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Wu C, Mulakaluri A, Chaurasia P, Suryanarayana S, Singh A, Krauss N, Tahir P, Elder C, Puthiyedath R, Dhruva A. A scoping review of Ayurvedic rasayana adaptogens in oncology. J Ayurveda Integr Med 2024; 15:100879. [PMID: 38301299 PMCID: PMC10847161 DOI: 10.1016/j.jaim.2023.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Rasayanas are Ayurvedic natural products that have adaptogenic effects. The extensive research on rasayanas in oncology is not currently well summarized. The aim of this review is to investigate the range and nature of the current body of research, identify gaps in knowledge, and to summarize the existing literature as it relates to Ayurvedic rasayanas and oncology. MATERIALS AND METHODS A comprehensive literature search of fifteen Ayurvedic adaptogen rasayanas was conducted using three main concepts: Ayurvedic herbal terms, neoplasm terms, and oncological pathways. After screening was performed, key variables were extracted (tagged) including type of adaptogen, cancer type, type of study design, constituent type, and mechanisms of action (MOA). The results were synthesized and summarized using descriptive statistics and narrative summaries. RESULTS Five hundred and eighty-four articles were reviewed and tagged. The two most tagged adaptogens were Glycyrrhiza glabra (Yashthimadhu/licorice) (n = 166 (28.4 %)) and Withania somnifera (Ashwagandha) (n = 151 (25.9 %)). The most frequently tagged cancer diagnostic categories were gastrointestinal (n = 175 (30 %)), and breast (n = 126 (21 %)). Most of the articles focused on in vitro studies (n = 470 (80.3 %)). Of the 12 MOA tags, the most frequently tagged was apoptosis (n = 298 (29.2 %)). CONCLUSION A large body of pre-clinical literature exists on adaptogen rasayanas in oncology, indicating this field of research is still in its early phase. Comparatively few studies focused on the effects on the immune system. Given the growing interest in immuno-oncology therapeutics and the potential impact of adaptogen rasayanas on the immune system, future research may focus more in this area, along with work that is more directly linked to future clinical studies.
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Affiliation(s)
- Cairn Wu
- Osher Center for Integrative Health, University of California, San Francisco, USA.
| | - Ashley Mulakaluri
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Pranay Chaurasia
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Sindhu Suryanarayana
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Ambreen Singh
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Nicole Krauss
- Osher Center for Integrative Health, University of California, San Francisco, USA
| | - Peggy Tahir
- UCSF Library, University of California, San Francisco, USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Anand Dhruva
- Osher Center for Integrative Health, University of California, San Francisco, USA; Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
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Naleway AL, Henninger ML, Irving SA, Bianca Salas S, Kauffman TL, Crane B, Mittendorf KF, Harsh S, Elder C, Gee J. Epidemiology of Upper Limb Complex Regional Pain Syndrome in a Retrospective Cohort of Persons Aged 9-30 Years, 2002-2017. Perm J 2023:1-12. [PMID: 37154719 DOI: 10.7812/tpp/22.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Introduction This paper describes the epidemiology and clinical presentation of complex regional pain syndrome (CRPS) in a large, integrated health care delivery system; and CRPS incidence rates (IRs) over a time period spanning human papillomavirus (HPV) vaccine licensure and published case reports of CRPS following HPV vaccination. Methods The authors examined CRPS diagnoses in patients aged 9-30 years between January 2002 and December 2017 using electronic medical records, excluding patients with lower limb diagnoses only. Medical record abstraction and adjudication were conducted to verify diagnoses and describe clinical characteristics. CRPS IRs were calculated for 3 periods: Period 1 (2002-2006: before HPV vaccine licensure), Period 2 (2007-2012: after licensure but before published case reports), and Period 3 (2013-2017: after published case reports). Results A total of 231 individuals received an upper limb or unspecified CRPS diagnosis code during the study period; 113 cases were verified through abstraction and adjudication. Most verified cases (73%) were associated with a clear precipitating event (eg, non-vaccine-related injury, surgical procedure). The authors identified only 1 case in which a practitioner attributed CRPS onset to HPV vaccination. Twenty-five incident cases occurred in Period 1 (IR = 4.35/100,000 person-years (PY), 95% confidence interval (CI) = 2.94-6.44), 42 in Period 2 (IR = 5.94/100,000 PY, 95% CI = 4.39-8.04), and 29 in Period 3 (IR = 4.53/100,000 PY, 95% CI = 3.15-6.52); differences between periods were not statistically significant. Conclusion These data provide a comprehensive assessment of the epidemiology and characteristics of CRPS in children and young adults and provide further reassurance about the safety of HPV vaccination.
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Affiliation(s)
| | | | | | - S Bianca Salas
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Bradley Crane
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stacy Harsh
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Julianne Gee
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cannon K, Elder C, Young M, Scott DA, Scully IL, Baugher G, Peng Y, Jansen KU, Gruber WC, Watson W. A trial to evaluate the safety and immunogenicity of a 20-valent pneumococcal conjugate vaccine in populations of adults ≥65 years of age with different prior pneumococcal vaccination. Vaccine 2021; 39:7494-7502. [PMID: 34839993 DOI: 10.1016/j.vaccine.2021.10.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A 20-valent pneumococcal conjugate vaccine, PCV20, was developed to expand protection against vaccine-preventable pneumococcal disease. PCV20 contains the components of the 13-valent pneumococcal conjugate vaccine, PCV13, and includes capsular polysaccharide conjugates for 7 additional serotypes. Thus, PCV20 may cover those additional serotypes in individuals previously vaccinated with PCV13 or provide benefits of immunization with a conjugate vaccine to individuals previously immunized with a pneumococcal polysaccharide vaccine. This study described the safety and immunogenicity of PCV20 in adults ≥65 years of age with prior pneumococcal vaccination. METHODS This phase 3, multicenter, randomized, open-label study was conducted in the United States and Sweden. Adults ≥65 years of age were enrolled into 1 of 3 cohorts based on their prior pneumococcal vaccination history (23-valent pneumococcal polysaccharide vaccine [PPSV23], PCV13, or both PCV13 and PPSV23). Participants were randomized 2:1 within their cohort to receive a single dose of PCV20 or PCV13 in those with prior PPSV23 only, and PCV20 or PPSV23 in those with prior PCV13 only; all participants with prior PCV13 and PPSV23 received PCV20. Safety was assessed by prompted local reactions within 10 days, systemic events within 7 days, adverse events (AEs) within 1 month, and serious AEs (SAEs) and newly diagnosed chronic medical conditions (NDCMCs) within 6 months after vaccination. Immune responses 1 month after PCV20 were assessed. RESULTS The percentages of participants reporting local reactions, systemic events, and AEs after PCV20 administration were similar across cohorts and comparable with the PCV13 and PPSV23 control groups. SAE and NDCMC rates were low in all groups. Robust immune responses, including opsonophagocytic antibody responses, to the 20 vaccine serotypes were observed 1 month after PCV20 regardless of prior pneumococcal vaccination. CONCLUSIONS PCV20 was well tolerated and immunogenic in adults ≥65 years of age previously vaccinated with different pneumococcal vaccine regimens. Clinicaltrials.gov NCT03835975.
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Affiliation(s)
- Kevin Cannon
- PMG Research of Wilmington, LLC, Wilmington, NC, USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mariano Young
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA.
| | - Daniel A Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Ingrid L Scully
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Gary Baugher
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Kathrin U Jansen
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, Oregon
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Affiliation(s)
- Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR.,Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Charles Elder
- Kaiser Permanente Northwest and Kaiser Permanente Center for Health Research, Portland, OR
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Elder C, Ijaz N, Weeks J, Rioux J, Ritenbaugh C. Convergent Points for Conventional Medicine and Whole Systems Research: A User's Guide. J Altern Complement Med 2019; 25:S12-S16. [PMID: 30870016 DOI: 10.1089/acm.2018.0515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT Value-based health care has emerged as a manifestation of the conventional medicine community's awareness of the overlapping needs to both better incorporate patient centeredness into practice and research paradigms and further develop a systemic approach to cost reduction. BACKGROUND The origins of the whole systems research (WSR) movement date to the late 1990s, when the U.S. Congress legislated appropriation of funds to stimulate the U.S. National Institutes of Health to evaluate popular traditional, complementary, and integrative medicine (TCIM) practices. Questions immediately arose over how well these forms of practice could be measured through standard randomized controlled trials, and the WSR community began to articulate and adapt innovative methodologies for evaluating TCIM interventions. DISCUSSION This column explores the potential impact of WSR methods and exemplars on the clinical practice and research communities seeking to successfully implement and measure the complexities of value-based health care. Four potentially cross-talking themes are specifically discussed: complex behaviorally focused interventions, patient-centered outcomes, team-based care, and resilience and well-being. CONCLUSION The time is ripe for clinicians and investigators to capitalize on methodologies, exemplars, and learnings from the WSR literature toward improving care, developing more robust research strategies, and furthering the dialogue between the TCIM and conventional medicine communities.
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Affiliation(s)
- Charles Elder
- 1 Kaiser Permanente Center for Health Research, Portland, OR
| | - Nadine Ijaz
- 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - John Weeks
- 3 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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Abstract
Objectives: This scoping review evaluates two decades of methodological advances made by “whole systems research” (WSR) pioneers in the fields of traditional, complementary, and integrative medicine (TCIM). Rooted in critiques of the classical randomized controlled trial (RCT)'s suitability for evaluating holistic, complex TCIM interventions, WSR centralizes the principle of “model validity,” representing a “fit” between research design and therapeutic paradigm. Design: In consultation with field experts, 41 clinical research exemplars were selected for review from across 13 TCIM disciplines, with the aim of mapping the range and methodological characteristics of WSR studies. Using an analytic charting approach, these studies' primary and secondary features are characterized with reference to three focal areas: research method, intervention design, and outcome assessment. Results: The reviewed WSR exemplars investigate a wide range of multimodal and multicomponent TCIM interventions, typified by wellness-geared, multitarget, and multimorbid therapeutic aims. Most studies include a behavioral focus, at times in multidisciplinary or team-based contexts. Treatments are variously individualized, often with reference to “dual” (biomedical and paradigm-specific) diagnoses. Prospective and retrospective study designs substantially reflect established biomedical research methods. Pragmatic, randomized, open label comparative effectiveness designs with “usual care” comparators are most widely used, at times with factorial treatment arms. Only two studies adopt a double-blind, placebo-controlled RCT format. Some cohort-based controlled trials engage nonrandomized allocation strategies (e.g., matched controls, preference-based assignment, and minimization); other key designs include single-cohort pre–post studies, modified n-of-1 series, case series, case report, and ethnography. Mixed methods designs (i.e., qualitative research and economic evaluations) are evident in about one-third of exemplars. Primary and secondary outcomes are predominantly assessed, at multiple intervals, through patient-reported measures for symptom severity, quality of life/wellness, and/or treatment satisfaction; some studies concurrently evaluate objective outcomes. Conclusions: Aligned with trends emphasizing “fit-for-purpose” research designs to study the “real-world” effectiveness of complex, personalized clinical interventions, WSR has emerged as a maturing scholarly discipline. The field is distinguished by its patient-centered salutogenic focus and engagement with nonbiomedical diagnostic and treatment frameworks. The rigorous pursuit of model validity may be further advanced by emphasizing complex analytic models, paradigm-specific outcome assessment, inter-rater reliability, and ethnographically informed designs. Policy makers and funders seeking to support best practices in TCIM research may refer to this review as a key resource.
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Affiliation(s)
- Nadine Ijaz
- 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Charles Elder
- 3 Kaiser Permanente Center for Health Research, Portland, OR
| | - John Weeks
- 4 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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Ball D, Mai G, Vinod S, Babington S, Ruben J, Kron T, Chesson B, Herschtal A, Vanevski M, Rezo A, Elder C, Skala M, Wirth A, Wheeler G, Lim A, Shaw M, Schofield P, Irving L, Solomon B. Quality of life in the CHISEL randomized trial of stereotactic ablative radiotherapy (SABR) versus standard radiotherapy for stage I non-small cell lung cancer (Trans-Tasman Radiation Oncology Group 09.02). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Elder C, DeBar L, Ritenbaugh C, Dickerson J, Vollmer WM, Deyo RA, Johnson ES, Haas M. Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain. J Gen Intern Med 2018; 33:1469-1477. [PMID: 29943109 PMCID: PMC6108992 DOI: 10.1007/s11606-018-4539-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/27/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored. OBJECTIVE To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain. STUDY DESIGN Prospective cohort study using propensity score-matched controls. PARTICIPANTS Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months. MAIN MEASURES Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care. KEY RESULTS Both groups' (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. (severity - 0.10 (95% CI - 0.30, 0.10), interference - 0.07 (- 0.31, 0.16), bothersomeness - 0.1 (- 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group ($1996 [SD = 3874] vs $1086 [SD = 1212], p = .034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072). CONCLUSIONS We found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | - Eric S Johnson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mitchell Haas
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
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Ball D, Mai T, Vinod S, Babington S, Ruben J, Kron T, Chesson B, Herschtal A, Rezo A, Elder C, Skala M, Wirth A, Wheeler G, Lim A, Vanevski M, Shaw M. MA 13.07 A Randomized Trial of SABR vs Conventional Radiotherapy for Inoperable Stage I Non-Small Cell Lung Cancer: TROG09.02 (CHISEL). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dunlap C, Hanes D, Elder C, Nygaard C, Zwickey H. Reliability of self-reported constitutional questionnaires in Ayurveda diagnosis. J Ayurveda Integr Med 2017; 8:257-262. [PMID: 29089187 PMCID: PMC5747507 DOI: 10.1016/j.jaim.2017.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/04/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Ayurveda is one of the most ancient and widely practiced forms of medicine today, along with Traditional Chinese Medicine. It consists of determining an individual's constitution or Prakriti and current imbalance(s) through the use of multimodal approaches. Ayurveda practitioners may choose to include either a self-reported or structured interview constitutional questionnaire as part of the Prakriti assessment. Currently, there is no standardized or validated self-reported constitutional questionnaire tool employed by Ayurveda physicians or western Ayurveda educational institutions. Objectives To examine test-retest reliability of three self-administered constitutional questionnaires at a one month interval and internal consistency of items pertaining to a single constitution. Materials and methods Three constitutional questionnaires were administered online. 19 participants completed three questionnaires at two time points, one month apart. Age range was 21–62 years old with a mean age of 34. Of the 19, 5 were male and 14 female. Vata, Pitta, and Kapha scores obtained from each questionnaire were standardized to give a vector of three relative percentages, summing to 100. These percentages were further translated from numerical values to one of ten possible dosha diagnoses. Results Analysis indicated that the three questionnaires had moderately good test-retest reliability according to numerical scores, but highly variable reliability according to discrete Ayurveda diagnosis. Internal consistency pertaining to individual constitutions within one questionnaire was poor for all three primary doshas, but especially for Kapha. Conclusion Further research is necessary to develop a reliable and standardized constitutional questionnaire.
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Affiliation(s)
- Corina Dunlap
- Helfgott Research Institute c/o National University of Natural Medicine, 2220 SW 1st Ave, Portland, OR 97201, USA.
| | - Douglas Hanes
- Helfgott Research Institute c/o National University of Natural Medicine, 2220 SW 1st Ave, Portland, OR 97201, USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Carolyn Nygaard
- Helfgott Research Institute c/o National University of Natural Medicine, 2220 SW 1st Ave, Portland, OR 97201, USA
| | - Heather Zwickey
- Helfgott Research Institute c/o National University of Natural Medicine, 2220 SW 1st Ave, Portland, OR 97201, USA
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Elder C. Mind-Body Training for At-Risk Populations: Preventive Medicine at its Best. Perm J 2017; 21:16-174. [PMID: 28241906 DOI: 10.7812/tpp/16-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article is a companion to "Transcendental meditation and reduced trauma symptoms in female inmates: A randomized controlled pilot study," available at: www.thepermanentejournal.org/issues/2017/6290-meditation.html, and on page 39 and to "Reduced trauma symptoms and perceived stress in male prison inmates through the Transcendental Meditation program: A randomized controlled trial," available at: www.thepermanentejournal.org/issues/2016/fall/6227-incarcerated-healthcare.html and in the Fall 2016 issue of The Permanente Journal.
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Affiliation(s)
- Charles Elder
- Physician Lead for Integrative Medicine at Kaiser Permanente Northwest; Affiliate Investigator at the Center for Health Research in Portland, OR; and Associate Editor for Integrative Medicine at The Permanente Journal.
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Penney LS, Ritenbaugh C, DeBar LL, Elder C, Deyo RA. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. BMC Fam Pract 2017; 17:164. [PMID: 28403822 PMCID: PMC5390355 DOI: 10.1186/s12875-016-0566-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. METHODS Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. RESULTS We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. CONCLUSIONS These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers. TRIAL REGISTRATION ClinicalTrials.gov NCT01345409 , date of registration 28/4/2011.
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Affiliation(s)
- Lauren S. Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA
| | - Cheryl Ritenbaugh
- The University of Arizona, Department of Family and Community Medicine, 1450N. Cherry Ave, Tucson, AZ 85719 USA
| | - Lynn L. DeBar
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Richard A. Deyo
- Oregon Health & Science University, 3181S.W. Sam Jackson Park Rd, Portland, OR 97239 USA
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Caress SM, Elder C, Elling R, Faletta JP, Orr SK, Rader E, Sarbaugh-Thompson M, Strate J, Thompson L. Effect of Term Limits on the Election of Minority State Legislators. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0160323x0303500304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stanley M. Caress
- Stanley M. Caressis an associate professor of political science and director of the Center for Future Democracy at the State University of West Georgia. He has written articles on legislative term limits that have been published in the American Review of Politics, PS: Political Science & Politics, and Women and Politics
| | - Charles Elder
- Charles Elderis a professor of political science at Wayne State University, where he is a member of the Term Limits Research Project, State Policy Center
| | - Richard Elling
- Richard Ellingis a professor and chair of the political science department at Wayne State University and a member of the Term Limits Research Project, State Policy Center
| | - Jean-Philippe Faletta
- Jean-Philippe Falettais an assistant professor at the University of St. Thomas and was previously with the Term Limits Research Project, State Policy Center, Wayne State University
| | - Shannon K. Orr
- Shannon K. Orris a Ph.D. candidate in political science at Wayne State University, where she is a member of the Term Limits Research Project, State Policy Center
| | - Eric Rader
- Eric Raderis a Ph.D. candidate in political science at Wayne State University, where he is a member of the Term Limits Research Project, State Policy Center
| | - Marjorie Sarbaugh-Thompson
- Marjorie Sarbaugh-Thompsonis an associate professor of political science at Wayne State University, where she is the principal investigator of the Term Limits Research Project, State Policy Center
| | - John Strate
- John Strateis an associate professor of political science at Wayne State University, where he is a member of the Term Limits Research Project, State Policy Center
| | - Lyke Thompson
- Lyke Thompsonis a professor of political science and urban, labor, and metropolitan affairs at Wayne State University, where he is a member of the Term Limits Research Project, State Policy Center
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Penney LS, Ritenbaugh C, Elder C, Schneider J, Deyo RA, DeBar LL. Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns. Altern Ther Health Med 2016; 16:30. [PMID: 26810302 PMCID: PMC4727288 DOI: 10.1186/s12906-016-1005-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND A variety of people, with multiple perspectives, make up the system comprising chronic musculoskeletal pain (CMP) treatment. While there are frequently problems in communication and coordination of care within conventional health systems, more opportunities for communicative disruptions seem possible when providers use different explanatory models and are not within the same health management system. We sought to describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor (A/C) providers, and CMP patients. METHODS We collected qualitative data from CMP patients (n = 90) and primary care physicians (PCPs) (n = 25) in a managed care system, and community acupuncture and chiropractic care providers (n = 14) who received high levels of referrals from the system, in the context of a longitudinal study of CMP patients' experience. RESULTS Multiple points of divergence and communicative barriers were identified among the main stakeholders in the system. Those that were most frequently mentioned included issues surrounding the referral process (requesting, approving) and lack of consistent information flow back to providers that impairs overall management of patient care. We found that because of these problems, CMP patients were frequently tasked and sometimes overwhelmed with integrating and coordinating their own care, with little help from the system. CONCLUSIONS Patients, PCPs, and A/C providers desire more communication; thus systems need to be created to facilitate more open communication which could positively benefit patient outcomes.
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Elder C, DeBar L, Ritenbaugh C, Vollmer W, Deyo RA, Dickerson J, Kindler L. Acupuncture and chiropractic care: utilization and electronic medical record capture. Am J Manag Care 2015; 21:e414-e421. [PMID: 26295269 PMCID: PMC6354921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture. STUDY DESIGN Cross-sectional survey. METHODS Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate. The survey included questions about self-identified presence of CMP, use of acupuncture and chiropractic care, use of ancillary self-care modalities, and communication with conventional medicine practitioners. Analysis of survey data was supplemented with a retrospective review of EMR utilization data. RESULTS Of 6068 survey respondents, 32% reported acupuncture use, 47% reported chiropractic use, 21% used both, and 42% used neither. For 25% of patients using acupuncture and 43% of those using chiropractic care, utilization was undetected by the EMR. Thirty-five percent of acupuncture users and 42% of chiropractic users did not discuss this care with their health maintenance organization (HMO) clinicians. Among chiropractic users, those accessing care out of plan were older (P < .01), were more likely to use long-term opioids (P = .03), and had more pain diagnoses (P = .01) than those accessing care via clinician referral or self-referral. For acupuncture, those using the clinician referral mechanism exhibited these same characteristics. CONCLUSIONS A majority of participants had used acupuncture, chiropractic care, or both. While benefit structure may materially influence utilization patterns, many patients with CMP use acupuncture and chiropractic care without regard to their insurance coverage. A substantial percentage of acupuncture and chiropractic use thus occurs beyond detection of EMR systems, and many patients do not report such care to their HMO clinicians.
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227. E-mail:
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Elder C, Nidich S, Moriarty F, Nidich R. Effect of transcendental meditation on employee stress, depression, and burnout: a randomized controlled study. Perm J 2014; 18:19-23. [PMID: 24626068 DOI: 10.7812/tpp/13-102] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT Workplace stress and burnout are pervasive problems, affecting employee performance and personal health. OBJECTIVE To evaluate the effects of the Transcendental Meditation program on psychological distress and burnout among staff at a residential therapeutic school for students with severe behavioral problems. DESIGN A total of 40 secondary schoolteachers and support staff at the Bennington School in Vermont, a therapeutic school for children with behavioral problems, were randomly assigned to either practice of the Transcendental Meditation program or a wait-list control group. The Transcendental Meditation course was provided by certified instructors. MAIN OUTCOME MEASURES Outcome measures were assessed at baseline and four months, and included perceived stress, depression, and burnout. A multivariate analysis of covariance was used to determine overall effects. RESULTS Analysis of the 4-month intervention data indicated a significant improvement in the main outcomes of the study resulting from practice of the Transcendental Meditation program compared with controls (Wilks Λ [3,28] = 0.695; p = 0.019). Results of univariate F tests indicated a significant reduction of all main outcome measures: perceived stress (F[1,32] = 13.42; p = < 0.001); depression (F[1,32] = 6.92; p = 0.013); and overall teacher burnout (F[1,32] = 6.18; p = 0.018). Effect sizes ranged from 0.40 to 0.94. CONCLUSIONS The Transcendental Meditation program was effective in reducing psychological distress in teachers and support staff working in a therapeutic school for students with behavioral problems. These findings have important implications for employees’ job performance as well as their mental and physical health.
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Affiliation(s)
- Charles Elder
- Physician Lead for Integrative Medicine at Kaiser Permanente Northwest and an Affiliate Investigator at the Center for Health Research in Portland, OR.
| | - Sanford Nidich
- Professor of Physiology and Health, and Education at Maharishi University of Management and Senior Investigator at the Institute for Natural Medicine and Prevention in Fairfield, IA.
| | - Francis Moriarty
- Clinical Director at Mountain Valley Treatment Center in Pike, NH, and the Founder of Metta, LTD in Arlington, VT.
| | - Randi Nidich
- Adjunct Associate Professor of Education at Maharishi University of Management in Fairfield, IA.
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Abstract
The objective of this study is to examine the use of complementary and alternative medicine (CAM) for weight loss among Mexican-American women. Cross-sectional survey of different CAM modalities, including traditional Mexican medicine therapies. The sample was drawn from women participating in a weight-loss program in Portland, Oregon. Sample consisted of 31 adult Mexican-American women. Most respondents reported using some form of CAM for weight loss, with most reporting using herbs and teas (70 %), home remedies (61 %) and massage (55 %). Mexican-American women report using a wide range of CAM therapies for weight loss. Understanding their patterns of use will enhance cultural competence of health care professionals and help address their medical needs.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR 97227-1110, USA.
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Witt CM, Aickin M, Cherkin D, Che CT, Elder C, Flower A, Hammerschlag R, Liu JP, Lao L, Phurrough S, Ritenbaugh C, Rubin LH, Schnyer R, Wayne PM, Withers SR, Zhao-Xiang B, Young J, Berman BM. Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document. Trials 2014; 15:169. [PMID: 24885146 PMCID: PMC4045891 DOI: 10.1186/1745-6215-15-169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 04/16/2014] [Indexed: 12/04/2022] Open
Abstract
Background There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making. Methods The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document. Results Recommendations were developed for “using available data” and “future clinical studies”. The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. Conclusion The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland.
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Elder C, Ritenbaugh C, Aickin M, Hammerschlag R, Dworkin S, Mist S, Harris RE. Reductions in pain medication use associated with traditional Chinese medicine for chronic pain. Perm J 2013; 16:18-23. [PMID: 23012594 DOI: 10.7812/tpp/12.967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Participants in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction (TMD) had a linear decline in pain over 16 TCM visits. OBJECTIVE To investigate whether reductions in pain among participants receiving TCM can be explained by increased use of pain medications, or whether use of pain medications also declined in this group. DESIGN One hundred sixty-eight participants with TMD were treated with TCM or enhanced self-care according to a stepped-care design. Those for whom self-care failed were sequentially randomized to further self-care or TCM. This report includes 111 participants during their first 16 TCM visits. The initial 8 visits occurred more than once a week; participants and practitioners determined the frequency of subsequent visits. OUTCOME MEASURES Average pain (visual analog scale, range 0-10) and morphine and aspirin dose equivalents. RESULTS The sample was 87% women and the average age was 44 ± 13 years. Average pain of narcotics users (n = 21) improved by 2.73 units over 16 visits (p < 0.001). Overall narcotics use trended downward until visit 11 (-3.27 doses/week, p = 0.156), and then trended upward until week 16 (+4.29 doses/week, p = 0.264). Among those using narcotics, use of nonsteroidal anti-inflammatory drugs (NSAIDs) declined linearly over visits 1-16 (-1.94 doses/week, p = 0.002).Among the top quartile of NSAID-only users (n = 22), average pain decreased linearly over 16 visits (-1.52 units, p = 0.036). Overall NSAID doses/week declined between visits 1 and 7 (-9.95 doses/week, p < 0.001) and then remained stable through 16 visits. NSAID use also declined among the third quartile (n = 23) and remained low and stable among the lower half (sorted by total intake) of NSAID users. CONCLUSIONS Among the heaviest NSAID users, we observed a short-term reduction in NSAID use that was sustained as TCM visits became less frequent. There was no indication that pain reduction during TCM treatment was influenced by drug use.
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Rioux J, Elder C, Vinjamury S. 19A. Practical Strategies for Integrating Ayurvedic Therapies into the Integrative Medicine Clinical Encounter. Glob Adv Health Med 2013. [PMCID: PMC3875039 DOI: 10.7453/gahmj.2013.097cp.s19a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Focus Area: Experiential Workshop The 3 Ayurvedic clinicians presenting this experiential session have delivered Ayurvedic medicine in diverse settings, including: a conventional managed care network using a group clinic format; with research participants at an academic medicine center; and in private practice. The 3 presenting Ayurvedic clinicians have approximately 50 years' combined experience practicing Ayurvedic medicine and have developed strategies for overcoming logistical and cultural challenges in working with patients. Ayurveda can be accessed for both acute and chronic conditions and includes multitarget therapies tailored to the unique constitution/imbalance profile of each patient, while accounting for any biomedical diagnoses. The focus of Ayurveda goes beyond symptom alleviation to the identification of the root cause of the imbalance and eventual resolution of the disorder. Ayurveda has a primary focus on modification of the diet and daily routine of the individual in an effort to create sustainable lifestyle change to promote overall health and prevent comorbid conditions. Ayurvedic clinicians also use herbal supplements, medicated oils, and hands-on manual therapies, as well as detoxification and rejuvenation therapies, to enhance healing holistically and synergistically and to create a state of durable well-being. The presenters of this workshop will focus on 3 key areas of Ayurvedic clinical practice: (1) Ayurvedic diet, daily routine, and yoga therapy (JR); (2) herbal therapies and home detoxification regimens (CE); and (3) manual therapies and Ayurvedic acupressure points (PV). Participants in the workshop will have the opportunity to (1) sample some simple medicinal teas and experience Ayurvedic dietary theory according to food qualities; (2) experience the effects of simple Ayurvedic breathing techniques and therapeutic yoga poses; and (3) participate in a basic demonstration of Ayurvedic manual therapies and acupressure.
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Affiliation(s)
- Jennifer Rioux
- University of New Mexico, Department of Internal Medicine, Albuquerque, United States
| | - Charles Elder
- Kaiser Permanente Northwest, Department of Internal Medicine, Portland, Oregon, United States
| | - Sivarama Vinjamury
- Southern California University of Health Sciences, Whittier, United States
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Rioux J, Saper R, Vinjamury S, Elder C. 02A. Design, Methods, and Outcomes for Recent Clinical Trials Utilizing Ayurvedic Medicine, Yoga, and Meditation. Glob Adv Health Med 2013. [PMCID: PMC3875075 DOI: 10.7453/gahmj.2013.097cp.s02a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Focus Area: Integrative Approaches to Care The panel discussants will present on the outcomes of four recent pragmatic trials covering the spectrum of Ayurvedic medicine, yoga, and meditation as therapeutic approaches for both acute and chronic conditions. The presenters will discuss: (1) a pilot study of a whole-systems Ayurveda and Yoga Therapy intervention for obesity; (2) a comparative effectiveness randomized controlled trial of hatha yoga, physical therapy, and education for non-specific chronic low back pain in low-income minority populations; (3) an investigation of the therapeutic usefulness of Shirodhara (Ayurvedic oil dripping therapy) as a treatment for insomnia; and (4) a discussion of the evidence base supporting implementation of meditation interventions in schools and workplace settings. Discussants will present information on study designs, research methodology, and outcome measure selection to highlight special considerations in conducting research on whole medical systems that use multi-target therapies and focus on patient-centered outcomes. Ayurvedic medicine and yoga are characterized by low-cost, noninvasive interventions that can be usefully offered as part of an integrative medicine therapeutic approach.
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Affiliation(s)
- Jennifer Rioux
- University of New Mexico, Department of Internal Medicine, Albuquerque, United States
| | - Robert Saper
- Boston University School of Medicine, Massachusetts, United States
| | - Sivarama Vinjamury
- Southern California University of Health Sciences, Whittier, United States
| | - Charles Elder
- Kaiser Permanente Northwest, Department of Internal Medicine, Portland, Oregon, United States
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Elder C. Integrating Naturopathy: Can We Move Forward? Perm J 2013. [DOI: 10.7812/tpp/13.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Medical records contain an abundance of information, very little of which is extracted and put to clinical use. Increasing the flow of information from medical records to clinical practice requires methods of analysis that are appropriate for large nonintervention studies. The purpose of this article is to explain in nontechnical language what these methods are, how they differ from conventional statistical analyses, and why the latter are generally inappropriate. This is important because of the current volume of nonintervention study analyses that either use incorrect methods or misuse correct methods. A set of guidelines is suggested for use in nonintervention clinical research.
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Stevens G, Loh J, Kolbe J, Stevens W, Elder C. Comparison of recommendations for radiotherapy from two contemporaneous thoracic multidisciplinary meeting formats: co-located and video conference. Intern Med J 2012; 42:1213-8. [DOI: 10.1111/j.1445-5994.2012.02817.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/10/2012] [Indexed: 12/18/2022]
Affiliation(s)
- G. Stevens
- Department of Radiation Oncology; Auckland Hospital; Auckland New Zealand
- Discipline of Oncology; University of Auckland; Auckland New Zealand
| | - J. Loh
- Department of Radiation Oncology; Auckland Hospital; Auckland New Zealand
| | - J. Kolbe
- Department of Respiratory Services; Auckland Hospital; Auckland New Zealand
- Department of Medicine; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - W. Stevens
- Discipline of Oncology; University of Auckland; Auckland New Zealand
- Northern Cancer Network; Auckland New Zealand
| | - C. Elder
- Department of Radiation Oncology; Auckland Hospital; Auckland New Zealand
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Elder C, Hinchliffe C, Wright N. Response to Alleyn et al. Comparison of longitudinal point-of-care and high-performance liquid chromatography HbA1c measurements in a multi-centre trial. Diabet Med 2012; 29:1213-4. [PMID: 22283435 DOI: 10.1111/j.1464-5491.2012.03600.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elder C, Ritenbaugh C, Aickin M, Hammershlag R, Dworkin S, Mist S, Harris R. P02.196. Changes in medication use associated with Traditional Chinese Medicine for chronic pain. BMC Complement Altern Med 2012. [PMCID: PMC3373700 DOI: 10.1186/1472-6882-12-s1-p252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Elder C, DeBar L, Ritenbaugh C, Aickin M, Deyo R, Meenan R, Dickerson J, Webster J, Yarborough B. P04.09. Acupuncture and chiropractic utilization among chronic musculoskeletal pain patients at a health maintenance organization. Altern Ther Health Med 2012. [PMCID: PMC3373759 DOI: 10.1186/1472-6882-12-s1-p279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ritenbaugh C, Penney L, DeBar L, Welch D, Schneider J, Catlin C, Firemark A, Elder C. OA16.01. Patients, physicians, and CAM providers regard communication as central for integrating conventional and CAM therapies for chronic pain. BMC Complement Altern Med 2012. [PMCID: PMC3373446 DOI: 10.1186/1472-6882-12-s1-o62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elder C, DeBar L, Funk K, Vollmer W, Lindberg N, Ritenbaugh C, Meltesen G, Gallison C, Stevens V. P02.11. Adherence and satisfaction with the experimental mind and body intervention in the LIFE weight loss maintenance study. BMC Complement Altern Med 2012. [PMCID: PMC3373907 DOI: 10.1186/1472-6882-12-s1-p67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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DeBar LL, Elder C, Ritenbaugh C, Aickin M, Deyo R, Meenan R, Dickerson J, Webster JA, Jo Yarborough B. Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC Complement Altern Med 2011; 11:118. [PMID: 22118061 PMCID: PMC3256110 DOI: 10.1186/1472-6882-11-118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/25/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substantial recent research examines the efficacy of many types of complementary and alternative (CAM) therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community. METHODS/DESIGN This multi-phase, mixed methods study will: (1) conduct a retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data. DISCUSSION Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations. TRIAL REGISTRATION ClinicalTrials.gov: NCT01345409.
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Affiliation(s)
| | - Charles Elder
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Carmit McMullen
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Jeffrey Weih
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
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Elder C, Gallison C, Lindberg NM, DeBar L, Funk K, Ritenbaugh C, Stevens VJ. Randomized trial of Tapas Acupressure Technique for weight loss maintenance: rationale and study design. J Altern Complement Med 2010; 16:683-90. [PMID: 20569037 DOI: 10.1089/acm.2009.0454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this article is to present the rationale, study design, and methods of an ongoing randomized controlled trial assessing the efficacy of an energy psychology intervention, Tapas Acupressure Technique (TAT), to prevent weight regain following successful weight loss. DESIGN This is a randomized controlled trial. SETTINGS/LOCATION The study is being conducted at a large group-model health maintenance organization (HMO). SUBJECTS The study subjects are adult members of an HMO. INTERVENTIONS TAT is being compared to a self-directed social support comparison intervention. OUTCOME MEASURES The primary outcome measure is weight-loss maintenance at 6 and 12 months post-randomization. CONCLUSIONS This randomized controlled trial will test the efficacy of an energy psychology intervention, TAT, by comparing it with a self-directed social support group intervention. This is, to our knowledge, the largest randomized controlled study to date of an energy psychology intervention. Positive findings would support the use of TAT as a tool to prevent weight regain following successful weight loss.
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR 97227, USA.
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Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R. Corrigendum to 'Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey' [HEAPRO 24 (2009) 252-261]. Health Promot Int 2009. [DOI: 10.1093/heapro/dap063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sutherland EG, Ritenbaugh C, Kiley SJ, Vuckovic N, Elder C. An HMO-based prospective pilot study of energy medicine for chronic headaches: whole-person outcomes point to the need for new instrumentation. J Altern Complement Med 2009; 15:819-26. [PMID: 19678772 DOI: 10.1089/acm.2008.0592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate an energy healing treatment for possible inclusion as a Kaiser Permanente Northwest (KPNW) Pain Clinic provided therapy, and to identify the appropriate number of treatment sessions for a Pain Clinic protocol, should the intervention prove successful. In addition, our intent was to document the full range of outcomes experienced by patients undergoing energy healing, including whole-person and transformative outcomes should they occur. SETTING The setting for this study was Kaiser Permanente Northwest Pain Clinic. PARTICIPANTS Thirteen (13) patients with chronic headache who were members of the KPNW Health Plan were recruited through flyers or mailings. METHODS Thirteen (13) participants received at least three energy healing sessions at approximately weekly intervals. Assessments were based on pre- and post-treatment qualitative interviews. INTERVENTION The treatment consisted of three Healing Touch sessions provided by a Certified Healing Touch Practitioner. Treatments contained elements common to all sessions, and elements that were tailored to the individual subject. RESULTS Twelve (12) of 13 participants experienced improvement in frequency, intensity, or duration of pain after three treatments. In addition, 11 of 13 participants experienced profound shifts in their view of themselves, their lives, and their potential for healing and transformation. These changes lasted from 24 hours to more than 6 months at follow-up. CONCLUSIONS Energy healing can be an important addition to pain management services. More in-depth qualitative research is needed to explore the diversity of outcomes facilitated by energy healing treatments. Furthermore, the development of new instrumentation is warranted to capture outcomes that reflect transformative change and changes at the level of the whole person.
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Affiliation(s)
- Elizabeth G Sutherland
- Helfgott Research Institute, National College of Natural Medicine , Portland, OR 97201, USA.
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Elder C, Mossbrucker P, Davino-Ramaya CM, Bez I, Lin MM, Terry TA, Thomas EA, Jones S. Integrating Herbs and Supplements in Managed Care: A Pharmacy Perspective. Perm J 2008; 12:52-8. [DOI: 10.7812/tpp/07-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E, Leben J, Debar L, Elder C, Dworkin SF. A pilot whole systems clinical trial of traditional Chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders. J Altern Complement Med 2008; 14:475-87. [PMID: 18564953 DOI: 10.1089/acm.2007.0738] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. DESIGN A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). SETTING/LOCATION Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. SUBJECTS One hundred and sixty (160) women 25-55 years of age attending a KPNW TMD specialty clinic. INTERVENTIONS Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. OUTCOME MEASURES TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0-10 where 10 is worst). RESULTS Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = -1.11 +/- 0.43, p = 0.010 and -1.02 +/- 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (-1.07 +/- 0.51, p = 0.037 and -1.27 +/- 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. CONCLUSIONS These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted.
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Affiliation(s)
- Cheryl Ritenbaugh
- Department of Family and Community Medicine, The University of Arizona, Tucson, AZ 85719, USA.
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Ueda Y, Lewandoski M, Plisov S, Wilson C, Sharma N, Elder C, Perantoni. Fgf8 is essential for development of the male reproductive tract. Dev Biol 2007. [DOI: 10.1016/j.ydbio.2007.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Elder C, Aickin M, Bell IR, Fønnebø V, Lewith GT, Ritenbaugh C, Verhoef M. Methodological challenges in whole systems research. J Altern Complement Med 2007; 12:843-50. [PMID: 17109574 DOI: 10.1089/acm.2006.12.843] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Elder C, Ritenbaugh C, Mist S, Aickin M, Schneider J, Zwickey H, Elmer P. Randomized Trial of Two Mind–Body Interventions for Weight-Loss Maintenance. J Altern Complement Med 2007; 13:67-78. [PMID: 17309380 DOI: 10.1089/acm.2006.6237] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Regain of weight after initial weight loss constitutes a major factor contributing to the escalating obesity epidemic. The objective of this study was to determine the feasibility and clinical impact of two mind-body interventions for weight-loss maintenance. DESIGN Randomized, balanced, controlled trial. SETTING Large-group model health maintenance organization. PARTICIPANTS Overweight and obese adults were recruited to a 12-week behavioral weight-loss program. Participants meeting threshold weight loss and attendance requirements were eligible for randomization. INTERVENTIONS The three weight-loss maintenance interventions were qigong (QI), Tapas Acupressure Technique (TAT (registered trademark of Tapas Fleming, L.Ac.), and a self-directed support (SDS) group as an attention control. OUTCOMES The main outcome measure was weight loss maintenance at 24 weeks postrandomization. Patient interviews explored additional benefits of the interventions, as well as barriers and facilitators to compliance. RESULTS Eighty-eight percent (88%) of randomized patients completed the study. There were no significant study-related adverse events. At 24 weeks, the TAT group maintained 1.2 kg more weight loss than the SDS group did (p = 0.09), and 2.8 kg more weight loss than the QI group did (p = 0.00), only regaining 0.1 kg. A separation test (0.05 level, 0.95 power) indicated that TAT merits further study. A secondary analysis revealed that participants reporting a previous history of recurrent unsuccessful weight loss were more likely to regain weight if assigned to the SDS arm, but this effect was suppressed in both the QI and TAT groups (p = 0.03). Although QI participants reported important general health benefits, the instruction sequence was too brief, given the complexity of the intervention. CONCLUSIONS TAT warrants further research for weight-loss maintenance. Any further research on qigong should use a modification of our protocol.
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Affiliation(s)
- Charles Elder
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
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Elder C, Aickin M, Bauer V, Cairns J, Vuckovic N. Randomized trial of a whole-system ayurvedic protocol for type 2 diabetes. Altern Ther Health Med 2006; 12:24-30. [PMID: 17017752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
CONTEXT Though complementary and alternative medicine (CAM) treatments are popular, evidence to support their application to diabetes care is scarce. Previous CAM diabetes research has generally focused on single modalities, but CAM practitioners more commonly prescribe complex, multimodality interventions. OBJECTIVES The aims of this study were to determine the feasibility and clinical impact of a whole-system, Ayurvedic intervention for newly diagnosed people with type 2 diabetes. DESIGN Patients were randomly assigned to either an experimental or control arm. SETTING Group model health maintenance organization. PARTICIPANTS We recruited 60 adult patients with baseline glycosylated hemoglobin (HbA1c) values between 6.0 and 8.0. INTERVENTION Treatment for the experimental group included exercise, an Ayurvedic diet, meditation instruction, and an Ayurvedic herb supplement (MA 471). Control patients attended standard diabetes education classes with primary care clinician follow-up. MEASUREMENTS Clinical outcomes were assessed at 3 and 6 months and included HbA1c, fasting glucose, lipids, blood pressure, and weight. RESULTS Ninety-two percent of randomized patients completed the study, and there were no significant adverse study-related events. Using analysis of co-variance (ANCOVA), we found no significant differences for clinical outcomes at 6 months between on-study patient groups, though trends favored the Ayurvedic group. When we included a factor measuring how much baseline HbA1c exceeded the mean (6.5%), however, we found statistically significant improvements in the Ayurvedic group for HbA1c (P = .006), fasting glucose (P = .001), total cholesterol (P = .05), low-density lipoprotein (LDL) cholesterol (P = .04), and weight (P = .035). CONCLUSIONS These results suggest that the Ayurvedic intervention may benefit patients with higher baseline HbA1c values, warranting further research.
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Affiliation(s)
- Charles Elder
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
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Sabatier MJ, Stoner L, Mahoney ET, Black C, Elder C, Dudley GA, McCully K. Electrically stimulated resistance training in SCI individuals increases muscle fatigue resistance but not femoral artery size or blood flow. Spinal Cord 2006; 44:227-33. [PMID: 16158074 DOI: 10.1038/sj.sc.3101834] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal. OBJECTIVES The purpose of this study was to evaluate the effect of lower extremity resistance training on quadriceps fatigability, femoral artery diameter, and femoral artery blood flow. SETTING Academic Institution. METHODS Five male chronic spinal cord injury (SCI) individuals (American Spinal Injury Association (ASIA): A complete; C5-T10; 36+/-5 years old) completed 18 weeks of home-based neuromuscular electrical stimulation (NMES) resistance training. Subjects trained the quadriceps muscle group twice a week with four sets of 10 dynamic knee extensions against resistance while in a seated position. All measurements were made before training and after 8, 12, and 18 weeks of training. Ultrasound was used to measure femoral artery diameter and blood flow. Blood flow was measured before and after 5 and 10 min of distal cuff occlusion, and during a 4-min isometric electrical stimulation fatigue protocol. RESULTS Training resulted in significant increases in weight lifted and muscle mass, as well as a 60% reduction in muscle fatigue (P = 0.001). However, femoral arterial diameter did not increase. The range was 0.44+/-0.03 to 0.46+/-0.05 cm over the four time points (P = 0.70). Resting, reactive hyperemic, and exercise blood flow did not appear to change with training. CONCLUSION NMES resistance training improved muscle size and fatigue despite an absence of response in the supplying vasculature. These results suggest that the decreases in arterial caliber and blood flow seen with SCI are not tightly linked to muscle mass and fatigue resistance. In addition, muscle fatigue in SCI patients can be improved without increases in arterial diameter or blood flow capacity.
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Affiliation(s)
- M J Sabatier
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, USA
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Letourneau D, Sharpe M, Moseley D, Wong R, Elder C, Bissonnette J, Jaffray D, Gospodarowicz M. Online Strategy for Palliative Treatment of Patients with Bone Metastases of the Spine: A Feasibility Study. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Elder C. Is Routine Lipid Testing for Patients Presenting to an Emergency Department with Chest Pain Worthwhile? Acad Emerg Med 2005. [DOI: 10.1197/j.aem.2005.03.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elder C. Ayurveda for diabetes mellitus: a review of the biomedical literature. Altern Ther Health Med 2004; 10:44-50. [PMID: 14727499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Diabetes mellitus is a condition that is extremely serious from both clinical and public health standpoints. The traditional healthcare system of India, Ayurveda, offers a balanced and holistic multi-modality approach to treating this disorder. Many Ayurvedic modalities have been subjected to empirical scientific evaluation, but most such research has been done in India, receiving little attention in North America. This paper offers a review of the English language literature related to Ayurveda and diabetes care, encompassing herbs, diet, yoga, and meditation as modalities that are accessible and acceptable to Western clinicians and patients. There is a considerable amount of data from both animal and human trials suggesting efficacy of Ayurvedic interventions in managing diabetes. However, the reported human trials generally fall short of contemporary methodological standards. More research is needed in the area of Ayurvedic treatment of diabetes, assessing both whole practice and individual modalities.
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Elder C. Full Text LINK - camcare. Perm J 2003. [DOI: 10.7812/tpp/03.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elder C. Full Text LINK - integrateKPNW. Perm J 2002. [DOI: 10.7812/tpp/02.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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