Thursday, November 7, 2019

Fall (Sept/Oct) 2019 Research Roundup for the HH Project

keywords:  research literacy

Topics: 
  • Community survey on integrative oncology
  • Community discussion articles: oncology acupuncture, general acupuncture scientific evidence, ED acupuncture, the "whole system paradigm"
  • Metrics: Interested in measuring your work?
  • Reviewing some research basics
  • Research conference notes and recording availability
  • funding announcements
  • NAM new book, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being
  • The Gold Foundation's Research Roundup--highlights from

The Fall (Sept/Oct) 2019 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.


Community Survey: What Does Success Look Like in an Integrative Oncology Program?
The survey is now closed for processing.

Community Discussion Articles, Research this Autumn
Oncology
1.      “The National Cancer Institute’s Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps” published 11.13.2017. JNCI Monographs, volume 2017, issue 52.  https://doi.org/10.1093/jncimonographs/lgx005
2.      The following original research article recommended by colleague Bobbee Vang is out of Memorial Sloan Kettering Cancer Institute and about Hematopoietic Stem Cell Transplantation. Why this research and published work is important, “As you know, oral mucositis from high-dose chemotherapy causes severe acute pain with folks doing stem cell transplant. They burn from the inside out. Opioids help but they are also drying which sometimes makes the healing time worse. Acupuncture appears to significantly reduce the need for pain medications during transplant.” -Bobbee Vang, LAc.
a.      Citation: Gary Deng, Sergio Giralt, David Chung, Heather Landau, Jonathan Siman, Qing S, Li MS, Kaitlyn Lapen, Jun Mao. “Reduction of Opioid Use by Acupuncture in Patients Undergoing Hematopoietic Stem Cell Transplantation: Secondary Analysis of a Randomized, Sham-Controlled Trial”. Pain Medicine, 0(0), 2019, 1–7 doi: 10.1093/pm/pnz190
b.     I (Megan) watched Dr. Deng present this work at the SAR conference in June 2019. For my related notes on the talk, including some photos, please go to this lecture in the SAR conference notes. You have access to this entire Notes course by belonging to the membership site.  Here’s the link to the specific lecture.
Acupuncture, general
3.      “Overview of Treatment Guidelines and Clinical Practice Guidelines that Recommend the Use of Acupuncture: A Bibliometric Analysis”. The Journal of Alternative and Complementary Medicine. Vol.24(8). 6.18.2018. published online ahead of print. http://doi.org/10.1089/acm.2018.0092
a.      This article is behind a paywall. For how to access peer-reviewed journal articles through your workplace, see our recent blog post on this process and resource:  Your Medical Library and Professional Journal Access: An Employee Benefit *
                                                    i.     This blog post is also available as a pdf with a separate document example of “how to request a new journal/article from your medical reference library” in the New Employee Resource
c.      “Acupuncture: An Overview of the Scientific Evidence” from Evidence-based Acupuncture is available at their website
d.     “Acupuncture Evidence-based Summary: Pain” by Evidence-Based Acupuncture
e.      The Acupuncture Evidence Project – A Comparative Literature Review 2017 with pdf download is available at the link noted
                                                
Acupuncture in the Emergency Department
4. Interview with Dr. John Burns about his program and his ED acupuncture feasibility research project.
Burns JR, Kram JJ, Xiong V, Stark Casadont JM, Mullen TA, Conway N, Baumgardner DJ. Utilization of acupuncture services in the emergency department setting: a quality improvement study. J Patient Cent Res Rev. 2019; 6:172-8. 10.17294/2330-0698.1688

Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, Volume 18, Issue 1, 1 January 2017, Pages 169–178, https://doi.org/10.1093/pm/pnv114 
The following are new citations, recommended by Sandro Graca.
a.      “Acupuncture for analgesia in the emergency department: a multicenter, randomized, equivalence and non-inferiority trial”, published in Med J Aust 2017.
b.     “Acupuncture in the emergency department: a systematic review of randomized controlled trials”, published in Acupunct Med in June 2018.
East Asian Medicine/Acupuncture as a “whole system paradigm”
5.      East Asian Medicine as a “whole system” paradigm for wellness and improving the social determinants of health. I started a new thread on this in the discussion groups. Please feel free to add citations related to the subject. 
Why this subject is important to hospital-based practice: it is useful when talking about healthcare culture change and when discussing the issues related to decreasing the overall cost of healthcare by addressing chronic health conditions and social determinants of health (SDOH).
a.      Related subjects include social determinants of health (SDOH), acupuncture changes in patient perception (aka improves self-awareness) which thereby increases patient involvement in their own behavior change (lifestyle modifications, patient therapy compliance, increase in practicing self-care activities). This then improves SDOH of patients and their communities (teaching positive health behaviors and normalizing such behaviors for a community).
b.     This is an important subject/discussion topic for federal qualifying health centers (FQHC) and VHA work (directly related to their Whole Health Program).
c.      Recommended article on the subject:
                                                    i.     McPherson, F et al (2016) Health Perception and Wellness Behavior Survey among Military Beneficiaries. Ann Psychiatry Ment Health 4(2): 1060.
d.     If you have similar articles on the subject of acupuncture/East Asian Medicine and patient perception of health, please add the link or citation in the comments section. Thank you.

Interested in Measuring Your Work?
  • Are you tracking your patient outcomes? If you want to learn or review how to use a validated pain scale, check out our short course with pdfs and videos, How to Use a Validated Pain Scale in Your Chart Note 
  • Learn more about the importance of metrics in your work by following the Hospital Handbook Project. We are currently tagging blog posts related to metrics with "metrics". You can use the search feature in the blog and type in "metrics" to find related posts.
  • If the term "metrics" and/or "performance management metrics" are new to you, sign up for our new series, Basics of Being an Employee in a Healthcare System: Performance Metrics. We have finished recording the series. Just doing the slow work of video editing and note-taking. If you sign up, you will be notified when any of it is next published. More information about that here.

Reviewing Some Research Basics
Research Conferences

 SAR Conference Notes
My notes from attending The Society of Acupuncture Research Conference and links to related articles and blog posts are available for about the cost of taking me for coffee at this link. If you are already enrolled in the membership site, you already have access.
NCCIH at 20: A Catalyst for Integrative Health Research, a One Day Conference with the NCCIH Stephen E. Straus lecture

Research Funding Announcements from NCCIH
Source: An October 2019 NCCIH electronic newsletter edition, NCCIH Update: new tools for clinical researchers...
For those of you working with your research team or are program leads and program managers, here's the list of new funding announcements from NCCIH. All seem to be related to the HEAL initiative:

More about these funding HEAL initiatives that are related to work with chronic pain and the opioid crisis: 
“NIH Rolls Out Large Wave of NIH HEAL Initiative Funding -NCCIH’s Ongoing Role” from the Director’s Page of Dr. Helene Langevin, published 9.26.2019.
"Among the NIH HEAL initiative awards announced today are a combined $86.9 million over 6 years, pending the availability of funds, for initatives that NCCIH is leading or coleading. This includes, Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM), Behavioral Research to Improve Medication Assisted Treatment (BRIM), and the NIH Back Pain Consortium (BACPAC) Research Program."
"NIH HEAL Initiative research will develop non-addictive medications and nondrug treatments for pain and test new models of care in real-world settings. This includes a controlled trial of acupuncture under PRISM for chronic low-back pain in adults 65 years and older, and NIH is working with the Centers for Medicare & Medicaid Services (CMS). The results of this study will inform CMS coverage decisions. While some nondrug treatments of pain have been found to be effective, patients often do not have access to these treatments in their health care systems. The trials supported by the PRISM program will assess whether making these treatments directly available to patients with pain conditions improves their symptoms and ability to function." [highlight added for emphasis]
"Working together, I am confident that we can address the national opioid and pain crises and save lives." --Dr. Helene Langevin, NCCIH director

Metrics: Clinician Employee Burnout & Employee Well-Being
Are you interested in measuring burnout or well-being?
Learn more about the NAM Clinician Well-Being Series at our concise blog post here

 New publication from NAM on Clinician Burnout
The National Academy of Medicine has a new publication on clinician burnout, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. **This is a consensus study report. The pdf download is free and available as of late October 2019. It will be available in paperback December 1st.
For more information and the pdf download, go to this NAM webpage.

Quotes from the NAM webpage:
"Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care." 
"Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being and recommendations for the field."  -NAM webpage
citation: 
National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.


What is a NAM consensus study report?
Any "Consensus Study Report" from the National Academies of Sciences, Engineering, and Medicine is the documentation of the "evidence-based consensus on the study's statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee's deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task."

The National Academy of Medicine has a lot of resources on clinician burnout. In fact, their recorded sessions on the topic are a recommended Lunchtime Listen. Learn more about these resources at this blogpost. 



Humanism in Healthcare: Patient-Centered-ness and Clinician Resilience
  • The September edition of the Jeffrey Silver Humanism in Healthcare Research Roundup includes these relate-able articles:
    • Researchers looking at how to measure the change when you ask patients to stop and reflect on a question before answering it.  “Reflective pause.”
      Reflecting on shared decision making: a reflection-quantification study Free full-text Kunneman M, LaVecchia CM, Singh Ospina N, Abu Dabrh AM, Behnken EM, Wilson P, Branda ME, Hargraves IG, Yost KJ, Frankel RM, Montori VM. Health Expect. 2019 Aug 14. 
      "Shared decision-making (SDM) refers to the collaborative nature of clinicians and patients in making decisions about health and care. It is considered an important component of healthcare, but assessing it accurately can be difficult. After testing the three versions of this questionnaire on 107 patients, they pursued further modifications to emphasize “stop-and-think” reflection. In this second study, they distributed a second version of the questionnaire to 212 patients. Overall, they found that that the “stop-and-think” emphasis did not significantly alter the ratings. Still, the authors conclude by noting that “other ways to induce a reflective pause” should be considered when studying SDM in these sorts of challenging settings."
    • Mentoring and Professionalism in Training (MAP- IT) programs
      Humanistic topics are emphasized…appreciative inquiry, enhancing well-being, and mindfulness and self-care.
      “graduates continued to use these practices and skills in their professional and personal lives. To their surprise, self-care, which was not designed to be an outcome..emerged as a major theme.”  "MAP-IT exercises with the greatest staying power was the participant's selection of a "third thing."
      “The authors conclude that there is durability in humanistic faculty development programs and that they may help to foster cultures of medical education and practice that promote wellness, community, and social support.”

      The long-term impact of an interprofessional humanistic faculty development programme: a qualitative investigation Tortez LM, Quinlan PS, Makaryus AN, George C, Caruso V, Gilman S, Ricardo A, Fornari A.   J Eval Clin Pract. 2019 Sep 3.
      Faculty development programs are important components of professional growth among academic clinicians once they have completed formal training, and constitute opportunities for building skills necessary for humanistic care.
    • "A Third Thing". Third things as inspiration and artifact: a multi-stakeholder qualitative approach to understand patient and family emotions after harmful events Gaufberg E, Olmsted MW, Bell SK. J Med Humanit. 2019 Jul 24. 
    • “Third things” are objects, images, or texts that serve as reflective triggers or conversational mediators to help create a safe space for sharing stories and perspectives. They can be used to approach sensitive topics that may otherwise cause emotional harm. Elizabeth Gaufberg and colleagues examined whether visual reflective triggers could serve as 'third things' to foster useful dialogue about the emotional impact of harmful events and medical errors. At an Agency for Healthcare Research and Quality conference called 'Healing After Harm,' the authors engaged 41 participants in a visual reflective trigger exercise to formulate domains and themes associated with medical injuries."
    • Teaching empathy to nursing students: a randomised controlled trial  Bas-Sarmiento P, Fernández-Gutiérrez M, Díaz-Rodríguez M; iCARE Team. Nurse Educ Today. 2019 Sep;80:40-51.
      "Empathy is a touchstone of humanistic healthcare, but can it be acquired as part of health pro      fessions education?" "They measured outcomes before and after the intervention using standardized measures like the       Jefferson Scale of Empathy (JSE), the Consultation and Relational Empathy (CARE) Measure, and a 10-point Likert scale on student perception of learning. They determined that experimental groups had higher post-test scores and that there was an increased perception of learning and understanding compared to control groups. The authors noted that certain elements of empathy can be developed through training, but follow-up over longer periods of time and more rigorous studies controlling for other variables are necessary before establishing more definitive conclusions." [highlight added to metrics noted]
    • Compassion fatigue and compassion satisfaction among multisite multisystem nurses
      Kawar LN, Radovich P, Valdez RM, Zuniga S, Rondinelli J. Nurs Adm Q. 2019 Oct/Dec;43(4):358-369.
      Compassion fatigue is defined as “emotional exhaustion due to severe and prolonged interaction with clients, use of self and exposure to stress.”  This is a major occupational hazard among inpatient nurses and is associated with burnout. The converse of this is compassion satisfaction, which refers to when “a nurse gains fulfillment through helping clients.”  
      "However, there was low variability accounted for by these factors, suggesting that there are other factors, which could include unit culture and management support, that could mitigate the risk of compassion fatigue, and consequently burnout. Overall, these results point to the need for interventions designed for specific specialties and for less-experienced nurses." [highlight added for emphasis]  

For more on the topic of research

Other monthly research summary blogposts
Research Review posts
Research Resource Websites & Journals


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