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Handout evidence based practice update

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Handout evidence based practice update

  1. 1. Slide 1 Evidence-based Practice Update Rachel Busse, MD Diplomate, American Board of Family Medicine Director of Integrative Medicine at Norton Suburban ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Evidence-based practice update  Research challenges  Implementing integrative programs  Recent research  Massage  Aromatherapy  Reiki  Relaxation  Music ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 Research challenges -Herbs and supplements not standardized -Individualized treatments -Placebo or “sham” treatments -Difficult to randomize and double blind studies -Funding ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  2. 2. Slide 4 Research & Integrative medicine ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Implementing integrative programs  Holistic nursing department at 261 bed hospital  Therapies:  Relaxation techniques  Therapeutic touch  Aromatherapy  Therapeutic suggestion  Retrospective chart review and pt survey  Reduction in pain  Increase in patient satisfaction Complement Ther Nurs Midwifery. 2004 Aug;10(3):168-74. Development and evaluation of an inpatient [correction of impatient] holistic nursing care services department. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  3. 3. Slide 7 Implementing integrative programs  Inpatient oncology unit at Beth Israel hospital  Yoga therapy, healing environment, holistic nursing  2 nonrandomized groups  Compared: Length of stay, total medication costs, and cost of as-needed medications  Demonstrated decrease in meds for pain, nausea & anxiety, also decrease in overall cost Am J Manag Care. 2011 Dec;17(12):779-84. Cost savings in inpatient oncology through an integrative medicine approach. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 Implementing integrative programs  102 studies  Majority looked at music  Aromas, decoration, flooring, lighting  May affect anxiety http://summaries.cochrane.org/CD005315/sensory-environment-on-health- related-outcomes-of-hospital-patients ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 Massage  Massage in acute care setting  Reduction in pain  Improvement in sleep  Improvement in relaxation  Improvement in overall well-being Int J Ther Massage Bodywork. 2010; 3(1): 4–11. PMCID: PMC3091428 The Effects of Massage Therapy on Pain Management in the Acute Care Setting ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  4. 4. Slide 10 Massage  Cochrane review of massage and aromatherapy massage  8 RCTs, 357 patients  Reduction in anxiety  Reduction in pain  Some trials showed reduction in nausea  Mixed data as to whether aromatherapy enhances effects of massage Cochrane Database Syst Rev. 2004;(2):CD002287. Aromatherapy and massage for symptom relief in patients with cancer. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 Massage -RCT with 68 patients -osteoarthritis of the knee -significant improvement in stiffness, range of motion, pain, time to walk 50 feet Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial Arch Intern Med. 2006;166(22):2533-2538. doi:10.1001/archinte.166.22.2533 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 Aromatherapy  Anxiety*  Depression  Nausea  Insomnia  Pain  Agitation (in dementia) Br J Gen Pract. Jun 2000; 50(455): 493–496.PMCID: PMC1313734 Aromatherapy: a systematic review. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  5. 5. Slide 13 Aromatherapy  Literature review, limited studies  Lavender or orange to treat anxiety  Peppermint to treat nausea  Risks of allergic reactions and oral toxicity J Adv Nurs. 2004 Oct;48(1):93-103. Aromatherapy practice in nursing: literature review. Evid Based Complement Alternat Med. 2014;2014:726341. Epub 2014 Feb 24. Essential Oils for Complementary Treatment of Surgical Patients: State of the Art. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Aromatherapy Post-operative nausea and vomiting  120 patients in 2014 RCT showed significant improvement  Cochrane review 2012  9 studies, 402 participants  Evidence insufficient J Perianesth Nurs. 2014 Feb;29(1):5-11. doi: 10.1016/j.jopan.2012.12.004. A prospective randomized study of the effectiveness of aromatherapy for relief of postoperative nausea and vomiting. http://summaries.cochrane.org/CD007598/aromatherapy-for-treating- postoperative-nausea-and-vomiting ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Touch therapies  Therapeutic touch – Energy therapy developed in 1970s  Jin Shin Jyutsu  Harmonizing the body's energetic system  Incorporates acupressure, QiGong, philosophy  Verbal guidance, light exercise and massage  Reiki  Developed 1922 by Mikao Usui  Universal life energy transferred through palms ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  6. 6. Slide 16 Touch therapies  Review of 10 studies of biofield therapies  Little or no changes in physiologic markers  Review of biofield therapies for palliative care  Relieving pain, improving quality of life, reducing stress Explore (NY). 2014 May-Jun;10(3):150-61. doi: 10.1016/j.explore.2014.02.003. Epub 2014 Feb 24. Biofield-based Therapies: A Systematic Review of Physiological Effects on Practitioners During Healing. Am J Hosp Palliat Care. 2013 Nov 20. [Epub ahead of print]. Biofield Therapies for Symptom Management in Palliative and End-of-Life Care. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 Reiki  Literature review of RCTs  Seven studies met inclusion criteria  Evidence suggests that Reiki therapy may be effective for pain and anxiety  Larger sample sizes, randomized groups, protocols are needed ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 Reiki  Systematic review of therapeutic effects of Reiki  12 trials included  9 showed positive results  Low quality of reporting, most trials lacking:  Randomization  Blinding, or  Accountability J Altern Complement Med. 2009 Nov;15(11):1157-69. doi: 10.1089/acm.2009.0036. A systematic review of the therapeutic effects of Reiki. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  7. 7. Slide 19 Reiki  118 patients with cancer  30 minute Reiki session  Statistically significant reduction in anxiety  Also helped with pain, relaxation and sleep Am J Hosp Palliat Care. 2012 Jun;29(4):290-4. doi: 10.1177/1049909111420859. Epub 2011 Oct 13. The effects of Reiki therapy on pain and anxiety in patients attending a day oncology and infusion services unit. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 Music therapy  Cochrane review  5 studies, 4 of which demonstrated significant reduction in symptoms of depression  Need additional studies Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 Music therapy -Cochrane review -26 trials -listening to pre-recorded music -improved anxiety scores -reduction in need for medication Cochrane Database Syst Rev. 2013 Jun 6;6:CD006908. doi: 10.1002/14651858.CD006908.pub2. Music interventions for preoperative anxiety. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
  8. 8. Slide 22 Music therapy -373 patients at 12 ICUs -patient directed music (PDM) vs noise canceling headphones (NCH) -PDM reduced need for sedation more than NCH or usual care -PDM and NCH reduced anxiety more than usual care Music Therapy for Reducing Anxiety in Critically Ill Patients. JAMA. 2013;309(22):2386-2387. doi:10.1001/jama.2013.5657. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 Future of research ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

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