Tony Y. Chon

Efficacy of Acupuncture for Chronic Constipation: A Systematic Review

This study was to evaluate the efficacy and safety of acupuncture for chronic functional constipation. Randomized controlled trials were searched in several databases. The primary outcome was a change in the number of weekly spontaneous bowel movements. The secondary outcomes included colonic transit activity, effective rate, Cleveland Clinic Score, and health-related quality of life score. Meta-analysis was done by using RevMan 5.1. After strict screening, 15 RCTs were included, containing 1256 participants. All of them were conducted in China and published in Chinese journals. Meta-analysis indicated that acupuncture for chronic functional constipation was probably as effective as conventional medical therapy in the change of bowel movements. For the colonic transit activity, acupuncture might be the same as conventional medical therapy and could be better than sham acupuncture. For the Cleveland Clinic Score, acupuncture was unlikely inferior to conventional medical therapy and the deep acupuncture was better than normal depth acupuncture in abdominal region. No obvious adverse event was associated with acupuncture for constipation. In conclusion, acupuncture for chronic functional constipation is safe and may improve weekly spontaneous bowel movements, quality of life, and relevant symptoms. However, the evidence was limited by the small sample size and the methodological quality.

Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: 8-year follow-up at an academic medical center.

The purpose of this study was to determine changes in attitude toward complementary and alternative medicine (CAM) therapies and knowledge of specific CAM therapies among internists at our institution. We compared the results of a survey given in 2004 and 2012. During this time period, the attitudes of physicians in our department of medicine toward CAM became much more positive, and physicians showed an increased willingness to use CAM to address patient care needs. However, knowledge of and experience with many specific CAM treatments did not change. These results will be used to develop further educational interventions and research studies.

Complementary and Integrative Medicine at Mayo Clinic

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: A pilot study

This study assessed feasibility and effect of weekly, 15-min chair massages during work for 38 nurses. Mean Perceived Stress Scale-14 (PSS-14), Smith Anxiety Scale (SAS), linear analog self-assessment scale (LASA), and symptom visual analog scale (SX-VAS) scores were tracked at baseline, 5 weeks, and 10 weeks. Of 400 available massage appointments, 329 were used. At 10 weeks, mean PSS-14 score decreased from 17.85 to 14.92 (P = .002); mean SAS score, from 49.45 to 40.95 (P < .001). Mean LASA score increased from 42.39 to 44.84 (P = .006); mean SX-VAS score, from 65.03 to 74.47 (P < .001). Massages for nurses during work hours reduced stress-related symptoms.

Trial of intensive acupuncture for smoking cessation: a pilot study

Background Despite the significant decline in smoking rates in the USA over the last 50 years, 42 million Americans continue to smoke. Although the combination of behavioural counselling with FDA-approved medications offers the best evidence-based treatment approach, 12-month relapse rates remain at >60%. Both healthcare providers and patients are searching for alternative treatment options. Most acupuncture trials have yielded poor results for smoking cessation; however, most trials have not used an intense treatment protocol and maintained treatment for at least 12 weeks. Methods We designed a pilot study to address these methodological problems. Twenty-eight smokers were recruited to attend two 1 h acupuncture sessions weekly for 12 weeks. Primary endpoints included completion rate, acceptability of the protocol and side effects. Secondary endpoints included carbon monoxide (CO)-confirmed, 7-day point prevalence quit rates at 12 weeks and 26 weeks. Results Sixteen of the 28 patients enrolled (57%) completed 12 weeks of treatment. Of the 17 patients who completed the end-of-study questionnaire, 94% (16/17) rated the programme as helpful, and 82% noted they would recommend it to friends for smoking cessation. Three of the 28 who initially enrolled in the study were confirmed abstinent at 12 weeks (10.7%); one of the 28 (3.6%) was abstinent at 26 weeks. Conclusions A larger study with a slightly less rigorous and more acceptable treatment protocol is feasible and should be considered.

Cost-effectiveness of acupuncture in an employee population: A retrospective analysis

OBJECTIVES To determine whether acupuncture is a cost-effective adjunct to usual care for Mayo Clinic employees and their dependents experiencing pain symptoms. DESIGN Retrospective review of the medical and billing records of 466 employee-patients and their dependents who had received acupuncture as part of their care and 466 propensity score-matched control patients. INTERVENTIONS Usual care in combination with acupuncture compared with usual care alone. MAIN OUTCOME MEASURES The primary outcome measure was the total costs of care for all medical care and pharmacy services incurred from 1year before the index visit to 14 months after the index date. Secondary outcomes included the number of hospital visits, total inpatient days, emergency department visits, primary care or general medicine office visits, specialty office visits, and physical therapy services. Pain scores (patient-rated scores from 0 to 10) were extracted from the medical record, if available. RESULTS Costs of care were similar between the 2 groups. No cost savings were noted for the acupuncture group. CONCLUSIONS Several limitations to the study may have precluded a finding of cost-effectiveness. Future studies should include prospective evaluation of costs and other outcomes in a comparison between acupuncture and usual care in a randomized control trial.

P02.70. Feasibility and effect of chair massage offered to nurses during working hours on stress related symptoms: a pilot study

Methods Single arm study performed between 10/15/2010 and 12/ 24/2010 at an academic medical center. A mass e-mail was sent to all nurses working in an inpatient psychiatric and an outpatient pain rehabilitation unit. The first 40 respondents were enrolled; two were excluded due to missing enrollment data. A 15 minute chair massage once a week for 10 weeks was provided by one of three Certified Massage Therapists available 3 days a week. Instruments used included the Perceived Stress Scale (PSS-14), Smith Anxiety Scale (SAS), and Linear Analogue Scale Assessment (LASA) scale. Mean and standard deviations of PSS-14, SAS and LASA scores at baseline and at 10 weeks were calculated and analyzed with the paired t-test. Any p-value <0.05 was considered statistically significant.

86-Year-Old Man With Atrial Fibrillation and Dyspnea on Exertion

dicine, te ester, o t in ne, , MN A n 86-year-old man with a history of atrial fibrillation (AF) and lower extremity venous stasis ulcers presented to our primary care clinic to establish care. He had dyspnea on exertion that had worsened from baseline limiting his capacity to perform basic activities of daily living including getting dressed. He also had progressive lower extremity swelling for several years and had received ongoing treatment of his venous stasis ulcers from a local vascular surgeon. The patient was taking metoprolol tartrate, 25 mg twice a day, for symptomatic AF diagnosed at an outside institution. His other medications included fish oil and aspirin, 325 mg daily. He reported no nonsteroidal antiinflammatory drug use or excessive salt intake. He had not experienced any cough, sputumproduction, angina, syncope, presyncope, paroxysmal nocturnal dyspnea, orthopnea, or sleep apnea and did not use tobacco or alcohol. On examination, thepatientwas able to speak in full sentences but with difficulty. His blood pressure was 135/89 mm Hg, pulse rate was 93 beats/min, respiratory rate was 18 breaths/min, and oxygen saturation was 97% while breathing room air. His body mass index was 26 kg/m. Cardiovascular examination revealed an irregularly irregular rhythm, normal S1 and S2, and no murmurs, rubs, gallops, or heaves. The point of maximal impulse was enlarged and laterally displaced. There was mild jugular venous distention with a jugular venous pressure of 9 cm and normal waveforms. On pulmonary examination, bibasilar crackles without wheeze were noted. Abdominal examination findings were normal. Examination of the lower extremities revealed 3þ pitting edema involving both knees and healing venous stasis ulcers.