a goal of decreasing pain levels and increasing quality of life. But what often gets overlooked are the patient’s goals.

“Determining what the patient wants and needs out of the care is essential. Patients need to create their own outcomes and the medical team helps them to quantify it and work towards this goal,” says Wayne B Jonas, MD, President and CEO of Samueli Institute.

His work in the area of patient-centered approaches to care helped to re-structure his concept of assessment.

Optimizing care requires allowing patients to choose their own outcomes of focus. Having the patient establish an outcome of focus is part of a chain of events that helps empower a patient. If a patient wants to go on a trip, or sit on the floor with their grandkids, that becomes the goal and the treatment is aimed at helping the patient achieve that goal.

Engaging the patient prevents them from being a victim of their care. The patient becomes an active member of their pain care team and is more incentivized to engage in self-care and adhere to treatment,” said Sandi Gordon, Senior Program Manager, Samueli Institute.

Collecting patient-focused data rather than pain-focused data is an important strategy in starting to turn the tide in pain management.

Integrative Pain Management

We love data here at Samueli Institute. So when we have an opportunity to share this passion while also improving the health of the nation we are in our sweet spot. Participants in the chronic pain collaborative learned to use data to improve their chronic pain programs.

Samueli Institute is currently seeking participants for the next learning community on chronic pain. Learn more.

 


 

[i] http://www.futuremedicine.com/doi/abs/10.2217/pmt.14.25?src=recsys&journalCode=pmt

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When evidence matters, rigorous reviews for pain care http://samueliinstituteblog.org/evidence-matters-rigorous-reviews-pain-care/ http://samueliinstituteblog.org/evidence-matters-rigorous-reviews-pain-care/#respond Fri, 11 Dec 2015 14:14:57 +0000 http://samueliinstituteblog.org/?p=1102 Patients struggling with chronic pain need non-pharmacological therapies that can decrease pain, improve function and enhance quality of life. Our rigorous reviews have uncovered the evidence for various therapies that can be easily integrated into a pain practice such as massage therapy and manipulation, and self-care tools such as yoga, tai chi, music therapy, meditation and relaxation exercises.

Establishing a strong evidence base for self-care approaches helps answer the most challenging questions affecting the world’s health and wellness:

  • What can we add to the physician’s bag of tools to replace or supplement the prescription pad?

  • Are there self-care practices to include in a patient’s pain management solution set?

Samueli Institute evaluates pain from the view of the person as a whole and looks at the bigger picture of the “chronification” of pain that the patient experiences. This objective, third-party analysis of the evidence provides guidelines for clinical practice, policy decisions and research recommendations.

Samueli Institute’s research process was highlighted in a recent article in BMC Research Notes.

The article explores how this process overcomes the traditional challenges of current systematic review methods to efficiently and effectively answer “what works” in patient care. In addition to research in the area of pain, Samueli Institute has worked to identify safe, effective, and affordable healing practices, programs or products to improve individual and public health.

  • Breast Cancer: A review uncovered specific interventions (i.e., pharmacological, behavioral, psychological, complementary and alternative medicine, multi-modal) aimed at mitigating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients and survivors.
  • Resilience in the Military: Samueli Institute rigorously assessed the quantity, quality, effectiveness, and safety concerns on multi-modal, biopsychosocial training programs used for the self-management of emotional stress.
  • Supplements: Samueli Institute’s reviews have uncovered how supplements can improve performance and sustain health for omega 3’s, melatonin for sleep, and others.

As more non-traditional health care treatments are accepted, this research becomes even more important to inform providers, guide policy and empower patients.

When evidence matters, contact Samueli Institute.

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Registration Now Open for Chronic Pain Breakthrough Collaborative http://samueliinstituteblog.org/registration-open-chronic-pain-breakthrough-collaborative/ http://samueliinstituteblog.org/registration-open-chronic-pain-breakthrough-collaborative/#respond Mon, 07 Dec 2015 11:29:19 +0000 http://samueliinstituteblog.org/?p=1091 Heather Tick (center) engages with other participants to discuss modalities of integrative care.

Faculty and participants discuss innovations in pain care

To adequately address chronic pain in today’s healthcare system, industry innovators must create a new patient-focused and interdisciplinary chronic pain care model that focuses on drugless therapies and self-care.

Samueli Institute invites pioneering pain practices to join leading providers in civilian, military and veteran healthcare to form the Chronic Pain Breakthrough Collaborative, a learning and action community designed to accelerate education and widespread implementation of best practices in interdisciplinary care for chronic pain.

The team is led by an expert faculty—including Adam Perlman, MD, of Duke Medicine who guides and mentor participating organizations through the 12-month improvement process that will begin in the spring of 2016.

Goals

Participants in the Samueli Institute Chronic Pain Breakthrough Collaborative will:

  1. Integrate multiple disciplines, including complementary and integrative medicine, in team-based approaches for more effective pain management.
  2. Increase health-related quality of life and patient safety for chronic pain patients through decreasing the level of pain, medication burden, and risk of opioid dependence.
  3. Increase autonomy for individuals to manage their pain through non-pharmacological approaches.
  4. Provide clear return on investment over time.

The Chronic Pain Breakthrough Collaborative is ideal for pain practices within healthcare organizations that desire to offer a more integrative approach to pain management and are willing to optimize the level of integration of medical care, psychological care, self-care modalities, and complementary and integrative care.

Previous participants in the Chronic Pain Breakthrough Collaborative report a decrease in the number of patients relying on opioids for chronic pain, an increase in the number of patients using non-pharma and self-care therapies for pain, and an increase in quality of life and patient function. Additionally, previous participants report improvements in staff communication, multi-disciplinary teamwork and collaboration.

Samueli Institute is registering a limited number of participants in the next Chronic Pain Breakthrough Collaborative now.

Learn more at SamueliInstitute.org/ChronicPain

To reach us directly, contact Sandi Gordon at Samueli Institute: collaboratives@siib.org or call (703) 965-7227.

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Does Biofield Healing Work? 3 Challenges of the New Field http://samueliinstituteblog.org/biofield-healing-work-3-challenges-field/ http://samueliinstituteblog.org/biofield-healing-work-3-challenges-field/#respond Tue, 24 Nov 2015 21:13:52 +0000 http://samueliinstituteblog.org/?p=1024 New is scary. That is especially significant in a field like medicine that is based on proven theories of respected experts, the evidence of scientific research, and finally the knowledge of clinical practice. Scientists are now only beginning to understand the potential impact that the human biofield can have upon healing.

Like all fields in their infancy, integrating biofield healing into mainstream medicine is slow and the field is facing some major challenges to progress.

 

1.     Lack of a biological mechanism.

Biofield healing processes cannot be understood by conventional explanations. This creates some resistance or friction amongst scientists, researchers and practitioners. It is not yet universally accepted how to properly measure the energy, how energy is transferred, or how to reproduce positive effects in studies. When the active factors aren’t known, it’s nearly impossible to control for those factors. Researchers need to learn the rules of the game before they can control for them.

2.     New field, new lexicon, no structure.

For any field to progress, a solid academic infrastructure is necessary. Being able to study and understand the mechanisms of healing will allow for the theory and practice to develop in a way that is critical but not biased. Biofield healing is also a broad term that includes many different practices related to energy. Because we do not yet know the underlying mechanism, the varying practices and terms confuse and lead to varied interpretations.

3.     Science on the fringe.

Some of the aspects of biofield healing like the role of healing intention are connected to parapsychology which skeptics criticize as pseudo-science. Some definitions also include practices that appear similar to prayer or “laying on of hands,” which have religious connections, making scientists hesitant to tackle these traditionally stigmatized topic areas.

Solving these challenges will require the research community to be boldbiofield special issue and innovative.

“The appropriate response of biofield advocates must be to continue doing empirical work and clarifying their own definition of the boundary of science. If biofield healing does emerge as part of a new medical paradigm, then presumably that will bring with it some salutary modifications to the boundaries of scientific medicine.” [1]

Learn more about these challenges and others in the new article, “Barriers to the Entry of Biofield Healing into ‘Mainstream’ Healthcare” in the new biofield supplement.

[1] “Biofield Science and Healing: An Emerging Frontier in Medicine,” published in Global Advances in Health and Medicine, from the Special Issue in Biofield Science and Healing, released November 17th, 2015.

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New Academic Journal Special Issue Explores the Science of Energy Medicine http://samueliinstituteblog.org/academic-journal-special-issue-explores-science-energy-medicine-2/ http://samueliinstituteblog.org/academic-journal-special-issue-explores-science-energy-medicine-2/#respond Wed, 18 Nov 2015 11:51:09 +0000 http://samueliinstituteblog.org/?p=1010 gahmj.2015.4.issue-suppl.largecoverFor centuries global healing traditions, such as Traditional Chinese Medicine and Ayurveda, made use of a vital force—called chi or prana— to stimulate and guide healing. Today a new report compiling scholarship from leading researchers and health care providers considers how modern medicine could benefit from the use of these time-honored healing practices.

A special issue of the peer-reviewed journal Global Advances of Health and Medicine released today explores the theoretical and scientific basis for biofield science, the emerging field of research that studies how energy and information help guide our health. The 12 articles in the special issue explore the scientific evidence behind energy therapies such as Healing Touch and Reiki and examines whether healing intention can improve health outcomes.

“Modern medicine has made miraculous strides in the past 100 years, but its laser focus on disease at the expense of holistic health is reaching diminishing returns,” explains Wayne B. Jonas, MD, President and CEO of Samueli Institute, a sponsor of the special issue. “Biofield science and energy medicine offer great potential for a future of care that fosters health and wellbeing.”

The academic publication is the outcome of a conference on biofield science and healing held in San Diego, California in 2014 and sponsored by Samueli Institute, Miraglo Foundation, Chopra Foundation and Institute of Noetic Sciences.

The Special Issue, published by Global Advances in Health and Medicine, released November 18th and can be accessed here http://www.gahmj.com/page/samueli.

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Learning in and from the Military http://samueliinstituteblog.org/learning-military/ http://samueliinstituteblog.org/learning-military/#respond Mon, 02 Nov 2015 12:46:16 +0000 http://samueliinstituteblog.org/?p=980 In 2009, the Chairman of the Joint Chiefs of Staff commissioned a study to look at how to develop a whole systems approach to prevention, wellness, recovery and resilience.

At that time, the military was seeing increases in obesity, diabetes, lowering of psychological resilience, chronic pain, PTSD and suicide. It became clear that a fit force could not depend upon a health care system to improve health, as health care focused primarily on disease treatment and little on prevention. What was needed was a whole-systems approach that came from the units, the families and the communities in which service members were living.Total Force Fitness

The result was a framework called Total Force Fitness. It showed that creating a fit and flourishing fighting force required optimizing all the areas of a person’s life—a mind-body psychosocial approach.

Integration and Evaluation

Many programs are available to enhance health and human functioning in each of the areas of a service member’s life. However integrating and evaluating these programs is essential to their success.

When Samueli Institute mapped all of the fitness programs and health-promoting, resilience-promoting programs on a major military base, researchers confirmed the importance of integration and evaluation. Researchers found more than 50 independently funded and operated programs for service members, with very little coordination and practically no evaluation opportunities to measure what worked and what didn’t.

This lack of coordination and evaluation meant that money was possibly being wasted, and the value of many of the effective programs was not being captured nor were best practices shared to improve other programs. Samueli Institute is currently working with many health care systems outside of the military that are also facing these same challenges of integration and evaluation in our learning collaboratives.

A Focus on Self-Care

During my time as an Army physician and for the last decade at the Institute, I have been investigating self-care and alternative approaches for their potential application to enhance and optimize human performance. These so-called “alternative practices” form the foundation of military health care, as they allow independent optimization of function, and they do not dependent upon medical interventions and technologies.

My team and I have been scientifically investigating these self-care approaches, with an eye on their application to the military fighting force. They’ve worked with many military organizations across the country to examine ways of re-integrating service members optimally, as they come back from the wars. Learn about this work.

As the wars in Afghanistan and Iraq wind down, it’s time to collect these self-care and alternative approaches, and explore again their application within the military community.

In 2015 the Institute started a process to assist in implementing many of these self-healing practices in health care settings for the application of chronic pain. This learning collaborative on chronic pain, has begun to do the detailed operational testing of new self-care and drugless pain approaches, to assist in these areas.

These whole-person healing approaches seem to have application well beyond individual medical problems. Post-traumatic stress, optimal functioning even with a traumatic brain injury, and self-healing of chronic pain, are only the tip of the iceberg.

Health systems that are interested in learning about and implementing non-drug approaches to pain are welcome to join the community of learning. Learn more.

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The Future of Health Care is Now http://samueliinstituteblog.org/future-health-care/ http://samueliinstituteblog.org/future-health-care/#respond Fri, 23 Oct 2015 18:47:12 +0000 http://samueliinstituteblog.org/?p=976 Imagine a health scenario where patients receive care that promotes health rather than simply preventing disease. Where patients feel empowered to take charge of their health and are able to access different models of care in addition to their yearly check-ups to stay healthy. This is not mere fantasy, and in many health care centers this is a reality. For patients suffering from chronic pain, alternative methods of care may vastly improve their health outcomes.

Models of self-care such as yoga, meditation, acupuncture or even as simple as taking a walk can do wonders for an individual’s overall health. Robert Bonakdar, MD, a physician at the Scripps Center for Integrative Medicine in La Jolla, Calif., recently joined Dr. Wayne Jonas for a podcast. In the episode, Dr. Bonakdar specifically addresses the concerns of pain patients. Chronic pain affects more than 100 million Americans and their needs go beyond management.

“It’s not about here’s a drug that’s going to help X, but here’s an approach, starting with diet and then adding other things like stress management, that are kind of a win-win-win.” Said Bonakdar, “I think that’s what is different about integrative medicine. It’s about looking at how a condition fits in the big picture of a patient’s health and how can you then approach this complex picture in a way that’s patient centered.”

In addition to his work at Scripps, Bonakdar is also the president of the American Academy of Pain Management (AAPM). Dr. Jonas was the keynote speaker at the annual meeting of the AAPM in which he stressed the need to change behaviors and create health. These changes include lifestyle, inclusion of integrative medicine and a focus on patient-centered care.

“Having gone through medical school and residency, it seems natural that when someone is in pain, you’re going to use the best medications, you’re going to use the best exercises, diet, supplements and mind-body therapies,” Bonakdar remarked. “We also understand that working with our colleagues who are message therapists, chiropractors, et cetera, is the best way to approach pain.”

It is through associations such as AAPM that medical professions are able to share their success stories and also learn from each other. While many physicians are currently integrating their practices, health care professionals can come together as a team to provide the best possible care for the patient.

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A Collaborative Focus On Pain Management http://samueliinstituteblog.org/collaborative-focus-pain-management/ http://samueliinstituteblog.org/collaborative-focus-pain-management/#respond Tue, 20 Oct 2015 13:00:00 +0000 http://samueliinstituteblog.org/?p=974 In early September, Samueli Institute convened more than 40 leaders in pain management as part of the Chronic Pain Breakthrough Collaborative. The meeting was the second of three highly interactive learning sessions focused on state-of-the-art ideas in integrative chronic pain care.  Participants shared with each other the specific best practices they’ve tried – what worked and what didn’t – and learned how to customize recommended ideas to accelerate improvement in their own organizations.

Participants included military and civilian health system practitioners, from senior health system leaders, physicians, anesthesiologists, and surgeons to social workers, acupuncturists, physical therapists, and process improvement specialists, all dedicated to providing better care for patients who suffer from chronic pain.

Diane Flynn, M.D., Primary Care Pain Advisor for the Interdisciplinary Pain Management Clinic at the Madigan Army Medical Center (IPMC), came to the collaborative with the goal of improving the quality of life and military medical readiness for patients who complete the Integrative Modalities Pain Care Team (IMPACT) program between June 2015 and January 2016. Although her team had been using PDSA cycles, the collaborative offered a more intensive approach to the process.

“What we’re focusing on in terms of our outcomes is pain intensity, depression, anxiety, [the ability to] function, and anger. We’re helping people to have better function in their lives with safer types of therapies like acupuncture, chiropractic, yoga, massage, physical and occupational therapy, health psychology, and self-management, and we attempting to reduce the need for invasive surgeries and exposure to surgical risks.” Flynn explained. “Taking part in this collaborative has really helped us take what we knew in our minds and put it into practice. It’s also just generated a lot of valuable input from members of our team on how we can improve our clinical processes.”

This learning session offered the opportunity for participants to share what results they’re experiencing at their hospitals, institutions, or clinics as a result of their Collaborative participation. During the time between the first and second learning sessions, using the PDSA process, participants developed a plan to test possible changes for their organization, carried out the test, and then observed the results.

The teams have concentrated on making improvements in four areas:

  1.  Increasing autonomy for individuals to manage their pain through non-pharmacological approaches;
  2.  Integration of multiple disciplines in team-based approaches;
  3.  Increasing quality of life through decreasing the level of pain, medication burden, and risk of opioid dependence; and
  4.  Building a sustainable business model that provides positive or neutral financial impact over time. These improvements are adding up to a sustainable business model for the future.

Samueli Institute is currently seeking participants for the next learning community on chronic pain. Learn more on our website: http://samueliinstitute.org/chronicpain

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Non-precision Medicine for Maximum Impact http://samueliinstituteblog.org/non-precision-medicine-maximum-impact/ http://samueliinstituteblog.org/non-precision-medicine-maximum-impact/#respond Wed, 14 Oct 2015 18:29:16 +0000 http://samueliinstituteblog.org/?p=969 headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

In health care and in science, there are lumpers and then there are splitters. Scientists tend to be splitters, dissecting different aspects of a disease, different parts of your brain receptors, and looking for different effects on different organs. Then, they look for drugs that inhibit those different parts form the basis for a medical treatment. Nobel Prizes and profits are based on splitting up the body into finer and finer parts down to a cell and its genome and showing that they have broad implications.

The advance of convergence of genomics and technology allows us to take this splitting to a new level.

The latest term for this type of medicine is “precision medicine.” Recently there’s been a suggestion that precision medicine is the most important advance possible for creating health in the population.

Advances of precision medicine are lifesavers for specific individuals with a chronic illness, in which a particular underlying genetic cause can be identified.

Have We Taken A Wrong Turn?

But many cell-specific advances don’t help the majority of the population. Precision medicine doesn’t tackle the core issues affecting public health: prevention of cancer, heart disease, diabetes and chronic stress. The potential for widespread impacts in public health are not found in identifying a specific genetic cause, or metabolic pathway for their condition. Instead, we need to focus on broad lifestyle changes that can affect the vast majority of the population.

The solution is about implementing and applying what we already know impacts 70 percent of chronic disease.

Dean Ornish, MD, demonstrated this in a dramatic fashion years ago and he still continues to do so today as he looks at the fundamental factors of disease prevention and applies them as treatment. These include exercise, food, stress management, and the social and economic factors that help people live a healthy life. When applied intently and intensively to individuals, it’s not just preventive, it’s therapeutic. These solutions are cheaper and have wider impact than drugs focused at genetic targets.

The Value of Non-Precision Medicine

The value in population health is not identifying the specific cause and treatment of a condition on factors that will have the greatest value, but rather factors that have the greatest value for the greatest number of people.

These solutions are non-precise. In fact, they’re general.

Recently, Dr. Ornish demonstrated that the same lifestyle principles he applied years ago to cardiovascular disease, also seemed to help mitigate and treat cancer. These same factors are now known to affect diseases such as obesity, diabetes, stroke, and others. The strength of these factors is that they benefit a wide array of chronic illness—their impact lies in their imprecision.

While precision medicine may be invaluable to individuals with unique genetic patterns, what we need first is the efficient application of non-precision medicine on the health population (and on the population in general) as a treatment approach. Precision medicine should only be used after the maximum application of non-precision medicine. Then, we’ll have an optimized and efficient system that’s both the most cost-effective and widely impactful.

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Integrated Team Approaches To Improving Outcomes For Chronic Pain http://samueliinstituteblog.org/integrated-team-approaches-improving-outcomes-chronic-pain/ http://samueliinstituteblog.org/integrated-team-approaches-improving-outcomes-chronic-pain/#respond Wed, 07 Oct 2015 19:28:52 +0000 http://samueliinstituteblog.org/?p=963 In early September, Samueli Institute convened more than 40 leaders in pain management as part of the Chronic Pain Breakthrough Collaborative. The meeting was the second of three highly interactive learning sessions focused on state-of-the-art ideas in integrative chronic pain care.  Participants shared with each other the specific best practices they’ve tried – what worked and what didn’t – and learned how to customize recommended ideas to accelerate improvement in their own organizations.

Participants included military and civilian health system practitioners, from senior health system leaders, physicians, anesthesiologists and surgeons to social workers, acupuncturists, physical therapists, and process improvement specialists, all dedicated to providing better care for patients who suffer from chronic pain.

PainCollaborative-19

Dr. Paul Mittman

“When Samueli Institute partnered with the Institute for Healthcare Improvement (IHI), it was really a brilliant marriage in that they took a conceptual framework of using this rapid cycle of change that they call Plan Do Study Act (PDSA) and gave us an opportunity to make big changes, but starting with little bite-size changes that we do over and over again.” Paul Mittman, ND, President/CEO of Southwest College of Naturopathic Medicine & Health Sciences.

This learning session offered the opportunity for participants to share what results they’re experiencing at their hospitals, institutions, or clinics as a result of their Collaborative participation. During the time between the first and second learning sessions, using the PDSA process, participants developed a plan to test possible changes for their organization, carried out the test, and then observed the results.

The teams have concentrated on making improvements in four areas:

1) increasing autonomy for individuals to manage their pain through non-pharmacological approaches;

2) integration of multiple disciplines in team-based approaches;

3) increasing quality of life through decreasing the level of pain, medication burden, and risk of opioid dependence; and

4) building a sustainable business model that provides positive or neutral financial impact over time. These improvements are adding up to a sustainable business model for the future.

For Dr. Mittman, collaborating with like-minded physicians was an inspiring experience that he and his participating colleagues took back with them to SCNM’s pain relief center.

“Just bringing three people with very different backgrounds, let’s say an acupuncturist, a medical doctor and a naturopathic doctor and putting them in the same place doesn’t guarantee that you have a team,” Mittman explained. But by participating in the learning collaborative his staff has, “developed into a cohesive team.”

And the teamwork is already having a positive effect.

“Our anesthesiologist has observed a decrease in opioid use in his patients, which is really interesting because that’s without fully implementing the program,” Mittman explained. “I think the awareness of the problem and by beginning to implement new solutions to it you can start to see subtle changes—and we’re starting to see that already.”
Samueli Institute is currently seeking participants for the next learning community on chronic pain. Learn more about our Chronic Pain Breakthrough Collaborative.

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On Human Flourishing – an interview with Dr. Robert Bonakdar http://samueliinstituteblog.org/human-flourishing-interview-dr-robert-bonakdar/ http://samueliinstituteblog.org/human-flourishing-interview-dr-robert-bonakdar/#respond Wed, 07 Oct 2015 17:59:41 +0000 http://samueliinstituteblog.org/?p=961 Dr. Robert Bonakdar is Director of Pain Management at the Scripps Center for Integrative Medicine in La Jolla, California and a member of the Scripps Green Hospital Pain Management Committee. He also serves as Assistant Clinical Professor (Voluntary) at the University of California, San Diego School of Medicine. Dr. Bonakdar completed a fellowship in integrative medicine at Scripps Clinic, focusing on integrative pain management. He also completed the UCLA Acupuncture Course for Physicians and a Richter Fellowship in Southeast Asia, where he studied acupuncture, tai chi, and mind-body practices. His current clinical and research interests include novel approaches to pain management including dietary supplementation and biostimulation using microcurrent, laser, auricular, and acupuncture therapies.

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http://samueliinstituteblog.org/human-flourishing-interview-dr-robert-bonakdar/feed/ 0 Dr. Robert Bonakdar is Director of Pain Management at the Scripps Center for Integrative Medicine in La Jolla, California and a member of the Scripps Green Hospital Pain Management Committee. He also serves as Assistant Clinical Professor (Voluntary) a... Dr. Robert Bonakdar is Director of Pain Management at the Scripps Center for Integrative Medicine in La Jolla, California and a member of the Scripps Green Hospital Pain Management Committee. He also serves as Assistant Clinical Professor (Voluntary) at the University of California, San Diego School of Medicine. Dr. Bonakdar completed a fellowship in integrative medicine at Scripps Clinic, focusing... Integrative Medicine – Samueli Institute Blog clean 25:58
Integrated Before Integrative http://samueliinstituteblog.org/integrated-integrative/ http://samueliinstituteblog.org/integrated-integrative/#respond Thu, 01 Oct 2015 10:29:56 +0000 http://samueliinstituteblog.org/?p=958 Let’s cut the confusion.  One hears a lot of talk these days about “integrative” health care.

In fact, the name of the National Center for Complementary and Alternative Medicine recently changed to the National Center for Complementary and Integrative Health. We also hear a lot about the need to have “integrated” systems built into our health care. Approaches such as the patient-centered medical home (PCMH), Accountable Care Organizations (ACA) and improved systems of care are built into the Affordable Care Act. 

Although the words seem similar,


integrative and integrated
are often miles apart.

What is Integrated Care?

Integrated systems are efficient and smooth. The parts work well together and within the whole. Individuals communicate well, have clear roles and operations, and deliver only what’s necessary in an efficient manner.

Methods for improving efficiency were originally developed for other industries, like the Toyota production method, and are now being applied to health care to create an integrated system.[i] In an integrated system members of the health care team trust each other, know what their job is, communicate rapidly and know how to work together. Each person knows when someone is not accountable for his or her particular part of the team’s care. Team members don’t go too far outside of the box in delivering what’s in their competency, is demonstrated and paid for. And the patient expects what’s in the box when they come in through the clinic door.

Integrated Health Care is not Integrative

The patient-centered medical home (PCMH), when properly operating and effective, is a good example of an integrated system. Recently, I visited a well-integrated PCMH practice in Tennessee. The physician there said the secret to good primary care is having an effective and efficient system that meets the needs of the patient and gets costs covered by the system of health care.

However, when I asked him if he implemented any integrative practices or had thought about hiring a nutritionist or behavioral medicine expert into his practice, he immediately said no. He believed most patients cannot make the behavioral changes they need to do anyway, especially with the limited number of visits that were reimbursed, which would not cover a full-time person. Instead, he refers patients out when those services are really needed, that is, when recommended in national guidelines and paid for by insurance.

As for integrative medicine he does none of those types of practices. It is not that he is against them (except for dietary supplements, which he thinks are unsafe for most people) but because he doesn’t think there is much evidence that they’re very effective. He does not believe in passing these costs on to patients if they are not proven. “When they get approved by the FDA and covered by health insurance,” he said, “then I will be ready to implement them in my system. I keep my practice evidence-based.” So although his practice is integrated, it is not integrative.

What is Integrative Care?

Health practices that attempt to bring in other non-conventional healing modalities, so-called “complementary and alternative medicine,” into the mainstream are called integrative. They bring healing techniques that are outside of the mainstream into the current system of care. They have a philosophy and a set of practices, and a scientific basis that’s often quite different from conventional medicine. They seek healing and not just cure.

The practices that are trying to be “integrative” derive from traditional practices or independent systems of medicine, such as Chinese medicine, Ayurvedic medicine, chiropractic, homeopathic, and others. Complementary and integrative practices include acupuncture, massage, manipulative therapies, and education on diet, nutrition, and other self-care approaches.

Unfortunately, these integrative practices are not very integrated, with conventional medicine or themselves. They are not part of normal medical training, are usually delivered in silos of practice, often aren’t found in the same place, are not part of a PCMH, are not incorporated into national guidelines and are not paid for by insurance. Therefore, integrative practices tend to operate in isolation—and are not well integrated.

The true integrator in this case, is the patient, who searches around and tries to do their best in putting practices together that resonate with them and decide for themselves whether they’re effective or not.

Achieving Both Goals: Integrative and Integrated Care

I recently visited a health care center that was attempting to achieve both goals of integrated and integrative care. Despite the challenges it faces in doing so, the Casey Health Institute in Gaithersburg, Maryland is attempting to integrate their integrative systems. However, they are finding the efficiency of such a system challenging and are still working to make it a profitable one.

What lessons can we learn from these approaches in health care?

First, we shouldn’t confuse the two terms or processes of integrative and integrated. We need both. But, right now they have different goals and they fundamentally operate differently. In some cases, they’re incompatible with each other; one seeking healing and the other cure.

Those who seek to put both of these together must ensure that experts in integration and experts in integrative are first working together as a team. This involves properly selecting and training people, so that they can work together cooperatively and effectively. The patient must be at the center rather than the focus being on the condition or the modality that they happen to know about or the tool they want to apply.

For example, while it’s always preferable to relieve pain without more drugs and medications, that’s not always the best course of action. Sometimes, in fact, it’s better to use a drug or a surgical intervention. Sometimes it’s better to incorporate behavioral techniques that are not normally part of complementary medicine. Sometime diet changes can improve a condition. But how do we figure that out when these practitioners rarely work together and our systems are not organized with clear roles and accountability?

Relationships are key for both integrative and integrated systems. In fact, they’re the first thing that needs to happen. Simply substituting a healing practice like Reiki for a drug like Reglan does not make it integrative medicine.

Finally, the services needed to be tailored to the needs and the readiness of the patient.

There are times when the patient has limited resources (time, energy, interest or money) for their own care. It’s essential for the care providers to acknowledge this, and incorporate the patient’s wishes and resources into the plan of care. The services can later be expanded as the patient is willing and able to accept a larger investment in their care. If integrative practices are not effectively integrated into our delivery systems, they will not become widely available.

But there is progress. As I write this blog I am at a week-long training program from the Institute of Functional Medicine, an approach I have worked with for decades. Fifteen years ago it used to be chaotic, hodgepodge of findings about nutrition and lifestyle seemingly thrown at random at patients.

However, now much progress has been made. An organized approach for working with patients, nutritionists, physicians and health coaches is being developed to deliver integrative care in a more integrated manner. Nearly 500 physicians, many of them new to integrative medicine, have responded by attending.

An efficient, integrated, well-operating, patient-centered team system needs to be the focus of any health care delivery. Only then can bringing in complementary and alternative practices, so-called integrative medicine, be of value. First make sure the system works well and then expand to more holistic and integrative care. Then we will be able to provide healing to all people.

First integrated and then integrative.

 


[i] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678835/

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From SOAP to HOPE: Adding Healing into the Traditional Medical Encounter http://samueliinstituteblog.org/soap-hope-adding-healing-traditional-medical-encounter/ http://samueliinstituteblog.org/soap-hope-adding-healing-traditional-medical-encounter/#respond Thu, 24 Sep 2015 10:47:19 +0000 http://samueliinstituteblog.org/?p=945 It’s time we got rid of the SOAP note.  

The SOAP note is the subjective-objective-assessment and plan around which every medical encounter in the country is framed. The priority is to identify the disease, measure it to confirm that it is a disease, and develop a treatment plan to try to control and eliminate it. This disease-based approach frames everything that goes on in health care.

It works well when a cause of a disease is easily identified and eliminated. However it works poorly for the factors that are now seen to impact most of health— prevention, lifestyle and holistic practices.

We now know that 80 percent of health care actually comes from outside of the clinic, and it won’t fit into that particular diagnostic plan that we create with SOAP. Patient’s goals and their decision-making are crucial for the creation of health and healing, even more so than the specific treatments of disease medical professionals sometimes provide.

Putting all encounters into a framework of subjective-objective-assessment and plan, around a specific diagnosis and verification of treatment, is no longer the model needed in the health care box. 

From SOAP to HOPE

We need a new model for structuring the visits within the health care system. To achieve patient-centered care this new model must include the factors that change behavior and create health. These include social determinants of disease, holistic and integrative medicine, the importance of lifestyle, as well as the key role of purpose and meaning in the patient’s life. 

In this new Healing Oriented Practices and Environments (HOPE) model, the patient and their own goals in life would be part of the diagnosis and the plan – all components that don’t currently fit into a standard SOAP note. Expectations and beliefs are a key part of healing, and so are social support and the relationships that are essential for recovery and the optimization of any kind of treatment. Thus, the social components must be part of the note. 

Interested in incorporating HOPE in your practice? Here are 4 questions to add to your patient encounter.

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4 Questions for Medical Providers to add HOPE to Health Care http://samueliinstituteblog.org/4-questions-medical-providers-add-hope-health-care/ http://samueliinstituteblog.org/4-questions-medical-providers-add-hope-health-care/#respond Thu, 24 Sep 2015 09:33:14 +0000 http://samueliinstituteblog.org/?p=942 Doctor with patientWhat would a medical encounter look like if we were focused on Healing Oriented Practices and Environments (HOPE) in health care?

I propose it would consist of four components that are essential to creating health. These would be in addition to the areas already included in the traditional medical assessment called SOAP, which are the subjective-objective-assessment and plan assessment that come in making a traditional medical diagnosis and treatment.

The four components of HOPE are reflected in the following questions:

1. What is your goal and intention for your healing? What do you want to heal?

  • This may be  a certain percentage less pain, ability to climb stairs or play with a grandchild
  • Rate your health and what you expect can happen (1-10)
  • Why are you here in life? What is meaningful for you? What is your purpose?

This addresses a person’s the inner environment — their desires, their beliefs, and their needs—their  reason for getting up in the morning, their purpose in life—what’s meaningful for them?  What gives them a sense of wellness and motivation? 

Sometimes a simple thing such as spending time in the woods, or with family, is the primary avenue into treating their pain. Sometimes the goal of being able to play with their grandchildren will generate the physical activity necessary to prevent a future illness or disease that could impair them. Sometimes it’s the desire to serve their country, or their God.  

2. What are your connections and relationships?

  • Do you have family, friends, live alone, have hobbies, and have fun? Can you get rides to airport?
  • Tell me about yourself. Tell me about your traumas. Do you have a best friend? Are you part of a group? A club? How often do you meet?

So often the reason and process for healing has to do with social relationships — with family, friends, communities and colleagues.  Therefore, after we finish putting lines around the box of the diagnosis and the treatment, let’s capture the social components and the interpersonal components that drive an individual in their daily life. 

3. What do you do during the day? What is your lifestyle like?

  • Do you smoke or drink? What about diet, exercise, sleep and water?
  • What do you do for stress management? How do you relax, reflect and recreate?
  • What is your CAM use (supplements, herbs, other practitioners)?

Lifestyle and behavior can impact up to 60-70 percent of chronic illnesses; therefore these behaviors are essential for creating health.

4. What is your home like? Your work environment? Do you get out in nature?

  • This includes light, noise, clutter, colors, plants, walls.

The communities, the work sites, the schools and the environment in which our patients live, often dictate what they’re able to do, what happens, how long they live, and how well flourish, and how well they function. The physical environment, then, needs to be explored.

Let’s make asking these questions a routine part of medical care. 

The HOPE note is one powerful component in transforming your practice into an Optimal Healing Environment. To learn more about Samueli Institute’s research into Optimal Healing Environments, visit SamueliInstitute.org.

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Combating The Effects of Chronic Pain Through Collaboration http://samueliinstituteblog.org/combating-effects-chronic-pain-collaboration/ http://samueliinstituteblog.org/combating-effects-chronic-pain-collaboration/#respond Fri, 11 Sep 2015 15:03:58 +0000 http://samueliinstituteblog.org/?p=913 More than 3 million people in the U.S. are affected by chronic pain. Often the symptoms are treated with opioids, such as codeine, oxycodone and morphine. The drugs are highly addictive and this method of treatment is costly.

About 40 people convened last week for the second learning session of Samueli Institute’s Breakthrough Collaborative to tackle the rampant use of opioids in this country.

The members of this group represented eight different organizations, including: Bastyr University, University of Bridgeport College of Chiropractic, Southwest College of Naturopathic Medicine and Health Sciences, Fort Belvoir Community Hospital, Madigan Army Medical Center, Essential Integrative Health, Washington DC VA, and Walter Reed Pain Clinic. Each group had at least four staff members from CEOs to social workers on hand to offer their points of view.

Learn more about Learning Communities and Breakthrough Collaboratives.

Participants convened for two days in Alexandria, Va. to present their separate organization's aims in treatment of patients with chronic pain. Heather Tick (center) engages with other participants to discuss modalities of integrative care. Participants of the Learning Session were made up of representatives from 8 organizations. LTG Eric Schoomaker (ret.) Sandi Gordon, Senior Program Manager for Samueli Institute, encourages participants to share their tools for success such as intake assessments, referral protocols and patient goal-setting and follow-up. Martha Menard (right) demonstrates techniques in massage therapy that promotes relaxation and symptom management.

 

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Breakthrough Collaboratives vs. Learning Communities http://samueliinstituteblog.org/breakthrough-collaboratives-vs-learning-communities/ http://samueliinstituteblog.org/breakthrough-collaboratives-vs-learning-communities/#respond Fri, 11 Sep 2015 14:56:08 +0000 http://samueliinstituteblog.org/?p=904 Continuum of Collaborative Events
  1. Annual or One time meeting on a shared topic- Network/Symposium
  2. When coordinating needs, resources and activities, meetings become more frequent, accountability increases, relationships strengthen, participation increases, it’s a Learning Community (Task Force, Council, Alliance)
  3. When working together cooperatively towards common goals and sharing resources, it’s a Partnership/Consortium/Coalition
  4. A Breakthrough Collaborative is a systematic approach to health care quality improvement in which organizations and providers test and measure practice innovations and then share their experiences in an effort to accelerate learning and widespread implementation of best practices. A collaborative involves organizations working together at a high level of intensity for a specific period of time, typically 6-18 months.  During that time, the group participates in Learning Sessions, and maintains continual contact with each other and faculty members via selected site visits, conference calls/webinars, a listserv and a dedicated website.

Definitions

A Breakthrough Collaborative is a systematic approach to health care quality improvement in which organizations and providers test and measure practice innovations and then share their experiences in an effort to accelerate learning and widespread implementation of best practices. A collaborative involves organizations working together at a high level of intensity for a specific period of time, typically 6-18 months.  During that time, the group participates in Learning Sessions, and maintains continual contact with each other and faculty members via selected site visits, conference calls/webinars, a listserv and a dedicated website.

 

In a Breakthrough Collaborative, you have a set problem, measures and a roadmap established by a panel of experts. The team members chose changes to make and complete a rapid cycle test of change. This process includes starting with very small scale tests then follow-up tests, wide-scale tests, and finally the implementation of change.

 

In a Learning Community, the problem or challenges have not yet been determined and therefore, the group is not ready for the rapid cycle test of change needed for breakthrough change. Leaders engage in facilitating the group so that the group members determine the challenges to tackle together and the appropriate metrics that will be measured. The goal is joint learning to achieve collective impact. Participants decide what they want to work on as a community and experts help to create a roadmap for improvement based on the agreed upon challenges. Participants may decide to effect change as part of the process for their own organization or to embark on collaborative efforts together with other groups.

How Learning Communities and Breakthrough Collaboratives Compare

Element

Learning Community

Breakthrough Collaborative

Success is…

Coming together for collective impact; Getting teams to sign on and envision a collective action that will be more impactful than individual groups working in silos

Engaged and deepened relationships even after the project is over; Opportunity for networking and learning from one another

Transformational change at the individual organization with plans to spread/scale

Roadmap

Developed during the course of the learning community; Primary and secondary drivers to arise from participants’ discussions

Called the Change package or improvement guide; Primary and Secondary Drivers understood and established; Developed by SMEs BEFORE the collaborative begins; may be edited and tweaked after; Organizations select changes to take from the Improvement Guide

Participants

Community organizations

7-10 representatives from each organization (can range from 10-100 organizations);
An organization is considered one operating unit, so several operating units from one organization may attend but each is considered a separate entity

Change

Make small progress/ change is the goal but not necessary;

Large change is the next step of the process IF the team has the will

Goal is breakthrough change achieved in 8 of 10 groups;

Move along the continuum

Problem to solve

Identified as part of the Learning Community

Decided BEFORE the collaborative begins through an in-depth R&D process

Roles

 

There is usually an Advisory Group to provide leadership;
Roles are fluid; people can come in and out as needed

Set roles (Executive leader, Chair, Faculty Member, leadership team: Director, Improvement advisor, Project coordinator, System sponsor)

SMEs

Act as mentors and advisors;
Help participants develop a roadmap based on the learnings;
Must represent community diversity (Service members, veterans, families)

Faculty/experts;

Co-develop materials (improvement guide);

Represent multiple disciplines and organizational roles

Readiness

Will is not yet established;

Participants may need to be convinced of the value of the effort

Will is clear and established

Progress tracking

Teams sets measures;

Qualitative progress is important

Set Quantitative Measures  based on the Measurement guide;

Strategic progress

Role of Facilitation

Essential;
Maintain positivity; Appreciative Inquiry;

Achieve transparent and authentic communication; Help groups with common vision

Same + encourage rapid cycle testing

Cooperation

Goal is to get different participants from different organizations working towards continuous improvement;

Collective responsibility and goal alignment
Shared learning: all teach, all learn

Participants learn from others’ experiences to help them achieve their goals at their individual organizations;

Shared learning; all teach, all learn

Accountability

Some accountability; accountability and relationships develop over time;
Shared goal(s)

Extensive accountability, data is measured

Process Improvement

Continuous learning is less structured;
Test and learn

Required; may include some research; improvement is immediate;

Uses rapid cycle testing model

Process

Regular meetings

Framework established; 3-5 learning sessions with work time in between

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Transforming Health Care http://samueliinstituteblog.org/transforming-health-care/ http://samueliinstituteblog.org/transforming-health-care/#respond Tue, 11 Aug 2015 10:21:10 +0000 http://samueliinstituteblog.org/?p=879 Improving the nation’s health takes more than a big idea. Samueli Institute builds partnerships in health care, worksites, the military and community settings to change a complex and financially-driven network of care. This systematic collaboration balances the often competing priorities of population health, personal experience and cost.

Packaging Change for a Ripple Effect in Health Care

Samueli Institute uses its expertise in the areas of integrative patient-centered care and whole systems learning to tackle key challenges of our health care system and produce system-level change. Solutions scale from a single doctor’s office to a large hospital system, allowing measurable, sustainable change to spread throughout the health care system. This change occurs through collaboratives, a team-based approach to problem-solving.

Collaboratives combine subject matter expertise with tools and methods to effect change. This science of improvement has been well-established by our partner, the Institute for Healthcare Improvement (IHI). Two areas of focus for the Institute are chronic pain and palliative care.

Breakthrough Series Collaborative on Chronic Pain Launched

Samueli Institute is driving toward a more integrative approach to chronic pain management. The learning collaborative brings together experts in military, veteran and civilian health care to identify and implement innovative ways to reduce chronic pain and optimize quality of life through timely delivery of team-based, person-centered integrative pain management.

Hospice and Palliative Care as an Optimal Healing Environment

The National Hospice and Palliative Care Organization has partnered with Samueli Institute to initiate a collaborative focused on healing oriented practices, relationships and spaces for patients with advanced illnesses. This work concentrates on care given in a home setting since this is where most people with advanced illnesses receive their ongoing care.

_LT_0143Combating Pain and Stress in the Military with Acupuncture

After two promising Samueli Institute pilot studies, the United States Air Force developed the first known training program to teach military primary care physicians a simple auricular (ear) acupuncture procedure called Battlefield Acupuncture. Samueli Institute helped standardize the training and expand it throughout the military and Veterans Health Administration to more than 1,300 medics and corpsmen, nurses and physician assistants. Samueli Institute’s evaluation and assessment of the training will help integrate acupuncture into a variety of military and veteran care environments to combat pain and stress.

Engaging Communities to Create Wellness

As part of its Well Community Project, Samueli Institute helps community leaders move beyond disease-oriented approaches to community health and focus on missing elements of healing, resiliency, wellness and quality of life. The community wellness effort is a collaboration between Samueli Institute and Institute for Alternative Futures, with funding by the W.K. Kellogg Foundation.

Sign up for enews to stay on top of Samueli Institute’s work 

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Wellness Training in Mind-Body-Spirit http://samueliinstituteblog.org/wellness-training-mind-body-spirit/ http://samueliinstituteblog.org/wellness-training-mind-body-spirit/#respond Thu, 30 Jul 2015 11:25:39 +0000 http://samueliinstituteblog.org/?p=850 Samueli Institute teaches a holistic approach to wellbeing through a teaching kitchen and self-care educational program. The curriculum includes training on nutrition, culinary skills, mindfulness and stress reduction, exercise and fitness, and access to a health coach. 
Samueli_SelfCare_Graphic_v2

Optimizing Military Performance

????????With its military partners, Samueli Institute provides a self-care educational program that reinforces the military’s performance triad, which focuses on how service members eat, sleep and move. The 12-week program and study aims to increase skills and confidence in the kitchen, support lifestyle changes, and improve the overall health and wellness of its participants, who include military service members and spouses. Learn more

Empowering Military Families

Tools are available to help military health care facilities help Service members and their families cope with stress, improve their health, and thrive by using self-applied mind-body skills to manage stress. Samueli Institute’s “Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Health Care Setting” take a family empowerment approach: empowering Service members and families to take active participation in their medical care and symptom management; to be responsible for and participatory in their health and healing process;  to instill them with a sense of control over their recovery;  and to increase operational efficiency of an increasingly utilized military health care system.

Wellbeing at Work

Samueli Institute’s comprehensive curriculum is also available for the workplace to create sustained lifestyle changes in the areas of nutrition, exercise and mindfulness to improve health, productivity and quality of life. Current clients use the curriculum to move beyond the traditional focus of workplace wellness programs into one that acknowledges the core components of human flourishing.

In addition to the teaching kitchen and self-care education program, Samueli Institute also delivers a mindfulness training program that explores the connection between optimizing performance and mind-body skills.

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Medical Center Combines Holistic Person-Centered Care with Integrative Modalities, Business Flourishes http://samueliinstituteblog.org/medical-center-combines-holistic-person-centered-care-integrative-modalities-business-flourishes/ http://samueliinstituteblog.org/medical-center-combines-holistic-person-centered-care-integrative-modalities-business-flourishes/#respond Tue, 28 Jul 2015 11:33:41 +0000 http://samueliinstituteblog.org/?p=862 When hospital leaders come together with the goal of holistic, team-based care centered on the patient, business flourishes. At Cancer Treatment Centers of America (CTCA), this focus was embedded upon inception and financial success has been a constant for the hospital system. As of 2014, both revenues and profits for CTCA have grown at a compounding annual rate of 15% to 20% for several years.One of five CTCA hospitals, Eastern Regional Medical Center (ERMC)  in Philadelphia, Pa. has seen high year over year growth since its launch in 2006.

 

PERSON-CENTERED CARE

CTCA founder Richard J. Stephenson created a culture combining a whole-person treatment approach with a compassionate, nurturing environment. Creating a “mother standard” of care, the hospital system provides a patient-centered approach to cancer treatment, an approach that one would want for their own mother. At ERMC, the Mother Standard® is expressed and manifested by staff at all levels, from the CEO, CFO, and CNO to housekeeping staff and shuttle drivers.  There is a deep-seated commitment to “looking at care through the patients’ eyes,” finding out and providing what the patients want. In fact, ERMC will absorb costs for extra services not covered by insurance if the services are valuable to patients. At ERMC, the patient is “at the center of [their] hearts and souls.

 

COMPLEMENTARY AND INTEGRATIVE THERAPIES

ERMC offers a unique integrative approach to cancer care that includes both standard medical, surgical, and radiological oncology treatments integrated with complementary and integrative therapies.  Each patient is assigned a Patient Empowered Care® (PEC) team comprised of an oncologist, nurse manager, naturopathic doctor, nutritionist and two care managers.  Integrated therapies – such as nutrition, herbs and supplements, mind-body

 

therapies, acupuncture, chiropractic, massage, physical therapy, and pastoral care – are fully incorporated into each patient’s individual treatment plan.   Their approach is to “focus on the person not the cancer.

By providing such holistic and integrative care, ERMC maximizes the health and strength of the patient – body, mind, and spirit – leaving them in the strongest position possible to fight cancer and withstand side effects of treatment, while also improving their quality of life.  As one administrator notes, “We leave no stone unturned to create a healing environment.”

 

PATIENT AND STAFF LOYALTY

ERMC’s financial success is due in part to patient loyalty and resultant referrals leading to sustained growth. 

Patient satisfaction with ERMC’s integrative care is reflected in high patient loyalty and experience of care scores.   ERMC’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are substantially higher than regional and national averages.  Of the 18 Philadelphia hospitals participating in the public reporting system, ERMC scores the highest in overall hospital rating (88% of respondents give ERMC a score of 9 or 10) and likelihood to recommend (91% answered they would definitely recommend).  

ERMC was recognized as a best place to work in the Philadelphia Business Journal for the past three years and administrators report minimal recruiting costs for professional positions. They have a 2% nurse turnover rate, significantly less than the regional (14.2%) and national (18%) averagesCalculated potential cost avoidance is in the $4-5 million range. 

Potential cost avoidance for nurse turnover rate at ERMC is $4,387,730 compared to other hospitals in the northeast region; $5,394,750 compared to national hospitals of a similar size.

Potential cost avoidance for nurse turnover rate at ERMC is $4,387,730 compared to other hospitals in the northeast region; $5,394,750 compared to national hospitals of a similar size.

As one ERMC administrator states, “…build your reputation and the financials will follow.

OHE IN PRACTICE

“ERMC is exemplary in their provision of holistic team-based care combined with complementary and integrative therapies.  They illustrate how Optimal Healing Environment initiatives can financially benefit a hospital system,”  said Wayne B. Jonas, MD, President and CEO, Samueli Institute.

Learn more about becoming an OHE
or
Download a print-friendly version of this article: ERMC Business Case


(1) Herzlinger RE KN. Cancer Treatment Centers of America (A). Boston: Harvard Business School; 2014.


This work is supported by the US Army Medical Research and Materiel Command under Award No. W81XWH-08-1-0615. The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation. In the conduct of research where humans are the subjects, the investigator(s) adhered to the policies regarding the protection of human subjects as prescribed by Code of Federal Regulations (CFR) Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).

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Faculty Announced for Hospice and Palliative Care Collaborative http://samueliinstituteblog.org/faculty-announced-hospice-palliative-care-collaborative/ http://samueliinstituteblog.org/faculty-announced-hospice-palliative-care-collaborative/#comments Tue, 21 Jul 2015 12:22:47 +0000 http://samueliinstituteblog.org/?p=816 Collab_Samueli-infographic-April-2015-WEB600x600Earlier this year Samueli Institute and the National Hospice and Palliative Care Organization partnered to launch a Breakthrough Series Collaborative on Hospice and Palliative Care. The structure of the collaborative is based on the Breakthrough Series model, the Institute for Healthcare Improvement’s Collaborative model for achieving breakthrough improvement.

A Breakthrough Series Collaborative is a short-term (6- to 15-month) learning system that brings together a large number of teams from healthcare settings to seek improvement in a focused topic area.

The esteemed faculty will inspire transformational change for advanced illness or end of life care in the face of significant pain or distress.

Hospice and Palliative Care faculty are the following:

Gwynn Sullivan, RN, MSN, Chair
Director of Access
National Hospice and Palliative Care Organization (NHPCO)
Carla Cheatham, PhD, M.Div.
Section Leader, Spiritual Caregiver Section
National Council of Hospice and Palliative Professionals
Sandi Gordon, B.Sc., CPC
Senior Program Manager
Samueli Institute
Lorissa MacAllister, PhD (c), BSW, AIA, NCARB, LEED, EDAC
Healing Spaces Specialist
Samueli Institute
Ann Marie Lombard Pessagno, BSN, MSA, NEA-BC, RN
Senior Nursing Director of Acute Care and Critical Care Services (Former)
Anne Arundel Medical Center
Bonnie Sakallaris, PhD, RN
Vice President, Optimal Healing Environments
Samueli Institute
Linda Simon, PhD
Director of Quality
Gilchrist Hospice Care

 

In this nine-month Collaborative, Samueli Institute and participating home hospice and palliative care organizations will achieve breakthrough improvements in relieving human suffering — specifically, pain, anxiety, dyspnea, helplessness and finding meaning in suffering.

This Breakthrough Series Collaborative will be in the forefront of change to define innovative solutions to:

  • Relieve caregiver burnout and fatigue
  • Address pay-for-performance issues
  • Gain a competitive edge when serving the baby boomer population

Qualifying Organizations

In this first Collaborative, only 50 hospice and palliative care organizations that provide home care monitoring and services can be accommodated. Organizations will be asked to submit an application and letter of intent — impacting their communities and those who most need this type of care.

For more information, or to download the application and letter of intent, please visit SamueliInstitute.org/Collaboratives or email palliativecollaborative@SIIB.org.

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Acupuncture for the Trauma Spectrum Response: A Reading List http://samueliinstituteblog.org/acupuncture-trauma-spectrum-response-reading-list/ http://samueliinstituteblog.org/acupuncture-trauma-spectrum-response-reading-list/#respond Mon, 13 Jul 2015 10:21:27 +0000 http://samueliinstituteblog.org/?p=808 Faced with more than 11 years of combat deployment, the US military is motivated to find innovative solutions to sustained problems. Samueli Institute’s collaborations with the US military expand drugless pain management, alleviate post-traumatic stress disorder (PTSD), heal from traumatic brain injuries (TBI), develop resilience, and promote Total Force Fitness.

One factor that makes treating Service members challenging, is that when they return from combat, their symptoms, such as chronic pain, post-traumatic stress disorder (PTSD), cognitive deficits, sleep and drug use and neuropsychiatric conditions often coexist. They have multiple problems that occur together.

Individuals with chronic pain, for example, often report depression, anxiety, sleep disturbance, fatigue and changes in physical and cognitive functioning, as well as difficulties with motivation, anger and social relationships.

TSRThese patterns of response to poly-trauma have been referred to by different names including Complex Multi-symptoms Illness and Post-Deployment Multi-Symptom Disorder; however, we refer to this constellation of symptoms as the Trauma Spectrum Response or TSR.

TSR can be elicited when individuals are exposed to environmental and/or psychosocial stress and injury, such as that faced in combat, and can present a core pattern of common symptoms including:

  • Emotional Dysfunction, including psychological and emotional distress, depression, anxiety, anger and PTSD
  • Cognitive Dysfunction, including deficits in memory, attention, and concentration as well as difficulties with problem solving
  • Headaches and chronic pain
  • Somatic Dysfunctions including fatigue, sleep disturbances, and sexual problems
  • Addiction and substance abuse

So, not only do Service members who have experienced a traumatic injury suffer from the physical injury, but they can also be affected by some or all of these co-morbid symptoms.

 

This pattern of symptoms is a growing problem, afflicting thousands of Service members. As such, identifying appropriate self-management and treatment interventions for PTSD, TBI, chronic pain and their related co-morbid symptoms is critically important.

Samueli Institute began exploring acupuncture as a potential treatment approach the trauma spectrum  a decade ago because it appears to be safe, effective and non-stigmatizing.

We found that it can be highly effective as an addition to conventional treatment for healing the entire trauma spectrum, not just one or two of its symptoms. Indeed, it appears that acupuncture, when properly applied may “reset” the individual to a functional life even when other treatments have failed. To learn more about our acupuncture studies, read the following journal articles that Samueli Institute has authored over the past few years:

  • 2014: Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder—Read more
  • 2013: Acupuncture for posttraumatic stress disorder: a systematic review of randomized controlled trials and prospective clinical trials—Read more
  • 2012: The effectiveness of acupuncture research across components of the trauma spectrum response (TSR): a systematic review of reviews.—Read more
  • 2011: Acupuncture research in military and veteran populations: a rapid evidence assessment of the literature—Read more

Additional Acupuncture studies are searchable on our Research Archives.

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