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Milken 2nd floor lounge Poster Session
Jun 22, 2018 12:20 PM - 01:20 PM (America/Los_Angeles) Switch to local time
20180622T1220 20180622T1320 America/Los_Angeles Poster Session

The Role of Intermittent Fasting in the Prevention and Treatment of Diabetes Mellitus Type 2

Maggie Quinn, ND Resident, Darlene Lee, ND Resident, MSW

Fasting is a tradition that has been practiced by many cultures for spiritual, emotional, and physical healing. Types of fasting vary immensely and cover a broad spectrum of criteria. Intermittent Fasting (IF) is an umbrella term, which can be defined by cycling a feeding period with a period of zero calorie intake.

IF has sparked the interest of researchers and clinicians for its role in weight loss, cancer prevention, autoimmune disease, digestive disorders and longevity. Additionally, IF has been shown to reduce markers for cardiometabolic disease by improving lipid profiles, decreasing triglycerides, lowering blood pressure, decreasing visceral fat, facilitating weight loss, and increasing insulin-sensitivity. Hypotheses for the mechanism of IF?s effects include cellular/organ rejuvenation, reduction of oxidative stress, increased stress adaptation, and optimization of mitochondrial function. Since IF is a cost-effective therapy, it may be particularly useful in the treatment of DM2 for patients in underserved communities.? ?The aim of this study is to provide an overview of the literature which examines the use of Intermittent Fasting as a strategy to address Diabetes Mellitus Type 2 (DM2).

A Randomized Controlled Trial to Reduce Chronic Pain and Depression using Integrative Medicine Group Visits

Paula Gardiner, Anna Lestoquoy, Man Luo, Salvatore D'Amico, Laura White

Background: Chronic pain is affecting more than 100 million Americans? live, while current treatment options are largely medication-based that may cause adverse side effects. Integrative Med ...

Milken 2nd floor lounge IM4US 8th Annual Conference info@im4us.org

The Role of Intermittent Fasting in the Prevention and Treatment of Diabetes Mellitus Type 2

Maggie Quinn, ND Resident, Darlene Lee, ND Resident, MSW

Fasting is a tradition that has been practiced by many cultures for spiritual, emotional, and physical healing. Types of fasting vary immensely and cover a broad spectrum of criteria. Intermittent Fasting (IF) is an umbrella term, which can be defined by cycling a feeding period with a period of zero calorie intake.

IF has sparked the interest of researchers and clinicians for its role in weight loss, cancer prevention, autoimmune disease, digestive disorders and longevity. Additionally, IF has been shown to reduce markers for cardiometabolic disease by improving lipid profiles, decreasing triglycerides, lowering blood pressure, decreasing visceral fat, facilitating weight loss, and increasing insulin-sensitivity. Hypotheses for the mechanism of IF?s effects include cellular/organ rejuvenation, reduction of oxidative stress, increased stress adaptation, and optimization of mitochondrial function. Since IF is a cost-effective therapy, it may be particularly useful in the treatment of DM2 for patients in underserved communities.? ?The aim of this study is to provide an overview of the literature which examines the use of Intermittent Fasting as a strategy to address Diabetes Mellitus Type 2 (DM2).

A Randomized Controlled Trial to Reduce Chronic Pain and Depression using Integrative Medicine Group Visits

Paula Gardiner, Anna Lestoquoy, Man Luo, Salvatore D'Amico, Laura White

Background: Chronic pain is affecting more than 100 million Americans? live, while current treatment options are largely medication-based that may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits to reduce chronic pain and depression, which is a promising adjunct to medications, especially for diverse underserved patients with limited access to non-pharmacological therapies. We aim to compare the effectiveness of an IMGV intervention with an active control (primary care visits) in reducing self-reported pain, depressive symptoms, and pain medication use.

Methods: We conducted a single-blinded randomized controlled trial in a low-income, diverse population in Boston. Outcome data were collected at baseline, 9 weeks, and 21 weeks.

Results: A total of 155 participants joined this study, 76 were randomized to intervention and 79 to control. The average age was 51 years old, with 86% female, 58% identified as black and 14% identified as Hispanic. Half of participants (50%) had an income range of $5,000 - $29,999 and 42% were on work leave or disability. At 21 weeks, there was a reduction in depression symptoms (RR: 0.89, 95% CI: 0.75-1.06) and average pain (RR: 0.98, CI: 0.88-1.08) in intervention group compared with control group. At 21 weeks, there was a significant reduction in pain medication use (OR: 0.42, CI: 0.18-0.98) and a significant increase in quality of life (RR: 1.07 CI: 1. 01, 1.24).? At 9 weeks, there was a significant reduction in total emergency department visits (RR 0.32 95% CI: 0.12, 0.83) comparing intervention with control.?

Conclusion: Our results suggest that a medical group visit is an option to increase non-pharmacological strategies for low-income, racially diverse patients with chronic pain and depression.

Using an Innovative mHealth Tool to Reduce Chronic Pain in Patients with Health Disparities

Man Luo, Salvatore D'Amico, Paula Gardiner:

Background: Chronic pain affects millions of Americans and great concerns have been addressed on drug-based treatments. Our Whole Lives (OWL) is a patient-centered, eHealth chronic pain management platform that introduces strategies and knowledge about pain reduction, especially for low-income patients with no access to non-pharmacological therapies. The primary goal of this study is to evaluate the feasibility of OWL on reducing pain impact and changing pain associated outcomes, such as opioid use and pain self-efficacy.?

Methods: We conducted an open pre-post cohort study (2 cohorts of 20 patients) to assess the feasibility of OWL use among low-income patients with chronic pain. Outcome data were collected at both baseline and 9 weeks included Promis-29 Questionnaire and Pain Self-Efficacy Questionnaire. In statistical analysis, demographic characteristics were presented in descriptive statistics. To compare baseline and follow-up outcomes, we performed logistic regression for binary variables as well as linear regression fitted with Poisson model for non-parametric continuous variables.

Results: Forty-three participants were enrolled in our study, among which 36 completed follow-up outcome collection. The baseline demographic data are as follow: the average age was 50, 91% were female, 37% identified themselves as black, and 16% were Hispanic. Only 35% participants were working full-time or part-time, 26% were unemployed or retired, and 40% were on sick leave or disability. Eleven (26%) participants had an annual income of $10,000 or less and 60% of them had less than college degree. From baseline to follow-up, the average pain impact score decreased significantly from 34.0 (sd=8.5) to 30.6 (sd=7.4) (p=0.02), and the opioid use had a 13% reduction (p=0.03). The pain self-efficacy score increased from 32.3 (sd=3.3) at baseline to 39.6 (sd=12.2) at follow-up (RR: 1.21, 95%CI: 1.10, 1.34), which was statistically significant (p<0.01).?

Conclusion: The patient-centered, eHealth chronic pain management platform OWL is a potential tool to reduce

The Prevalence of Integrative Medicine Services within an Interdisciplinary Pediatric Pain Clinic in an Urban Safety Hospital

Salvatore D?Amico, Kristen Bodner, Mandy Luo, Caitlin Neri, Laura Goldstein, Paula Gardiner

Background: Chronic pain is a growing problem among children and adolescents, and is more prevalent in children from low income families. In 2015, the Boston Medical Center Interdisciplinary Pain Clinic launched an Integrative Medicine (IM) team model to address chronic pain in children. In 2016 we began enrolling patients to assess feasibility of expansion of IM services within our population. Types of IM services include yoga, physical therapy, acupuncture, massage, nutrition, aromatherapy, nutrition, and therapeutic karate. Children are referred to pain clinic from various providers including primary care, rheumatology, neurology, gastroenterology, etc. During initial consultation, the clinical team discusses which IM therapies are appropriate for the patient. The patient is scheduled for follow-up visits with the IM adjunctive services.?

Methods: For this observational study, a trained research assistant approaches families to obtain consents/assents from patients and parents, upon initial consultation. Information gathered included socioeconomic demographics, pain and baseline previous IM use, missed school days, and sleeping habit via self-reported surveys and electronic medical records.

Results: Eighty-three participants were enrolled from June 2016 ? December 2017. Demographics include: average age of 14.67 years old; 26% identified as Black, and 30% identified as Latino. For primary pain regions: 43 (52%) participants reported chronic abdominal pain, 19 (23%) reported chronic migraines/headaches, and 15 (18%) reported musculoskeletal pain, 43 patients (52%) reported having previous experiences using IM, including dietary supplements (89%), massage (30%) and acupuncture (21%). Among patients who attended the pain clinic, 81 (98%) were recommended acupuncture, 79 (95%) were recommended aromatherapy and 74 (89%) were recommended massage.

Discussion: IM services including acupuncture, aromatherapy, nutrition and massage are feasible to children who attend a pediatric specialty pain clinic in an urban safety-net hospital. For the majority of patients, this is their first experience with IM.

Initial experience with co-management of low income pediatric patients with functional abdominal pain

Salvatore D'Amico, Mandy Luo, Caitlin Neri, Laura Goldstein, Paula Gardiner

Background: Functional abdominal pain (FAP) is the most common type of abdominal pain in children, and serves as a common source of referrals to pediatric gastroenterologists. As a safety net hospital, Boston Medical Center BMC?s interdisciplinary pediatric Pain Clinic aims to effectively treat chronic pain in children and introduce families with low-income to Integrative Medicine (IM) such as acupuncture, mind/body techniques, massage, aromatherapy, physical therapy, and therapeutic karate.?

Methods: The Interdisciplinary Pain Clinic at BMC addressed pediatric chronic pain through a consult and follow-up model. Children are referred to the pain clinic through primary care or specialty providers. Upon initial consultation, a trained research assistant obtains consent and assent from pain clinic patients and their families in order to gather data on pain, coping skills, medical and family history, psychosocial stressors, and related clinical/demographic information. Participants are assessed at three-month follow-up for clinical characteristics related to their pain and quality of life. A subset of patients referred to the clinic for chronic abdominal pain were analyzed for demographic and clinical characteristics to document the initial experience with this novel model for children from low income families with functional abdominal pain.?

Results: Among 84 participants, 43 were referred for abdominal pain of more than six months duration in 53% of patients. Demographics are as follows: 47% White, 21% African-American, 32% other, with an average age of 14 years and 79% of patients insured by Medicaid. Additional health concerns among these patients included irregular sleep (58%), self-reported co-occurring anxiety, depression, or trauma (47%), and self-reported ADHD or other behavioral problems (14%).? Early results show a 100% utilization of integrative medicine services and mind/body strategies.

Discussion: Pediatric gastroenterologists readily refer patients to an interdisciplinary pain clinic, and patients from low income backgrounds do participate in such a model.

Policy Lessons Learned: Creating Equitable Health Services and Outcomes via Primary Care in South America 1978-2008

Jennifer Pollard, MD, MPH

We did an extensive review of South American experiences with primary health care since the Declaration of Alma-Ata. The following questions were addressed:

  • What are the enabling and constraining historical and structural conditions for primary health care policies and practices??
  • How has health care reform supported or undermined primary health care???
  • What evidence exists for the role of citizen participation and intersectoral action??
  • And finally, what are the policy lessons to be learned from these experiences??

Narrative synthesis was used to identify and examine patterns in the data consistent with these questions.?

Features of effective primary health care systems are described that were found to? help create more equitable health services and health outcomes, with illustrative case studies.

See: Nayd? Acosta Ram?rez; Jennifer Pollard Ruiz; Rom?n Vega Romero; Ronald Labont?, Comprehensive Primary Health Care in South America: contexts, achievements and policy implications, Cad. Sa?de P?blica vol.27 no.10 Rio de Janeiro Oct. 2011.

Centering Group Care: The Connection Between Quality, Model Fidelity and Improved Outcomes

Tanya Munroe, Marena Burnett

Centering Healthcare Institute (CHI) drives the spread of Centering group care and is the standards organization for the evidence-based model.? CHI partners with clinicians and health systems to implement several Centering group care models:? CenteringPregnancy evidence-based group prenatal care, CenteringParenting group well-child care, and CenteringHealthcare for other patient populations.? The model naturally provides limitless opportunities for integration with complementary care since each group session is 90 ? 120 minutes and requires stable patient cohorts.

The evidence-based for the Centering model indicates that fidelity to the model as defined by its essential elements is necessary to achieve improved patient outcomes.? This presentation will give participants an inside look into the quality assurance and improvement processes that CHI has developed to ensure model fidelity and drive increased access to Centering group care for a variety of health conditions.

Educating Providers about the Importance of Food and Nutrition in Medical Practice

Deborah J. Manst

Nutritional education is insufficient in medical schools. In 2012-2013, 71% failed to have the minimum of 25 hours of nutrition education, as recommended by the National Research Council. As a result, many residents don?t feel comfortable talking to patients about food and nutrition. Additionally, residents are unaware of the resources that are available to help their patients.?

In response to this problem, along with the director of policy at Cook County Health & Hospitals System (CCHHS), a presentation for the medical residents of CCHHS designed to educate them about food and nutrition in medicine was developed. This presentation covers the link between food and nutrition, reviews beneficial foods and diets that can help to treat chronic disease, talks about the resources at CCHHS that exist for their patients, and explains how to talk with patients about food and nutrition.

So far, this presentation has reached 33 residents in primary care (10), family medicine (14) and internal medicine (19). Verbal feedback of the presentation has been very positive. I created a short online survey for the first group, and of the three residents who responded, all felt that this presentation helped them to feel more comfortable talking to patients about food and nutrition. More survey data is anticipated soon.

In conclusion, providing an educational presentation about food and nutrition in medicine can help residents build their practical knowledge and become more comfortable speaking with patients about their diet and nutrition. Ideally, this will result in increased front-end counseling of patients by doctors on nutrition that will hopefully translate into overall better health outcomes for our patient population.

Acupuncture Integration at Lifelong Medical Care

Emilio Esquivel

Detailed Title: Acupuncture Integration at Lifelong Medical Care: Qualitative interviews with providers and administrators at a federally qualified health center on providing access to acupuncture for underserved patients.

My research will describe how Lifelong Medical Care, a federally qualified health center (FQHC) in the Bay Area of California, has integrated acupuncture into their clinics in order to provide access to acupuncture for low socioeconomic populations. To investigate the acupuncture model, I interview providers and administrators to understand the history of the acupuncture service and the current state of the model, including funding and sustainability, assess their desires to expand services, and collect ideas for future changes.?

Overall, the study aims to expand knowledge about what factors need consideration for effective acupuncture integration at a FQHC. Expanding this model to other FQHCs across the country will provide additional healing options to individuals of low socioeconomic status and may improve overall health outcomes.

John H. Stroger Jr. Hospital of Cook County
PGY3
West Holistic Medicine, PLLC
Physician
+ 7 more speakers. View All
No moderator for this session!
Square Medical Group
NA
Doctors To You, LLC
Founder
N/A
Consultant Physician Inn From The Cold Homeless Shelter

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