Research Thursdays Summary for April 2019

keywords:  research literacy, funding and grants, sharing related research in the field, research in integrative health; JACM special focus issue on whole system approach to integrative health in mainstream systems, the new Flourish Index from Harvard T. Chan School of Public Health in Boston, update on Medicare and Medicaid (CMS) policy papers on acupuncture for chronic low back pain (cLBP), humanism in healthcare spotlights from the Gold Foundation's research roundup, review of some research literacy basics, and funding announcements

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The JACM Special Focus issue March 2019
 "Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems"
 the entire issue is free to access

The April Research Roundup

Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter

At the Hospital-practice Handbook Project, we encourage practitioners to cultivate mentor-relationships and practice research literacy.

Recommended Research Reads this Month

• Models of integrative health in hospitals and medical centers.  An entire special issue focused
  
  on this topic in the March 2019 JACM.  volume 25, issue S1.  Special Focus Issue on Multimodal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems.  Article titles include:
• "Values Align for Researching Whole Systems: A Reflective Overview of the Special Issue" by John Weeks, Heather Boon, and Cheryl Ritenbaugh
• "What Should Health Care Systems Consider When Implementing Complementary and Integrative Health:  Lessons from Veterans Health Administration" by Taylor et al
• "Whole Health in the Whole System of the Veterans Administration:  How Will We Know We Have Reached This Future State?" by Tracy Gaudet, MD and Benjamin Kligler, MD, MPH
• "Evaluation of an Integrative Post-Traumatic Stress Disorder Treatment Program" by Hilton et al.

• From this April’s IHPC newsletter—measuring health and wellness
• A different set of metrics than the conventional paradigm of measuring the presence of disease: The Flourish Index

“Harvard T. Chan School of Public Health, Boston, released a much anticipated manifesto in JAMA on April 2, 2019 that dramatically shifts the philosophy of patient care from an "absence of disease or infirmity" to a concept that embraces whole-person care and patient well-being. This important paradigm change that "reimagines health" is a concept that is not new to integrative health. It respects patients' desires to grow and feel satisfied with their health and subsequent quality-of-life. 

 Author Howard, K. Koh, MD, MPH defines this as a flourish index, which includes six domains of patient wellness: 1: happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, 5. close social relationships, and 6. financial and material security. 

 Dr. Koh writes: "Measurement of flourishing makes possible weighing the effects of different treatment decisions not only on physical and mental health, but in the full context of what matters in a person’s life. While this makes treatment decisions more complex, it lies at the heart of patient-centered care."  link to JAMA article

• New paper from Memorial Sloan-Kettering on insomnia in cancer patients
• Both cognitive behavioral therapy and acupuncture had clinical effectiveness in treating the severity of insomnia and had sustained benefits for 20 weeks It was the first comparative effectiveness study for this clinical research query
• Sheila N Garland, Sharon X Xie, Kate DuHamel, Ting Bao, Qing Li, Frances K Barg, Sarah Song, Philip Kantoff, Philip Gehrman, Jun J Mao, Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial, JNCI: Journal of the National Cancer Institute.  https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djz050/5426666

When Clinical Research Impacts Health Policy

• U.S. Medicare and Medicaid Policy Information Call-Out Updates on Acupuncture for Low Back Pain
• JACM article, "Acupuncture for Chronic Low Back Pain: Recommendations to Medicare/Medicaid from the Society for Acupuncture Research". This is a free access article on the JACM website.
• citation:  Jun J. Mao, Robert T. Davis Remy Coeytauz, Lee Hullender-Rubin, Jiang-Ti Kong, Hugh MacPherson, Vitaly Napadow, Rosa Schnyer, Peter M. Wayne, Claudia Witt, and Richard Harris. The Journal of Alternative and Complementary Medicine. Apr 2019. ahead of print. published in volume 25, issue 4: April 9, 2019.   http://doi.org/10.1089/acm.2019.29067.jjm 
• The U.S. Centers for Medicare and Medicaid (CMS) Call for Submissions on acupuncture for cLBP updates, February 2019
• The ASA and NCCAOM joint submission to the CMS call
• ASA and NCCAOM collaborated to write a response to the CMS call for info on the use of acupuncture for chronic back pain.  You can find the coalition response here. 
• The February 22nd, 2019, CMS Acupuncture Policy statement (after receiving all the letters and statements for their call-out), in the CMS Bulletin dated 2.22.2019,
• "Medicaid Strategies for Non-Opioid Pharmacologic and NonPharmacologic Chronic Pain Management":

“States have considerable flexibility in determining what non-pharmacologic services are available in the state plan under optional benefits. For example, a state may elect to provide coverage for acupuncture, massage therapy, chiropractic care, cognitive behavioral therapy, physical therapy or other Medicaid-coverable services through an array of Medicaid coverage authorities. States wishing to add coverage in optional benefit categories described below would need to submit a state plan amendment for CMS approval.” 

Reviewing the Basics

• "How to Identify and Assess Well-Designed Trial Research", a resource post from the Society of Acupuncture Research (SAR)
• On writing a scientific paper—this article is a good review with specifics to the practice of acupuncture and East Asian medicine. 
• “Writing a Solid Scientific Paper That Will Sail Through the Peer Review Process:  Valuable tricks from the experts” by Jennifer A.M. Stone, LAc, pages 30-35 of Meridians: The Journal of Acupuncture and Oriental Medicine, spring 2018. 

Bodywork/Massage Therapy

• Massage therapy can relieve low back pain, fibromyalgia pain, arthritis pain, tension headaches, and improve post-operative recovery.  AMTA article has a concise list with links.
• “Research continues to support the health benefits of massage therapy for pain management. Find out how massage therapy can help these five painful conditions.”

Humanism in Healthcare: Patient-Centered-ness and Clinician Resilience

• The April edition of the Jeffrey Silver Humanism in Healthcare Research Roundup includes:
• "The timing of family meetings in the medical intensive care unit." Piscitello GM, Parham WM 3rd, Huber MT, Siegler M, Parker WF. Am J Hosp Palliat Care. 2019 Apr 14.  quote:

"This troubling pattern suggests that family meetings are often used to negotiate withdrawal of life support rather than to learn about values. The authors conclude that there are ample opportunities to improve communication skills training for clinicians in the ICU to help maximize the role of family meetings."

• "The crossroads of posttraumatic stress disorder and physician burnout: a national review of United States trauma and nontrauma surgeons." Jackson TN, Morgan JP, Jackson DL, Cook TR, McLean K, Agrawal V, Taubman KE, Truitt MS. Am Surg. 2019 Feb 1;85(2): 127-135
• "Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study." Moss J, Roberts MB, Shea L, Jones CW, Kilgannon H, Edmondson DE, Trzeciak S, Roberts BW. Intensive Care Med. 2019 Mar 25.

Research Conferences

• The Society of Acupuncture Research (SAR) conference will be June 27-29, program here.
• The 2019 International Massage Therapy Research Conference will be May 9-10, 2019 in Alexandria, VA.  "IMTRC 2019 will feature keynote speaker Helene Langevin, MD, Director of the National Center for Complementary and Integrative Health (NCCIH), and panel sessions on pain management and addressing the opioid epidemic with massage therapy.  Education sessions will explore the use of therapeutic massage for arthritis, breast cancer, low back pain, and anxiety."  

Funding Announcements

• The Society of Acupuncture Research (SAR) posted an easy-to-read blogpost on all the current NIH acupuncture research funding announcements.  
• PCORI funding announced April 2019
• $45 million to support research in improving treatment for opioid use
• Of that $45 million, “$2.7 million in funding for a study comparing two non-drug approaches – acupuncture and massage therapy -- to improve care for severe pain in people with cancer”
• For more about the research on non-pharm options for pain relief study (acupuncture and massage), go to this article link.

For more on the topic of research

• follow the tag/label in this blog for "research literacy"

Other monthly research summary blogposts

• March Research Roundup
• February Research Roundup
• January Research Roundup
• December Research Roundup

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