2025 International Congress Abstract Supplement

Oral Abstracts

Oral Abstract Session 01: Education

OA01.01

Developing Medical Cannabis Competencies: A Modified Delphi Study

Mikhail Kogan¹, Leslie Mendoza Temple², Yuval Zolotov³, and Richard Isralowitz⁴

¹George Washington University, Takoma Park, MD

²Endeavor Health and University of Chicago Pritzker School of Medicine, Highland Park, IL

³Albert Einstein School of Medicine, Tel Aviv, Israel

⁴Ben Gurion University, Beersheba, Tel-Aviv, Israel

Contact: Mikhail Kogan, [e-mail]

Abstract

Purpose: The use of cannabis for medical purposes in the US has increased steadily in recent years and is currently legal in 38 states. However, healthcare providers and trainees alike feel unprepared to counsel patients about medical cannabis or to recommend its use when appropriate. Given the lack of standardized education on medical cannabis within medical school curricula, the objective of this study was to develop consensus-based medical cannabis competencies.

Method(s): Between February and October 2023, we engaged 23 experts from a broad spectrum of expertise in a modified Delphi process. Anonymous to one another, they provided quantitative and qualitative feedback, which was fed back to the expert panel in two iterative rounds and used to develop and refine a consensus-based list of medical cannabis competencies and sub-competencies.

Results: The Delphi process generated six core competencies: (1) understand the basics of the endocannabinoid system; (2) describe the main components of the cannabis plant and their biological effects; (3) review the legal and regulatory landscape of cannabis in the US; (4) describe the evidence base for health conditions that are commonly managed with cannabis; (5) understand the potential risks of medical cannabis use; and (6) understand basic clinical management with medical cannabis. There are 2-7 sub-competencies associated with each core competency. The expert panel had a high degree of agreement on the importance of the competencies and the appropriateness of their wording.

Conclusions: Outlining prominent learning objectives, our list of core medical cannabis competencies contributes to bridging a considerable educational gap. These proposed competencies should serve as a roadmap for academic programs to ensure that the next generation of physicians is adequately informed to counsel patients and address medical cannabis competently in their clinical practice.

OA01.02

Reimagining the Integrative Health Fellowship Core Competencies: An Update

Vincent Minichiello ¹ , Melinda Ring², Tieraona Low Dog³, Jill Schneiderhan⁴, Darshan Mehta⁵, Katie Hu⁶, Suhani Bora⁷, Ann Marie Chiasson⁸, Adam Rindfleisch¹, Anand Dhruva⁹, Scarlet Soriano¹⁰, Mikhail Kogan¹¹, Wendy Kohatsu¹², and Shelley Adler⁹

¹University of Wisconsin, Madison, WI

²Osher Center for Integrative Health at Northwestern University, Chicago, IL

³UCI Susan Samueli Integrative Health Institute, Irvine, CA

⁴University of Michigan, Ann Arbor, MI

⁵Osher Center for Integrative Health at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

⁶UCLA, Los Angeles, CA

⁷Greater Lawrence Family Health Center, Lawrence, MA

⁸University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ

⁹University of California, San Francisco, San Francisco, CA

¹⁰Duke Health and Well-Being, Durham, NC

¹¹George Washington University, Takoma Park, MD

¹²Sutter Santa Rosa Family Medicine Residency, Santa Rosa, CA

Contact: Vincent Minichiello, [e-mail]

Abstract

Purpose: Since its launch in January 2024, the Consortium-appointed Task Force has made significant progress towards reimagining integrative health fellowship core competencies with a health equity lens. We present the interim work and outline the plan for finalizing the new competencies.

Method(s): Early steps included a visioning process, and gathering input from fellowship directors and participants at the Consortium Congress and Integrative Medicine for the Underserved (IM4US) conference. The Task Force then divided into subgroups for the core competencies for Medical Knowledge, Patient Care, Practice-Based Learning, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice. Each subgroup revised the competencies, incorporating health equity and other refinements to ensure the competencies appropriately reflect the expected achievements by the end of fellowship training. The Task Force co-chairs integrated this feedback into a cohesive draft. This draft was circulated to the whole group for a holistic and comprehensive review, emphasizing relevance, clarity, language consistency, health equity, evidence-based practice, and self-care. The Task Force co-chairs then incorporated the individual Task Force members’ feedback to create a “final” version.

Results: The first stage of the competency updates, completed at the time of this abstract submission, incorporated feedback from several sets of key stakeholders. Participants at the IM4US conference advised against working in an “echo chamber,” prompting us to strategize for additional input from external experts in medical education and health equity. The new competencies will also be piloted in selected fellowship programs to assess their practical application and usefulness.

Conclusions: The Task Force has advanced the core competencies with thoughtful integration of health equity and stakeholder feedback. Our next steps involve piloting and refining the competencies to ensure their applicability in integrative medicine training and the broader healthcare landscape.

OA01.03

Building Capacity for Evidence Synthesis among Complementary and Integrative Medicine Learners: Neurotrauma Evidence Synthesis Training (NEST) Program

Joshua Goldenberg ¹ , Monique Aucoin², Heather Zwickey³, and Richard D Batson⁴

¹Helfgott Research Institute, Colorado Springs, CO

²Canadian College of Naturopathic Medicine, Toronto, ON

³National University of Natural Medicine, Portland, OR

⁴Helfgott Research Institute, Friday Harbor, WA

Contact: Joshua Goldenberg, [e-mail]

Abstract

Purpose: Traumatic brain injury (TBI) presents a significant global health burden, with 69 million cases annually. The Neurotrauma Evidence Synthesis Training (NEST) program seeks to address this by building research capacity in evidence synthesis, particularly within complementary and integrative medicine (CIM) environments. Led by evidence-based CIM advocates at the National University of Natural Medicine (NUNM) and the Canadian College of Naturopathic Medicine (CCNM), and supported by pilot funding from the RAND Corporation through the National Center for Complementary and Integrative Health (NIH), NEST equips trainees with the skills to conduct high-quality systematic reviews in neurotrauma.

Method(s): NEST employs a “train-the-trainer” model to provide structured mentorship in evidence synthesis and TBI-specific content. Trainees work in pairs, progressing from protocol development to publication. Learning is delivered through synchronous and asynchronous digitally delivered content and hands-on research training, utilizing evidence synthesis software and incorporating regular feedback. Evaluation includes both quantitative and qualitative measures to assess skill development, confidence in research methods, and competency in research ethics.

Results: The initial phase of NEST involved 24 trainees, 52 participants, and led to ten systematic review projects. Early assessments highlight significant improvements in research design, critical appraisal, and systematic review methodology. Additionally, the program has fostered a strong collaborative community, enhancing knowledge sharing and skill-building in evidence-based medicine within the CIM environment.

Conclusions: NEST addresses a critical gap in the field of neurotrauma research and provides a replicable model for building capacity in evidence synthesis. By training future leaders and fostering collaboration, NEST strengthens the integration of high-quality, evidence-based research into the CIM community, building research capacity in CIH institutions and ultimately improving interventions and care for individuals affected by TBI.

OA01.04

Pilot of a Culinary Medicine Experience in Required Medical School Education: Introduction to Nutrition and Healthy Lifestyle Behaviors

Theresa Dvorak ¹ , Margaret Petzold¹, and Amy Locke¹

¹University of Utah, Salt Lake City, UT

Contact: Theresa Dvorak, [e-mail]

Abstract

Purpose: Medical School is designed to train students to provide high-quality patient care. The landscape of medical education is shifting in terms of valuing health behavior education, particularly the skills needed to adequately assess, advise, and assist patients in addressing health behaviors and social determinants of health. Therefore, a required interprofessional Culinary Medicine (CM) experience was developed, with a focus on integrative health promotion.

Method(s): School of Medicine first-year students from 2022-2024 (n=382) completed a one-time culinary medicine experience embedded in the required curriculum. Students completed didactic pre-experience work, a 2-3 hour hands-on cooking class, and a post-experience reflection assignment. Methodologically, survey questions addressed students’ forecasting of how to use the information learned in their lives and future careers. The survey also included questions about the experience’s usefulness and any changes they would recommend for the experience. Survey questions were analyzed using thematic analysis.

Results: Students who completed the CM experience reported overwhelmingly positive experiences (n=376). Identified themes from student reflections include 1) students appreciated learning for their future career such as role of diet in health, social determinants of health, application to patient care, insights into healthy eating; skills for themselves such as learning new recipes and cooking techniques; and collaborating with their peers; 2) the desire for more nutrition education and shared enthusiasm for similar experiences in the future; 3) opportunities for improvement included more time in the kitchen, incorporating meat or dessert options, more time for discussion and conversation.

Conclusions: Our findings suggest that a Culinary Medicine experience provided as a required element of medical school is an active learning opportunity with likely effects on student abilities to provide high-quality patient care related to nutrition and health.

Oral Abstract Session 02: Community-Engaged Research

OA02.01

Building a Community Partnership to Support Caregivers of Neurodivergent Children: Barriers & Progress

Brett Goshe ¹ , Isabelle Miranda¹, Lucy Finkelstein-Fox², Pam Nourse³, Renee Williams³, Gabriella Nicolosi¹, Esteban Barreto¹, Rachel Millstein¹, Brittain Mahaffey⁴, Brian Winklosky¹, Rosalie Rippey³, Karen Lopez³, Ruth DeLa Cruz³, Karen Kuhlthau¹, and Elyse Park¹

¹Massachusetts General Hospital, Boston, MA

²Massachusetts General Hospital/Harvard Medical School, Boston, MA

³Federation for Children with Special Needs, Boston, MA

⁴Stony Brook, Stony Brook, NY

Contact: Brett Goshe, [e-mail]

Abstract

Purpose: Caregivers of neurodivergent children often experience significant stress, negatively impacting their health. Researchers from Massachusetts General Hospital (MGH) partnered with the Massachusetts Federation for Children with Special Needs (Federation), to adapt a mind-body group intervention and a group health education program to improve caregivers’ stress management and resilience. This qualitative study describes lessons learned during the start-up phase and proposed modifications to the clinical program design, informing an upcoming open pilot trial.

Method(s): From September 2023 to May 2024, MGH and Federation experts met 22 times to establish study design, outreach/enrollment strategies, and program modifications. The team hosted multiple Federation staff listening sessions, 8 Federation staff manual review sessions, and 7 English and Spanish parent listening sessions. We utilized rapid analysis coding on session notes and transcripts to refine the group programs.

Results: The study faced start-up challenges, particularly differing institutional workflows for participant outreach. Key recruitment decisions involved orienting MGH staff to the Federation’s programming and defining the target population, aiming to balance inclusivity with the need for shared experiences among participants. We refined our recruitment processes following fraudulent inquiries from individuals unaffiliated with the Federation. Our protocol initially relied on qualitative feedback from caregivers accessing Federation services, but we recognized the value of input from Federation staff who possess deep insights into family needs. Based on feedback, we shortened group programs, included caregiver-specific stressor examples, simplified language, and incorporated diverse representations of families through images. A list of Federation resources was created to address the tangible needs of children. Parental feedback guided Spanish translations and cultural adaptations of our materials.

Conclusions: Collaborative research with community partners is complex but essential for creating culturally sensitive clinical programs. This partnership enabled us to navigate challenges and reach a consensus on study design and program content, laying the foundation for sustainable, community-based implementation.

OA02.02

Social Support in Integrative Group Medical Visits for Chronic Pain Management in the Primary Care Safety Net

Heejoo Ko ¹ , Ariana Thompson-Lastad², Jhia Jackson¹, Denise Ruvalcaba³, and Maria Chao⁴

¹University of California, San Francisco, San Francisco, CA

²UCSF Osher Center for Integrative Health, Berkeley, CA

³UCSF Osher Center for Integrative Health, San Francisco, CA

⁴Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

Contact: Heejoo Ko, [e-mail]

Abstract

Purpose: Social support is associated with improved pain outcomes and decreased emotional distress for people with chronic pain; and is an important but understudied component of optimal biopsychosocial pain care. We sought to explore how IGMVs facilitate distinct subtypes of social support for racially and ethnically diverse patients in the primary care safety net.

Method(s): As part of an ongoing pragmatic randomized trial of group-based chronic pain care, we conducted participant-observation of 21 IGMV sessions. Observations included 45 racially diverse safety net patients in four IGMV cohorts (two in English, two in Spanish). Each cohort included twelve weekly clinician-facilitated sessions delivered in primary care clinics, incorporating mindfulness, therapeutic movement, and psychoeducation on pain. Field notes were analyzed by an interprofessional team using inductive and deductive flexible coding, a well-established qualitative approach, with a focus on patient-clinician and peer interactions and three subtypes of social support (instrumental, emotional, and informational).

Results: We identified informal and structured processes that cultivate emotional, informational, and instrumental support during IGMV sessions. Emotional support developed longitudinally and was characterized as mutual understanding, unconditional care, and nonjudgmental acceptance from peers and clinicians. Patients described mind-body practices and flexible facilitation that allowed for vulnerable disclosures by ‘creating open spaces for grief and buried emotions.’ Informational support synthesized clinicians’ professional expertise with patients’ lived experiences. Patients taught each other how to manage pain symptoms (substituting common household objects for expensive medical supplies), cope with pain-related limitations (‘teach your grandkids to cook if you can’t move around the kitchen’), and navigate healthcare institutions (which clinic to find the best knee brace). Instrumental support included participants making medical calls for one another and receiving referrals to mental health and social services from clinicians.

Conclusions: IGMVs confer three distinct subtypes of social support, which may improve biopsychosocial chronic pain care in the primary care safety net.

OA02.03

Elevating Participant Voices in the Design of Complementary and Integrative Health Community Programs to Address Pain Related Disparities

Roni Evans¹, Brent Leininger ² , Linda Hanson¹, and Douglas Kennedy³

¹University of Minnesota, Minneapolis, MN

²University of Minnesota, Wanamingo, MN

³University of Minnesota--Twin Cities; Integrative Health & Wellbeing Research Team, Minneapolis, MN

Contact: Brent Leininger, [e-mail]

Abstract

Purpose: Back pain (BP) is the most common pain condition in the U.S, however racial and ethnic minoritized groups are disproportionately impacted. The purpose of this NIH R61/R33 project is to increase access to effective, complementary and integrative health (CIH) for people with pain who are likely to experience health disparities due to race, ethnicity and income. The goal of this presentation is to describe how feedback was systematically sought and used to tailor programs and research processes to better address peoples’ needs.

Method(s): We used mixed-methods (quantitative and qualitative) data collection and analyses informed by an established behavioral model. Feedback was gathered in multiple ways at several points over the course of the pilot study (R61) leading to the full scale trial (R33). It included interviews to learn about pain-related lived experiences, surveys gathering opinions about the programs and research processes, and discussions seeking participants’ insights into the pilot results to inform further program optimization.

Results: Over 70 unique participants provided information. Interviews (n=28) identified barriers to past pain care included being negatively labeled and not feeling seen or heard. They also shared the desire for trustworthy information and quality pain care; choice and access to culturally appropriate resources; and respectful partnerships with health professionals. Of the pilot study participants (n=51), >80% were satisfied with the programs, felt their pain improved, and liked what they learned. Importantly, >95% felt their beliefs were respected and staff worked in partnership with them. After viewing the results, participants provided important ideas for future implementation including involving health providers and employers, incorporating patient voices earlier in the process and others.

Conclusions: Thinking more expansively about how rigorous research methods can be integrated with marginalized patients’ views iteratively over time can elevate their voices and improve scientific quality and relevance.

OA02.04

Design, Implementation, and Feasibility of a Novel Community Co-Led Culinary Medicine Shared Medical Appointment Model

Amulya Agrawal ¹ , Willis Wong¹, Abigail Knowles¹, Milette Siler¹, and Jaclyn Albin¹

¹UT Southwestern, Dallas, TX

Contact: Amulya Agrawal, [e-mail]

Abstract

Purpose: The utility of dietary interventions as primary tools in metabolic syndrome prevention have been well studied, yet American dietary patterns fall short of recommendations. Limited culinary skills and nutritional literacy may be key contributors to this phenomenon. Shared medical appointments (SMAs) with culinary education offer one solution to this by promoting both culinary and nutrition literacy among patients. Our study seeks to advance the early data on the feasibility of culinary nutrition-focused SMAs and demonstrate a model for community co-leadership.

Method(s): Sixteen participants were recruited from UT Southwestern Culinary Medicine Clinic. The SMA course was led by a physician and culinary dietitian in a church kitchen in the Oak Cliff area of Dallas County, Texas. The course consisted of 6 classes taking place over roughly 2 months. Each class included a brief didactic and demonstration of a culinary skill related to the class’s topic followed by a hands-on portion where participants cooked an assigned recipe in groups of 3-4. Classes were billed as primary care visits through patients’ insurance. To assess feasibility, we collected participant demographics and engagement and retention data.

Results: Total class attendance was 71.9%. Class participants were mostly Black or African American (75%) and female (88%). Most patients (12 of 16) attended more than half of classes (4 of 6); participants aged 71-77 had the highest attendance (94.4% of classes).

Conclusions: Our attendance and engagement data indicates that SMAs with a culinary education focus are feasible and suggests that these classes may be a way to provide much needed culinary/nutrition education for the American public.

Oral Abstract Session 03: Opioid Use Disorder

OA03.01

Interoceptive Awareness Training has Long-term Positive Effects as an Adjunct to Medication for Opioid Use Disorder

Cynthia Price ¹ , Joseph Merrill¹, Anna Treadway¹, Julia Palmer¹, and Kenneth Pike¹

¹University of WA, Seattle, WA

Contact: Cynthia Price, [e-mail]

Abstract

Purpose: Medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring mental health and chronic pain conditions. This NIH-funded RCT examined the effectiveness of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD.

Method(s): Using a 2-group repeated measures design, participants stabilized on MOUD (N=303) from 6 community clinics in the U.S. Pacific Northwest were randomly assigned to MABT+MOUD or MOUD. MABT is designed to develop interoceptive awareness skills to promote self-care and emotion regulation. MABT was delivered in eight 75-minute individual sessions by licensed massage therapists. Five assessments were administered over 12 months. An intent-to-treat approach using multilevel linear mixed models examined change on health outcomes from baseline to 12 months.

Results: The sample included 52% women, 57% with chronic pain, and 72% on Medicaid. 79% were white and 21% BIPOC. Findings showed overall low substance use across time and no difference between groups, and significant change from baseline to 12 months for MABT+MOUD vs. MOUD in PTSD symptoms (p =.01), emotion regulation difficulties (p < .05), interoceptive awareness (p < .001), mindfulness skills (p = .02), and opioid craving (p =.05). Significant group x time interactions were in pain activity interference (Wald χ2 = 9.41; p =.05), physical symptom frequency (Wald χ2 = 11.23; p =.02), and interoceptive awareness (Wald χ2 = 24.37; p = <.001). More than 60% of MABT participants reported maintained regular practice (3 x/week to daily) of MABT skills learned across the 12-month period.

Conclusions: In this stable MOUD population, substance use showed no change however MABT+MOUD vs. MOUD demonstrated multiple significant positive mental and physical longitudinal outcomes critical for improving MOUD treatment. These findings, along with the high level of intervention engagement and continued use of MABT skills, highlight the appropriateness of this integrative approach in community care.

OA03.02

Examining STOP: Self-Regulation Therapy for Opioid Use Disorder and Pain

Amy Wachholtz¹

¹University of Colorado Denver, Denver, CO

Contact: Amy Wachholtz, [e-mail]

Abstract

Purpose: Opioid addiction has reached epidemic levels and chronic pain is common among individuals with Opioid Use Disorder (OUD). There is so much that we do not know about the psycho-physiological needs of this population making it difficult to design effective and efficient treatments. In this study series, we used psycho-physiological data to create a novel psychotherapy treatment to target both the physiology of cravings and pain as well as the psychology. The STOP Study is a NIDA-funded Stage 1B clinical trial for adults with OUD and chronic pain.

Method(s): STOP is a 12-week rolling entry RCT of psychotherapy to be used in conjunction with medication assisted treatment for Comorbid Opioid Addiction and Pain (COAP) in conjunction with methadone or buprenorphine assisted treatment in community addiction treatment centers. Participants (N=26) were randomized to STOP or treatment as usual (TAU). Both groups completed psychological and physiological assessments at baseline, post-treatment, and at a 1-month follow-up.

Results: Repeated measures ANOVAs showed significant differences between STOP vs TAU treatments. Specifically significant differences occurred in reported pain levels: Significant differences occurred in current pain levels (p<.05), pain interference in daily tasks (p<.01), days using illicit drugs in the past week (p<.01), and opioid craving levels (p<.05).

Conclusions: The STOP study treatment shows promise as a unique treatment to simultaneously treat comorbid pain and opioid addiction within the setting of community addiction treatment centers. Implications and training needs to implement this treatment will be discussed.

OA03.03

A Quality Improvement Assessment of the Integration of Healing Touch into a Multi-disciplinary Non-Pharmacological Pain Management Program

Jill Schneiderhan ¹ , Becky Bail², Tina Berkholz¹, and Afton Hassett³

¹University of Michigan, Ann Arbor, MI

²Michigan Medicine, Ann Arbor, MI

³University of Michigan Medical School, Ann Arbor, MI

Contact: Jill Schneiderhan, [e-mail]

Abstract

Purpose: In 2018 Michigan Medicine underwent a large-scale change event to address opioid related harm and improve non-opioid options to treat chronic pain. In response, the Michigan Medicine Back & Pain Center within the Department of Anesthesiology expanded to offer non-pharmacological strategies that included Integrative Medicine (IM) consultation and several IM modalities such as Healing Touch (HT), acupuncture and movement therapy. This clinic sees approximately 16,000 patients a year with 70% of that volume having a primary diagnosis of spine pain. The purpose of our project was to assess the impact of HT as a non-invasive biofield therapy treatment option. HT was provided to 74 patients with chronic pain to evaluate changes in pain severity and psychological distress.

Method(s): Pre- and post-treatment assessments were conducted using the Numeric Pain Rating Scale (NPRS) and Subjective Units of Distress (SUDS).

Results: The sample included 184 patient visits with 74 individual participants who had at least one HT session. Most participants were female (71.3%), and the mean age was 51.33. Pain was often present in multiple locations (72.5% of the time), with lower back pain being the most common followed by shoulder pain. Statistically significant decreases in mean pain scores and subjective distress scores were observed.

Conclusions: Our study is one of the first to evaluate the direct effect of HT in an outpatient chronic pain clinic for patients with complex histories that clearly demonstrated a positive benefit for our patients with chronic pain. Although this was a small, open, QI project without randomization or blinding, preliminary evidence suggests that HT has the potential to be beneficial for use in multidisciplinary pain programs as a non-pharmacological option to optimize pain and stress management in patients with chronic pain.

OA03.04

Adapting a Yoga Protocol for Comorbid Chronic Low Back Pain and Opioid Use Disorder

Steffany Moonaz ¹ , Joanna Starrels², Lisa Uebelacker³, Mary Beth Hribar², Megan Ghiroli², and Shadhi Nahvi²

¹Southern California University of Health Sciences, Whittier, CA

²Albert Einstein College of Medicine, New York, NY

³Brown University, Providence, RI

Contact: Steffany Moonaz, [e-mail]

Abstract

Purpose: Chronic low back pain (cLBP) frequently co-occurs with opioid use disorder (OUD). Yoga offers biopsychosocial pain management, but there are barriers to access. Little prior research has tested the feasibility of providing yoga onsite at opioid treatment programs (OTPs). We modified a previously tested 12-week yoga protocol for cLBP.

Method(s): Class themes and poems were selected for appropriateness for the population. Yoga interventionists had 500+ hours of training, experience working with cLBP and/or OUD, were bilingual in English and Spanish, and were trained in research ethics, harm reduction, and trauma-informed care. Practice sheets, online videos, and other materials were in Spanish and English and photos of yoga practices were tailored to the population. A fidelity checklist was used to assess 10% of classes.

Results: The 4 class themes were: Non-Harming or Kindness, Self-Study or Awareness, Balancing Effort and Ease, Contentment and Gratitude. Elements included: checking in and settling, mindfulness and centering, joint mobilization, yoga asana, progressive relaxation, breathing practices, and closing. Seven seated or standing poses were offered every session, plus 10 optional postures, individualized as needed. Props included a chair with arms and a yoga mat. Practice videos focused on balancing, strengthening and stabilizing, joint mobilization, breathing practices, relaxation. Initial evaluation suggested acceptable protocol adherence.

Conclusions: This innovative yoga protocol for onsite delivery at OTPs aims to reduce barriers to yoga for people living with OUD and chronic pain. Trial findings will help to determine feasibility, acceptability, and effectiveness of the program.

Oral Abstract Session 04: Pediatrics

OA04.01

Pediatric Integrative Medicine Consultations at a Major Academic Tertiary Care Children’s Hospital: A Pilot Study

Kenneth Busby ¹ , John Mark¹, Alexis Morvant¹, Justin Baker¹, Brenda Golianu¹, and AnnMing Yeh¹

¹Stanford University, Palo Alto, CA

Contact: Kenneth Busby, [e-mail]

Abstract

Purpose: Pediatric integrative medicine (PIM) is an emerging subspecialty. To date, only a few centers in North America have begun to implement inpatient consultations for pediatric populations. Studies indicate that parents of hospitalized children desire increased access to PIM. PIM inpatient consultations have improved parent-reported patient anxiety and pain. We aim to describe the results of a single-center pilot data of 9 months of implementing PIM consultations at a major academic children’s hospital.

Method(s): A chart review was conducted in the electronic medical record for PIM consults between January 2024 and October 2024. Patient age, gender, reason for consult, underlying diagnosis, number of patient encounters, number of integrative modalities, and type of integrative modality was recorded. PIM interventions were categorized as mind-body (breath work, meditation, hypnosis), biochemical (botanicals, aromatherapy), biomechanical (acupressure, acupuncture), and caregiver support.

Results: Two PIM MD’s and one PIM fellow performed 37 PIM consults (mean age 12.815 years; 48.6% female, 45.9% male, and 5.4% non-binary). PIM encounters per patient ranged from 1-19 (mean 2.77, median 1). The primary reason for consult was non-pharmacologic pain management (70.27%), followed by nausea (10.81%), and comfort (8.11%). Primary patient diagnoses included: oncologic (35.14%), cardiac (24.32%), and neurologic (13.51%). Given limited PIM provider availability, four patients were referred for consultation but not seen in hospital. Four consultations were with parent only. When seen, patients were offered multiple modalities, with a mean of 3.65 modalities (median 3). Of 114 modalities offered to the 37 patients, 53.51% were categorized as biomechanical, 35.09% mind-body, and 7.89% caregiver support.

Conclusions: This pilot PIM consult service indicated high referral rates for non-pharmacologic approaches to pain and nausea with successful utilization of multiple mind-body and biomechanical interventions in hospitalized children. Future directions will qualitatively assess efficacy and quantitatively assess patient, parent, and provider perspectives.

OA04.02

Evaluating the Effectiveness of an Integrative Medicine Pediatric Pain Management Workshop

Carine Renner ¹ , Jenifer Matthews², and Mala Mathur³

¹University of Wisconsin, Madison, WI

²UCSF Health, San Francisco, CA

³University of Wisconsin School of Medicine and Public Health, Verona, WI

Contact: Carine Renner, [e-mail]

Abstract

Purpose: Integrative nonpharmacologic therapies offer effective Pediatric pain management with minimal risk of side effects. Despite this, many providers remain unfamiliar with these approaches. The purpose of this study was to assess the effectiveness of a workshop in teaching four specific Integrative Pediatric Pain Management Therapies to Pediatric Practitioners.

Method(s): A three-hour Integrative Medicine Pediatric Pain Workshop was held by the University of Wisconsin Department of Pediatrics in collaboration with the UCSF Osher Center for Integrative Health. Participants received didactic and hands-on learning in Therapeutic Language, Magic Glove Technique, Aromatherapy, and Acupressure. To assess level of confidence in each therapy, pre- and post-workshop surveys using five-point Likert scales (very confident, confident, neutral, less confident, not confident) were administered. An additional survey was conducted six months after completion of the workshop.

Results: 13 of 17 total participants completed pre- and post-workshop surveys including physicians (n=4), APPs (n=2), nurses (n=4), trainees (n=2), and other (n=1). The majority worked in Sedation Clinic (n=9). The pre-workshop Likert scale questionnaire demonstrated that 15% of participants were “Confident” in Therapeutic Language and Aromatherapy, and the remainder fell into “Neutral” or “Less/not confident” for all therapies. Post-workshop survey results showed that the majority of participants felt “Confident” in the therapies, including 100% in Therapeutic Language and Aromatherapy, 88% in Magic Glove, and 64% in Acupressure. Six-month surveys (n=7) demonstrated that 71% felt “Confident” in Therapeutic Language, 43% in Magic Glove, 71% in Aromatherapy, and 29% in Acupressure. Reported barriers to use included time constraints, lack of administrative support, and lack of comfort.

Conclusions: The workshop effectively increased provider confidence in the selected Integrative Pain Management Therapies. However, confidence levels decreased six months after the workshop compared to immediately post-workshop. This finding may suggest that administrative support as well as reinforcement of knowledge through supplemental materials/training may be beneficial.

OA04.03

Piloting a Yin Yoga and Music Therapy Group for Parents of Inpatient Pediatric Patients: A Feasibility Study

Jenna Marcovitz ¹ , Allison Guzman¹, and Rashmi Mullur²

¹UCLA Health, Los Angeles, CA

²UCLA, Los Angeles, CA

Contact: Jenna Marcovitz, [e-mail]

Abstract

Purpose: This pilot study investigates the feasibility and impact of a combined yin yoga and music therapy group for parents of children undergoing inpatient care. Aimed at alleviating the unique stressors faced by these caregivers, the study promotes emotional well-being and resilience while identifying barriers to stress management in the hospital environment.

Method(s): The study involved seven group meetings incorporating yin yoga and music therapy for parents. Participants were recruited through hospital networks, and pre- and post-intervention assessments utilized anonymous standardized questionnaires to measure emotional well-being and stress levels. Qualitative feedback was also collected through open-ended questions. Sessions were designed to be supportive and accessible, with ongoing data collection to assess long-term effects.

Results: Preliminary data include 24 participants across the seven meetings. Results indicate that 100% of parents reported reduced stress levels after participating. Feedback highlighted emotional release and connection, with many expressing a desire for more frequent offerings. Participants identified barriers such as time constraints and emotional exhaustion, which will inform future program improvements.

Conclusions: The study suggests that a combined yin yoga and music therapy group is a feasible intervention for parents of hospitalized pediatric patients. This approach enhances emotional well-being and addresses caregivers’ mental health needs. The findings emphasize the demand for more frequent sessions and reveal important barriers to stress management. Future research will focus on expanding the program and evaluating its long-term impact on caregivers and their children.

OA04.04

Does Yoga or Meditation Buffer the Link between Childhood Abuse and Spiritual Struggle? Results from the Study on Stress, Spirituality and Health

Camille Garnsey ¹ , Mariel Emrich¹, Katherine Gnall¹, Crystal Park², Blake Kent³, Alka Kanaya⁴, A. Heather Eliassen⁵, Martha Daviglus⁶, Isabel Chin⁷, and Alexandra Shields⁸

¹University of Connecticut, Storrs, CT

²Department of Psychological Sciences, University of Connecticut, Storrs, CT

³Westmont College, Santa Barbara, CA

⁴University of San Francisco School of Medicine, San Francisco, CA

⁵Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital, Cambridge, MA

⁶University of Illinois Chicago, Chicago, IL

⁷USC/LA General Medical Center, Los Angeles, CA

⁸Center on Genomics, Vulnerable Populations, and Health Disparities, Harvard Medical School, Boston, MA

Contact: Camille Garnsey, [e-mail]

Abstract

Purpose: Experiencing childhood abuse is associated with spiritual struggle (i.e. conflict stress or strain related to anything one views as sacred). Research has implicated spiritual struggle in the link between childhood abuse and adverse psychological outcomes. There is a need for research identifying avenues for resolving spiritual struggle in survivors of childhood trauma. Yoga and meditation are two promising practices, but their potential in this area is understudied. The aim of this study was to examine whether yoga or meditation practice buffered the associations between childhood abuse and spiritual struggle in adulthood across White Latinx and South Asian Participants in the study on Stress, Spirituality, and Health (SSSH).

Method(s): The present sample includes 3683 White participants recruited to the SSSH from the Nurses’ Health Study II, 827 South Asian participants recruited from the Mediators of Atherosclerosis in South Asians Living in America Study, and 914 Latinx participants from the Hispanic Community Health Study/Study of Latinos. Generalized linear regressions were constructed to test whether engagement in yoga or meditation moderated the associations between childhood abuse (sexual, physical, and emotional) and spiritual struggle in adulthood for each of the distinct racial/ethnic groups.

Results: Regular yoga practice weakened the relationship between some types of childhood abuse and spiritual struggle for White and Latinx participants (p<.05). Yoga practice did not attenuate associations between childhood abuse and adult spiritual struggle among South Asian participants. Meditation practice did not moderate the associations between childhood abuse and spiritual struggle in any racial/ethnic group.

Conclusions: Overall, results suggest that regular yoga practice holds some promise for mitigating the impact of childhood abuse on spiritual struggle, although only for some types of abuse, and not for South Asian participants. Future clinical trials are needed to more rigorously test whether, how, and in what context yoga interventions alleviate or resolve spiritual struggle.

Oral Abstract Session 05: Health Services Research I

OA05.01

Perspectives of Pain Specialists on Complementary, Alternative, and Integrative Medicine: A Survey of Clinicians and Researchers

Jeremy Y. Ng ¹ , Dennis Anheyer², and Holger Cramer³

¹(1) Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; (2) Bosch Health Campus, Stuttgart, Germany; (3) Centre for Journalology, Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

²Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

³University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

Contact: Jeremy Y. Ng, [e-mail]

Abstract

Purpose: This study examined the views of pain clinicians and researchers on complementary, alternative, and integrative medicine (CAIM) in pain management, focusing on perceived safety, effectiveness, and the potential for clinical integration.

Method(s): An anonymous online survey was distributed to authors of pain-related research articles published in MEDLINE-indexed journals. The survey consisted of multiple-choice and open-ended questions designed to capture both quantitative and qualitative insights on CAIM for pain management.

Results: A total of 1,024 participants responded, with most identifying as pain researchers (43.59%) or as both researchers and clinicians (39.88%), and a majority in senior roles (61.55%). Mind-body therapies, including meditation, yoga, and biofeedback, received high ratings, with 68.47% of respondents viewing these approaches as promising for pain prevention, treatment, and management. While 43.89% believed that most CAIM therapies are generally safe, only 25.55% were confident in their overall effectiveness. Strong support emerged for additional research into CAIM, with 45.88% agreeing and 42.53% strongly agreeing on the need for further investigation. Many respondents also favored integrating CAIM training into clinician education, with 46.40% endorsing formal training programs and 52.71% supporting supplementary courses. Notably, mind-body therapies received the most positive feedback, whereas biofield therapies were met with greater skepticism, reflecting a mixed response within the CAIM spectrum.

Conclusions: These findings highlight significant interest in CAIM among pain specialists and emphasize the need for additional research and structured educational programs to guide CAIM use in pain management. Mind-body therapies are particularly well-regarded, suggesting their strong potential in this field, while other CAIM therapies may require more evidence to support safe and effective integration into clinical practice. This study underscores the importance of addressing both research gaps and training needs to advance CAIM use among pain professionals.

OA05.02

Complementary and Integrative Health Therapies for Pain Management in the Military Health System: A Scoping Review

Tracy Rupp ¹ , Abigail Crosier², Erin Tracy³, Austin Bell⁴, Kathryn Eliasen⁵, Thomas Peterson⁶, and Rhonda Allard²

¹Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD

²Uniformed Services University, Bethesda, MD

³Department of Anesthesiology, School of Medicine, Uniformed Services University, Bethesda, MD

⁴Department of Anesthesiology, School of Medicine, Uniformed Services University; Department of Anesthesiology, Dwight D. Eisenhower Army Medical Center, Fort Eisenhower, GA

⁵Department of Anesthesiology, School of Medicine, Uniformed Services University; Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD

⁶Department of Anesthesiology, School of Medicine, Uniformed Services University; Department of Anesthesiology, Brooke Army Medical Center, San Antonio, TX

Contact: Tracy Rupp, [e-mail]

Abstract

Purpose: This systematic review evaluated the efficacy and utilization of complementary and integrative health (CIH) therapies for pain management within the Military Health System (MHS). Specifically, it aimed to assess evidence-based modalities such as acupuncture, biofeedback, hypnosis, massage therapy, meditation, guided imagery, Tai Chi/Qi Gong, and yoga, which are part of the VA’s Whole Health program. The goal was to determine their effectiveness in military service members and understand their implementation in the MHS as well as the state of the science of CIH research in the MHS and identify gaps.

Method(s): A comprehensive search of PubMed, Embase, and Cochrane CENTRAL databases was conducted for studies published between 2014 and 2024. The search focused on CIH therapies related to pain management in military populations, yielding 433 studies. After screening for eligibility, 55 studies were included for detailed review. Studies included randomized controlled trials (RCTs), case studies, and large database analyses and retrospective chart reviews. Exclusion criteria involved non-peer-reviewed articles and those not specific to the military health system.

Results: The review identified significant evidence supporting the use of CIH modalities for pain management. Acupuncture, particularly Battlefield Acupuncture (BFA), showed immediate pain relief in acute conditions and chronic pain reductions. Massage therapy and biofeedback demonstrated efficacy in reducing pain and improving functional outcomes in various musculoskeletal and stress-related disorders. Meditation and yoga were effective for chronic pain, stress management, and enhancing overall well-being. Utilization data indicated a steady increase in CIH therapy use across military facilities, although implementation varied.

Conclusions: CIH therapies, particularly acupuncture, massage therapy, and yoga, are effective non-pharmacologic interventions for pain management in military populations. Their growing utilization reflects the recognition of their benefits in managing chronic pain and improving quality of life among service members. Further research is needed to standardize practices and optimize implementation across the MHS.

OA05.03

Cost Sharing for Reimbursed Acupuncture Therapy between 2012 and 2021: A Claims-Based Study

Molly Candon ¹ , Jeffery Dusek², and Arya Nielsen³

¹University of Pennsylvania, Philadelphia, PA

²University of California - Irvine, Irvine, CA

³Icahn School of Medicine at Mount Sinai, New York, NY

Contact: Molly Candon, [e-mail]

Abstract

Purpose: Cost sharing refers to the proportion of health care spending paid out of pocket by the patient, which could take the form of copays, coinsurance, or deductible payments. Multiple studies have demonstrated the impact of cost sharing on outcomes, including the use of preventative care and even mortality. This study is the first to leverage administrative data to examine cost sharing for acupuncture.

Method(s): We use Optum’s de-identified Clinformatics® Data Mart Database between 2012 and 2021 to track copays, coinsurance, and deductible payments, as well as total spending (i.e., out-of-pocket spending plus insurance payments). Our study sample includes adults aged 18 and older with commercial insurance, and we focus on patients who had visits with in-network acupuncturists. We further examine whether the number of acupuncturist visits is associated with out-of-pocket spending using linear regression models.

Results: Preliminary findings indicate that copays were larger than coinsurance and deductible payments—between 2012 and 2021, in 2021 dollars, the average copay for acupuncturist visits was $17.89 (SD: $17.48), the average coinsurance payment was $4.24 (SD: $10.22), and the average deductible payment was $10.61 (SD: $36.95). Given the total spending per visit of $188.81 (SD: $110.94), the mean share of spending paid out-of-pocket was 19.4%. Of note, the average copay fell from $20 in 2012 to $15 in 2021; total spending per acupuncturist visit also fell, from $197 in 2012 to $156 in 2021. Finally, we found that the size of the copay and the share of spending paid out-of-pocket were negatively associated with the number of acupuncturist visits (both p < 0.001).

Conclusions: In conclusion, roughly $1 in $5 spent on acupuncturist visits reimbursed by a large national insurer was paid for by the patient, total spending on acupuncturist visits fell over time, and less cost sharing was associated with more visits with acupuncturists.

OA05.04

The Effect of Real-World Diffusion of CIH Therapies and Whole Health Coaching on Tobacco Cessation Outcomes in the Veterans Health Administration

Sihang Zeng ¹ , Scott Coggeshall², Ethan Rosser³, Stephanie L. Taylor⁴, Diana Burgess⁵, Gang Luo⁶, and Steven Zeliadt⁷

¹University of Washington, Seattle, WA

²Veterans Health Administration, Seattle, WA

³VA Puget Sound Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA

⁴Veterans Health Administration, New Haven, CT

⁵Minneapolis VA Health Care System, Minneapolis, MN

⁶Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA

⁷VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Sihang Zeng, [e-mail]

Abstract

Purpose: To determine how use of complementary and integrative health (CIH) therapies and Whole Health (WH) coaching impacted tobacco cessation outcomes and activities among veterans receiving care from the Veterans Health Administration (VHA).

Method(s): This retrospective cohort study identified 38,682 veterans who were current tobacco users and newly initiating meditation (n=3,662), acupuncture (n=30,097), clinical hypnosis (n=560), or WH coaching (n=4,363) between October 2016 and March 2023. Propensity scores were used to match them with similar veterans receiving VHA care but not utilizing such therapies. The 13-month sustained cessation, as documented in the EHR, was assessed for each group using time-to-event methods with follow-up through April 2024, while use of cessation medications within 6 months of study entry was assessed using logistic regression.

Results: Meditation (Hazard Ratio/HR=1.25), acupuncture (HR=1.14), and WH coaching (HR=1.18) were associated with higher sustained tobacco cessation rates (all p < 0.001). There was a positive trend between clinical hypnosis and sustained tobacco cessation (HR=1.12), though not statistically significant. Meditation (Relative Risk/RR=1.49), clinical hypnosis (RR=1.35), and WH coaching (RR=1.46) were associated with higher cessation medication use within 6 months, while acupuncture (RR=0.90) was associated with lower cessation medication use (all p < 0.001).

Conclusions: These findings suggest that the diffusion of CIH therapies and WH coaching are having substantial positive impacts on the lives of veterans as VHA makes these services more widely available. Although veterans may not have started these therapies specifically with the goal of tobacco cessation, observing these positive effects at the population level highlights the range of value these services offer.

Oral Abstract Session 06: Headaches

OA06.01

Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache

Robert Trager ¹ , Timothy J. Williamson², Pratheek S. Makineni³, and Lindsay H. Morris⁴

¹Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

²UCHealth Spine Center, University of Colorado Hospital, Aurora, CO

³Case Western Reserve University School of Medicine, Cleveland, OH

⁴Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH

Contact: Robert Trager, [e-mail]

Abstract

Purpose: Butalbital is an acute headache medication commonly prescribed for tension-type headache (TTH), yet discouraged by guidelines due to the risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared MOH likelihood.

Method(s): For this retrospective cohort study, we searched a de-identified United States medical records database (TriNetX, Inc.) for adults with TTH, from 2013 to 2024, excluding those with other headaches and seen in inpatient/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non-SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH.

Results: 3,116 patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non-SMT cohort (SMT: 1.7%; non-SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33-0.63; P < 0.001). The incidence of MOH was lower in the SMT cohort versus non-SMT cohort (SMT: 0.5%; non-SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25-0.80; P < 0.001).

Conclusions: Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.

OA06.02

Assessing the Use of Veterans Health Administration Chiropractic Care by Patients With Headache Disorders

Anthony Lisi ¹ , Kaicheng Wang¹, Melissa Skanderson², Pamela Rist³, Peter Wayne⁴, and Jason Sico⁵

¹Yale University, New Haven, CT

²VA Connecticut, West Haven, CT

³Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

⁴Osher Center for Integrative Medicine at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

⁵Department of Veterans Affairs, West Haven, CT

Contact: Anthony Lisi, [e-mail]

Abstract

Purpose: To describe characteristics of patients with headache disorders (HAD) who use Veterans Health Administration (VA) chiropractic care for any condition, and analyze the associations between clinical features and receipt of chiropractic visits for HAD specifically.

Method(s): A serial cross-sectional analysis of VA electronic health record data limited to on-station outpatient visits between 10/1/2014 - 09/30/2021. We used a national cohort of HAD patients identified by index visits including International Classification of Diseases 10th Edition (ICD-10) codes for HAD. From this, we identified the VA facilities providing a threshold of at least 500 chiropractic visits in one fiscal year. From these facilities, we identified patients receiving chiropractic visits with or without ICD-10 HAD codes. Multivariable logistic regression analyses were used to assess the association of demographics and comorbidities with chiropractic visits including HAD codes versus those without.

Results: We identified 1,744,513 patients with HAD, and of these 114,868 (6.6%) received any VA chiropractic care. Chiropractic users compared with non-users were younger (mean age 45.4 vs. 50.5 years), more likely to be female (23.2% vs. 17.1%), and have comorbid back pain (57.0% vs. 29.2%), neck pain (30.5% vs. 12.5%), depression (37.2% vs. 29.5%), or anxiety (19.5% vs. 14.2%). In total, chiropractic users received 852,957 VA chiropractic visits, of which 61,286 (7.2%) included ICD-10 HAD codes. Chiropractic visits that included HAD codes were more likely associated with index tension HA [odds ratio (OR) =4.24 (95% confidence intervals (CI) =4.20, 4.27)] migraine HA [OR =1.64 (95% CI=1.61, 1.66)], and neck pain [OR =1.63 (95% CI=1.61, 1.66)], and less likely in males [OR =0.66 (95% CI=0.64, 0.68)] and black race [OR =0.53 (95% CI=0.43, 0.62)].

Conclusions: In VA patients with HAD we observed differences in the demographics and comorbidities of chiropractic recipients versus non-recipients. This highlights the importance of understanding VA care provided to patients with HAD.

OA06.04

Infra-Low Frequency Neurofeedback Impact on Post-Concussive Symptoms of Chronic Headache, Sleep and Attention Disorders

Judy Carlson ¹ , Belkys Fiame¹, Caitlin Tyrrell¹, Courtnee Nunokawa¹, G. Webster Ross¹, and Chathura Siriwardhana²

¹VA Pacific Islands Health Care System, Honolulu, HI

²University of Hawaii John A. Burns School of Medicine, Honolulu, HI

Contact: Judy Carlson, [e-mail]

Abstract

Purpose: This presentation will be a report of the findings of a funded 5-year study evaluating an integrative health intervention. The study’s purpose was to evaluate Infra-Low Frequency (ILF) Neurofeedback (NFB) intervention as a low risk, non-invasive, effective treatment for Veterans who experienced an mTBI, while serving in the military.

Method(s): The study was a randomized control trial offering 20 sessions of ILFNFB to those randomized into the intervention and 8 sessions of health topic discussions to those randomized into the control group. Those in the control group were offered ILFNFB after completion of control group procedures. It was hypothesized, that those Veterans who receive ILF NFB training will experience a clinically significant: 1) reduction in the frequency and/or severity of headaches; 2) decreased severity of insomnia and/or enhanced perceptions of sleep; 3) improved attention; and 4) improved perceptions of quality of life and decreased levels of PTSD and depression. Assessment data was collected at baseline, mid-point, end of treatment and 2-month follow-up

Results: Study will be completed October 2024 with the final 2-month follow-up assessment collected. At this point enrollment goals were met. Eighty-seven Veterans were enrolled with 36 Veterans completing the intervention and 38 completing the control procedures. In addition thirty (80%) of the controls will have completed the delayed intervention procedures. Each participant in the intervention and delayed intervention groups completed 20 one-hour sessions of ILF NFB.

Conclusions: ILFFNFB was offered in a funded randomized control trial to Veterans who experienced an concussion while in theatre and continue to experience headache, sleep and attention disorders. All intervention sessions are complete, and the last of the 2-month follow-up assessment will be completed in October. The analysis will be completed in November 2024 and the first presentation of results of this important study will be presented in March 2025.

Oral Abstract Session 07: Acupuncture

OA07.01

Feasibility and Acceptability of MENOGAP: Conventional and Integrative Menopause Care with Group Acupuncture

Lisa Taylor-Swanson ¹ , Micaela Besser¹, Tammy Dunklebarger¹, Marge Dalseth², Wen Tu³, Xiaoming Sheng¹, and Camille Moreno³

¹University of Utah College of Nursing, Salt Lake City, UT

²Cornell University, Ithaca, NY

³University of Utah, Salt Lake City, UT

Contact: Lisa Taylor-Swanson, [e-mail]

Abstract

Purpose: An estimated 85% of women experience vasomotor symptoms during peri- and post-menopause which may lead to poor menopause-related quality of life (MRQoL). Women may also experience bothersome symptoms such as pain, anxiety, and depression during menopause. These symptoms lead to decreased menopause-related quality of life and reduced productivity. Women report feeling unprepared to deal with menopause and seek healthcare to address symptoms and yet do not receive adequate care for menopause related symptoms. To address these gaps in care, we developed and are feasibility testing MENOGAP, a multi-modal group medical visit intervention comprised of education, experientials, and social support.

Method(s): A single arm, pre/post design was employed with quantitative and qualitative data collected at baseline, 4 and 12 weeks. Inclusion criteria: women aged 35+ who reported low MRQoL (≥2 on a 0-6 scale), moderate or severe hot flashes (severity ≥3 on a 0-10 scale) lasting for 6+ months and were willing to provide a menstrual history.

Results: Twelve menopausal women self-identified as 100% female, 25% Hispanic, mean age=48.54 years (4.26). All sessions were attended by 75% of participants. Participants rated MENOGAP as feasible and acceptable on a scale of 1-5. Menopause Rating Scale scores trended in a favorable direction (decreased symptoms), knowledge about menopause and perimenopausal health self-efficacy increased, as did the number of self-care practices (increase from 25% to 42%). Qualitative themes include: increased understanding, improved hot flashes, and appreciation of combined acupuncture therapy and medical information.

Conclusions: MENOGAP appears to be feasible and acceptable but this needs to be evaluated with a larger sample. MENOGAP may address unmet needs of this population by encompassing the biological, behavioral, and social dimensions of health, aligning with the holistic approach advocated by the NIH’s Whole Person Health Initiative.

OA07.02

Model of Skills Trainings in Protocolized Acupuncture to Increase Utilization of Acupuncture Services in the Veterans Health Administration (VHA)

Juli Olson ¹ , Steph Gregory², and Claudia Voyles³

¹VA Central Iowa HCS, Clive, IA

²VA Portland Healthcare System, Portland, OR

³Central Texas Veterans Healthcare System, Austin, TX

Contact: Juli Olson, [e-mail]

Abstract

Purpose: The purpose of this oral presentation is to describe the VHA skills trainings for protocolized auricular acupuncture and acupressure, engagement of healthcare professionals in the trainings and subsequent increases in utilization of auricular acupuncture and acupressure. Courses include combined Battlefield Acupuncture (BFA) and Battlefield Auricular Acupressure (BAA), a stand-alone BAA, and a National Acupuncture Detoxification Association (NADA) Protocol course. Also discussed will be the tracking methods for trainings, and the correlation to the use of the protocolized auricular approach.

Method(s): Methods include trainee tracking for BFA, BAA and the NADA Protocol through the Talent Management System and Integrative Health Coordinating Center. Utilization data for growth of BFA, BAA and the NADA Protocol produced through nationally templated notes and health factors which indicate that the type of acupuncture/acupressure used is a protocolized auricular approach. The Whole Health 4 All (WH4ALL) dashboard is the source of utilization data.

Results: 10,852 healthcare providers have been trained in BFA, 410 in BAA, and 58 in the NADA Protocol as of October 1, 2024. BFA training tracking was introduced in 2017, BAA training and tracking was in 2019 and the NADA Protocol training and tracking in 2024. Growth in utilization has been on the rise for BFA, BAA and the NADA protocol. Total encounters for BFA in fiscal year 2024 were 118,748 with a 59% growth from fiscal year 2023. BAA encounters grew by 16% for a total of 8,333 encounters and the NADA Protocol grew by 41% for a total of 20,495 encounters.

Conclusions: By training a variety of healthcare providers (physicians, nurses, allied health) in the use of protocolized auricular acupuncture healthcare systems may increase utilization of acupuncture, an evidence-based non-pharmacologic approach for pain management and other indications. The VA’s experience indicates demand for skills training, and training is resulting in increased utilization.

OA07.03

Acupuncture Reduces Medication Use in Breast Cancer With Chemotherapy-Induced Peripheral Neuropathy

Ye-Seul Lee¹

¹Jaseng Medical Organization, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Ye-Seul Lee, [e-mail]

Abstract

Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) remains a persistent challenge among breast cancer survivors1, with duloxetine being the only recommended treatment2. This study assesses the impact of acupuncture as an adjunct therapy on the use of neuropathic medications over a five-year period post-CIPN diagnosis.

Method(s): In this retrospective, longitudinal national cohort study, we used the National Health Insurance Service (NHIS) database in Korea to identify breast cancer survivors diagnosed with chemotherapy-induced peripheral neuropathy (CIPN) between 2011-2013. Patients included had undergone cancer surgery within six months of diagnosis, received adjuvant chemotherapy within six months post-surgery, and were diagnosed with CIPN (G62.0) within two years. The CIPN diagnosis date was the cohort entry point. Exclusion criteria were prior cancer or neuropathic pain history. Patients who received acupuncture or physiotherapy more than six times within one year post-CIPN diagnosis were categorized as acupuncture users; the rest were non-users. We used 1:2 propensity-score matching to balance covariates, with outcomes focusing on duloxetine re-initiation and other medication use. Cox proportional hazards models and Kaplan-Meier curves were used for analysis.

Results: Of 35,550 breast cancer survivors, 1,208 developed CIPN within two years post-chemotherapy, with 337 (27.9%) identified as acupuncture users. The PS-matched cohort consisted of 250 acupuncture users and 389 controls. Acupuncture users had delayed re-initiation of duloxetine (adjusted hazard ratio (aHR) 0.47, 95% CI [0.23–0.94]) and tramadol (aHR 0.82 [0.67–0.99]), with no significant differences for gabapentin or amitriptyline. Duloxetine usage decreased in acupuncture users, particularly in the second year (adjusted odds ratio (aOR) 0.14 [0.04–0.49]), while tramadol use gradually declined until the third year. Gabapentin usage remained unchanged.

Conclusions: Acupuncture, as a nonpharmacological therapy, was associated with delayed re-initiation and reduced duloxetine use in breast cancer survivors with CIPN. Its benefits may extend beyond immediate treatment, though symptom resurgence suggests reduced long-term efficacy, warranting further investigation.

OA07.04

Acupuncture for the Management of Stress and Anxiety: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials

Andrew Jang ¹ , and Maren Wenninger²

¹Jaseng Hospital of Korean Medicine, Seoul, Seoul Teugbyeolsi, South Korea

²Julius-Maximilians-Universität, Würzburg, Würzburg, Hamburg, Germany

Contact: Andrew Jang, [e-mail]

Abstract

Purpose: Stress and anxiety are widespread mental health concerns that not only diminish quality of life but also contribute to the development and progression of various health problems. Chronic stress has been linked to conditions such as cardiovascular diseases, hypertension, diabetes, gastrointestinal disorders (e.g., irritable bowel syndrome), and weakened immune function. Acupuncture, a cornerstone of Traditional Chinese Medicine, is increasingly explored as a complementary therapy for managing stress and anxiety. While several systematic reviews on this topic exist, many include low-quality randomized controlled trials (RCTs), limiting the robustness of their conclusions. This systematic review and meta-analysis, conducted in accordance with the updated PRISMA 2020 guidelines, aims to critically evaluate the efficacy of acupuncture in alleviating stress and anxiety, focusing on higher-quality studies.

Method(s): A comprehensive literature search was conducted in March 2024 across multiple databases, including PubMed, MEDLINE, ScienceDirect, CINAHL, Embase, and AMED, to identify randomized controlled trials (RCTs) examining the effects of acupuncture on stress and anxiety. A total of 4,561 RCTs were identified. Studies were included if they had a sample size of more than 30 participants, were published in English, and assessed changes in stress and anxiety using validated scales. The primary outcomes included changes in stress and anxiety levels measured by the Hamilton Anxiety Rating Scale (HAM-A), Perceived Stress Scale (PSS), State-Trait Anxiety Inventory (STAI), Self-Rating Anxiety Scale (SAS), and Hospital Anxiety and Depression Scale (HADS). A total of 17 studies were identified for synthesis, and meta-analyses are currently being conducted to assess overall efficacy, with heterogeneity across studies being examined.

Results: The results and conclusions of this systematic review and meta-analysis are currently being finalized and will be completed before the date of the annual meeting.

Conclusions: The results and conclusions of this systematic review and meta-analysis are currently being finalized and will be completed before the date of

Oral Abstract Session 08: Mental Health

OA08.01

Breathwork Effectiveness for Reducing Stress Reactivity to Trauma Reminders: Impact of Interoceptive Awareness

Sinead Sinnott ¹ , Crystal Park², Linda Pescatello³, and Stephanie Milan³

¹Massachusetts General Hospital/ Harvard Medical School, Hyde Park, MA

²Department of Psychological Sciences, University of Connecticut, Storrs, CT

³University of Connecticut, Storrs, CT

Contact: Sinead Sinnott, [e-mail]

Abstract

Purpose: Sexual trauma survivors experience high levels posttraumatic stress symptoms, particularly hyperarousal. Coping strategies used to reduce hyperarousal when exposed to sexual trauma reminders, such as breathwork, are currently understudied. Effectiveness of coping strategies for reducing acute cardiovascular distress may be dependent upon one’s ability to attend to signs of physiological distress. Interoceptive awareness, the awareness and ability to respond to internal physiological and emotional sensations, predicts lower reactivity to non-trauma-related stressors, though how it impacts the effectiveness of breathwork for trauma-related distress has not been examined.

Method(s): 130 female sexual trauma survivors attended a laboratory visit and utilized two coping strategies (diaphragmic breathwork and cognitive reappraisal) while viewing sexual trauma reminder images. Blood pressure (BP) and high-frequency heart rate variability (HF-HRV) were measured at rest, then before, during, and after each trauma image. Individuals completed the Multidimensional Assessment of Interoceptive Awareness-Version 2 (MAIA-2). We examined how three facets of the MAIA-2 (emotional awareness, self-regulation, body trusting) predicted the effectiveness of each coping strategy for reducing cardiovascular responses to trauma reminders. Structural equation modeling was used to examine how interceptive awareness impacts coping strategy effectiveness.

Results: Individuals who reported higher levels of body trusting (CMIN=4.122, p=.042) and emotional awareness (CMIN=7.56, p=.006) were more likely to experience a greater magnitude of reduction in systolic BP when using breathwork than when using reappraisal. Body trusting (CMIN=4.122, p=.028) and self-regulation (CMIN=5.554, p=.018) were also associated with a greater magnitude of increase in HF-HRV when using breathwork than when using reappraisal.

Conclusions: For individuals high in interoceptive awareness, particularly trust in their bodily sensations, breathwork is a more adaptive strategy than reappraisal for regulating trauma-related distress and cardiovascular reactivity. Trust in one’s bodily sensations likely confers greater benefit for a body-focused coping strategy than for a cognitive one due to breathwork relying on bodily awareness and physiological control.

OA08.02

Ayahuasca Observational Pilot Study: Effects on Depression, Connectedness, Epigenetics and Microbiome

Payton Follestad ¹ , Patricia Filbin², Atara Jaffe³, Austin Perlmutter⁴, and Heather Zwickey¹

¹National University of Natural Medicine, Portland, OR

²National University of Natural Medicine, Vancouver, WA

³AIMS Institute Seattle, Seattle, WA

⁴National University of Natural Medicine, Bainbridge Island, WA

Contact: Payton Follestad, [e-mail]

Abstract

Purpose: Depression affects many adults in the U.S. and rates have increased significantly, highlighting the urgent need for effective treatment options. While lifestyle changes like sleep, nutrition, and exercise play a role in mental wellness, they alone may not be enough to address the root causes of depression. Ayahuasca is an ancient brew that is prepared from plants found in the Amazon Rainforest; Psychotria viridis and Banisteriopsis caapi vines, containing psychoactive N,N-dimethyltryptamine (NN-DMT) and β-carboline, a monoamine oxidase inhibitor (MAOI) which allows for NN-DMT to be orally absorbed. Traditionally, Ayahuasca has been used to facilitate perception change, aid in ancestral communication and healing by indigenous populations of the Amazon basin. This observational pilot study is the first of its kind in evaluating Ayahuasca for epigenetic, inflammatory, neurological and microbiome changes, all of which can provide insight on a potential treatment option for a large population suffering from depression and other mental health challenges.

Method(s): Participants were recruited from communities engaging in Ayahuasca ceremonies. Data collection was carried out through surveys administered both before and after Ayahuasca consumption. These surveys assessed depressive symptoms and psychological connectedness. A subset of participants completed microbiome and epigenetic analysis pre/post Ayahuasca ceremonies.

Results: Preliminary findings indicate significant reductions in depressive symptoms and increases in feelings of interconnectedness post-Ayahuasca use. Epigenetic and microbiome analysis reveal pre and post shifts in these outcome measures.

Conclusions: Ayahuasca demonstrates significant potential as a sustainable treatment for depression by addressing both psychological and physiological components of the disorder. With effects that extend beyond conventional pharmacotherapy and psychotherapy, Ayahuasca presents a promising alternative that can reshape the current therapeutic landscape.

OA08.03

Yoga as Monotherapy for Major Depressive Disorder: a Novel Ayurvedic Subtyping Measure and Randomized Controlled Trial Protocol

Claudia Brewer ¹ , Gabriela Gutierrez², and Sudha Prathikanti²

¹UCSF School of Medicine, San Francisco, CA

²Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

Contact: Claudia Brewer, [e-mail]

Abstract

Purpose: Conventional depression treatments have limited efficacy for mild-to-moderate symptoms, high dropout rates, and prevalent side effects. Preliminary data from small-scale RCTs suggest yoga may be a viable treatment for mild-to-moderate depression. Additionally, Ayurvedic medicine suggests that tailoring yoga interventions to match Ayurvedic depression subtypes may enhance therapeutic effects. While the tradition of matching yoga practices to Ayurvedic subtypes of illness is centuries-old, published studies testing this approach are scant. Here, we share our innovative protocol for the first clinical trial to test an Ayurvedic yoga intervention as a monotherapy for depression, and describe the Ayurvedic Depression Subtyping Measure (ADSM), a novel diagnostic questionnaire developed to identify Ayurvedic depression subtypes (Vata, Pitta, or Kapha) for a patient with mild-to-moderate depression.

Method(s): This RCT is recruiting 180 adults with mild-to-moderate depression, classifying their depression using both an interview with an Ayurvedic practitioner and the ADSM, and finally randomizing them equally to one of three intervention groups: 1) standard yoga practice, 2) yoga practice customized to Ayurvedic depression subtype, or 3) an educational control. Primary outcomes are Beck Depression Inventory-II (BDI) scores. Secondary outcomes include Perceived Stress Scale (PSS) scores, biomarkers associated with depression severity and stress, and the convergent validity (using Cohen’s kappa) between the Ayurvedic practitioner assessment and the ADSM.

Results: Enrollment is currently underway, with interim data analyzed by February 2025. We will report on the Cohen’s kappa value calculated from the interim dataset to analyze the convergent validity between the Ayurveda practitioner assessment and ADSM. Future analyses will assess whether the yoga groups combined achieve a greater reduction in BDI scores compared to the controls, how PSS scores and biomarker changes may differ between the yoga groups combined vs. controls, and any significant differences in those outcomes between the Ayurvedic yoga group vs. the standard yoga group.

Conclusions: Our study is one of the largest RCTs on yoga monotherapy for depression, and the first to evaluate yoga therapy tailored to Ayurvedic subtype of depression. Our results could validate a new diagnostic tool for the Ayurvedic evaluation of depression and establish yoga as a viable first-line therapy for mild-to-moderate depression.

OA08.04

Associations Between Use of Whole Health Care and Completion of Trauma-Focused Psychotherapy among Veterans with Posttraumatic Stress Disorder

Bella Etingen ¹ , Jamie Douglas², Scott Coggeshall³, David Reed⁴, Charles Engel⁵, Timothy Hogan⁶, Ethan Rosser⁷, Barbara Bokhour³, and Steven Zeliadt⁸

¹Research and Development Service, Dallas VA Medical Center, Veterans Health Administration, Dallas, TX

²VA Puget Sound Health Care System, Seattle, WA

³Veterans Health Administration, Seattle, WA

⁴University of Washington, Seattle, WA

⁵Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA

⁶Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

⁷VA Puget Sound Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA

⁸VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Bella Etingen, [e-mail]

Abstract

Purpose: The Veterans Health Administration (VHA) Whole Health (WH) System of Care is focused on achieving personalized, recovery-oriented healthcare for Veterans, including those with posttraumatic stress disorder (PTSD), through WH services (e.g., health coaching, wellness groups) and complementary and integrative health (CIH) therapies (e.g., yoga, meditation). About two-thirds of Veterans who initiate an evidence-based psychotherapy (EBP) for PTSD discontinue treatment early. We sought to examine the relationship between WH care use and completion of EBP for PTSD.

Method(s): We completed a national retrospective database analysis of VHA administrative records from Fiscal Years 2018-2022. We identified n=100,177 Veterans with PTSD who initiated an EBP for PTSD and used WH/CIH services close to (i.e., 6 months prior to-14 weeks following) the time of EBP initiation. We conducted adjusted multiple logistic regression models to assess associations between use of WH/CIH services and EBP completion when controlling for key demographic and health-related characteristics.

Results: Among the Veterans in our cohort, 10% had used WH services and 3% had used CIH therapies. Results indicated that use of WH care at various points in the EBP treatment trajectory was associated with increased odds of EBP completion. The strongest associations were among use of WH services both before initiation and during treatment, which was associated with 1.5 times higher odds of EBP completion (95%CI: 1.3-1.6), and use of CIH therapies during treatment or before initiation and during treatment, which was associated with 1.4 times higher odds of completion (95%CI: 1.2-1.6; 95%CI: 1.2-1.5, respectively).

Conclusions: Prior work has indicated that receiving WH/CIH services is associated with greater engagement in care. Our results suggest that parallel use of WH care may also bolster patient completion of EBP for PTSD, a critical component of the effectiveness of these psychotherapies.

Oral Abstract Session 09: Healthcare Workforce Wellbeing

OA09.01

Utilizing Holistic Integrative Wellness for Caregivers in the Surgical Setting

Rosemarie Yurcak ¹ , Darah Kristine Salmaggi¹, and Katrina Vigo¹

¹NYU Langone Health, New York, NY

Contact: Rosemarie Yurcak, [e-mail]

Abstract

Purpose: Although there is research on the impact of complementary modalities on stress reduction, there is limited research on the use of these modalities in caregivers of patients undergoing surgery. The purpose of this project was to decrease anxiety for the caregivers of patients undergoing surgery at our surgical center through utilization of evidence-based, holistic wellness kits.

Method(s): Wellness kits were designed utilizing holistic interventions that focus on mindfulness, relaxation breathing and the use of aromatherapy. The kits included complementary modalities including, a stress ball or lavender hand lotion paired with a 54321-mindfulness technique and aromatherapy patches or Biodots paired with counting breaths. Caregivers were offered a choice of wellness kit and completed pre-and post-intervention surveys utilizing the Visual Facial Anxiety Scale (VFAS) Cao, X., et. Al. 2017).

Results: A total of 282 caregivers took part in the three-month pilot program. The interventions used included stress balls (45%), Biodots (32%), lotion (16%) and aromatherapy (6%). Of the 282 caregivers surveyed, 89% stated they would utilize the modality again. Additionally, there was a 10% decrease in anxiety rated moderate to high, 18% decrease in anxiety rated moderate to mild and 27% increase in anxiety rated none to mild.

Conclusions: In conclusion, this intervention yielded positive outcomes, reflected in the reduction of reported anxiety levels among participants. Caregivers highlighted the significance of acknowledgement of their stress, underscoring the necessity of incorporating caregivers into patients’ care plans. Furthermore, this project is not only cost-effective and sustainable but also leverages integrative health principles that can be standardized across healthcare systems, promoting holistic care for both patients and caregivers. Cao, X., Yumul, R., Elvir Lazo, O. L., Friedman, (2017). A novel visual facial anxiety scale for assessing preoperative anxiety.

OA09.02

Protecting Time at Work for Whole Health Participation and Employee Well-Being: Results from a VHA Pilot Program

Bella Etingen ¹ , Tamara Schult², Jamie Douglas³, Steven Zeliadt⁴, Barbara Bokhour⁵, Danielle Lutz⁶, and Kavitha Reddy⁷

¹Research and Development Service, Dallas VA Medical Center, Veterans Health Administration, Dallas, TX

²Veterans Health Administration, Hastings, MN

³VA Puget Sound Health Care System, Seattle, WA

⁴VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

⁵Veterans Health Administration, Seattle, WA

⁶Veterans Health Administration, Finger Lakes, NY

⁷Veterans Health Administration, St. Louis, MO

Contact: Bella Etingen, [e-mail]

Abstract

Purpose: Employee Whole Health (EWH) programs encompass Whole Health education and experiences for employees to support engagement in activities and behaviors intended to improve well-being and facilitate self-care, such as skill-building around self-compassion and gratitude and complementary and integrative health therapies (e.g., yoga, meditation). The Veterans Health Administration (VHA) Office of Patient-Centered Care recently pilot-tested a program that provided employees with protected time during the workday to engage in self-care; this program was intended to improve employee participation in EWH. Our goal was to evaluate the impacts of the protected time for self-care pilot on employee well-being.

Method(s): Employees at three VHA Medical Centers self-selected to participate in the protected time for self-care pilot, which allowed them 60 minutes per week to participate in self-care activities during their workday. Prior to commencing participation, employees completed a self-care agreement with their supervisors, and completed a baseline survey that included a battery of self-report well-being measures. One year later, we asked employees to complete annual renewal of their self-care agreement and in tandem, invited them to complete a follow-up survey assessing those same measures. We conducted bivariate analyses (paired-samples t-tests) to assess changes in well-being measures from pre- to post-participation in the pilot.

Results: Of the 1,163 employees who signed up for the pilot, pre/post survey data were available for n=77. Mean scores on the following well-being measures significantly improved from pre- to post-participation among these employees: perceptions of organizational culture regarding well-being (mean difference=1.84, p<0.001), overall well-being (mean difference=0.05, p<0.01), self-reported overall physical (mean difference=0.45, p=0.05) and mental (mean difference=0.72, p=0.03) health, perceived stress (mean difference=-0.84, p=0.01), and self-efficacy (mean difference=0.45, p=0.01).

Conclusions: Providing protected time for employees to engage in self-care activities may help to bolster EWH programs and improve employee well-being.

OA09.03

What’s Up Doc? Effectiveness of an “Opt-out” Wellness Program on Physician Resident Wellness Session Attendance

Tobi Fishel¹

¹USC/LAC+USC, Los Angeles, CA

Contact: Tobi Fishel, [e-mail]

Abstract

Purpose: Nearly half of U.S. physicians experience burnout, with physicians practicing emergency medicine, internal medicine, family medicine, radiology, or neurology being at the highest risk [1]. Physicians experience burnout at greater rates than the US working adult population, and multiple studies have demonstrated that burnout symptoms begin in medical school [1]. Burnout affects not only the individual, but also the patient care level, with correlations to worse patient outcomes and medical errors [2, 4-6]. Burned out physicians and residents are more likely to report poor patient care practices, such as not treating patients’ pain and not discussing options or answering patient questions [6-8].

Several studies have demonstrated that targeted wellness interventions have positive effects on physician and resident wellness [11-13]. Interventions may include individual counseling sessions or group-based courses, with improvements in stress, coping strategies, mindfulness, and burnout reported [12-14]. Despite more wellness resources being made available, more research into their efficacy is needed [10, 16]. Our goal in this study is to assess if LAC+USC’s transition to an “opt out” model, where residents are auto-enrolled in wellness visits and can actively opt out if they wish, has improved utilization of these wellness visits.

Method(s): The objectives were to assess if LAC+USC’s transition to an “opt out” model for wellness visits has increased the number of resident attendees compared to the prior model of active scheduling and to assess if LAC+USC’s transition to an “opt out” model for wellness visits has increased the number of recurrent visitors compared to the prior model of active scheduling. This will be a descriptive and correlational study, using retrospective data. LAC+USC began making the transition to an opt-out system for their resident wellness visits in 2019 with the emergency medicine residency program. In 2020-2021, Dermatology, Anesthesia, and OB/GYN joined. In 2021-2022, Med-Peds and Psychiatry joined. For 2022-2023, ENT’s residency program has joined. We will be reviewing these past four years of resident wellness visits of the respective residency programs. Resident wellness visits were completed by clinicians in the GME wellness office. Only these clinicians know the identity of the residents who attended wellness visits and the number of visits conducted during this time. The identities of resident physicians will not be made available to research staff. Dr. Fishel and her team collected the following deidentified variables: Number of unique residents who attended a wellness visit, number of residents who attended more than one wellness visit, department affiliation of individuals who attended wellness visits, method of referral (Opt Out, self, peer or PD/admin referral), and the number of opt out appointments that were completed, cancelled, or no shows. In addition, the research staff will be collecting the following variables regarding the residency classes during the four years: total number of residents in class, gender breakdown of class, aggregated MBI scores, PHQ9 scores, and percent of residents endorsing suicidal thoughts. Comparator: Trainees from classes not yet participating in opt-out 2017-current.

Results: Preliminary results indicate that when trainees are given the opportunity to opt out rather than have the burden of opting into a session, they want to continue more often in sessions, they get their colleagues who missed their opt out to want sessions as well and stigma is reduced. Also, programs that offer opt out sessions where the trainees attend those sessions have less depression, less burnout, and better overall positive feelings toward their program.

Conclusions: Offering opt out sessions, that we call (what’s up doc check in’s now) are a useful way to improve well-being for resident trainees.

OA09.04

Working Conditions in Complementary and Integrative Healthcare Occupations

Margaret Whitley¹, John Finnell², Jocelyn Faydenko ³ , and Dana Madigan⁴

¹RAND Corporation, Santa Monica, CA

²Central Texas Veterans Health Care System, Austin, TX

³National University of Health Sciences, Lombard, IL

⁴University of Illinois Chicago, Chicago, IL

Contact: Jocelyn Faydenko, [e-mail]

Abstract

Purpose: Working conditions like decision-making freedom can improve worker health, while ergonomic hazards, time pressure, and long/irregular hours can harm workers. Working conditions and burnout in conventional healthcare are well-studied, but less is known about working conditions for complementary and integrative healthcare (CIH) professionals. This study aims to fill that gap.

Method(s): To describe CIH providers’ exposure to healthy and unhealthy working conditions, we used cross-sectional Occupational Information Network (O*NET) data. We examined means and 95% confidence intervals for decision-making freedom, ergonomics (e.g., bending/twisting), time pressure, hostile social interactions (all on 1-5 scale; 5=higher frequency), and schedule irregularity and hours for 5 CIH occupations: acupuncturists, chiropractors, massage therapists, midwives, and naturopathic doctors, from n=108 respondents, 2013-2021. We compared those to 9 non-CIH occupations including registered nurses and retail salespeople (n=256 responses, 2014-2023).

Results: CIH occupations had high decision-making freedom: for example, chiropractors had mean=4.96 [Cl: 4.90-5.00] compared to 3.43 for retail salespeople [Cl: 2.80-4.06]. CIH occupations also had moderate time pressure, few hostile interactions, and reasonable hours/scheduling. Massage therapists, chiropractors, and acupuncturists reported more ergonomic hazards than other CIH and non-CIH occupations; for instance, bending/twisting frequency for chiropractors=3.43 [Cl: 2.80-4.05] compared to 2.17 for midwives [Cl: 1.97-2.36] and 2.76 for retail salespeople [Cl: 2.06-3.46].

Conclusions: CIH occupations generally had healthy working conditions, although notable ergonomic hazards existed for chiropractors, massage therapists, and acupuncturists. Future research should consider determinants like financial stress, CIH’s distinct role within the healthcare system, and the challenges of small business ownership. Prevention strategies, especially for manual therapy occupations, should be further explored and promoted.

OA09.05

Promoting Employee Wellbeing and Workplace Wellness Culture through Group Health & Wellness Coaching

Gail Rose ¹ , Karen Westervelt¹, and Alyssa Smith¹

¹University of Vermont, Burlington, VT

Contact: Gail Rose, [e-mail]

Abstract

Purpose: Workplace stress is the target of wellness campaigns designed to promote emotional wellbeing and healthy behaviors. Positive work environments and supportive leadership can improve employees’ productivity, commitment, and wellbeing. A whole person approach to addressing stress and health of employees is integrative health and wellness coaching (IHWC). We evaluated an IHWC program that incorporated a group component designed to promote peer support and social connection among participants, hypothesizing the program would positively impact perceived stress and help create a workplace culture of wellness.

Method(s): The Employee Coaching Connection 12-week IHWC program consisted of 6 group sessions and 6 individual sessions conducted by National Board-Certified Health and Wellness Coaches and student trainees. Employee participants (n=50) at an East Coast university and affiliated medical center completed the Perceived Stress Scale (PSS-10) at baseline and weeks 5, 12, 18, and 24, and completed a brief measure of institutional support for wellness at 12-weeks (post-program).

Results: Mean PSS-10 scores were in the moderate range at baseline (M=15.84) and 5 weeks (M=15.07), and in the low range at 12- (M=12.67), 18- (M=13.24) and 24-weeks (M=13.14). Multivariate analyses showed reductions from baseline were significant at post-program and both follow up assessments (p<.01). 67% of respondents agreed their employer supported a “culture of health and wellness,” yet only 37% were given time off to attend the program. Qualitative feedback included desire for a longer program, more frequent coaching meetings, and larger groups for peer support.

Conclusions: Given the link between high stress and chronic disease, it is important to provide opportunities to address stress in the workplace. Including a group component in an IHWC program may help to reduce stress and promote individual emotional health even after the program is over. More should be done to promote an institutional culture of wellness.

Oral Abstract Session 10: Implementation Science

OA10.01

Barriers to Use of Complementary and Integrative Health Therapies among Veterans with Chronic Pain on Long-term Opioid Therapy

Anne Black ¹ , Steven Zeliadt², William Becker¹, Robert Kerns¹, Erica Abel¹, Samara Zuniga¹, Danielle Wesolowicz¹, and Jamie Douglas³

¹Yale School of Medicine, New Haven, CT

²VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

³VA Puget Sound Health Care System, Seattle, WA

Contact: Anne Black, [e-mail]

Abstract

Purpose: To gain insight into Veterans’ self-reported barriers to use of evidence-based complementary and integrative health (CIH) services to inform efficient, targeted efforts to broaden exposure.

Method(s): With input from operational leaders within the Department of Veterans Affairs (VA), content experts, and Veterans with lived experience, we developed a survey to assess barriers to use of CIH modalities. Leveraging a national cohort of Veterans with chronic pain on long-term opioid therapy, we randomly selected 3000 Veterans with no recorded CIH use for invitation to complete the survey, limiting responses to N=126. We conducted descriptive and group comparison analyses to assess patterns of responses overall, by CIH modality, and by Veteran characteristics.

Results: Among respondents, 42% were male, 57% were White, 29% Black, 14% another race, and 6% Hispanic. Barriers endorsed by the majority of Veterans who had never used specific CIH modalities related to provider referral or valuation, physical or health limitations, lack of access due to cost, time or location, lack of information, not wanting to take services from other Veterans, and believing the modality was not available. Over 90% of respondents who never tried meditation believed it would make their condition worse, and 90% who never tried tai chi/qi gong did not believe it would improve their condition. Half of Veterans who never tried yoga perceived they would feel like an outsider. Among Veterans who tried but didn’t continue specific CIH modalities, primary barriers were modality-specific, and related to access (cost, time, location), lack of improvement, lack of support from family or provider, and not feeling a sense of safety or belonging. Important differences in perceived barriers related to CIH modality and Veteran characteristics.

Conclusions: Early research suggests CIH therapies can be opioid-sparing. Insight into specific barriers creates the opportunity to employ targeted implementation strategies to promote CIH uptake and sustained use.

OA10.02

Determinants of the Implementation of Whole Person Pain Care in the Veterans Health Administration

John Finnell ¹ , and April Casselman²

¹Central Texas Veterans Health Care System, Austin, TX

²Veterans Health Administration, Arlington, TX

Contact: John Finnell, [e-mail]

Abstract

Purpose: The CARA Act tasked the VA with establishing an integrated biopsychosocial, stepped-care model for interdisciplinary pain care, termed Whole Person Pain Care (WPPC), to address chronic pain in Veterans. The objective of this quality improvement (QI) study was to evaluate the implementation of WPPC within a single VA region.

Method(s): A rapid-analysis approach using the Consolidated Framework for Implementation Research (CFIR) was used to assess the implementation. The QI study was approved by the IRB and Union. Interviewees were consented to undergo semi-structured interviews. Two interviewers conducted and coded responses, which were assessed for two-rater, intra-rater concordance. Site- and Stakeholder-related contextual influences were assessed for levels of heterogeneity, with Bonferroni correction for multiple comparisons.

Results: Of the N=60 invited interviews, N=45 interviews were completed across Stakeholder Type 0.75 (SE 0.06; 95%CI 0.62, 0.85), with an intraclass correlation of 0.702. Heterogeneity in CFIR Construct scores was observed across both Site and Stakeholder Type. Overall, structural characteristics and available resources were observed to be negative determinants of the implementation, whereas a culture of innovation and strategic planning were negative with heterogeneity. Thematic responses endorsed that ‘Veterans are the #1 customer’ and the ‘goal is that Veterans choose the VA’. Whole Person Pain Care represents a ‘competitive advantage’ for the VHA, but successful implementation requires a ‘culture of innovation’, ‘planning for growth’, and ‘buy-in from everyone’. Importantly, ‘sustained leadership support’ that embraces ‘Veteran’s self-care’ is integral to realising this ‘paradigm shift’ in pain care.

Conclusions: A single VA region showed progress in systemwide implementation of WPPC. The Expert Recommendations for Implementing Change strategy of ‘develop a formal implementation blueprint’ was deemed to be of value. Respondent agreed that a shift away from the biomedical pain management paradigm is needed to fully implement the CARA Act-mandated pain management programs and achieve Whole Person Pain Care.

OA10.03

Understanding Primary Care Providers’ Referral Practices for Complementary and Integrative Health Therapies in the Veterans Health Administration

Diana Burgess ¹ , Marlena Shin², Michael McGowan³, Danna Kasom³, Jessica Friedman⁴, Lee Cross¹, and Stephanie L. Taylor⁵

¹Minneapolis VA Health Care System, Minneapolis, MN

²Center for Health Optimization and Implementation Research, VA Boston Healthcare System, Boston, MA

³Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁴Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA

⁵Veterans Health Administration, New Haven, CT

Contact: Diana Burgess, [e-mail]

Abstract

Purpose: Primary care providers (PCPs) are often the first point of contact for discussing and referring patients to complementary and integrative health (CIH) therapies, yet little is known about these referral practices. Our objectives were to: (1) learn more about PCPs’ referral practices for CIH therapies and factors that influenced these referral decisions and (2) identify solutions to improve this referral process.

Method(s): We conducted semi-structured interviews with 40 PCPs from 8 Veterans Health Administration (VA) hospitals that offer 8 evidence-based CIH therapies (acupuncture, massage therapy, yoga, Tai Chi, meditation, biofeedback, clinical hypnosis, guided imagery) and performed a rapid qualitative analysis using a matrix approach.

Results: PCPs referred patients to acupuncture, massage therapy, yoga, Tai Chi, and meditation the most and biofeedback, clinical hypnosis, and guided imagery the least. Pain was the main condition for referrals to most CIH therapies, except for clinical hypnosis and guided imagery. Decisions about referrals were largely driven by PCPs’ knowledge about the therapy—scientific evidence and knowledge about the referral process itself (e.g., whether the therapy was a covered VA benefit, how to refer patients)—which was lowest for biofeedback, clinical hypnosis, and guided imagery. To help PCPs make decisions about referrals, PCPs wanted to gain more knowledge about CIH therapies through scientific studies, clinical practice guidelines, and education/training.

Conclusions: Lack of knowledge is a critical barrier to PCPs referring patients to CIH therapies that would benefit them. Strategies should be developed to address key knowledge gaps, such as the availability of CIH therapies in VA, how to refer patients, and the scientific evidence for conditions for which these therapies are effective.

OA10.04

Complementary and Integrative Health Therapies and Pain: Delivery Through Veterans Affairs and Community Care

Collin Calvert ¹ , Diana Burgess¹, Juli Olson², Scott Coggeshall³, Stephen Frochen⁴, Brent Taylor¹, Steven Zeliadt⁵, and Stephanie L. Taylor⁶

¹Minneapolis VA Health Care System, Minneapolis, MN

²VA Central Iowa HCS, Clive, IA

³Veterans Health Administration, Seattle, WA

⁴US Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Healthcare System, Los Angeles, CA

⁵VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

⁶Veterans Health Administration, New Haven, CT

Contact: Collin Calvert, [e-mail]

Abstract

Purpose: Complementary and Integrative Health (CIH) services are a national priority for the Department of Veterans Affairs (VA) healthcare system and can be effective in reducing chronic pain. Eligible VA patients may choose to receive their CIH care through either a VA clinic or through community care that is funded by the VA. The present study compares the effectiveness of three CIH services (acupuncture, chiropractic, and medical massage therapy) delivered in direct care by VA versus community care providers at improving veterans’ chronic pain.

Method(s): Data were analyzed from the Complementary and Integrative Health Therapy Patient Experience Survey, a longitudinal, patient self-administered survey of CIH use and health outcomes. Linear mixed models were used to evaluate the relationship of higher CIH therapy visits delivered by the VA versus community care with pain interference and pain severity, using both raw counts of visits and by grouping visits into clinically meaningful groupings.

Results: Among veterans with chronic pain who engaged in CIH services (specifically, acupuncture, chiropractic, and medical massage therapy), the majority of their CIH use was delivered by community care only (52%) or a mixture of community and VA (12%) over an eight-month period. More CIH visits were associated with lower levels of pain severity and pain interference. VA acupuncture and chiropractic had a stronger beneficial relationship with pain than CC acupuncture and chiropractic, while conversely CC medical massage therapy had a stronger beneficial relationship than VA medical massage.

Conclusions: CIH therapies delivered through the VA and through community care both offer potentially effective means of reducing chronic pain. Some therapies may be more effective when delivered through the VA versus community care, or may indicate lack of full implementation, but the limitations of observational data preclude any causal statements.

OA10.05

Implementation of a Primary Spine Practitioner Model in Academic Health Systems: A Qualitative Study of Provider and Administrator Perceptions

Logan Benjamin ¹ , Stacie Salsbury², Jon Lurie¹, Adam Goode³, and Christine Goertz⁴

¹Dartmouth Hitchcock Medical Center, Lebanon, NH

²Palmer Center for Chiropractic Research, Davenport, IA

³Clinical Research and Epidemiology, Department of Orthopaedic Surgery/Duke University, Durham, NC

⁴Duke University School of Medicine, Durham, NC

Contact: Logan Benjamin, [e-mail]

Abstract

Purpose: To identify provider and administrator perceptions about implementation of a first-contact primary spine practitioner (PSP) model using physical therapists or chiropractors in academic health systems (AHS).

Method(s): Interviews were conducted with 11 primary care providers (PCPs), 6 physical therapists, 1 chiropractor, and 6 administrators from 3 AHS: Duke University, University of Iowa, and Dartmouth-Hitchcock Medical Center, in preparation for IMPACt-LBP, a pragmatic clinical trial. Responses were thematically analyzed using NVIVO qualitative data analysis software, with the Consolidated Framework for Implementation Research (CFIR) guiding the iterative coding process.

Results: In our analysis of 24 interviews, we identified 5 themes. One key finding was “Patient-Centered Care,” mentioned 66 times across 21 interviews, where participants thought the PSP model added value by offering patients various care options. The theme of “Ensuring Evidence-Based Care” was mentioned 10 times in 7 interviews, raising concerns about patients receiving non-evidence-based treatments from chiropractors. “Communication and Collaboration Between Providers” was also an important theme, referenced 43 times across 24 interviews; participants stressed the importance of sharing medical records and treatment notes. A common worry raised by PCPs was the “Provider Competence and Diagnostic Confidence” of spine specialists, with concerns that they might misdiagnose serious conditions like cancer or cauda equina syndrome. “Access to care” was discussed in 13 interviews, with participants suggesting that integrating PSPs could expedite appointments and reduce burden on PCPs. Despite limited interactions with chiropractors, PCPs were open to collaborations. The sentiment towards the PSP model was positive among providers and administrators, with its acceptability and feasibility noted 25 times by 17 participants.

Conclusions: Consistent communication between providers, maintaining a patient-centered and evidence-based approach to spine care, and ensuring that PSPs are trained to screen and refer conditions outside of their scope will be essential for the success of the PSP model.

Oral Abstract Session 11: Expressive Therapies/Other

OA11.01

Healing Experiences and Lessons Toward Harmony (HEALTH) Soundtracks: An Integrative Collaboration

Angelique Foss ¹ , Seneca Block¹, and Santosh Rao²

¹University Hospitals Connor Whole Health, Cleveland, OH

²University Hospitals Case Medical Center, Pepper Pike, OH

Contact: Angelique Foss, [e-mail]

Abstract

Purpose: When a patient is diagnosed with cancer, the treatment, recovery, and survivorship stages can last from a few months to a lifetime. Unlike some other integrative modalities often utilized within oncology, music therapy can be (1) applied to address patients’ immediate needs; (2) adapted to patients’ cultural preferences; and (3) recorded as a resource to be used throughout cancer treatment. The purpose of the HEALTH Soundtracks program is to address patients’ symptom management needs and provide a means of self-reflection during their treatment journey.

Method(s): HEALTH Soundtracks involves the creation of original music and meditations tailored to patients’ preferences. The process begins with a music therapy referral from an integrative oncologist. Then, the MT conducts a virtual music therapy assessment and exploration of sounds that could be used to enrich the patient’s composition. The patient identifies their “peaceful place” with descriptors that are entered into ChatGPT generating a customized guided imagery script. The intervention is produced and recorded using Garageband music software simultaneously in a state-of-the-art recording studio with the digital distribution of the original soundtrack via email and added to a curated collection for additional resources and support.

Results: Over a 12 month span (August 2023 - August 2024), 45 patients were referred, and 23 assessments were conducted. In total, 17 unique personalized music and meditation soundtracks have been delivered. Patient responses, recordings of tracks, and utilization by patients have been collected as part of the evaluation for continued improvement.

Conclusions: HEALTH Soundtracks is an innovative collaboration between patients with cancer, integrative oncology clinicians, and music therapists to address patients’ symptom management needs throughout treatment. This intervention has the potential to address patients’ long-term needs for symptom management and coping skills during treatment. Future research is needed to evaluate the intervention efficacy and impact on the patient experience.

OA11.02

Implementing Music Therapy and Acupuncture within an Emergency Department at an Academic Medical Center to Combat the Opioid Epidemic

Christine Davis¹, Samuel Rodgers-Melnick ² , Ryan Marino¹, Megan Quesada¹, and Kiran A. Faryar³

¹University Hospitals, Cleveland, OH

²University Hospitals Connor Whole Health, Cleveland, OH

³Department of Emergency Medicine, University Hospitals, Cleveland, OH

Contact: Samuel Rodgers-Melnick, [e-mail]

Abstract

Purpose: To combat the opioid epidemic, a team of emergency department (ED) physicians and integrative health and medicine (IHM) researchers received a grant from the Substance Abuse and Mental Health Services Administration to (1) understand current pain complaints, approaches, and potential barriers to IHM implementation within the ED; (2) train ED providers on medications for opioid use disorder (MOUD) and IHM; (3) implement acupuncture and music therapy; and (4) disseminate best practices.

Method(s): We will use a combination of strategies to monitor the program and produce data to evaluate its effectiveness. These strategies will include collecting (1) structured encounter-level data from the electronic health record including demographics, opioid prescriptions, IHM exposure, and pain diagnoses; (2) data on symptoms, opioid use, IHM engagement and qualitative interviews among patients following their IHM treatment; (3) prospective data on ED providers’ knowledge and perspectives regarding IHM and MOUD; and (4) data (e.g., number of attendees, program evaluations) on IHM and MOUD trainings provided to ED staff. Throughout the program, we will compare rates of opioid utilization and IHM engagement by sociodemographic variables. If disparities persist, we will implement strategies including targeted provider education, assistance to facilitate outpatient follow up with IHM providers, and deploying staff to help with needs such as insurance coverage.

Results: IHM and MOUD trainings for ED physicians, residents and advanced practice providers began in August 2024, with 81 (76% of staff) being trained thus far. IHM implementation is set to begin in November 2024 with licensed acupuncturists and music therapists providing services at least 3 days/week. Preliminary data on IHM effectiveness and changes in opioid administration will be available in Spring 2025.

Conclusions: Successful implementation of this project will inform best practices for provider training, IHM delivery, and nonpharmacologic pain management within the ED at an academic medical center.

OA11.03

Acoustic Resonance Therapy for Treating Moderate-to-Severe Insomnia: A Non-Pharmacological, Personalized Audio Sleep Intervention Study

Kevin Lin¹, Vivek Mohan², Yifei Ma¹, Bryant Lin², Peter Hwang², Darshan Mehta ³ , Paramesh Gopi², and Clete Kushida²

¹Stanford Medicine, Palo Alto, CA

²SoundHealth, Palo Alto, CA

³Osher Center for Integrative Health at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

Contact: Darshan Mehta, [e-mail]

Abstract

Purpose: This single-center interventional study assessed the safety and efficacy of the Sonu Acoustic Resonance Therapy (ART) device by Sound Health Systems for treating moderate-to-severe insomnia.

Method(s): The study recruited 20 adults aged 18 or older who had experienced chronic insomnia for at least three months. Participants had an average baseline Insomnia Severity Index (ISI) score of 19.8, indicating significant sleep difficulties. The ART device, a headband with bone conduction transducers, delivered customized audio therapy based on the participant’s facial features, captured via a smartphone app. Each participant used the device for 45 minutes nightly for four weeks.

Results: The primary outcome measure was a reduction in ISI scores, with a clinically significant threshold of a 7-point decrease. The study found a statistically significant mean reduction in ISI scores of 11.3 points (95% Confidence Interval: -15 to -7.6, p < 0.0001), demonstrating substantial improvement in sleep quality—seventy-five percent of participants achieved at least a 7-point reduction, indicating a high response rate. The device’s effectiveness remained consistent across different demographic variables such as age, gender, and ethnicity. No serious adverse events were reported, highlighting the safety of the therapy. Participants reported 100% adherence to the treatment, reflecting its feasibility for daily use.

Conclusions: ART is a promising non-pharmacological intervention for managing chronic insomnia, significantly improving sleep quality without needing medication. However, further studies with larger sample sizes and more extended follow-up periods are recommended to validate these findings and compare ART with other insomnia treatments, such as cognitive behavioral therapy for insomnia (CBT-I). The results suggest that ART could offer an innovative, safe, and effective alternative for individuals seeking non-invasive sleep therapy options.

OA11.04

Music Therapy To Address Patient’s JOuRneys With CHronic Illness, Outcomes, and ReaDmission (MAJOR CHORD): A Single Arm Pilot Study

Haitong Yu ¹ , Angelique Foss², Tracy Segall³, Seneca Block², Kayleigh Risser¹, Rab Razzak³, Michael Zacharias³, Catalina Teba³, and Samuel Rodgers-Melnick²

¹Case Western Reserve University School of Medicine, Cleveland, OH

²University Hospitals Connor Whole Health, Cleveland, OH

³University Hospitals of Cleveland, Cleveland, OH

Contact: Haitong Yu, [e-mail]

Abstract

Purpose: Music therapy (MT) has the potential to address health challenges faced by patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF), but its impact on 30-day readmission rates and health-related quality of life remains largely under-explored. This study evaluated the feasibility, fidelity, and acceptability of a hybrid MT intervention as a precursor to a randomized control trial (RCT).

Method(s): Using a single-arm, mixed methods approach, twenty inpatients with COPD or HF and access to home videoconferencing technology were recruited. The MT intervention included 2 in-person sessions prior to discharge and 2 virtual sessions following discharge. Feasibility was assessed by rates of recruitment, retention, session attendance, and completion of patient-reported outcomes. Fidelity was evaluated by adherence to the session protocol, while acceptability was assessed through semi-structured interviews.

Results: Of 113 patients approached, 20 (17.7%) were enrolled, and 85% were retained. The median participant age was 61.5 years, with 80% having HF and participants having high rates of anxiety (50%) and depression (35%). Overall session attendance was 57.5%, with higher rates for in-person (75%) compared to virtual sessions (40%). Adherence to the intervention protocol was >80% across all monitored sessions. Challenges with the trial included difficulty reaching participants following discharge, frequent rescheduling of virtual sessions, and participants’ challenges using technology. Semi-structured interviews supported the acceptability of the intervention with three emerging themes: (1) the therapeutic relationship facilitated a positive intervention experience, (2) need for strategies to improve post-discharge engagement in the intervention, and (3) impacts on mental health.

Conclusions: The study supports the feasibility of delivering in-person and virtual MT to patients with COPD or HF. However, challenges in post-discharge communication and virtual session attendance were noted. These issues will be addressed in a subsequent feasibility RCT through implementing secure text-based communication, refined eligibility criteria, and in-person technology instruction.

Oral Abstract Session 12: Cancer Care I

OA12.01

The Mindfulness and Tai Chi for Cancer Health (MATCH) Study: A Preference-Based Multi-Site Randomized Comparative Effectiveness Trial

Linda Carlson ¹ , Jennifer Jones², Devesh Oberoi¹, Katherine-Ann Piedalue³, Peter Wayne⁴, Oluwaseyi Lawal¹, and Michael Speca¹

¹University of Calgary, Calgary, AB

²University Health Network, Toronto, ON

³Memorial University, St. Johns, NL

⁴Osher Center for Integrative Medicine at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

Contact: Linda Carlson, [e-mail]

Abstract

Purpose: A growing number of cancer survivors suffer high levels of distress and other psychosocial symptoms. Two mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been directly compared. This study was the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors.

Method(s): A preference-based multi-site randomized comparative effectiveness trial design was used with broad pragmatic inclusion criteria. Participants with a preference for either MBCR or TCQ received their preferred intervention; while those without a preference were randomized into either intervention. Further, within preference and non-preference groups, participants were randomized 2:1 into immediate intervention or wait-list control. Total Mood Disturbance (TMD) on the Profile of Mood States (POMS) post-intervention was the primary outcome. POMS subscales were also assessed.

Results: 587 participants provided baseline data, 75% females, average age of 60.7 years. 12 different types of cancers were represented, the most prevalent being breast (40.7%), prostate (11.2%), and gastrointestinal (9.7%) cancers. Most were in stage 0 - II (50.1%), with 17% having more advanced disease (stages III or IV). About two-thirds had a preference, of TCQ (213; 57% of those with a preference) and MBCR (163; 43%) and the remaining 36% had no preference and were randomized. Having a preference had no significant effect on outcomes. Both the combined MBCR and TCQ groups improved more than their respective waitlists on TMD scores with small to medium effects. Across subscales, the largest statistical improvements occurred for MBCR on Tension, Anger and Vigor, and in TCQ on Anger, Depression and Vigor, with small to medium effects.

Conclusions: Both interventions improved mood in distressed cancer survivors with some specificity, but being able to choose a program had no effect.

OA12.02

Group Acupuncture as a Model for Symptom Management for Oncology Patients

Alissa Huston ¹ , Sydney John², Kelly Griffith³, Jin Fang², and Aizhong Li²

¹Pluta Integrative Oncology & Wellness Center, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY

²Pluta Integrative Oncology & Wellness Center, University of Rochester Medical Center, Rochester, NY

³Pluta Integrative Oncology & Wellness Center, Rochester, NY

Contact: Alissa Huston, [e-mail]

Abstract

Purpose: Recent SIO-ASCO guidelines recommend acupuncture for the management of cancer-related symptoms including joint arthralgias and neuropathy, both debilitating side effects of cancer treatment. The Pluta Integrative Oncology & Wellness Center implemented a pilot group model for acupuncture and presented here is data from a retrospective analysis.

Method(s): Eligibility: treatment with anti-estrogen therapy experiencing joint arthralgias (group 1) and treatment related neuropathy (group 2). The intervention involved 6 weeks of 60 minute twice weekly group acupuncture treatments (4-6 patients) administered by oncology trained acupuncturists. ESAS-R was performed at baseline, 3 weeks, 6 weeks and expanded to each session. Patients were provided opportunities for qualitative feedback.

Results: 42 patients (41 female, 1 male) ages 36-85 were treated in 2 groups (27 group 1 and 15 group 2) in 7 separate cohorts over 3 years. In group 1, 26 were taking AIs and 1 Tamoxifen and in group 2 the most common chemotherapy treatment received was a taxane. Acupuncture points used included: DU20 (百会), SSC (四神聪), LI4 (合⾕), LIV3 (太溪), ST36 (⾜三⾥), HT7 (神 ⻔) and Ashi Points (阿是). Trends in ESAS-R included improvements in pain, neuropathy, sleep quality and overall well-being. In addition, positive themes on qualitive feedback were observed.

Conclusions: Our retrospective analysis demonstrates the feasibility of a group acupuncture model to expand availability of and access to acupuncture. Qualitative responses indicated an overall improvement in symptoms and a sense of camaraderie unique to the group format. Access and affordability remain barriers to acupuncture, particularly within rural/underserved regions, and a group model offers a cost-effective way to reach a larger number of patients. Limitations include the retrospective format and limited data in several cohorts. Future directions include using this data to support a prospective intervention, expansion to other symptoms (i.e. xerostomia, hot flashes) and extension to our regional cancer center sites.

OA12.03

Association of Hospitals’ Organizational Characteristics and Market Factors Offering Integrative Medicine Services to Adult Cancer Patients

Sanober Ajani ¹ , Kristine Ria Hearld², Soumya Niranjan², Allyson Hall², and Nancy Borkowski²

¹University of Alabama - Birmingham, Houston, TX

²University of Alabama - Birmingham, Birmingham, AL

Contact: Sanober Ajani, [e-mail]

Abstract

Purpose: Integrative medicine (IM) plays an important role in cancer symptom management by providing patients with a range of non-pharmacological options to help manage the physical and emotional symptoms associated with cancer and its treatment. More patients are seeking IM services due in part to a more holistic or patient-centered approach to cancer care, alleviating side effects from cancer treatments, improving quality of life, and enhancing cancer treatment effectiveness. Although the demand for IM services is increasing, there is a gap in our knowledge regarding which cancer hospitals are providing IM programs and what services are offered within these programs. As such, the aim of this exploratory cross-sectional study is two-fold: (1) to examine the association of the organizational characteristics and market factors between cancer hospitals that provide IM services and those that do not, and (2) to better understand what services comprise IM programs within these cancer hospitals and how these services are funded.

Method(s): Bivariate analysis evaluated the relationship between the dependent variable (cancer hospitals offering IM services) and the independent categorical variables. Chi-square tests were performed for categorical variables, and t-tests were used to compare means for continuous variables. Descriptive statistics were used to summarize and describe survey results.

Results: Key findings showed statistically significant associations between cancer hospitals providing IM services and those that do not. A higher proportion of cancer hospitals with IM are not-for-profit, larger (bed size 400+), system-affiliated, teaching entities located in metropolitan areas with larger populations and higher per capita income. Survey results reflect that the most frequently offered IM services are nutrition counseling, acupuncture, and massage therapy. Additionally, philanthropy plays an essential role in providing financial support for IM services.

Conclusions: This study emphasizes the need for a better understanding of the factors influencing the availability and accessibility of IM services in cancer care.

OA12.04

Restoring Wholeness: Breast Cancer Survivors’ Perspectives on Fragmentation and Healing After a 4-month Ayurvedic Medicine Intervention

Nikita Patel ¹ , and Anand Dhruva²

¹Kaiser Permanente School of Medicine, Pasadena, CA

²University of California, San Francisco, San Francisco, CA

Contact: Nikita Patel, [e-mail]

Abstract

Purpose: The treatment of breast cancer and subsequent transition into survivorship can be a challenging period, often disrupting the sense of self and breaking the idea of wholeness. With its roots as a holistic thought system, we hypothesized that Ayurveda may benefit post-treatment breast cancer survivors (BCS) in their journey to feeling whole again.

Method(s): This qualitative study included 21 BCS who had completed cancer treatment for stage I-III disease within the past year. All women had received chemotherapy. Patients then underwent a 4-month Ayurvedic intervention that involved personalized counseling on nutrition, lifestyle, yoga, and marma during 8 one-on-one visits with an Ayurvedic practitioner. Semi-structured qualitative interviews were conducted at baseline and upon completion of the intervention. Transcripts were analyzed using thematic content analysis.

Results: The major themes that emerged highlighted the distressing nature of the cancer experience and post-treatment period, where the Ayurvedic intervention was found to have a positive impact. The transition to survivorship involved elements of anxiety about cancer recurrence, frustrations with depersonalized care, and mind-body disconnect after diagnosis and treatment. Participants described feeling less whole and even “broken” during this period. After the Ayurvedic intervention, patients endorsed feeling empowered through skill building including greater nutritional knowledge and an increased sense of control over their health. Patients reported improved body awareness and a focus on self-care through practicing Ayurveda, strengthening the previously fragmented connection between mind and body and fostering a stronger sense of wholeness.

Conclusions: We found that the significant sources of distress during cancer treatment and survivorship can contribute to a diminished sense of “wholeness” in BCS, which Ayurveda shows potential to alleviate. An Ayurvedic intervention in the post-treatment period may be beneficial in helping breast cancer survivors work towards restoring wholeness and well-being in their lives.

Oral Abstract Session 13: Management of Opioid-Treated Pain

OA13.01

Mindfulness-Oriented Recovery Enhancement Alleviates Opioid-Treated Chronic Pain By Evoking Self-Transcendence

Eric Garland¹

¹University of California San Diego (UCSD), La Jolla, CA

Contact: Eric Garland, [e-mail]

Abstract

Purpose: Mindfulness-based interventions are thought to relieve pain via mechanisms including acceptance and attention regulation. However, for millennia, mindfulness has been held as a means of alleviating suffering by transcending the limited sense of self. Given the role of the default mode network in self-referential processing and the development of chronic pain, mindfulness might produce pain relief by eliciting self-transcendent experiences.

Method(s): In a NIH R01-funded randomized controlled trial, patients with chronic pain (N=250) on long-term opioid therapy were randomized to receive 8 weeks of Mindfulness-Oriented Recovery Enhancement (MORE), or Supportive Group (SG) therapy, delivered in a primary care environment. Chronic pain symptoms were assessed with the Brief Pain Inventory through 9-month follow-up. Self-transcendent experiences like ego dissolution and unity were assessed with the Nondual Awareness Dimensional Assessment. Path analysis tested self-transcendence as a mediator of the pain relieving effects of MORE. Participants also completed a laboratory-based mindfulness meditation task while EEG was recorded from 10 midline scalp sites.

Results: The effects of MORE on reducing chronic pain severity through 9-month follow-up were statistically mediated by increases in self-transcendence from pre- to post-treatment. MORE also led to significant increases in frontal midline theta EEG power during mindfulness meditation, which were associated with self-transcendent experiences and predicted reduced pain-related functional interference.

Conclusions: MORE alleviated chronic pain symptoms among patients on long-term opioid therapy by stimulating self-transcendent states of consciousness. Hypothetically, mindfulness-induced self-transcendence may disrupt aberrant self-referential processing in the default mode network via endogenous theta stimulation of the prefrontal cortex, and thereby enhance self-regulation of pain.

OA13.02

Learning Ways to Reduce Preoperative Anxiety May Assist in Postoperative Opioid Levels

Maryanna Klatt ¹ , Jacqueline Caputo², Yulia Mulugeta², Slate Bretz³, Jane Ginther⁴, Lisa Coleman⁴, Laura Pheiffer⁵, Amythest Gauthier⁶, Natalie Weber⁶, Selemawit Woldesenbet⁷, Jessica Joseph⁶, Elizabeth Palmer-Kelly⁷, Timothy Pawlik⁸, and Anne-Marie Duchemin⁹

¹Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

²The Ohio State University, Columbus, OH

³The Ohio State University, College of Medicine, Dept. of Family and Community Medicine, Columbus, OH

⁴The Ohio State University Wexner Medical Center, Columbus, OH

⁵The Ohio State University Medical Center, Columbus, OH

⁶Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH

⁷Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH

⁸Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH

⁹Stress, Trauma and Resilience Program, Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: To evaluate the effectiveness of a 10-minute meditation vs recorded silence on the anxiety of pre-operative orthopedic patients and subsequent opioid utilization in postoperative care.

Method(s): Patients were consented and randomized into one of two groups: 10-minutes of either a pre-recorded meditation or silence administered through noise cancelling headphones in the pre-operative area. Pre-post intervention surveys were administered in the pre-op area. Additionally, three days of post-surgical opioid data was collected via Electronic Medical Record chart review. Morphine Milligram equivalents (MMEs) were calculated per patient.

Results: Patients in both arms, recorded silence and guided meditation (n=106) achieved significant decreases on the Emotional Distress Scale (EDS) (p=0.00001) comparing pre/post levels. The meditation group (n=50) was significantly more effective in reducing distress compared to the silence group (n=56) (p=0.0024). Patients also rated their anxiety levels on a scale of 1(no anxiety) to 10(high anxiety), the overall anxiety level was reduced in both conditions pre/post (p=0.00001). Like the distress results, the meditation group’s anxiety score reduction was significantly greater than the silence study arm (p=0.00001). 76 patients had complete opioid medication data and the average MME across 3 days post-surgery was 41.67. There were no significant differences in MME levels given after surgery comparing intervention arms. However, the average MME across both conditions was less than 50 MMEs, which is the value prescribing practitioners are cautioned not exceed post-surgery. The intent is to avoid dependency or increased tolerance resulting from opioids administered post-surgery.

Conclusions: A 10-minute meditation prior to surgery can reduce anxiety and emotional distress in patients receiving orthopedic surgery. Offering a guided meditation or silence as standard of care in the pre-operative environment to address surgical patient anxiety is cost effective and a pragmatic approach to pre-surgical patient anxiety/distress. Pre-op anxiety/distress reduction may keep post-op MMEs to a minimum.

OA13.03

Associations Between Increased Use of Nondrug and Integrative Modalities and Reduction in Pain and Opioid Dose in Veterans with Chronic Pain and PTSD

Karen Seal ¹ , Patrick Hammett², William Becker³, Elizabeth Goldsmith², and Erin Krebs²

¹San Francisco VAHCS, University of California, San Francisco, San Francisco, CA

²Minneapolis VA Health Care System, Minneapolis, MN

³Yale School of Medicine, New Haven, CT

Contact: Karen Seal, [e-mail]

Abstract

Purpose: Chronic pain and posttraumatic stress disorder (PTSD) are common co-occurring conditions associated with poorer outcomes. Nondrug therapies (NDTs, e.g., yoga, acupuncture) are first line for chronic pain, but their effects among patients with co-occurring PTSD is unknown.

Method(s): From 2017 to 2021, 820 patients with chronic pain prescribed long-term opioids enrolled in VOICE, a pragmatic trial at 10 VA sites. Participants were randomized to one of two pain care delivery models. NDT use, Brief Pain Inventory (BPI) scores, and opioid dose were assessed at baseline, 6-, and 12-months. NDTs were categorized as manual (acupuncture, chiropractic, massage), movement (yoga, tai chi, aerobic, stretching/strength), and behavioral therapies (meditation, relaxation). Frequency thresholds for clinically meaningful use of NDTs were defined by expert consensus. Multivariable repeated measures regressions modelled associations between increases in NDT use of ≥1 therapy (vs. stable/decreased use) and changes in pain and opioid dose from baseline at 6- and 12-months, adjusted for intervention condition, age, sex, race, and baseline values of the predictors and outcomes.

Results: Two hundred (24%) of participants had probable PTSD at baseline. Both pain care delivery models resulted in significant increases in NDT use. Among participants with co-occurring chronic pain and PTSD, an increase in the total number of NDTs used was positively associated with a 30% reduction in BPI total score at 12 months and increased manual therapy use was associated with a 30% reduction in BPI severity at 6 months. Increased use of movement therapy was associated with a 25% reduction in opioid dose at 12 months (OR=2.01, 95% CI=1.10-3.70; p=0.024).

Conclusions: Among participants with co-occurring chronic pain and PTSD, increased use of NDTs, and manual and movement therapies was associated with decreases in chronic pain and opioid dose.

OA13.04

Relief: A Placebo-Controlled, Randomized Trial Assessing Medical Cannabis Impact on Opioid Use in Chronic Pain

Stephen Dahmer ¹ , Deepika Slawek², Chenshu Zhang³, Julia Arnsten³, Joanna Starrels⁴, Giovanna DiFrancesca⁵, and Olivia Uhley⁶

¹AWCIM, Tucson, AZ

²Montefiore, Bronx, NY

³Albert Einstein, Bronx, NY

⁴Albert Einstein College of Medicine, New York, NY

⁵Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY

⁶Vireo Health, New York, NY

Contact: Stephen Dahmer, [e-mail]

Abstract

Purpose: Chronic non-malignant pain affects nearly 30% of US adults, yet few therapies improve outcomes. Amidst an opioid overdose crisis, new treatments are needed. This trial (ReLeaf) will examine if medical cannabis reduces prescription opioid use among 267 chronic pain patients over 14 weeks. No controlled studies have directly looked at medical cannabis’s impact on opioid use or adverse events. ReLeaf aims to fill these evidence gaps and determine the effectiveness of medical cannabis in reducing opioid use.

Method(s): ReLeaf, a randomized controlled trial, is conducted at Montefiore Medical Center in the Bronx and Vireo Health dispensary in Queens. Participants are adults with severe or chronic pain prescribed opioids within the past 30 days. They are randomized to one of four medical cannabis softgel capsules: placebo, high THC:low CBD, 1:1 THC:CBD, or low THC:high CBD. Over 14 weeks, participants complete research visits and weekly surveys. The primary outcome is cumulative opioid use by self-report and NYS prescription monitoring program records.

Results: Among 142 ReLeaf participants, the mean age is 57+10 years, with 66% female, 43% Black, 45% Latinx, and 82% not employed. Almost all had taken prescribed opioids for pain in the past 30 days, with severe pain symptoms reported by 44%. Over 40% screened positive for anxiety, depression, or PTSD.

Conclusions: We conducted a placebo-controlled trial of different cannabis softgel formulations among adults with chronic pain and prescription opioid use. The goal is to determine if medical cannabis reduces opioid use over time. We’ve successfully enrolled over half our planned cohort with participants having high burdens of pain severity and mental health symptoms. Results will inform dosing and prescribing recommendations for medical cannabis.

Oral Abstract Session 14: Whole Health Implementation

OA14.01

What Do We Know About Health & Wellness Coaching for a Complex Patient Population? Insights From VA’s Electronic Health Record Data

Ekaterina Anderson ¹ , Alexandre Vilela Braga², Renda Wiener², Makayla Dones³, Seppo Rinne², Marla Clayman⁴, Justeen Hyde⁵, Christian Helfrich⁶, Barbara Bokhour⁷, and Steven Zeliadt⁸

¹Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

²VA Center for Health Optimization and Implementation Research, Bedford, MA

³Center for Healthcare Organization and Implementation Research, Bedford, MA

⁴VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA

⁵Veterans Health Administration, Bedford, MA

⁶VA Center for Veteran-Centered and Value-Driven Care, Seattle, WA

⁷Veterans Health Administration, Seattle, WA

⁸VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Ekaterina Anderson, [e-mail]

Abstract

Purpose: Health & Wellness Coaching (HWC), which provides patients with support in setting and pursuing personally meaningful health and well-being goals, is offered by a growing number of health systems. Improving HWC implementation requires understanding its current utilization. The Veterans Health Administration (VA) is leading the way with its system-wide roll-out of access to HWC. We sought to understand HWC use among VA patients with chronic obstructive pulmonary disease (COPD) -- a population that is both high-priority and well-positioned to achieve greater engagement in care and improved quality of life through HWC.

Method(s): Using administrative data, we built a national cohort of patients with COPD receiving care in the VA during 2021-2023 (n=400,829). Patients with >=1 HWC session during the study period were classified as HWC users. A mixed effects logistic regression model was constructed to identify significant (p<0.05) predictors of HWC utilization.

Results: 4.4% of the cohort used HWC during the study period, varying from 0.5% to 34% of patients with COPD getting HWC per site. Half of all users were concentrated at 10% of the sites (13/130). Users were more likely to be female, younger, Black, Hispanic/Latino, not married, and urban dwelling. Patients with recently diagnosed COPD (within past 6-12 months), substance use (tobacco, alcohol or drugs), mental health conditions (depression, anxiety, or PTSD), chronic pain, obesity, or polypharmacy were more likely to use HWC.

Conclusions: Use of HWC among VA patients with COPD is highly variable, with opportunities for improving the system-wide spread of HWC. HWC appears to be reaching patients with complex clinical needs, which is a promising development, given the unmet needs of this population. The sociodemographic differences between HWC users and non-users are notable and may indicate disparities in HWC implementation. Qualitative research is needed to verify and contextualize these findings.

OA14.02

Increasing Usage and EHR Documentation of VA Whole Health Patient Centered Care Model: A Process Improvement Project

Sakuna Thongchanh ¹ , Mala Sanchez¹, and Julie Melbourne¹

¹VA Puget Sound Health Care System, Seattle, WA

Contact: Sakuna Thongchanh, [e-mail]

Abstract

Purpose: We sought to increase usage and documentation of the Veteran Health Administration’s patient-centered care (PCC) model in our electronic health record (EHR) at the Veteran Affairs Puget Sound Healthcare System (VAPSHCS).

Method(s): This process improvement project was guided by ADKAR change management and innovation concepts such as ‘pitching and storytelling’ and Human Centered Design (HCD) iterations. We first increased awareness of existing national Whole Health (WH) templates. We then streamlined the process by pulling key PCC questions into local templates. Both national template and the questions in local templates were optional to use. We brought awareness to the templates through initiatives such as the Personal Health Inventory (PHI) challenge, in-services, posters, and cheat sheets. The templates were socialized and disseminated non-discriminately throughout various clinical care settings starting April 2023. Health factors were used in the EHR templates to capture adoption metrics. We reviewed VA national data from fiscal year 2022 through 2024.

Results: From Oct 2022 through March 2023, average monthly number of Veterans asked at least one PCC question was 54 (median of 55). During our first initiative to increase awareness (PHI Challenge) from April 2023 through June 2023, monthly average increased to 261 (median of 301). From August 2023 through September 2024, PCC questions were added to local templates, during this period the monthly average rose to 2929 (median of 3011).

Conclusions: Increase usage of optional PCC questions occurred with awareness of national EHR templates. Dramatic increase in usage occurred after these questions were added to local EHR templates. Anecdotal reports suggest increasing visibility and accessibility of PCC questions in local templates is likely not the sole reason for increased adoption. We postulate that including questions in local templates must be accompanied by change management and innovative designs to create a culture and an expectation to adopt PCC usage and documentation.

OA14.03

Healing Beyond Hospitalization: Introducing Whole Health to Acute Care Veterans

Candace McNulty ¹ , and Ashley Rush¹

¹VHA, Orlando, FL

Contact: Candace McNulty, [e-mail]

Abstract

Purpose: National studies show that Veterans who engage in Whole Health services report improved satisfaction with VA care, higher engagement in healthy behaviors, participation in health care decisions and improvements in overall well-being. This project aims to support Veterans in Acute Care by addressing gaps in their understanding of Whole Health services. It enhances continuity of care between inpatient and outpatient settings, empowering Veterans and staff to take charge of their health and well-being. In Acute Care, no process existed for educating and referring Veterans and caregivers to Whole Health and the benefits of engaging in proactive care for many of the conditions they are hospitalized for in the Acute Care setting

Method(s): A holistic team member was assigned to the hospital units to engage with hospitalized Veterans and promote Pathway and well-being to the patients. They provided holistic interventions at the bedside and referred interested patients to the outpatient Whole Health program upon discharge, effectively bridging the gap between acute care and preventative services.

Results: To date, we have provided a holistic intervention on 309 patients and placed 204 (64%) Whole Health consults upon discharge to connect the Veteran to Whole Health preventative care resources. Before the initiation of the pilot, direct referrals to Whole Health upon discharge was 0%. Of the 309 patients, 84% were Whole Health naïve, and unaware of the availability of Whole Health services. Also, 47% wanted additional holistic interventions during their hospital stay.

Conclusions: Increasing exposure to Whole Health for Veterans and caregivers while admitted in Acute Care setting will encourage a proactive healthcare model and improve recovery outcomes. This method created continuity of care between the hospitalized vulnerable patient population and the Whole Health program.

OA14.04

Whole Health is Positively Associated with Multiple Measures of Care Quality: A National Evaluation of the Veterans Health Administration (VA)

Xiaoyi Zhang ¹ , Jamie Douglas², Chase Eck³, Gang Luo¹, Barbara Bokhour⁴, and Steven Zeliadt⁵

¹Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA

²VA Puget Sound Health Care System, Seattle, WA

³Michael E. DeBakey VA Medical Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA, Houston, TX

⁴Veterans Health Administration, Seattle, WA

⁵VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Xiaoyi Zhang, [e-mail]

Abstract

Purpose: For nearly a decade, the Veterans Health Administration (VA) has implemented a Whole Health system of care to improve patient-centered care. This study explores associations between use of Whole Health services (WHS) and population-level changes in standardized Healthcare Effectiveness Data and Information Set (HEDIS) quality measures.

Method(s): We monitored 9 prevention-focused HEDIS-derived electronic quality measures for 5,977,381 eligible veterans across all VA facilities from October 2022 to March 2023. The outcome variable was the change in each measure from 1 month prior to 6 months post WHS initiation. For each quality measure, χ2 tests of independence (α = .05) were used to compare outcomes between WHS initializers and the corresponding VA reference cohorts over the same time period.

Results: 548,968 veterans were identified as new users of WHS. Significant improvements were observed in 8 out of 9 quality measures following WHS initiation compared to reference cohorts: HbA1c control (<8%) for diabetes improved by 5.2% versus 1.6% (P<0.001); poor HbA1c control for diabetes (≥9%) decreased by 4.9% versus 1.4% (P<0.001); blood pressure control (<140/90 mmHg) for diabetics improved by 7.6% versus 3.5% (P<0.001); colorectal cancer screening rates increased by 4.9% versus 1.7% (P<0.001); breast cancer screening rates increased by 3.4% versus 0.5% (P<0.001); pneumococcal vaccination rates in older adults increased by 2.9% versus 0.6% (P<0.001); hypertension blood pressure control (<140/90 mmHg) increased by 5.2% versus 4.2% (P=0.008); statin therapy for diabetes increased by 1.2% versus 0.4% decrease (P=0.002); statin therapy for cardiovascular disease increased by 0.4% versus 0.1% (P=0.7). Improvements were generally observed immediately following WHS initiation and sustained throughout the 6-month follow-up period.

Conclusions: Initiation of WHS in the VA was associated with meaningful improvements in multiple standardized quality measures among patients already engaged in primary care, suggesting WHS offers a potential benefit in enhancing overall care quality.

Oral Abstract Session 15: Group-Based Interventions

OA15.01

External Qi Gong in the Treatment of Long COVID: A Pilot Study

Michael Yanuck ¹ , Michelle Dossett², and Monica Joy³

¹Sacramento VA Medical Center, Mather, CA

²University of California, Davis, Sacramento, CA

³University of California Davis School of Medicine, Sacramento, CA

Contact: Michael Yanuck, [e-mail]

Abstract

Purpose: A substantial proportion of individuals who have been infected with the SARS-CoV-2 virus causing COVID-19 disease have persistent symptoms beyond 12 weeks. These individuals have so-called “long COVID.” Few treatments for these symptoms have been identified. It has been suggested that these patients may benefit from complementary and integrative health (CIH) approaches. Qigong may be one such approach. Qigong is a Traditional Chinese Medicine practice based on the idea that qi (“vital energy”) circulates through the body to facilitate gong (“function”). We conducted a pilot feasibility trial of external qigong for long COVID symptoms.

Method(s): Thirty-nine individuals with long COVID symptoms were randomized 1:1 to participate in qigong immediately or in a waitlist control group. Study participants received six weekly external qigong sessions delivered in a group-based format (4-12 individuals). Participants completed PROMIS-29 v2.1 and PROMIS cognitive function questionnaires at baseline, 8, and 16 weeks. Intent-to-treat paired samples t-tests were performed to examine differences in symptoms before and after the qigong intervention for all participants, regardless of group assignment. Longitudinal analyses were used to examine differences between the immediate and waitlist control groups.

Results: Thirty-one individuals completed questionnaires at all time points; 26 participated in at least 5 of 6 qigong sessions. The average age of participants was 54 years (range 25-79), and 72% identified as female with 77% identifying as white. Paired samples t-tests demonstrated significant improvements in ability to participate in social roles (p=0.003), anxiety (0.02), depression (0.005), fatigue (0.001), and pain interference (p=0.045) following participation in the qigong intervention. Longitudinal analyses demonstrated a significant improvement in fatigue (p=0.048) between groups at 8 weeks with a trend toward improvement in ability to participate in social roles (p=0.07) and pain interference (p=0.12).

Conclusions: External Qigong is a low-risk CIH approach that may improve long COVID symptoms.

OA15.02

A Whole Health Approach to Comprehensive Diabetes Care

Rashmi Mullur ¹ , Jennifer Allen², and Keerthana Haridas¹

¹UCLA, Los Angeles, CA

²VA Greater Los Angeles, Los Angeles, CA

Contact: Rashmi Mullur, [e-mail]

Abstract

Purpose: Patients with Diabetes Mellitus (DM) require a holistic approach to address their glycemic and non-glycemic goals. Providing a Whole Health (WH) approach to diabetes care allows for broader understanding of diabetes-related distress and the challenges that patients with diabetes face. Our virtual group clinic model allows patients with DM to improve shared decision making and self-efficacy with the guidance and education on WH principles specifically tailored to the lived experience of a patient with diabetes.

Method(s): We recruited patients from VA-Greater Los Angeles to attend a virtual group visit on “A Whole Health Approach to Diabetes Care.” During the 90-minute visit, Veterans participated in a virtual education session where they learned about the principles of WH and were introduced to the personal health inventory (PHI). Veterans were instructed on the impact of mind-body spirit approaches to improve diabetes outcomes and encouraged to share barriers and challenges they faced in relation to their diabetes care. At the end of the didactic portion, Veterans were instructed in a mind-body practice and referred to relevant CIH and WH classes upon request.

Results: Thus far, 44 Veterans have participated in the clinic with an age range of 33-87 and 91% being male. The starting average A1c was 8.4% with 25 (56%) participants struggling with high diabetes-distress emotional burden scores. Only 25 (56%) of Veterans had previous exposure to CIH or WH. To date, follow up A1c data is available for 72% of participants showing an average A1c reduction of -0.68 and 48% Veterans requested referrals to additional CIH or WH services.

Conclusions: The WH for DM clinic provides a successful framework to introduce principles of WH for patients with Diabetes. Our clinical approach is feasible and effective to improve glycemic control. Our preliminary findings support further expansion and evaluation of this program for holistic diabetes care.

OA15.03

Mindfulness-Based Pain Management for Patients With Chronic Musculoskeletal Pain: A Randomized Controlled Trial

Holger Cramer ¹ , Sanja Krstic¹, Jörg Meibert², Dennis Anheyer³, Petra Meibert², Marleen Schröter⁴, and Heidemarie Haller⁵

¹University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

²Mindfulness Institute Ruhr, Essen, Nordrhein-Westfalen, Germany

³Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

⁴Charité-Universitätsmedizin Berlin, Berlin, Germany

⁵Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany

Contact: Holger Cramer, [e-mail]

Abstract

Purpose: Mindfulness-Based Pain Management (MBPM) is a behavioral medicine program developed by Vidyamala Burch et al. specifically as an intervention for chronic pain. Initial studies suggest its effectiveness, but the effect on patients with chronic musculoskeletal pain has not yet been investigated in randomized trials. The aim of this study was therefore to investigate MBPM in patients with chronic musculoskeletal pain.

Method(s): Patients (18 years and older) with chronic (specific and non-specific) musculoskeletal pain were randomized to MBPM, 8 weekly 150-minute sessions, or to a wait-list control group. MBPM included mindfulness and (self-)compassion training, gentle physical and body awareness exercises, and mindful pain management. The primary outcome measure was pain acceptance as assessed by the Chronic Pain Acceptance Questionnaire at week 8. Secondary outcomes included pain acceptance at week 26 as well as pain intensity (Numeric Rating Scale), pain disability (Pain Disability Index), health-related quality of life (SF-12), psychological well-being (Hospital Anxiety and Depression Scale), pain self-efficacy (Arthritis Self-Efficacy Scale), mindfulness (Conscious Presence and Self Control Scale), self-compassion (Self-Compassion Scale) and adverse events at weeks 8 and 26, respectively.

Results: Forty patients (75% female, mean age 61.8±8.7 years) were randomized to MBPM (n=20) or wait-list (n=20). By week 8, pain acceptance increased from 66.2±15.9 to 70.1±14.4 in the MBPM group and decreased from 69.7±14.5 to 64.8±19.6 in the waiting list group, with no significant group differences observed (effect size=0.35; p=0.090). No significant group differences were found for the secondary outcomes either. There were no serious adverse events.

Conclusions: Non‐pharmacological interventions continue to be an important alternative to drug therapies for chronic pain. However, no significant benefits were found for MBPM in this study. Nevertheless, since a small effect was found that is comparable to other mind-body therapies, effectiveness of the approach cannot be ruled out. Larger studies with higher statistical power are therefore indicated.

OA15.04

Breaking the Cycle: Exploring the Feasibility of a ‘Dopamine Reset’ Online Shared Medical Appointment for Behavioral Addiction Awareness

Michelle Loy¹

¹Integrative Health/Weill Cornell Medical/NYP Hospital, New York, NY

Contact: Michelle Loy, [e-mail]

Abstract

Purpose: Behavioral addictions, such as internet overuse, binge eating, shopping, gambling, and gaming are increasingly recognized for their harmful effects on both physical and mental health. While substantial debate exists regarding the official recognition of behavioral addictions as mental disorders, discussion of the topic by workgroups involved with the DSM V and International Classification of Diseases (ICD-11) highlight their potential clinical importance. Shared Medical Appointments (SMA) have emerged as innovative care models that improve both physical and mental health outcomes. This pilot aimed to assess the feasibility of a virtual SMA focused on raising awareness of behavioral addictions.

Method(s): A four-week virtual SMA series was developed at a large urban academic teaching hospital. Led by a physician from the Integrative Health practice, each one-hour session combined education on the neuroscience of addiction with practical strategies such as hormesis (e.g., nature exposure, exercise, and meditation) to rewire reward pathways and regain control over cravings. The program included engagement tools such as time-tracking, mindful self-binding strategies, dopamine-supportive hormetic activities, and group discussions. Data collection included electronic surveys at enrollment, attendance records, and chart reviews.

Results: 15 participants (divided into two 4-week long cohorts) attended at least one session. Demographics included 60% White, 40% Black or Hispanic; 87% female; mean age 50 years. Overall attendance rate was 94%, with an average of 6 participants per session. Common goals for joining included addressing sleep disturbances due to excessive screen time; improving focus; and reducing stress, anxiety, depression. Post-SMA feedback indicated increased outdoor activity, improved in-person social connections, greater awareness of mindless behaviors, reduced phone usage, fewer impulse purchases, decreased sleep medication use, and heightened productivity. All 58 SMA visits were successfully billed to insurance without denial.

Conclusions: This “Dopamine Reset” pilot demonstrates feasibility and suggests potential for positive impact of virtual SMAs for behavioral addiction awareness and habit.

Oral Abstract Session 16: Health Services Research II

OA16.01

Integrative Health Awareness, Use, and Needs: A Case Study of Vermonters

Christine Vatovec ¹ , and Kristie Grover¹

¹University of Vermont Osher Center for Integrative Health, Burlington, VT

Contact: Christine Vatovec, [e-mail]

Abstract

Purpose: An integrative approach to health care offers the potential for better outcomes for both people and the planet, but current levels of awareness, use, and needs related to integrative therapies are unknown.

Method(s): In March to April 2024, we employed standard online survey methodology to elicit data from current residents of Vermont aged 18 years and older regarding their perspectives on, utilization of, and barriers to accessing integrative therapies.

Results: Survey respondents (n=493; 95% CI +/- 4.4%) included 58% Females, 41% Males, the majority of whom identified as white/Caucasian (87%), employed at least part-time (88%), and having at least a college degree (40%). A Whole Person Health approach appealed to 75% of respondents, and 71% responded that they would prefer integrative therapies over pharmaceuticals whenever possible, while 57% were familiar with integrative therapies and how they can be used to support health and healing. While 51% reported wanting to learn more about integrative therapies, only 13% responded that their doctor discusses these options at every visit. The most commonly used integrative therapies currently included Lifestyle Tools (62%), followed by Biochemical therapies (49%), Mind-Body (48%), Biomechanical (34%), and Biofield (13%), while 20% had never used any form of integrative or complementary therapy. Primary barriers to using integrative therapies included lack of insurance coverage (39%), lack of time (16%), and lack of local providers (12%).

Conclusions: These findings from Vermont suggest that adults have strong interest in learning about and utilizing integrative health approaches, but that their healthcare providers are not currently discussing these options on a regular basis with patients, and lack of insurance coverage is a primary barrier to integrative care. Our results have implications for policies regarding both clinician training in support of sharing integrative options with patients, and support calls for insurance carriers to cover integrative therapies.

OA16.03

Evidence-Based Approaches to Chronic Pain Management in São Paulo City, Brazil

Mariana Cabral Schveitzer ¹ , Ricardo Ghelman², Caio Portella³, Carmem Veronica Mendes Abdala⁴, and Adalberto Aguemi⁵

¹UNIFESP and CABSIN, São Paulo, Brazil

²CABSIN, São Paulo, Brazil

³Brazilian Academic Consortium for Integrative Health, São Paulo, Brazil

⁴BIREME/OPAS/WHO, São Paulo, Brazil

⁵São Paulo Health Council, São Paulo, Brazil

Contact: Mariana Cabral Schveitzer, [e-mail]

Abstract

Purpose: The strategic integration of evidence-based traditional and complementary medicine (TCIM) practices holds significant promise, particularly within countries with universal health systems like Brazil. This is exemplified by São Paulo city’s recent endeavor to develop guidelines for chronic pain management, reflecting a broader trend in Brazil’s healthcare system. Our primary objective is to illustrate the pivotal role of evidence-based TCIM in informing healthcare policy and practice, with a focus on chronic pain management. We aim to showcase the successful collaboration between the Brazilian Academic Consortium of Integrative Health (CABSIN) and local health authorities in São Paulo city, highlighting the process of developing and implementing evidence-informed guidelines for TCIM practices.

Method(s): We initiated our project by meticulously mapping TCIM evidence, leveraging existing resources such as systematic reviews, in collaboration with Bireme/PAHO/WHO. The collected evidence, comprising over 2000 systematic reviews, was made accessible on the TCIM Virtual Health Library website. Subsequently, we collaborated with São Paulo city’s health authorities to design evidence-based guidelines for chronic pain management, informed by the identified TCIM evidence. All TCIM Evidence Maps are available at - https://mtci.bvsalud.org/en/evidence-maps/

Results: TCIM Evidence Mapping culminated in the development and publication of evidence-based guidelines for chronic pain management, encompassing the following TCIM practices: Tai chi, meditation, cupping therapy, acupuncture, auriculotherapy, herbal remedies, reflexology, yoga. The guidelines were made available for public review and subsequently disseminated to all relevant stakeholders, marking a significant milestone in promoting evidence-based TCIM within São Paulo city’s healthcare system.

Conclusions: This collaborative initiative underscores the tangible impact of integrating evidence-based TCIM practices into a universal health system. Moving forward, our goal is to further expand the integration of TCIM evidence across diverse healthcare domains, thereby enhancing the accessibility and efficacy of TCIM interventions for the benefit of all.

OA16.04

Prevalence and Determinants of Complementary and Integrative Health Approaches: A Cross-Sectional Study Using the All of Us Research Program

Brian Anderson ¹ , Ryan Bradley², James M Whedon³, and Patricia M Herman⁴

¹Palmer College of Chiropractic, Davenport, IA

²National University of Natural Medicine, Portland, OR

³Southern California University of Health Sciences, Whittier, CA

⁴RAND Corporation, Sonoma, CA

Contact: Brian Anderson, [e-mail]

Abstract

Purpose: To estimate prevalence and predictors of Complementary and Integrative Health (CIH) utilization within the All of Us (AoU) Research Program’s electronic health record (EHR) dataset.

Method(s): retrospective, cross-sectional analysis of AoU EHR data was performed using the Athena repository to identify procedure codes for NCCIH-defined CIH approaches. Adults with available EHR data, completed baseline surveys, full demographic information, and at least one CIH procedure were included. Data on demographics, self-rated health, employment status, and insurance coverage were collected. General linear models were used to estimate odds ratios for each CIH approach, adjusting for demographics, health status, and insurance coverage.

Results: Among the full AoU cohort (n=410,264), 5,125 (1.2%) had >1 CIH procedure code and 3,171 met inclusion criteria. Five CIH approaches were identified: chiropractic manipulative therapy (CMT), osteopathic manipulative treatment (OMT), acupuncture, dietary modification, and massage therapy. Adjusted multivariable modeling revealed the following significant associations: CMT – higher odds for higher self-rated health, high school vs college education, Medicaid vs employer insurance, Black vs White ethnicity, and male gender; OMT – lower odds for high school vs college education, higher odds for purchased vs employer insurance, female gender, and non-Hispanic ethnicity; Acupuncture – lower odds for lower self-rated health, higher odds for purchased or other vs employer insurance, Asian race; Dietary modification – higher odds of college education, Medicaid or purchased vs employer insurance, female gender, and lower odds of Black vs White race; Massage – Higher odds for increasing age, college education, not currently employed and employer-based insurance.

Conclusions: CIH utilization varies across sociodemographic groups, with education, insurance, and self-rated physical health emerging as key predictors. The integration of AoU EHR data provides a more nuanced understanding of CIH utilization versus traditional survey-based methods. Further research is needed to address data gaps for CIH approaches received outside of conventional healthcare settings.

Oral Abstract Session 17: Cancer Care II

OA17.01

Home-Based Virtual Reality Guided Mindfulness (VGRM) Intervention for Chronic Pain in People with Cancer: A Pilot Feasibility Trial

Zen Gajtani ¹ , Mohamad Baydoun², Haley Schuman¹, Athina Spiropoulos¹, Sofia Barkova¹, Katie Birnie¹, and Linda Carlson¹

¹University of Calgary, Calgary, AB

²University of Regina, Regina, SK

Contact: Zen Gajtani, [e-mail]

Abstract

Purpose: Chronic cancer-related pain (CRP) adversely impacts cancer survivors’ quality of life. Mindfulness is shown to mitigate chronic CRP by regulating both physical and emotional resistance to pain. Virtual reality (VR) may provide an immersive environment for delivering mindfulness which is shown to reduce chronic pain but remains unexamined in people living with cancer. We investigated the feasibility of a VR guided mindfulness (VRGM) intervention for adult survivors with chronic pain.

Method(s): This mixed-methods study used a single-arm, pretest–posttest design with 6-week followup and semi-structured interviews. Survivors finished their cancer treatments participated in the 6-week, home-based intervention with daily VRGM practice. Feasibility metrics and psychosocial outcomes were assessed at 3 time points. Possible moderation or mediation effects were assessed in relation to changes in pain. Descriptive statistics, paired samples t-tests, Pearson correlations and inductive thematic analyses were used.

Results: Participants (N= 20) had a mean age of 49.8 years and 90% were female. Most common diagnoses were breast (60%), hematologic (15%), and central nervous system (15%) cancers. Participants reported moderate to severe pain severity lasting for 3 months to 6 years at baseline. 14 participants successfully completed the 6-week program resulting in a 70% retention rate. Daily ratings of pain intensity before and after VRGM use decreased reliably by 0.5 to 1.0 points on a 0-10 point scale, but on average pain intensity remained the same throughout the trial. Pain interference, neuropathic pain, fatigue, depression and anxiety all decreased pre-to-post intervention and continued to decrease at 6-week follow-up, with effect sizes ranging from medium to large (d=0.6 to 1.0). The largest effect was found on pain catastrophizing (d=1.17 for Intent-to-treat and 1.35 for completers).

Conclusions: VRGM emerged as a promising intervention for people with chronic cancer-related pain, seeming to work both through mechanisms of short-term distraction and the development of mindfulness skills and attitudes.

OA17.02

Changes in Resiliency Among Cancer Survivors Participating in Stress Management and Resiliency Training Program (SMART-3RP)

Rachel Rosen ¹ , Daniel Hall¹, Christina Luberto¹, Giselle Perez¹, Lucy Finkelstein-Fox¹, Natalie Durieux², and Elyse Park²

¹Massachusetts General Hospital/Harvard Medical School, Boston, MA

²Massachusetts General Hospital, Boston, MA

Contact: Rachel Rosen, [e-mail]

Abstract

Purpose: The Current Experiences Scale (CES) is a 23-item theoretically driven and psychometrically valid measure of resiliency, capturing changes in resiliency based on survivors’ perceptions of stress-related growth. However, it is unknown how survivors’ resiliency is indicative of distress and modifiable with treatment. The current analysis describes factors associated with resiliency and changes in resiliency following participation in a mind-body resiliency group treatment.

Method(s): Cancer survivors (N=326) participated in an 8-week mind-body resiliency clinical group program between 2016 and 2023. Participants completed optional assessments of resiliency (Current Experiences Scale; range 0 to 115), depression (2-item Patient Health Questionnaire; range 0 to 6), anxiety (2-item Generalized Anxiety Disorder Scale; range 0 to 6), and mindfulness (Cognitive and Affective Mindfulness Scale; range 12 to 48) pre- and post-treatment. We examine the relationship between pre- and post-treatment resiliency using a paired-sample t-test (Cohen’s d as standardized effect size) and describe the correlation between baseline resiliency and baseline levels of anxiety, depression, and mindfulness and change in resiliency from pre- to post-treatment. All available data were used at each time point (follow-up rate = 55%).

Results: Participants (Mage = 53.9, 88% female, 92% White) demonstrated moderate improvements in resiliency (d = 0.42), with M=72.5 (SD = 14.0) pre-treatment and M=78.1 (SD =12.0) post-treatment. Baseline resiliency was correlated with higher baseline depression (r = -0.41, p <.001) and anxiety (r = -0.22, p <.001) as well as lower mindfulness (r = 0.56, p < .001) and greater pre-post-program resiliency improvements (r = - 0.50, p < .001).

Conclusions: Prior to group treatment, low resiliency was associated with elevated depression and anxiety and lower mindfulness among cancer survivors. Resiliency increased over time, particularly among those with low resiliency. Future research is needed to establish meaningful change in resiliency over time.

OA17.03

Maple Water as a Functional Hydration Beverage for AYA Cancer Survivors: Chemical Composition and User Preference Results in a USDA-Funded Study

David Victorson ¹ , Amandeep Sandhu Sandhu², Bruriah Horowitz³, Azhar Alghamdi², Kile Zuidema⁴, and Jesse Randall⁴

¹Northwestern University, Evanston, IL

²Illinois Institute of Technology, Chicago, IL

³Northwestern University Feinberg School of Medicine, Chicago, IL

⁴Michigan State University, Escanaba, MI

Contact: David Victorson, [e-mail]

Abstract

Purpose: Maple water, a natural sap extracted from maple trees during early spring, has been used as a medicinal tonic by North American indigenous populations for centuries and is gaining popularity as a functional hydration beverage. This study, Sap to Survivors, aimed to assess the chemical properties of maple sap (collected from Michigan’s Upper Peninsula) as well as the dehydration challenges, hydration beverage preferences, and potential of maple water as a functional hydration beverage for adolescent & young adult (AYA) survivors, a population often facing dehydration challenges during and after treatment.

Method(s): Our IRB-approved study (STU00218204) involved a multidisciplinary team of food scientists, social scientists, and forestry scientists who employed three approaches: 1) A national online survey with 100 AYA cancer survivors assessing dehydration experiences and hydration beverage preferences; 2) Taste tests involving 51 cancer survivors and 12 caregivers that evaluated maple water’s taste and visual qualities; 3) Chemical analysis of 19 maple sap samples collected during the 2023 and 2024 harvesting seasons to determine their nutritional composition.

Results: Survey findings revealed that 65% of respondents experienced dehydration during treatment, and 34% reported continued dehydration post-treatment. Although only a few participants had previously tried maple water, 78% expressed interest in it as a healthier alternative to sugary drinks. In the maple taste tests, 92% rated their satisfaction between 7 and 10 on a 10-point scale. Maple water’s clarity and lightly sweet and refreshing taste profile were well received, with minimal aftertaste reported. Chemical analyses showed that calcium, potassium, and manganese—essential electrolytes for hydration—were the dominant minerals in the maple sap samples.

Conclusions: Maple water shows promise as a low-calorie, nutrient-rich, sustainable, functional hydration beverage for health-conscious consumers such as AYA cancer survivors and may offer a natural alternative to sweetened drinks often offered during cancer treatment.

OA17.04

Green Nanotechnology Affords Immunomodulatory Resveratrol Functionalized Palladium Nanoparticles for Prostate Tumor Therapy

Velaphi Thipe ¹ , Menka Khoobchandani², Alice Raphael Karikachery¹, Kavita Katti¹, and Kattesh Katti¹

¹University of Missouri, Columbia, MO

²Loma Linda University, Loma Linda University, CA

Contact: Velaphi Thipe, [e-mail]

Abstract

Purpose: Herbal-based pharmaceuticals hold significant societal value, with the World Health Organization (WHO) predicting that over 80% of the global population will rely on some form of herbal medicine for healthcare. A major impediment to the use of phytochemicals in medicine is achieving adequate bioavailability at tolerable doses—a perennial stumbling block in translating promising discoveries from cell culture and animal models into clinically effective treatments. We present an innovative green nanotechnology approach utilizing electron-rich potential of resveratrol, abundantly available from grapes skin, to convert palladium salt into biocompatible and tumor specific palladium nanoparticles (Res-PdNPs).

Method(s): The ‘Zero Carbon Emission’ process yields four types of nanoparticles (Res-PdNPs 1–4), where the phytochemicals function as both reductants and stabilizers. Comprehensive characterization identified Res-PdNP-4 (Zeta potential: -40±3 mV; TEM: 9±3 nm) as the most promising candidate for cancer therapy, due to its excellent in vitro stability and potential for in vivo applications.

Results: The relationship between NF-κB signaling and macrophage activation was investigated by evaluating Res-PdNP-4’s ability to target pro-tumor M2 macrophages and reprogram them into anti-tumor M1 macrophages using RAW 264.7 murine macrophage cells. Res-PdNP-4 demonstrated immunomodulatory properties, targeting NF-κB, thus paving the way for new precision medicine opportunities in cancer and inflammatory disease treatments. Its efficacy was further validated in prostate tumor-bearing SCID mice, where Res-PdNP-4 exhibited excellent therapeutic outcomes at various doses. Notably, Res-PdNP-4 selectively targeted tumor cells without harming normal cells, unlike Cisplatin and Etoposide, which caused severe toxicity to both tumor and healthy cells.

Conclusions: Res-PdNP-4 represents a new generation of immunomodulatory nanotherapeutics for treating prostate and other laminin receptor-positive tumors. This green nanotechnology approach using palladium offers promising potential in the development of advanced cancer diagnostics and therapies, paving the way for future immunotherapeutic agents with significant implications in oncology.

Oral Abstract Session 18: Health Equity

OA18.01

Culturally Tailored Nutrition Intervention: Addressing Health Equity in Latinx Communities for Diabetes Prevention

Jacqueline Moreira ¹ , Kimberly Del Toro¹, and Ann Cheney¹

¹University of California, Riverside School of Medicine, Riverside, CA

Contact: Jacqueline Moreira, [e-mail]

Abstract

Purpose: This 10-week culturally tailored intervention, ¡Coma, Muévase, Viva! (Eat, Move, Live), addressed health disparities in Latino communities in the Eastern Coachella Valley, California. The program combined cooking demonstrations and nutrition education to promote healthier eating habits and prevent chronic diseases, with a particular focus on diabetes management due to its high prevalence in the population. Participants received a bilingual recipe book, Ancestral Recipes: From My Grandma’s Kitchen to Yours, offering culturally relevant, healthy alternatives to traditional Mexican dishes.

Method(s): A randomized controlled trial of the ¡Coma, Muévase, Viva! program was conducted using mixed-methods. This presentation reports on qualitative and quantitative data on participants’ satisfaction with the program, specifically the educational sessions on diabetes management and nutrition. Focus groups assessed the program’s accessibility, knowledge retention, and perceived health improvements.

Results: Participants reported increased awareness of dietary changes for managing diabetes and other chronic conditions. Many felt empowered to make healthier food choices, supported by access to recipes in their preferred language (Spanish) and locally sourced ingredients accessible at food banks. They shared experiences of weight loss, improved blood sugar control, and healthier eating.

Conclusions: Culturally sensitive interventions are essential for promoting health equity in underserved communities. This program successfully integrated traditional food practices into cooking demonstrations and nutrition education, empowering Latino families to improve their health. Future initiatives should continue prioritizing culturally relevant approaches to enhance health outcomes and ensure equitable access to education and resources.

OA18.02

Applying Participant Observation Methods to Evaluate Mindfulness-Based Group Medical Visits Through an Equity Lens

Gabriela Gutierrez ¹ , Ariana Thompson-Lastad¹, Kavita Mishra², Ivan Leung¹, Anand Dhruva², Chloe Atreya¹, and Maria Chao¹

¹Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

²University of California, San Francisco, San Francisco, CA

Contact: Gabriela Gutierrez, [e-mail]

Abstract

Purpose: Clinical guidelines recommend mindfulness-based interventions (MBIs) for anxiety and depression symptoms during cancer treatment. However, access to MBIs remains limited; and interventions require tailoring to engage diverse populations for optimal therapeutic effects. This study aimed to evaluate facilitators and barriers to patient access and engagement in a telehealth mindfulness-based group medical visit (MB-GMV), adapted for racially and ethnically diverse cancer patients.

Method(s): We designed and implemented an equity-focused and culturally adapted MB-GMV with four sessions offered weekly during cancer treatment; 50% of slots are reserved for racially minoritized patients. Two integrative oncologists facilitate MB-GMVs as a billable, clinical service for patients in cancer treatment. We used participant-observation to evaluate patient access and patient and clinician engagement. We analyzed participant-observation field notes and other mixed methods data (e.g., demographic data and facilitator debriefs) using the lightning report method of rapid qualitative synthesis for quality improvement.

Results: Qualitative data from observations of 51 sessions across 13 MB-GMV cohorts serving 108 patients highlighted how different types of mindfulness practices prompt individuals to find new meanings from their cancer experience; the content, activities, and language that fostered group cohesion; and the benefits of specific adaptations for patients in active cancer treatment. For example, when facilitators emphasized flexibility, patients joined sessions from hospital beds or infusion chairs rather than skipping them. Diverse patients shared that the group was the first place within biomedical settings where they were invited to consider what positive learnings, resonant with their cultural heritage or spiritual practices, may emerge from their cancer experience.

Conclusions: Our findings support equity-focused adaptations to reduce barriers to accessing MBI and to promote engagement during cancer treatment. This data can inform future MB-GMV content adaptations and implementation strategies to optimize for positive experiences in multicultural patient populations, which may enhance the therapeutic effect of MBIs.

OA18.03

Indigenous and Decolonial Wellbeing: Findings From a Community-Based Participatory Study, Implications for Integrative Health Equity

Joanne Qinaʻau ¹ , and Maria Chao¹

¹Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

Contact: Joanne Qinaʻau, [e-mail]

Abstract

Purpose: Wellbeing is a construct important across health-related disciplines, and central to most conceptions of whole health. Little is known about wellbeing for Kānaka ʻŌiwi, the Indigenous peoples of the Hawaiian islands who face disproportionate challenges to behavioral and physical health. The present study was designed to identify an emergent theory of wellbeing for Kānaka ʻŌiwi with behavioral health challenges.

Method(s): The present study used the transformative paradigm, qualitative community-based participatory research, and grounded theory to conduct one pilot interview and 38 one-on-one interviews with Kanaka ʻŌiwi behavioral health clients (n = 19; M = 43), mental and behavioral health providers (n = 12; M = 43), and Kanaka ʻŌiwi cultural leaders (n = 10; M = 48). A new decolonial intersectionality method, ho‘omana i nā leo was developed to highlight data pertaining to health inequities. As a part of the participatory process, the research team also asked participants to provide preferences for a deliverable to be developed that would positively impact the community’s wellbeing in a timely manner.

Results: An emergent theory of wellbeing for Kānaka ʻŌiwi with behavioral health challenges was identified (Ke Ao Nōweo ‘Ula: KANU), along with implications for further interdisciplinary research and application. KANU theory consists of 6 processes of detriments to wellbeing, 9 processes describing supports and states, and 5 processes describing outcomes of wellbeing. A directory of 120+ wellbeing resources was also created for the public (E Ho’omana me nā Kumu Waiwai: Empowering through Resources).

Conclusions: Wellbeing processes conceived of from an Indigenous ontology and epistemology entail a unique theory axiologies and praxes. Findings may provide insight into wellbeing for communities beyond Kānaka ʻŌiwi with behavioral health concerns. Implications for integrative health equity will be discussed. Supporting evidence will be provided from an ongoing scoping review of Indigenous models of wellbeing.

OA18.04

Visually and Hearing Impaired Veterans Use More Whole Health/Complementary Integrative Health 2022-23 Compared to General Population

Martha Michel ¹ , Alex Kloehn², Esteban Zuniga³, Judy Schafer⁴, Jamie Douglas², and Steven Zeliadt¹

¹VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

²VA Puget Sound Health Care System, Seattle, WA

³VA, Tucson, AZ

⁴Veterans Health Administration, Washington, DC

Contact: Martha Michel, [e-mail]

Abstract

Purpose: As the Veterans Health Administration (VA) and other healthcare systems make CIH therapies more widely available, there is little known about their utilization among patients with sensory impairments.

Method(s): We identified all Veterans nationally with vision loss (n=64,873), hearing loss (n=878,899) or dual sensory impairment (n=16,437) and those with no sensory impairment (n=4,790,892) receiving care in VA in FY23. We examined utilization of ten CIH therapies and three types of Whole Health services. We included care from VA providers and care delivered in the community paid by VA.

Results: Utilization of any type of CIH or Whole Health service in FY23 was slightly higher overall among patients with dual sensory impairment (42.9%) and vision loss (36.2%) compared to hearing loss only (32.6%) and the general population (34.2%). Notably, Whole Health clinical care, including goal setting sessions, and Whole Health educational classes were used at higher rates among patients with dual sensory impairment (21.5% and 10.5%) and patients with vision loss (18.3% and 8.8%) compared to patients with hearing loss only (17.7% and 6.7%) and patients with no sensory impairment (17.3% and 7.8%). The use of chiropractic care, the most frequent CIH therapy, was used slightly less by patients with dual sensory impairment (1.8%) and patients with vision loss (1.5%) compared to the general population (2.3%). Notably, movement therapies offered within VA including yoga and Tai Chi were utilized by patients with sensory impairments at twice the rate of the general population.

Conclusions: Patients with sensory impairments are using many CIH and Whole Health services at higher rates than the general VA population. Some CIH therapies that often require attending appointments with providers in the community may be less accessible to patients with sensory impairments. Monitoring patterns of use of CIH therapies will help ensure equitable and inclusive use among patients with sensory impairments.

Oral Abstract Session 19: Geriatrics

OA19.01

Evidence Map of Tai Chi Interventions for the Elderly

Mariana Cabral Schveitzer ¹ , Lissandra Zanovelo Fogaça², Ricardo Ghelman³, Caio Portella⁴, Carmem Veronica Mendes Abdala⁵, Arthur Ferreira³, Maria Claudia Martins Ribeiro⁶, Michael Pratt⁷, and Luiz Ramos²

¹UNIFESP and CABSIN, São Paulo, Brazil

²Escola Paulista De Medicina - Universidade Federal De São Paulo, São Paulo, Brazil

³CABSIN, São Paulo, Brazil

⁴Brazilian Academic Consortium for Integrative Health, São Paulo, Brazil

⁵BIREME/OPAS/WHO, São Paulo, Brazil

⁶Unifesp, São Paulo, Brazil

⁷UCSD, San Diego, CA

Contact: Mariana Cabral Schveitzer, [e-mail]

Abstract

Purpose: Objective: This study aims to describe a transversal evaluation of an evidence map that identifies the best evidence for the effectiveness of Tai Chi interventions in the elderly population. The evaluation combines results and levels of confidence from cited trials to determine the most credible and impactful evidence.

Method(s): Methodology: An evidence map was constructed in 2024 by compiling systematic reviews from four major databases: PubMed, EMBASE, VHL, and CINAHL. Search keywords included “Tai Chi” and its synonyms, intersected with terms related to “systematic review” and “clinical use” and their synonyms. The inclusion criteria focused on articles that provided compelling evidence of Tai Chi’s effectiveness in the elderly. Exclusion criteria involved studies that lacked clear methodology or sufficient focus on the elderly demographic. To streamline the selection process, abstracts were initially pre-selected using the Rayyan platform, a tool designed for systematic review selection, allowing a rapid clustering of relevant publications. A subsequent manual filter refined this selection, ultimately identifying 146 eligible reviews. Each review was then independently assessed for quality and rigor using the AMSTAR-2 criteria by a dedicated team of evaluators. This rigorous filtering ensured that only high-quality studies contributed to the evidence map.

Results: Findings from the evidence map demonstrated diverse outcomes linked to Tai Chi practices among the elderly. Key areas of influence included improvements in balance and stability, reduced risk of falls, enhancements in cognitive function, and overall quality of life. Furthermore, comparisons across trials revealed a consistent pattern of moderate to high confidence in these outcomes, especially in large-scale trials with robust design frameworks.

Conclusions: The evidence map serves as a comprehensive resource for identifying and evaluating the effectiveness of Tai Chi interventions within the elderly population.

OA19.02

Pilot of a Brief Cognitive Behavioral Therapy Intervention to Enhance Benzodiazepine Deprescribing in Older Adults

Gloria Yeh ¹ , Kristen Kraemer¹, Brianna Wang², Marissa McCann², Julia Lindenberg², and Timothy Anderson³

¹Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA

²Beth Israel Deaconess Medical Center, Boston, MA

³University of Pittsburgh, Pittsburgh, PA

Contact: Gloria Yeh, [e-mail]

Abstract

Purpose: Chronic benzodiazepine use in older adults is associated with dependence, cognitive/functional impairment, fall risk, and increased hospitalizations and mortality. While deprescribing interventions can help, few treatments exist that address critical psychosocial barriers and predictors of medication reduction success. Cognitive Behavioral Therapy (CBT) added to deprescribing is promising, yet underutilized and limited by barriers of implementation and scalability. We sought to assess feasibility of a novel benzodiazepine deprescribing intervention that integrates brief, virtual touchpoints of “third-wave” mindfulness focused CBT.

Method(s): This single-arm pilot feasibility trial recruited adults (>=65 years) using benzodiazepines for sleep or anxiety from four primary care clinics within a large academic health system. Over 10 weeks, participants received 6 remote pharmacist-led tapering visits and 3 psychologist-led 1:1 CBT sessions teaching coping strategies and mindfulness skills to build confidence to reduce benzodiazepine use. In addition to feasibility metrics, we measured % change in daily diazepam milligram equivalents (DME), self-efficacy to taper benzodiazepines (Likert scale), PROMIS short-form scales (Sleep Disturbance and Anxiety), and included a semi-structured qualitative exit interview.

Results: Of 268 eligible patients, 17 (6.3%) enrolled in the study (mean age=72 years, 29% female, 12% Black, mean baseline daily DME=9.0/SD 8.6, median benzodiazepine use=15 years). This study is ongoing (5 still enrolled, 12 completed). Interim results (N=12) show a mean daily DME reduction of 41%, 7 participants reduced their daily dose by >=50% and 3 fully discontinued. Individual participant data showed decreases or no change in anxiety (mean difference -1.3/SD 5.2), decreases or no change in insomnia (mean difference -1.3/SD 5.1), and mixed results for composite self-efficacy to taper (mean difference 0.6/SD 3.5). Qualitative data supports program acceptability (further analyses to be presented).

Conclusions: A novel, virtual benzodiazepine deprescribing intervention that includes brief introduction to third-wave CBT is feasible/acceptable, has room for refinement, and should be further studied.

OA19.03

Culturally and Regionally Relevant Physical Activity for Public Health Promotion: Definitions and Evidence Synthesis

Tetine Sentell ¹ , Mele Look¹, Alban Ylli², Catherine Pirkle¹, Dan Heil³, Simone Schmid¹, and Leah Grout⁴

¹University of Hawai’i at Mānoa, Honolulu, HI

²Institute of Public Health of Albania and Tirana University of Medicine, Tirana, Tiranë, Albania

³Montana State University, Bozeman, MT

⁴Southern California University of Health Sciences, Whittier, CA

Contact: Tetine Sentell, [e-mail]

Abstract

Purpose: Health promotion approaches that prioritize cultural strengths and community values are critical to achieving improved health outcomes and equity. Culturally and regionally relevant physical activity (CRRPA) such as ethnic dance has value across multiple dimensions of spiritual and physical wellbeing including reducing chronic disease risk and supporting healthy aging. This transdisciplinary research is not well synthesized. Aims were to: (i) define CRRPA (ii) preliminarily assess potential size and nature of relevant research and (iii) develop a typology for CRRPA studies based on the location and population engaging in the activity.

Method(s): A multinational expert team developed a CRRPA definition and distinguished between related terms. PubMed was searched for CRRPA literature using a critical review methodology to assess the scope of this wisdom and scholarship. Search terms included “physical activity,” “exercise,” and “sport” and one of: “culturally relevant” “traditional” “folk” “Indigenous” “ethnic” or “culture.” We also searched for specific activities known to be culturally and regional relevant (e.g. surfing).

Results: We defined CRRPA as a PA based on a population’s customs, practices, and beliefs. The PA should have, or be hypothesized to have, a secondary positive health consequence when performed. In this definition, cultural and regional relevance indicates activities that are based in a shared, collective, historical context. CRRPA activities are increasingly being documented at various metabolic equivalent intensities. Preliminary review revealed a large breadth of evidence, including qualitative findings, program evaluation, energy expenditure studies, cultural histories, and intervention research across different areas of science (e.g., biomedical, nature and health, sports medicine, Indigenous world views). The typology developed is important for considering where, how, and for whom to scale up health promotion interventions.

Conclusions: Many CRRPAs are popular with general and at-risk populations and have potential to be implemented at scale. This work helps to consolidate and synthesize this vast transdisciplinary body of work.

OA19.04

Association Between Patterns of Chronic Disease Co-Morbidity and Medicinal Plants Consumption in Chinese Older Adults

Zhiqiang Li¹

¹Beijing University of Chinese Medical, Beijing, Beijing, China

Contact: Zhiqiang Li, [e-mail]

Abstract

Purpose: To explore the association between chronic disease comorbidity patterns and the consumption of medicinal plants among Chinese elderly individuals aged 65 and above.

Method(s): The data originated from the 2018 cross-sectional survey of the “Chinese Longitudinal Healthy Longevity Survey.” The study sample comprised 15,442 elderly aged 65 and above from 23 provinces (autonomous regions, municipalities) who completed questionnaires on the consumption of medicinal plants, self-reported diseases, and other surveys. SPSS 25.0 software was utilized for analysis of variance, chi-square tests, and multifactorial logistic regression analysis. Subgroup analyses were conducted based on age, gender, and adequate access to medical services.

Results: The average age of the enrolled elderly was 85.60 ± 11.61 years, with 83.7% occasionally or regularly consuming medicinal plants. In the single chronic disease comorbidity pattern, the rate of comorbidity of two or more chronic diseases was 53.4%. In the complex chronic disease comorbidity pattern, the prevalence rates for the simple comorbidity group, mild and severe complex comorbidity groups were 10.2%, 39.3%, and 17.2%, respectively. After adjusting for confounding factors, in the single chronic disease comorbidity pattern, the presence of two or more chronic diseases was positively correlated with occasional or regular consumption of medicinal plants (OR=1.45, 95% CI: 1.30-1.61). In the complex chronic disease comorbidity pattern, compared to the relatively healthy group, the simple comorbidity group, mild, and severe complex comorbidity groups all showed a positive correlation with occasional or regular medicinal plant consumption, with increases of 32%, 34%, and 56%, respectively (P<0.01, P<0.001). Regardless of the comorbidity pattern, especially among males, those aged 65-80, and those with adequate access to medical services, there was a greater tendency to frequently use medicinal plants (P<0.001).

Conclusions: The comorbidity patterns and numbers of chronic diseases in the Chinese elderly population are closely associated with occasional or regular consumption of medicinal plants.

Oral Abstract Session 20: Basic/Mechanistic Research

OA20.01

Differences in Network-Based Functional Connectivity Patterns Following Application of Force-Based or Simulated Chiropractic Care

Stephanie Sullivan ¹ , Margaret Sliwka¹, Tyson Perez¹, Emily Drake¹, and Ronald Hosek¹

¹Life University, Marietta, GA

Contact: Stephanie Sullivan, [e-mail]

Abstract

Purpose: Evaluate differences in network-based functional connectivity (FC) patterns using resting-state electroencephalography (rEEG) for individuals receiving force-based or simulated chiropractic care.

Method(s): Using a quasi-experimental design, rEEG data were obtained from 30 (33.1 ± 8.7yoa; 16F) adults before, immediately post, and 1-week post a single, full-spine instrument-assisted force-based (n=15) or simulated and segmentally matched (n=15) chiropractic care session. Robust to multiple comparisons, the network-based statistic (NBS) method (5000 permutations; threshold for significance p<.05) was used to isolate subnetworks within the triple-network (default mode; salience; central executive) that differed in FC between groups. In addition, differences in weighted global efficiency (GEw) were explored on NBS-identified subnetworks.

Results: Immediately post, the force-based group demonstrated 1) increased FC in delta band (1-4 Hz) in 25-node subnetwork within bilateral prefrontal cortex (PFC) extending into areas such as the right inferior parietal and bilateral insula and 2) decreased FC in theta band (4-8 Hz) in 18-node subnetwork concentrated within PFC extending into bilateral insula and right superior parietal cortex. At 1-week, the force-based group showed increased FC in beta band (13-30 Hz) in 21-node bilaterally distributed anterior-to-posterior subnetwork. No group differences in GEw were found.

Conclusions: Network-based FC changes were observed within PFC subnetworks and other regions-of-interest immediately after and 1-week post force-based chiropractic care when compared to simulated chiropractic care. However, no differences in GEw were observed.

OA20.02

Examining the Effects of Biofield Therapy Through Simultaneous Assessment of Physiological Outcomes in the Practitioner and Cancer Cellular Outcomes

Lorenzo Cohen ¹ , Arnaud Delorme², Andrew Cusimano¹, Sharmistha Chakraborty¹, Phuong Nguyen¹, Defeng Deng¹, Shafaqmuhammad Iqbal¹, Monica Nelson¹, Daoyan Wei¹, Chris Fields³, and Peiying Yang¹

¹The University of Texas MD Anderson Cancer Center, Houston, TX

²University of California San Diego, La Jolla, CA

³Independent Researcher, Caunes Minervois, Saône-et-Loire, France

Contact: Lorenzo Cohen, [e-mail]

Abstract

Purpose: The aim was to determine the effects of biofield therapy (BT) on cell activity, examine changes in the physiological state of the practitioner, and investigate the association between the practitioner’s physiological state, cell activity, and their possible mutual influences.

Method(s): A BT practitioner took part in multiple (n=60) treatment and control (non-treatment) sessions under double-blind conditions. During treatment, the practitioner provided BT alternating with rest phases where no such efforts were made. Human pancreatic cancer cell activity was assessed using three markers – cytoskeleton changes (tubulin and β-actin) and Ca2+ uptake. We examined changes in the practitioner’s physiological parameters including EEG and HRV during the treatment: 1) live cells and 2) either dead cells or medium only. The experimental setup was a 2 × 2 design, contrasting cell type (live vs. control) against session type (treatment vs. non-treatment). Parallel sham-treated control cells were examined for changes in the cell parameters over time while controlling for the presence of a person in front of the cells with no directed intention. Changes in cellular outcomes and if there was an association between the practitioner’s physiological parameters and cellular outcomes were examined.

Results: We observed significant (p<0.01) spectral changes in the participant’s EEG during BT treatment in all frequency bands, as well as HRV (RMSSD measure; p<0.01). We also observed significant differences in beta and gamma EEG and HRV (pNN50 measure) when the participant treated live but not control cells (p=0.02). We observed Ca2+ uptake was significantly less for the BT group relative to the sham-treatment controls (p=0.03). Granger causality analyses to examine directional associations between cell markers and practitioner’s physiological parameters, EEG measurements showed significant bidirectional causal effects with cell metrics, especially β-actin and intracellular Ca2+ levels(p<0.000001).

Conclusions: These outcomes suggest a complex relationship between physiological responses and cellular effects during BT treatment sessions.

OA20.03

Is Greener Better? Quantifying the Impact of a Nature Walk on Stress Reduction using HRV and Saliva Cortisol Biomarkers

J. Ray Runyon ¹ , Shravan Aras¹, Josh B. Kazman², Julian F Thayer³, Esther M. Sternberg¹, and Patricia A Deuster⁴

¹University of Arizona, Tucson, AZ

²Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD

³Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA

⁴Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Contact: J. Ray Runyon, [e-mail]

Abstract

Purpose: The physiological impact of walking in nature was quantified via continuous heart rate variability (HRV), pre- and post-walk saliva cortisol measures, and self-reported mood and mindfulness scores for N=17 participants who walked “The Green Road” at Walter Reed National Military Medical Center in Bethesda, Maryland.

Method(s): Participants walked both the 1.2 mile woodland path and a similar urban corridor for comparison. Continuous HRV was captured using a single lead ECG BodyGuard v2 device, and data processed using in-house methods. Salivary cortisol was measured using LC-MS/MS. The 37-item Profile of Mood States, and 5-item Mindfulness Attention Awareness Scale were administered pre/post walks to capture participant feeling/mood in the moment. Pairwise t-tests captured significant physiological changes between the two walks. Associations between HRV-derived metrics and state-scales were explored.

Results: HRV analysis revealed two main groups: group 1 individuals who had a 104% increase (mean) in root mean square standard deviation (RMSSD) and 47% increase (mean) in standard deviation of NN values (SDNN) indicating an overall reduction in physiological stress from walking the Green Road, and group 2 individuals who had a decrease (mean) of 42% and 31% in these respective HRV metrics signaling an increase in physiological stresses. Post-walk self-reported scores for vigor and mood disturbance were more robust for the Green Road than for a comparable urban road corridor and showed that higher HRV during the walk was associated with improved overall mood. Saliva cortisol was lower after taking a walk for all participants and showed that walking the Green Road elicited a significantly larger reduction in cortisol of 53% on average when compared with 37% of walking along an urban road.

Conclusions: These findings provide quantitative data demonstrating the stress-reducing effects of being in nature, thus supporting the health benefit value of providing access to nature more broadly in many settings.

OA20.04

Physicians’ Perspectives on Counseling Cancer Patients in Complementary, Alternative, and Integrative Medicine: A Qualitative Systematic Review

Jeremy Y. Ng ¹ , Aimun Qadeer Shah², Lana Abu Narr³, Alyssa Qian³, and Holger Cramer⁴

¹(1) Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; (2) Bosch Health Campus, Stuttgart, Germany; (3) Centre for Journalology, Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Ottawa, ON

²Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, Hamilton, ON

³(1) Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; (2) Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany, Tübingen, Baden-Wuerttemberg, Germany

⁴University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

Contact: Jeremy Y. Ng, [e-mail]

Abstract

Purpose: This qualitative systematic review aimed to assess physicians’ knowledge, attitudes, and experiences related to counseling cancer patients on complementary, alternative, and integrative medicine (CAIM), with a focus on their understanding, concerns, and communication practices.

Method(s): MEDLINE, EMBASE, and AMED databases were systematically searched from inception to May 27, 2023, along with manual searches of reference lists from related review articles. Studies were included if they provided qualitative data on physicians’ perceived knowledge and experience with CAIM counseling in cancer care. Extracted data were analyzed using a narrative synthesis approach to identify key themes and subthemes.

Results: A total of 35 articles were included, 30 identified from database searches and 5 from reference hand-searches. Analysis revealed four primary themes: limited CAIM knowledge and training, safety and efficacy concerns, recognition of CAIM’s role in patient-centered cancer care, and communication challenges with patients regarding CAIM. Physicians frequently cited a lack of formal training as a barrier to confidently discussing CAIM, which heightened concerns about the safety and efficacy of these therapies. Nevertheless, they acknowledged CAIM’s potential value, noting that many patients view it as an important aspect of their cancer care. The dynamics of CAIM communication were complex, as physicians often balanced their caution with patients’ strong interest in these therapies, navigating conversations that could support holistic care.

Conclusions: These findings underscore that while physicians consider CAIM a meaningful component of holistic cancer care, many feel unequipped to provide guidance due to limited training and safety concerns. Enhanced education on CAIM safety and efficacy is needed to better prepare physicians for these discussions. Further research should investigate CAIM perspectives among medical trainees and other healthcare professionals to broaden the understanding of CAIM counseling practices in oncology.

Oral Abstract Session 21: Interventions for Chronic Pain

OA21.01

Longer-Term Chiropractic Care Outcomes for US Active-Duty Military Personnel with Low Back Pain: Secondary Analysis of a Pragmatic Clinical Trial

Zacariah Shannon ¹ , Cynthia Long¹, Robert Vining², Jacob McCarey¹, and Christine Goertz³

¹Palmer College of Chiropractic, Davenport, IA

²Palmer Center for Chiropractic Research, Davenport, IA

³Duke University School of Medicine, Durham, NC

Contact: Zacariah Shannon, [e-mail]

Abstract

Purpose: We compare longer-term outcomes of chiropractic care plus usual medical care to usual medical care alone for US active-duty military personnel with low back pain (LBP).

Method(s): The last 154/750 trial participants were recruited from Walter Reed and Naval Hospital Pensacola to provide up to 1-year outcomes in a clinical trial evaluating the addition of 6 weeks of chiropractic care to usual medical care for treatment of US military personnel with LBP of any duration. We analyzed all observed data over all follow-up time points using linear mixed-effects regression models adjusted for baseline age, sex, site, pain duration, and worst pain intensity to estimate between-group differences at the primary endpoints of 12 and 52 weeks for the primary outcomes of disability using the Roland-Morris Disability Questionnaire (RMDQ) and pain intensity using the Numerical Rating Scale (NRS) and the secondary outcomes of PROMIS-29 subdomains.

Results: Participants were predominantly male (77%) with a mean age of 32 years, and 47% reported baseline chronic pain. Differences favored the chiropractic care plus usual medical care group for the RMDQ at 12 weeks (2.2 point mean difference, 95%CI: 0.4 to 4.0) and 52 weeks (2.0, -0.02 to 3.9), and the NRS at 12 weeks (0.6, -0.1 to 1.2) with no difference in 52-week NRS (0.1, -0.7 to 1.0). Differences in sleep disturbance also favored the group receiving chiropractic care at 12 weeks (2.0, -1.1 to 5.0) with a larger difference at 52 weeks (4.0, 0.6 to 7.3) while most other PROMIS outcomes showed little difference at 12 weeks that were similar or smaller at 52 weeks.

Conclusions: The addition of chiropractic care to usual medical care resulted in moderate short- and longer-term improvement in low back pain-related disability and sleep disturbance, but not other outcomes. Strategies to improve longer-term chiropractic care outcomes for US military members are needed.

OA21.02

The Relationship Between Self-Reported Physical Activity and Interoceptive Sensibility in US Adults With Fibromyalgia: A Cross-Sectional Study

Natasha Parman ¹ , Jamie Villanueva¹, and Dana Dharmakaya Colgan²

¹University of Washington, Seattle, WA

²OHSU, Portland, OR

Contact: Natasha Parman, [e-mail]

Abstract

Purpose: To investigate relationships among self-reported physical activity and interoceptive sensibility in a sample of adults with fibromyalgia.

Method(s): Online surveys were administered to approximately 2000 US adults via Qualtrics. Strategic sampling targeted respondents to be representative of the broader US population. Interoceptive sensibility was measured with the eight subscales of the Multidimensional Assessment of Interoceptive Awareness-Version 2 (MAIA-2). Self-reported physical activity was measured with the International Physical Activity Questionnaire-Short Form. Five metabolic equivalent task minutes per week (MET/min/week) subgroups were created: walking, moderate activity, vigorous activity, total activity (sum of walking, moderate, and vigorous activity), and the sum of moderate and vigorous activity. Partial correlation analyses characterized the relationship between physical activity and interoceptive sensibility, while controlling for age and sex.

Results: 213 complete surveys were analyzed. Mean (SD) age and body mass index were 50.6 (15.2) years and 29.1 (7.5) kg/m2, respectively, and 155/213 (72.8%) indicated their sex as female. The MAIA-2 Self-Regulation subscale score was positively associated with total activity (p = .02; PXY·Z = 0.16), vigorous activity (p = .04; PXY·Z =0.14), and the sum of moderate and vigorous activity (p = .03; PXY·Z= 0.15). The MAIA-2 Not-Worrying subscale score was associated with total activity (p=.005; PXY·Z= 0.19) and vigorous activity (p =.009, PXY·Z = 0.18). The MAIA-2 Non-Distracting subscale score was negatively associated with walking (p = .05, PXY·Z = -0.13).

Conclusions: Various aspects of interoceptive sensibility were significantly associated with differing levels of engagement in physical activity and between types of physical activity (i.e., low, moderate, and vigorous activity), though the magnitudes of the correlations are small. Limitations include the use of self-report to measure physical activity. Findings support future research to explore objective measures of physical activity and examine how associations in these variables change longitudinally and the clinical relevance of such changes observed.

OA21.03

Combining Self-Care with Practitioner-Delivered Therapies: The Assessing Pain, Patient Reported Outcomes and CIH (APPROACH) Study

Steven Zeliadt ¹ , Scott Coggeshall², Ethan Rosser³, Joy Toyama⁴, Xiaoyi Zhang⁵, Barbara Bokhour², Marlena Shin⁶, and Stephanie L. Taylor⁷

¹VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

²Veterans Health Administration, Seattle, WA

³VA Puget Sound Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA

⁴Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁵Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA

⁶Center for Health Optimization and Implementation Research, VA Boston Healthcare System, Boston, MA

⁷Veterans Health Administration, New Haven, CT

Contact: Steven Zeliadt, [e-mail]

Abstract

Purpose: Healthcare systems and insurers are expanding coverage for complementary and integrative health (CIH) therapies for chronic pain, including self-care activities. This large study compared patient outcomes for Veterans combining self-care activities (yoga, mindfulness meditation, or Tai Chi/Qigong) with practitioner-delivered therapies (acupuncture, chiropractic care, massage therapy) – labeled PD/SC-CIH – to those using practitioner-delivered therapies alone – labeled PD-CIH.

Method(s): Treatment assignment was quasi-experimental guided by facility business practices and availability of individual therapies, which changed over time due to easing of COVID19 restrictions and hiring of providers. Receipt of PD-CIH included at least one visit of acupuncture, chiropractic care or massage therapy (n=1,688). Participants in the PD/SC-CIH arm (n=1,618) also participated in at least 3 self-care sessions.

Results: Among 3,306 veterans with longitudinal study assessments, baseline pain severity 5.9 (1.8) vs 6.0 (1.7) and interference scores 6.3 (2.2) vs 6.6 (2.2) were similar between the PD-CIH and PD/SC-CIH arms. There were minor improvements in pain severity (-0.59 vs -0.53) and interference (-0.62 vs -0.70) in both arms at 6-months with no difference in change between arms for either severity -0.02 (95% CI: -0.15, 0.1) or interference -0.13 (-0.29, 0.03). Significantly more participants in the PD/SC-CIH arm reported perceived improvements attributed to their CIH use across four patient global impression of change measures: pain 10%; fatigue 23%; mental health 26%; and overall well-being 26% (all p-values <0.001), and greater improvement in physical health 0.49 (p=0.019) and mental health 0.43 (p=0.049).

Conclusions: Veterans with chronic pain using PD/SC-CIH therapies as part of routine care experienced improvements in clinical measures of chronic pain that were similar to those who used PD-CIH therapies alone. However, when prompted about their CIH use, patients using self-care combined with practitioner-delivered care were more likely to report that the combinations of CIH therapies they used meaningfully improved their pain and well-being.

OA21.04

Moderators of the Effects of Telehealth Mindfulness-Based Interventions for Chronic Pain: A Randomized Controlled Trial

Collin Calvert ¹ , Emily Hagel Campbell¹, Lee Cross¹, Ann Bangerter¹, Kelli Allen², Gert Bronfort³, Roni Evans³, Laura Meis¹, Alexander Haley³, Marianne Matthias⁴, Melissa Polusny¹, Brent Taylor¹, Stephanie L. Taylor⁵, John Ferguson³, and Diana Burgess¹

¹Minneapolis Veterans Affairs Health Care System, Minneapolis, MN

²VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC; Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC., Chapel Hil, NC

³University of Minnesota, Minneapolis, MN

⁴Indiana University, Indianapolis, IN

⁵Veterans Health Administration, New Haven, CT

Contact: Collin Calvert, [e-mail]

Abstract

Purpose: Mindfulness-based interventions (MBIs) have shown effectiveness in reducing chronic pain severity and interference with daily life. Less is known about who benefits most from MBIs, and whether certain groups differentially benefit from different types of MBI formats (group-based versus non-group based). The present study is a secondary analysis of data from a three-arm randomized controlled trial of two MBIs (self-paced and group-based) to test for moderating effects by gender and diagnoses of three mental health conditions (depression, anxiety, and post-traumatic stress disorder).

Method(s): The sample consisted of 811 veterans with moderate to severe chronic pain, recruited from three Veterans Affairs (VA) sites from 2020 to 2022. Survey data were collected at baseline and three follow-up time points (10 weeks, 6 months, and 12 months). Outcomes were indicators of 30% or greater improvement from baseline in pain interference, pain intensity, anxiety, depression, PTSD, fatigue, sleep disturbance, physical function, and social functioning. A difference of 10 percentage points in intervention effect across moderator subgroups was deemed as a potentially meaningful difference.

Results: Overall, both the group MBI and self-paced MBI arms had higher rates of improvement in all outcomes compared to usual care. Statistically significant interaction effects were found for gender, while potentially meaningful differences were found for both gender and anxiety diagnosis. For veterans in the group MBI, women had greater improvement in pain severity and depression than men, and those with diagnoses of anxiety had less improvement in PTSD than those without anxiety. For veterans in the self-paced arm, those with diagnoses of anxiety had greater improvement in depression than those without anxiety.

Conclusions: Certain subgroups of veterans differentially benefitted from different types of MBIs. Further research is needed to more systematically determine whether MBIs can be optimized for key subgroups.

Oral Abstract Session 22: Intervention Delivery and Dose

OA22.01

Understanding Yoga Videos on TikTok: How Useful Are They?

Sriram Arvind ¹ , Kristin Kotleski², Randi Stockwell¹, Ashley Maggia², Bradley Kerr², and Mala Mathur²

¹University of Wisconsin - Madison, Madison, WI

²University of Wisconsin School of Medicine and Public Health, Madison, WI

Contact: Sriram Arvind, [e-mail]

Abstract

Purpose: Integrative health practices like yoga have been associated with improved adolescent mental health and quality of life. TikTok, a popular social media platform among adolescents, is increasingly used to share health-related information, yet no known studies have evaluated the quality of yoga content on the platform. This study aimed to assess the content and characteristics of yoga-related TikTok videos relative to their understandability and actionability.

Method(s): This cross-sectional content analysis evaluated TikTok videos related to yoga in the spring of 2024. The first 100 videos under six predetermined hashtags were evaluated using an inductive codebook, and the PEMAT Audio/Visual scale. Data was collected with RedCap, and SAS software was used for descriptive statistics, as well as other relevant statistical analyses. Nonparametric tests were used to assess differences in video and content quality.

Results: A total of 600 videos were screened for eligibility, and 392 met inclusion criteria. The average understandability score was 71.9% (SD 21.7%), while the average actionability score was 45.2% (SD 39.4%). Videos under hashtags #howtopracticeyoga, #yogatutorial, and #beginneryoga had higher understandability and actionability compared to #yoga, #yogapractice and #yogainspiration (Wilcoxon Rank Sum, p<0.0001). Eligible videos under the median likes (22,800) also tended to have higher understandability and actionability. No association was found between video duration (± 30 seconds) and quality metrics.

Conclusions: TikTok videos under #howtopracticeyoga, #yogatutorial, and #beginneryoga hashtags scored higher in understandability and actionability, suggesting they may be more effective for learning yoga. Interestingly, TikTok videos with fewer likes tended to have higher quality scores, indicating these videos may have prioritized educational content over entertainment. Future studies should explore how TikTok’s yoga content might influence adolescent mental health and change attitudes toward regular practice.

OA22.02

What Number of Sessions of Yoga is Associated with Improved Health?

Stephanie L. Taylor ¹ , Stephen Frochen², Scott Coggeshall³, Ethan Rosser⁴, Joy Toyama⁵, and Steven Zeliadt⁶

¹Veterans Health Administration, New Haven, CT

²US Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Healthcare System, Los Angeles, CA

³Veterans Health Administration, Seattle, WA

⁴VA Puget Sound Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA

⁵Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA

⁶VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

Contact: Stephanie L. Taylor, [e-mail]

Abstract

Purpose: The optimal number of yoga sessions needed to improve some health outcomes is still unclear. Most yoga studies use a pre-set number of sessions to examine effectiveness; few have examined the effectiveness of varying numbers of sessions of yoga to determine the optimal number of sessions for health. In a large-scale Veterans Health Administration (VA) effort, we examined the number of yoga sessions needed to have an effect on several health outcomes.

Method(s): Among patients with chronic pain, we examined their use of yoga noted in VA’s electronic health records and the nation’s largest survey of CIH therapy use and patient-reported outcomes – the Complementary and Integrative Health Patient Experience Survey - at three (n=1,694) and six months (n=3,675). Using natural spline modeling, we examined the number of yoga sessions associated with changes in eight health outcomes at 3 and 6 months.

Results: Patients having 14+ yoga sessions over 3 months showed improved global physical health and those having 16+ sessions showed improved global mental health. Those with 18+ sessions over 3 months showed increases in having purpose in life and those having 20+ sessions reported improvements in daily depression. Improvements in severe fatigue were associated with using 1 session, but moderate fatigue was not improved with yoga. Finally, although doing yoga was unassociated with pain interfering with life, having 19+ sessions was associated with improved pain severity. Results were generally consistent over six-month periods.

Conclusions: Various health improvements were observed among patients using as little as 14 yoga sessions. Evidence from real-world delivery of CIH therapies can provide guidance for providers wanting to encourage patients to use self-care therapies as part of their pain management.

OA22.03

Impact of a 5-Day, 20-Minute Slow Deep Breathing Protocol on Wellbeing: Immediate and Post-Intervention Outcomes Across Various Environments

Danielle Devarney ¹ , and Beth Frates²

¹UCLA, Harvard Extension School, Carlsbad, CA

²Harvard Medical School, Harvard Extension School, Mass General Hospital, American College of Lifestyle Medicine, Wellesley Hills, MA

Contact: Danielle Devarney, [e-mail]

Abstract

Purpose: Research shows slow deep breathing (SDB) can reduce stress and enhance well-being. However, minimum effective doses and sustained effects of SDB across different settings are underexplored. The purpose of this study was to address these gaps with a 5-day, 20-minute SDB protocol featuring extended exhalations in both group and individual environments.

Method(s): This randomized pre-post, between-subjects study explored SDB in group and individual settings. Participants attended daily in-person SDB classes or accessed virtual recordings for five days. Depression, anxiety, stress, resilience, and sleep quality were assessed using validated tools (DASS-21, CD-RISC-10, PSQI) at pre-intervention, immediately post-intervention, and 30 days later. Data was collected online via Qualtrics and analyzed in SPSS with Pearson correlation, descriptive statistics, t-tests, and Cohen’s d.

Results: Of the 309 participants, 134 were included in the final analysis due to incomplete data and attrition. Regardless of environment, all participants showed significant improvements in resilience, depression, anxiety, and stress (p < 0.001) post-intervention. At 30 days, resilience (p = 0.001), stress (p = 0.015), anxiety (p < 0.001), and sleep quality (p = 0.036) remained significantly improved. Depression scores remained improved from baseline but showed no significant change from day 5 to day 30 (p = 0.103). No significant differences were found between individual and group settings, though dropout was higher in the individual setting (62%) compared to the group (6%), suggesting the importance of social support for adherence.

Conclusions: A 5-day SDB protocol significantly improved stress, anxiety, depression, resilience, and sleep across settings after 30 days. This study emphasizes the role of social dynamics in adherence and suggests further research into SDB’s long-term effects.

OA22.04

A Tool for Assessing Adequacy/Quality of Acupuncture Administered in Randomized Controlled Trial

Weijuan Gang ¹ , and Xiaoyi Hu¹

¹Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, Beijing, China

Contact: Weijuan Gang, [e-mail]

Abstract

Purpose: To rigorously and scientifically develop a tool for assessing adequacy/quality of acupuncture administered in randomized controlled trial (RCT).

Method(s): We conducted a systematic review on assessing the adequacy/quality of acupuncture administered in RCT and summarized the characteristics and contents of acupuncture adequacy assessment in previous other studies. On this basis, we used modified Delphi method to reach a consensus, in which two rounds Delphi survey and one face to face meeting was held.

Results: In the systematic review, 40 studies were included. Thirty-two studies (82%) assessed the components of the acupuncture process and seven studies (18%) assessed the overall quality of the acupuncture. Twenty-two studies (56%) assessed the rationality of the control group. The components of acupuncture usually assessed included the number of sessions (21, 54%), choice of acupoints (19, 49%), acupuncture technique (14, 36%), and needle sensation induced (13, 33%). Twenty-five Delphi experts were from American and England, Beijing, Shanghai, Sichuan, Tianjin, and Guangdong provinces in China, respectively. Experts reached a consensus on the adequacy/quality of acupuncture in RCT assessment tool: seven signaling questions in four domains and corresponding judgments. The four domains include the design rationality of acupuncture and sham acupuncture protocols, and the implementation adequacy of acupuncture and sham acupuncture protocols.

Conclusions: A new tool for assessing the adequacy/quality of acupuncture in RCTs was rigorously developed through the systematic review and the modified Delphi method. The tool will be useful to systematic review authors and clinicians making use of acupuncture RCTs, by providing a coherent framework for understanding and identifying the adequacy/quality of acupuncture in RCTs. It might also help those designing, conducting and reporting acupuncture RCTs to achieve the most consistent findings with clinical practice.

Posters

Topic Area 01 – Basic Science

P01.01

Auricular Therapy for Cognitive Function: A Narrative Literature Review

Yu-Min Cho ¹ , Chao Hsing Yeh², and Bianca Shieu³

¹Cizik School of Nursing The University of Texas Health Science Center at Houston, Houston, TX

²The University of Texas Health Science Center at Houston (UTHealth), Houston, TX

³UT Health San Antonio, San Antonio, TX

Contact: Yu-Min Cho, [e-mail]

Abstract

Purpose: Cognitive impairment, often an early indicator of dementia, disrupts memory, thinking, and decision-making, impacting daily independence and quality of life and posing significant challenges for caregivers and society. Treatment varies based on the cause and severity, ranging from medication to cognitive rehabilitation and lifestyle modifications. However, cognitive impairment is often incurable, particularly in degenerative diseases like Alzheimer’s, making non-pharmacological approaches essential for managing symptoms due to the potential complications associated with multiple drug use. This narrative review explored the potential mechanisms by which stimulating auricular acupoints may influence cognitive function, based on current evidence.

Method(s): In accordance with PRISMA guidelines, we conducted a comprehensive search across four English-language electronic databases: PubMed, CINAHL, Scopus, and Google Scholar. Additionally, we manually reviewed the bibliographies of relevant articles to identify further studies. Our search strategy incorporated a combination of relevant keywords and MeSH terms specific to the topic.

Results: We focus on the mechanisms of auricular therapy that may alter cognitive and executive functions. By stimulating vagal nuclei in the brainstem, auricular therapy activates the vagus nerve, enhancing cerebral blood flow, promoting glucose and oxygen supply to neurons, increasing brain glucose metabolism, and boosting oxyhemoglobin levels. It also promotes the release of key neurotransmitters such as serotonin, dopamine, and acetylcholine, while enhancing choline acetyltransferase (ChAT) activity in the hippocampus, improving neural communication. Auricular therapy stimulates nerve growth and enhances synapse quality, contributing to improved cognitive processes. Furthermore, it exerts anti-apoptotic effects by up-regulating Bcl-2 and down-regulating Bax, thereby protecting pyramidal cells from degeneration. It also reduces the overproduction of beta-amyloid protein, a hallmark of Alzheimer’s disease. Lastly, auricular therapy enhances antioxidant defenses via Nrf2 activation, reducing oxidative stress and protecting neurons from free radical damage, supporting overall cognitive health.

Conclusions: Auricular therapy a low-risk and non-pharmacological clinical modality may positively influence cognitive function presenting a promising.

P01.02

Gold Nanoparticle-Embedded Nano-Ayurveda formulations for Immune Enhancement and Cancer Treatment: An Innovative Integrative Medical Approach

Kavita Katti¹, Velaphi Thipe¹, Alice Raphael Karikachery ¹ , Anantkumar Hedge², Prajna Hegde², Vrushali Hegde², Deepa Prakash², Ilaadevi Hegde², and Kattesh Katti¹

¹University of Missouri, Columbia, MO

²Kadamba Intrac Private Limited, Bengaluru, Karnataka, India

Contact: Alice Raphael Karikachery, [e-mail]

Abstract

Purpose: Genetic aberrations cause modulations of various immune suppressive or immune compromising cascade of effects that initiate and propagate various diseases through upregulating or suppressing/downregulating the interconnected cytokines, macrophage phenotypes and numerous cells signaling pathways. In the context of cancer and many inflammatory diseases, drugs should initiate a cross talk and modulate several genetically derived parameters. Currently, there are no drugs that individually or in combination with other drugs, can respond to aberrations in epigenetic processes which is a primary cause of several diseases. Inflammation is a key is a hallmark of cancer and inflammatory cytokines dictate cancer progression and patient survival.

Method(s): Chlorogenic/caffeic acid and cadambine cocktail gold nanoparticles (CCC-AuNPs) were synthesized by adding 12 mg of gum arabic to a solution containing 1 mL of plant-derived compounds rich in chlorogenic/caffeic acid and cadambine, along with 5 mL of doubly deionized (DI) water. The CCC-AuNPs were fully characterized and assessed for their immunomodulatory and prophylactic activities.

Results: The serendipitous combination of gold nanoparticle embedded combinatorial ‘Nano-Ayurveda’ comprising of encapsuled chlorogenic/caffeic acid and cadambine cocktail (CCC-AuNPs) reactivated the fully suppressed and compromised immune system—showing significantly elevated levels of every immunomodulatory cytokine IL-12, IL-6, IL-10, IFN-γ, TNF-α, TGF-β, and levels of Nitric oxide (NO). This study shows unprecedented evidence demonstrated unprecedented results that CCC-AuNPs has a significant therapeutic effect on controlling or reducing tumor size in Nonobese diabetic/severe combined immunodeficiency (NOD-SCID) mice bearing 4T1 breast tumor cells with total cancer remission.

Conclusions: This study introduces an immunotherapeutic or immunomodulatory drug designed to enhance immunoglobulin levels in cancer patients, thereby improving therapeutic outcomes, particularly in immunocompromised individuals. The Nano-Ayurvedic medicinal approach represents a paradigm shift in integrative healthcare, offering innovative solutions for enhancing immune function and supporting cancer treatment.

P01.03

Preliminary Results from a Whole Organism Model of Salutogenesis: The Effects and Interactions of Two Interventions to Restore Memory in Aged Mice

Steve Chamberlin¹, and Nora Gray¹

¹Oregon Health & Science University, Portland, OR

Contact: Steve Chamberlin, [e-mail]

Abstract

Purpose: The results presented here are part of a larger project to develop a whole organism model for the study of salutogeneis, or health restoration. Age-related cognitive decline in mice is the primary health condition. Cognition is restored using two non-pharmaceutical interventions previously shown to improve memory in mice. Secondary outcomes of mobility and both global inflammatory and oxidative stress status are also assessed for the model. Molecular signatures of health restoration are evaluated using the transcriptome and metabolome of the hiippocampus of the animals, and how this correlates with the outcomes mentioned. In this presentation we present the preliminary assessment of memory in the mice in response to exercise and the botanical Centella asiatica.

Method(s): A cohort of 50 C57BL/6 male mice was assigned to five groups, 10 per group: 4 month old untreated, 18 month old untreated, 18 month treated with Centella, 18 month treated with exercise and 18 month treated with both exercise and Centella. After five weeks of treatment spatial learning and reference memory were evaluated with the Morris Water Maze test and the groups compared.

Results: Preliminary analyses showed the young untreated mice outperforming all of the other groups for both spatial learning and reference memory, as expected. The exercise and exercise + centella groups saw an improvement in spatial learning, relative to old untreated mice, with a possible additive effect. And both the centella and exercise groups saw improvement in reference memory separately. Interestingly, these two interventions combined seemed to have an antagonistic effect on this metric.

Conclusions: For our broader salutogenic model it is necessary to establish restored cognition, which these preliminary results seem to demonstrate. This design will now allow us to next compare mechanisms of both health decline and health restoration for age-related cognitive decline in C57/BL6 mice while simultaneously evaluating other age-related measures of health.

Topic Area 02 – Clinical: Acupuncture

P02.01

A Comparison of Osher Center Acupuncture Clinics’ Utilization Between 2022 & 2023

Melissa Zappa¹, and Anisha Durve ²

¹Huntsman Cancer Institute’s Wellness & Integrative Health Center, University of Utah, Salt Lake City, UT

²University of Miami, Miami, FL

Contact: Anisha Durve, [e-mail]

Abstract

Purpose: The Osher Collaborative for Integrative Health is an organization of eleven (11) healthcare institutions across the globe offering and prioritizing cutting-edge integrative and collaborative healthcare models. Acupuncture is one integrative modality offered to patients at 9 participating US-based Osher institutions. Not much is known about utilization, specialties, and interdepartmental collaboration among hospital-based acupuncture programs in the US. By examining 2022 and 2023 data from four of these acupuncture programs that are integrated within hospital settings, the Osher collaboration presents a much-needed opportunity to provide valuable insights and data for exploring the aspects most beneficial for patient care. These insights can help inform how to develop and expand the most efficient and effective integrative medicine practices across the US as acupuncture becomes more widely accepted and integrated into large healthcare institutions.

Method(s): Surveys to gather data from one representative acupuncturist at each Osher center were electronically distributed. Questions include information on clinic volumes, patient demographics, treatment methods, billing procedures, referral sources, most-commonly treated patient diagnoses, and clinical outcomes.

Results: Results will be analyzed and visually presented to showcase changes and trends among clinic volumes, conditions treated, and referring departments.

Conclusions: Showcasing the varying trends and utilization among Osher acupuncture clinics will provide valuable insights into how hospital-based integrative medicine programs can be utilized to support equitable access to care, improve patient care and outcomes, and identify paths to fiscal and provider-sustainable practices.

P02.02

A Novel Approach Utilizing Ultrasound-Guided Shinbaro2 Pharmacopuncture and MSAT in the Treatment of Herniated Intervertebral Disc: A Case Report

Young suk Yoon¹, and Andrew Jang ¹

¹Jaseng Hospital of Korean Medicine, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Andrew Jang, [e-mail]

Abstract

Purpose: This study aims to evaluate the clinical efficacy of non-surgical treatments for herniated intervertebral disc (HIVD) using ultrasound-guided high-dose Shinbaro2 pharmacopuncture combined with motion style acupuncture treatment (MSAT). The recent integration of ultrasound technology allows for more precise interventions in Korean medicine, and this case highlights the potential for improved outcomes using these techniques.

Method(s): A 45-year-old patient diagnosed with L5/S1 HIVD, as confirmed by MRI, presented with low back pain, radiating leg pain, and muscle weakness due to L5 nerve root compression. The patient underwent a 12-week treatment course, including a 7-day hospital stay, involving ultrasound-guided high-dose Shinbaro2 pharmacopuncture and MSAT. Pain was assessed using the Numeric Rating Scale (NRS), lumbar function with the Oswestry Disability Index (ODI), quality of life with the EQ-5D, and muscle strength with the Manual Muscle Testing (MMT) tool.

Results: After 12 weeks, the patient’s low back and radiating pain decreased from NRS 5 to NRS 0. Muscle strength improved from grade 3 to grade 5, with complete resolution of the leg dragging symptom. ODI and EQ-5D scores indicated significant improvements in lumbar function and quality of life.

Conclusions: This case report suggests that ultrasound-guided high-dose Shinbaro2 pharmacopuncture combined with MSAT may be effective in treating HIVD with radiating pain and muscle weakness. The use of ultrasound in pharmacopuncture has enhanced treatment precision, and a comprehensive approach that addresses both central and peripheral factors is of significant value in HIVD treatment.

P02.03

Acupuncture for Pseudobulbar Syndrome: A Case Report

Jane Abanes ¹ , and Dorothy Pang²

¹University of California, San Francisco, South San Francisco, CA

²Pang Acupuncture and Wellness, South San Francisco, CA

Contact: Jane Abanes, [e-mail]

Abstract

Purpose: The purpose of this case report is to describe the effectiveness of acupuncture for the treatment of pseudobulbar syndrome in a veteran with posttraumatic stress disorder (PTSD).

Method(s): This is a case report from clinical practice using the National Acupuncture Detoxification Association (NADA), Yin Tang, and Du 20 acupuncture points.

Results: Acupuncture was an effective treatment for pseudobulbar syndrome in a veteran with PTSD.

Conclusions: The findings of this case report showed that weekly acupuncture treatment using the NADA, Yin Tang, and Du 20 acupuncture points for 8 weeks was an effective treatment for pseudobulbar syndrome. The acupuncture treatment effects lasted for 6 months during which pseudobulbar episodes were absent for that duration. After 6 months, maintenance treatments with acupuncture were provided weekly for 4 weeks.

P02.04

Community Acupuncture in Integrative Healthcare and Academics: Implementing Community Clinics to Connect Students and Underserved Populations

McKenna Williams ¹ , and Aaron Cook²

¹Arizona School of Acupuncture and Oriental Medicine/Chill Acupuncture and Wellness, Tucson, AZ

²Arizona School of Acupuncture and Oriental Medicine, Tucson, AZ

Contact: McKenna Williams, [e-mail]

Abstract

Purpose: To demonstrate how integration of community acupuncture into medical education can enhance the training of integrative healthcare providers and how providing affordable acupuncture care can benefit the health of underserved communities and individuals.

Method(s): Gather both qualitative and quantitative data from patients and students, and assess learning outcomes and evaluate clinic skills of integrative medicine students, as well as assessing the effectiveness of integrative therapies in underserved communities.

Results: Patient Overall Health: Reduced pain, enhanced mental health, and improved lab results for community clinic patients. Patient Retention Analysis: Examined factors influencing patient retention in the community acupuncture program. Sense of Community: Identified the creation of a supportive and inclusive environment as a significant factor. Building Familiarity: Noted that establishing trust and rapport with patients contributed to ongoing engagement. Diverse Patient Group: Emphasized that these strategies were effective across a wide range of cultural and socioeconomic backgrounds. Academic Growth: Improved practitioner confidence, efficiency, and emphasis on patient centered care.

Conclusions: In conclusion, establishing a community acupuncture clinic within an integrative medicine educational program not only enhances the training and cultural competency of future healthcare providers but also provides accessible, affordable care that significantly benefits underserved communities. By fostering a sense of community, demonstrating measurable health improvements, and emphasizing patient-centered care, such programs can serve as a model for successful integrative healthcare delivery and education. We strive to continue to track data and collect more specific longitudinal data including more labs and other specific testing. We hope to inspire and integrate more community style clinics in medical institutions where diverse and underserved communities may benefit.

P02.05

Designing a Decentralized Randomized Controlled Trial of Acupuncture to Capture Whole Person Health

Lisa Conboy ¹ , Lisa Taylor-Swanson², Irina Conboy³, and Michael Conboy³

¹Harvard Medical School, Boston, MA

²University of Utah College of Nursing, Salt Lake City, UT

³University of California Berkeley, Berkeley, CA

Contact: Lisa Conboy, [e-mail]

Abstract

Purpose: Decentralized Randomized Controlled Trials (dRCT) are a way to collect clinical data that is both naturalistic data and high quality. Here we describe dRCT work using acupuncture to treat the complex multisymptom illness Gulf War Illness, with the goal of demystifying the process. Ten years ago our lab completed a successful Army Funded dRCT “The Effectiveness of Acupuncture in the Treatment of Gulf War Illness” (W81 XWH). In 2024 we received additional funding to confirm this parent study.

Method(s): As with our parent trial, we are using a dRCT, a design that has become even more popular during the COVID 19 epidemic, which can allow for naturalistic and clinically meaningful endpoints and, if appropriate, the opportunity to address gaps in care or service without sacrificing issues of validity or ethics We will recruit and randomize n=200 GWI veterans and 30 licensed practitioners from across the country. As with our previous project, this technique of using acupuncturists in the community reduces participant burden as the veteran can choose a trained acupuncturists conveniently located. Whole person health measurement collection will occur every two months via REDCap, a system allows us to automatically send out all follow-up questionnaires to participants via email. Practitioners can record electronic clinical notes and any adverse effects experienced by the participant. We are also collecting blood samples and wearable biomarker device data at 5 points in time to support our ongoing work on the mechanisms of GWI and of acupuncture treatment.

Results: We are currently executing this project and will provide up to date results at the time of presentation.

Conclusions: Flexible, low cost, and able to improve access for hard to reach populations, dRCTs can reduce participant burden and secure good retention by bringing the study apparatus to the clinical area.

P02.06

Efficacy of Auricular Acupressure for Cognitive Impairment and Dementia in RCTs: A Systematic Review and Meta-Analysis

Bianca Shieu ¹ , Yu-Min Cho², Min Wang³, and Lixin Song¹

¹UT Health San Antonio, San Antonio, TX

²Cizik School of Nursing The University of Texas Health Science Center at Houston, Houston, TX

³UTSA, San Antonio, TX

Contact: Bianca Shieu, [e-mail]

Abstract

Purpose: Auricular Point Acupressure (APA) a non-invasive auricular therapy technique has been widely used to manage various health conditions in cancer patients and the general population including cancer-related pain chronic low back pain and dysmenorrhea. However, research on its effects on individuals with cognitive impairment and dementia remains limited. This systematic review aims to summarize the implementation of APA specifically for individuals with cognitive impairment and dementia in RCTs.

Method(s): Following PRISMA guidelines, we conducted a comprehensive search across seven English and Chinese electronic databases (PubMed, CINAHL, Scopus, Google Scholar, CNKI, Weipu, and Wanfang) using relevant keywords and MeSH terms. Two investigators screened titles, abstracts, and full texts to identify eligible studies, resolving disagreements through discussion or consultation with a third investigator. Data extraction utilized a standardized form, including study characteristics, intervention details, outcomes, and risk of bias assessment. The Mixed Methods Appraisal Tool evaluated evidence quality. Data synthesis employed narrative synthesis and meta-analysis.

Results: Key findings indicate the effectiveness of the APA treatment procedure. Most studies reported improvements in Mini-Mental State Examination (MMSE) scores, Activities of Daily Living (ADL), Montreal Cognitive Assessment (MoCA), Barthel Index, and World Health Organization Quality of Life Brief version (WHOQOL-BREF). The experimental (APA) group showed statistically significant (p < .05) higher scores in MMSE, ADL, and MoCA compared to the control group, along with greater treatment satisfaction. After 12 weeks, MMSE scores improved, particularly in attention/concentration and delayed recall, with patients experiencing better outcomes for urinary retention, constipation, sleep apnea, and pain.

Conclusions: APA has demonstrated effectiveness in managing pain, enhancing daily living activities, improving mental status and cognition, reducing constipation, and improving sleep quality in individuals with cognitive impairment and dementia. These findings suggest that APA may be a promising non-pharmacological intervention for this population, warranting further research to establish its efficacy and optimal implementation strategies.

P02.07

Evaluation of a Battlefield Acupuncture Clinic at VA Northeast Ohio Healthcare System (VANEOHS)

Alecia Smalheer ¹ , Darshana Patel¹, Rosalie Diaz¹, and Michelle Treasure¹

¹Louis Stokes Cleveland VA Medical Center, Cleveland, OH

Contact: Alecia Smalheer, [e-mail]

Abstract

Purpose: Battlefield acupuncture (BFA) is a form of auricular acupuncture that is used as a non-pharmacological approach to pain management. Whole health and oncology at a Northeast Ohio VA collaborated to implement a BFA clinic for patients in an outpatient infusion clinic setting.

Method(s): Key Stakeholders created a workgroup that included guidance from the VA national lead acupuncturist. A BFA trained provider was approved for a Friday morning clinic. A national templated note was utilized along with a patient education handout that was modified to meet local facility needs. Information was disseminated to staff and patients.

Results: Data analysis from September 2023 to September 2024, revealed 373 procedures with 117 unique patients, male (n = 92) and female (n = 25). Patients with cancer, rheumatologic and gastrointestinal diseases, and other varying diagnoses were included. Most common pain sites, back (38%), lower extremities (26%), upper extremities (19%), and neck (9%). Using a numeric pain scale (0 – 10), average pain score pre-intervention was 5.6 and post 2.6. Overall, an average 3-point decrease in pain scores. Using a scale of 0 to 10, patients were also asked to score how pain interfered with activity, sleep, mood, and stress over the past 24 hours. Average scores demonstrated: activity (4), sleep (3.7), mood (3.5), stress (3.5).

Conclusions: Implementation of this BFA clinic has shown that integrating BFA into an infusion clinic is feasible and beneficial. Limited studies exist on BFA in cancer patients. Next steps involve a pilot clinical trial with protocoled BFA, as well as protocoled and standardized symptom and quality of life (QOL) assessments. The primary endpoint of the study will be change in pain score, with an exploratory analysis on BFA effects on symptoms and QOL in cancer patients.

P02.08

Factors and Their impact on Acupuncture Treatment Effect in Different Therapeutic Areas: A Meta-Regression of Acupuncture Randomized Controlled Trials

Xiaoyi Hu ¹ , Weijuan Gang¹, and Wencui Ziu¹

¹Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, Beijing, China

Contact: Xiaoyi Hu, [e-mail]

Abstract

Purpose: To identify factors and their impact on the acupuncture effect within specific therapeutic areas.

Method(s): Seven major database were searched from 2015 to 2019 for randomized controlled trials of acupuncture. Trials with eligible comparisons at least one patient-important outcome and a sample size exceeding 100 were included. Independent variables were collected through literature research and panel consultation. In each therapeutic area, the standardized mean difference (SMD) were used as effect estimate for the dependent variable. Meta-regression analyses were conducted using a three-level robust models including multivariable and univariable analyses.

Results: The analysis of musculoskeletal system identified three significant factors. Inadequate or unclear allocation concealment, compared to adequate allocation concealment, was associated with a larger effect [difference of adjusted SMDs 1.09, 95% confidence interval (CI) 0.29 to 1.89]. Compared to a sample size of 101-150, the effects proved of a greater magnitude in a sample size of 151-499 studies (0.6, [0.03 to 1.16]). Adequate sequence generation, compared to inadequate or unclear sequence generation, was associated with a larger effect (0.51, [0.03 to 0.99]). In the analysis of neurological diseases, penetration acupuncture, compared to the non-penetration type of acupuncture, was associated with larger effects (1.13, [0.43 to1.83]). Inadequate or unclear allocation concealment, compared to adequate allocation concealment, was associated with a larger effect (0.79, [0.01 to1.57]). A flexible acupuncture regimen, compared to the fixed regimen, was associated with a moderately larger effect (0.33, [0.07 to 0.59]). For gastroenterological studies, penetration acupuncture, compared to non-penetration acupuncture, was associated with moderately larger effect (0.37, [0.04 to 0.7]).

Conclusions: Patients and clinicians should consider penetrating over non-penetrating acupuncture for neurological and gastroenterological diseases. For neurological diseases a flexible acupuncture regimen is recommended over a fixed regimen. Researchers should consider the factors that impact the effect of acupuncture when designing future acupuncture trials of corresponding therapeutic areas.

P02.09

Pain Relief with Integrative Medicine (PRIMe)?: Feasibility Trial of Acupuncture for Long COVID

Nikki Gentile ¹ , Rachel Geyer¹, Aiko Bailey², Dan Cherkin³, Iman Majd⁴, Andrew Humbert¹, Jing Zhang⁵, and Janna L. Friedly⁶

¹University of Washington, Seattle, WA

²University of Washington, Osher Center for Integrative Health, Seattle, WA

³Osher Center for Integrative Health, Dept of Family Medicine, U. Washington, Seattle, WA

⁴Osher Center for Integrative Medicine, University of Washington, National Certification Commission for AOM (NCCAOM), Medical Acupuncture Research Foundation, Seattle, WA

⁵UW Medicine, Seattle, WA

⁶Rehabilitation Medicine, University of Washington, Seattle, WA

Contact: Nikki Gentile, [e-mail]

Abstract

Purpose: There is an urgent need to identify effective non-pharmacologic treatments for the growing number of patients with Long COVID, about half of whom report pain. This study assesses the feasibility of conducting a fully powered pragmatic randomized trial evaluating the effectiveness of acupuncture vs usual care for reducing pain and improving quality of life in patients with long COVID.

Method(s): We conducted a 2-arm pragmatic randomized feasibility clinical trial. Participants were patients over 18 years old from the University of Washington Long COVID Clinic reporting chronic pain. The intervention involved eight weeks of acupuncture versus usual care. Outcomes were measured at 4, 8 and 20 weeks on validated patient-reported outcome measures of pain, function, and quality of life, including the Pain, Enjoyment, and General Activity scale, PROMIS-29, PROMIS-Cognitive, Patient Reported Self-Efficacy, and Pain Catastrophizing Scale. Feasibility measures included recruitment, retention, response rates, and adherence to acupuncture treatment protocol.

Results: Enrollment began in June 2024. Initial feasibility outcomes included randomization of 23 participants in 6 days (12 to usual care and 11 to acupuncture); 2 dropped out of acupuncture before treatment but 8 of the remaining 9 participants completed more than 6 acupuncture visits. To date, 17 of 21 completed the 4-week and 8-week outcomes surveys. Intervention fidelity was 100%. Almost all participants reported (1) surveys were clear, easy to access online, and not too long, (2) scheduling acupuncture visits was easy, (3) no problems retaining press needles in ears, and (4) acupuncture was a pleasant experience. Challenges included the need for flexible treatment access and additional locations to reduce travel burdens.

Conclusions: Preliminary results indicate feasibility with strong participant engagement, adherence, and positive feedback on survey clarity. Findings will inform adjustments to study procedures, treatment protocols, and communication methods in preparation for a fully powered pragmatic randomized clinical trial.

P02.10

Predicting Acupuncture Treatment Outcomes in Lumbar Disc Herniation: Leveraging Sparse Electronic Health Records for Patient Phenotyping

Ye-Seul Lee¹

¹Jaseng Medical Organization, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Nikki Gentile, [e-mail]

Abstract

Purpose: Electronic health records (EHRs) offer a wealth of patient data but often fail to capture the dynamic progression of symptoms, particularly in non-continuously monitored conditions like lumbar disc herniation (LDH). This study was conducted to develop a predictive model that integrates latent class trajectory modeling (LCTM) with machine learning algorithms to enhance the prediction of acupuncture treatment outcomes and address the challenges posed by sparse data entries.

Method(s): The EHRs of 6,732 patients with lumbar disc herniation in 2017-2021 were obtained and divided into training (2017-2019) and prediction (2020-2021) datasets. Patient prognosis trajectories using Oswestry Disability Index (ODI) over time were identified using LCTM in the training dataset. The model fit of LCTM using training set was evaluated using Bayesian Inference Criterion (BIC) and average of posterior probability of assignments (APPA). Patient phenotypes by trajectories were trained using baseline characteristics in the training dataset and classified in the prediction set. Achievement of minimum clinically important differences (MCID) in ODI at discharge was predicted using a naïve model with only baseline characteristics and using combined model with patient phenotypes as intermediate variables.

Results: The LCTM showed three trajectories of ODI trends with the best model fit, and patient phenotypes were classified in the prediction set from baseline characteristics. The combined model, which integrated these phenotypes, demonstrated superior performance compared to a naïve model with an improvement in AUROC from 0.77 to 0.81.

Conclusions: The integration of LCTM and machine learning significantly enhanced the prediction of treatment outcomes in LDH. In prediction models of treatment outcomes where longitudinal input data is sparse, employing a data-driven approach to identify patient phenotypes and leveraging a chronologically stratified dataset may help improve performance and interpretability while mitigating the risk of temporal data leakage.

Topic Area 03 – Clinical: Herbs

P03.01

A Korean Medicine Approach to Managing Functional Dyspepsia in a Patient with Herniated Cervical Disc: A Case Report

Yujin Lee¹, Gilgeun Baek¹, Sanghun Yoon¹, Juheon Park¹, Nakyoung Lee ¹ , Hyungchul Lee¹, Manho Kang¹, and Sunghwan Park¹

¹Jaseng Hospital, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Nakyoung Lee, [e-mail]

Abstract

Purpose: In clinical settings, complex conditions involving multiple systems are commonly encountered. This case report, written in accordance with the CARE 2013 case report guidelines, examines the effectiveness of Korean medical treatments in managing a patient with functional dyspepsia and a herniated cervical intervertebral disc. The patient presented with both gastrointestinal symptoms (functional dyspepsia) and musculoskeletal issues (posterior neck pain).

Method(s): A comprehensive treatment approach was applied for 19 days, including herbal medicine (Banhabaekchulchunma-Tang), acupuncture (CV12, LI4, ST36, PC6), pharmacopuncture, moxibustion (CV12, CV10), cupping therapy (BL21, BL20, ST25), and Chuna manual therapy. Herbal medicine, acupuncture, and cupping therapy were administered twice a day. While pharmacopuncture, moxibustion, and Chuna manual therapy were administered once a day, for a total of 19 days. To evaluate treatment outcomes, the Gastrointestinal Symptom Score (GIS) assessed dyspepsia severity, the Numerical Rating Scale (NRS) measured both dyspepsia and neck pain, and the European Quality of Life Five Dimensions (EQ-5D) scale assessed overall health status.

Results: Post-treatment, the patient demonstrated significant improvements. The NRS score for pain decreased from 8 to 3, the GIS score for dyspepsia reduced from 31 to 11, and the EQ-5D score increased from 0.357 to 0.721.

Conclusions: The study demonstrates that comprehensive Integrative approach using Korean medicine, particularly Banhabaekchulchunma-Tang, may effectively manage complex conditions involving both gastrointestinal (functional dyspepsia) and musculoskeletal symptoms.

P03.02

Chinese Herbal Medicine in Treatment of Type 2 Diabetes Mellitus: A Systematic Review of Medicinals Used and Clinical Impact

Anisa Finney ¹ , and Lisa Conboy²

¹Seattle Institute of East Asian Medicine/Gather Acupuncture and Herbs LLC, Spokane, WA

²Harvard Medical School, Boston, MA

Contact: Anisa Finney, [e-mail]

Abstract

Purpose: With Diabetes Mellitus (DM) on the rise, biomedicine has identified its treatment as challenging due to the multitude of interventions necessary for disease management (Sapra & Bhandari, 2021). Biomedical treatment utilizes a single action approach, placing patients in the care of one specialist at a time. The traditional Chinese Herbal Medical approach can be of great utility to DM patients administered by a single practitioner aiming to address whole body imbalances. This project synthesized available research discussing Chinese Herbal medicine in the treatment of T2DM via PubMed.

Method(s): Systematic review was used to search PubMed database October 2022-April 2023 leading to eventual retrieved sample of 30 articles. Search terms included Chinese Medicine AND Diabetes Mellitus OR Chinese Medicine AND Type 2 Diabetes with the filters of clinical trial, open access, in English.

Results: Thirty articles met the inclusion criteria and were included in this review. Chinese herbal medicines were extensively considered, appearing in multiple forms such as pills, single herbs, granules, and decoctions. Of the 30 studies, the most reported outcomes were reduced fasting blood glucose, reduced HbA1c, and improved glycemic control.

Conclusions: Further research is necessary to capture the role of Chinese herbal medicine in the integrative treatment of T2DM patients.

P03.03

Effects of Xanthohumol on Health-related Quality of Life and Disease Activity in Adults with Crohn’s Disease: A Phase 2 Clinical Trial

Ryan Bradley ¹ , Paige Jamieson², Nini Callan³, Tom Metz⁴, and Jan Frederik Stevens²

¹Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA

²Linus Pauling Institute, Oregon State University, Corvallis, OR

³Helfgott Research Institute, National University of Natural Medicine, Portland, OR

⁴Pacific Northwest National Laboratory, Richland, WA

Contact: Ryan Bradley, [e-mail]

Abstract

Purpose: To determine the effects of the polyphenolic compound xanthohumol from hops on subjective changes in health-related quality of life and the Crohn’s Disease Activity Index as measures of tolerability in a Phase 2 clinical trial.

Method(s): A randomized, placebo-controlled, IND-approved, Phase 2 clinical trial of 99.8% pure xanthohumol (24 mg/day) was conducted in n=20 adults with active Crohn’s disease. Participants could not be in clinical remission, take probiotic or polyphenolic dietary supplements, or use biologic or cannabis-based medications to be eligible. The PROMIS-29 v2.0 and the Crohn’s Disease Activity Index (CDAI) were collected at baseline and every 2 weeks for 8 weeks. The primary comparison was baseline to Week 8. Mean CDAI scores and PROMIS domain-specific t-scores at each follow-up visit were compared to baseline by 2-sided, unpaired t-tests.

Results: Participants were 60% female with mean age 38.6 (15.2) years. Nineteen (95%) participants completed the trial. Mean (SE) baseline PROMIS-29 t-scores were: 55.42 (8.09), 52.47 (9.7), 51.64 (8.7), 49.17 (9.0), 55.61 (4.2), 48.76 (7.6), and 55.84 (8.2) for fatigue, anxiety, social interaction, depression, sleep, physical function and pain interference respectively. Baseline mean CDAI score was 215.89 (41.6), indicating the absence of remission. Following 8 weeks of xanthohumol, there were no significant changes in PROMIS-29 domains or CDAI (p>0.05 for all comparisons).

Conclusions: Xanthohumol was well-tolerated and did not negatively impact PROMIS-measured health-related quality of life or Crohn’s disease activity.

P03.04

Korean Medicine Approach to mononeuropathy and Reduced Lung Function Post-COVID-19: A Case Report

Nakyoung Lee ¹ , Gilgeun Baek¹, Sanghun Yoon¹, Yujin Lee¹, Juheon Park¹, Hyungchul Lee¹, Manho Kang¹, and Sunghwan Park¹

¹Jaseng Hospital, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Nakyoung Lee, [e-mail]

Abstract

Purpose: Amidst the growing number of patients seeking Korean medicine treatment for post-COVID-19 sequelae, we present a case that showed improvement through herbal medicine, pharmacopuncture, and acupuncture. This patient, who suffered from persistent cough, dyspnea, and reduced lung function since COVID-19 in August 2021, also experienced decreased strength in the right tibialis anterior muscle and pain in the right dorsum of the foot and 2nd and 3rd toes. After receiving Korean medicine treatment, the patient’s symptoms significantly improved, and we wish to share this case. This case report complies with the CARE 2013 Case Report Guidelines.

Method(s): A comprehensive treatment approach was applied for 24 days, including herbal medicine (Cheongsangboha-tang), acupuncture, pharmacopuncture (Shinbaro2), moxibustion, and cupping therapy. Herbal medicine, acupuncture, and cupping therapy were administered twice a day, while pharmacopuncture and moxibustion were applied once a day. To evaluate treatment outcomes, lung function was measured through a 6-minute walk test, pain in the right dorsum of the foot and 2nd and 3rd toes was assessed using the Numerical Rating Scale (NRS), and overall health status was evaluated with the European Quality of Life Five Dimensions (EQ-5D) scale.

Results: Post-treatment, the patient demonstrated significant improvements. The NRS score for pain decreased, the 6-minute walk test score increased from 3 minutes to 20 minutes, and the EQ-5D score increased from 0.712 to 0.904.

Conclusions: The study demonstrates that a comprehensive integrative approach using Korean medicine, particularly Cheongsangboha-tang, may effectively manage complex conditions triggered after COVID-19, involving reduced lung function and mononeuropathy symptoms.

P03.05

Using Traditional East Asian Medicine Tongue Diagnosis to Monitor Physiological Changes in Individuals Undergoing Psilocybin Therapy

Kris Ichigotora ¹ , Kayla Ruby¹, and Lisa Conboy²

¹Seattle Institute of East Asian Medicine, Seattle, WA

²Harvard Medical School, Boston, MA

Contact: Kris Ichigotora, [e-mail]

Abstract

Purpose: Personal and therapy assisted psilocybin usage has increased amongst the general population and Traditional East Asian Medicine (TEAM) patients. Although there is a copious amount of research regarding psilocybin use with biomedicine there is currently no published data through the lens East Asian Medicine. Data collected using the well-established and objective method of tongue diagnosis could potentially help practitioners better understand how psilocybin affects the body. This could be valuable to furthering the care of patients that are considering or are currently undergoing psilocybin therapy.

Method(s): Pilot work has been completed to produce a system to photograph both the top and underside of the tongue in a controlled setting. Practitioner rated results and DELPHI methods used for inter-rater reliability.

Results: Multiple TEAM practitioners were asked to fill out a questionnaire and assess each tongue for their specific characteristics. -Each question had multiple options, and participants were able to select more than one option. Additionally, participants had the ability to write in any additional information they felt important. Twenty-six TEAM practitioners and students took the test. Results showed that there were high levels of agreement amongst some characteristics, while others were mixed. This demonstrated that it is critical for the photographs in the parent study to be taken under a standardized and controlled environment, that the practitioners analyzing the photos have more than 5 years of clinical experience, and that the questions asked in the survey are as simplified as possible in order to obtain a high level of consensus.

Conclusions: This tongue diagnosis protocol is established and implemented it would be easy to apply to any other study involving a medical intervention where we would be interested in the effect that intervention has on the subject through the lens of Traditional East Asian Medicine.

P03.06

Traditional Chinese Medicine Therapy for Treating Amyotrophic Lateral Sclerosis: A Bayesian Network Meta-Analysis Protocol

Chen Shen ¹ , and Jianping Liu²

¹Beijing University of Chinese Medicine, Beijing, Beijing, China

²Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Chen Shen, [e-mail]

Abstract

Purpose: To explore whether traditional Chinese medicine alone or in combination with conventional medicine can provide therapeutic benefits for adults with amyotrophic lateral sclerosis.

Method(s): A systematic review and network meta-analysis will be conducted. Since the study results have not been completed yet, a study protocol is reported below. We will search the following electronic databases from their inception to 9th August 2024: Pubmed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang database, Chinese Scientific Journal Database and Chinese biomedical literature database. Parallel group, randomized controlled trials (RCTs) or non-randomized controlled trials (non-RCTs) regardless of blinding or publication types. Adults with age over 18 years who were diagnosed with ALS will be included. Traditional Chinese medicine therapies can be employed either independently or as adjunctive therapy alongside conventional medicine. These interventions encompass herbal medicine or preparations, as well as non-pharmacological approaches like acupuncture or massage. There are no specific restrictions regarding the dosage or formulation of herbal medicines. Eligible control therapy includes one or a combination of a placebo, no treatment and conventional medicine.

Results: Primary outcome includes functional status and the secondary outcomes include survival time, quality of life, respiratory function, symptom improvement or relief, motor neuron loss, cognitive and behavioral impairment and adverse events. The Cochrane Risk of Bias 2.0 (RoB 2.0) and Robins-I will be respectively employed to evaluate the methodological quality of included RCTs and non-RCTs. This study will be based on the Bayesian network meta-analysis and used R 4.4.0. A risk ratio (RR) with a 95% confidence interval (CI) will be calculated for dichotomous variables. Each outcome will be ranked using the surface under the cumulative ranking curve.

Conclusions: We will perform subgroup analyses based on different pattern of Chinese medicine syndrome, different comparisons of interventions, and randomized and non-randomized studies.

Topic Area 04 – Clinical: Manual Therapies

P04.01

A Delphi Panel Consensus Study Validating the Appropriateness, A Delphi Panel Consensus Study Validating the Appropriateness, Clarity, and Relevance of a Preliminary Set of Quality Measures for Chiropractic Care

Robert Vining ¹ , Elissa Twist¹, Amy Minkalis¹, Maranda Kleppe¹, and Sujatha Kedilaya¹

¹Palmer College of Chiropractic, Center for Chiropractic Research, Davenport, IA

Contact: Robert Vining, [e-mail]

Abstract

Purpose: As chiropractic services expand into multidisciplinary settings, methods to assess the quality of care are needed. This study refined a preliminary set of quality measures/indicators for chiropractic care, originally derived from care standards, clinical guidelines, and best practices.

Method(s): We conducted a modified online Delphi consensus process with chiropractic providers and administrators in integrated settings, and those with clinical administrative capacity at academic and residency programs accredited by the Council on Chiropractic Education. Panelists from these settings were invited because of anticipated familiarity with quality assessment and improvement efforts common in multidisciplinary and academic settings. Panelists individually rated 70 measures for: 1) clarity, 2) relevance to patients, families, clinicians, or health organizations, and 3) appropriateness. Measures were organized and reviewed by Donabedian category (structure, process, and outcome). Consensus was specified as ≥80% of appropriateness ratings in the 7-9 range, median rating in the 7-9 range, and ≥80% of responses noting relevance to ≥1 group. Following the consensus process, authors developed new measures to address gaps where no corresponding structure, process, or outcome measure existed.

Results: Two consensus rounds were conducted with 46 panelists. Fifty-one (73%) measures achieved consensus in Round 1. Three were subsequently split into 7 separate measures, and 14 were revised for clarity per panelist recommendations. Of the 19 (27%) measures failing to achieve consensus, 10 were removed. Of the 9 measures re-rated in Round 2, 6 achieved consensus. Three newly proposed indicators ensure process and outcome measures are supported by a corresponding structure category measure. The final set contained 5 outcome, 26 process, and 33 structure measures, totaling 64.

Conclusions: This study refined a preliminary set of quality measures for chiropractic care. To further validate and facilitate chiropractic integration, patient perspectives, feasibility data, pilot testing, and effective implementation methods are needed.

P04.02

Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-Related Adverse Events: A Retrospective Cohort Study

Robert Trager ¹ , Zachary Cupler², Roshini Srinivasan³, Elleson Harper⁴, and Jaime Perez⁵

¹Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH

²Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, PA

³Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH

⁴University Hospitals of Cleveland, Cleveland, OH

⁵Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH

Contact: Robert Trager, [e-mail]

Abstract

Purpose: Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, while limited evidence suggests that these patients have a lower risk of any type of adverse drug event. Opioid-related adverse drug events (ORADEs) are defined as moderate to severe adverse opioid-related effects, such as poisoning and overdose. We hypothesized that adults receiving CSM for sciatica would have a reduced risk of ORADEs over a one-year follow-up compared to matched controls not receiving CSM.

Method(s): We searched a de-identified United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ≥18 years with sciatica, excluding those with serious pathology, recent anesthesia or spine surgery, high risk of ORADEs, and an ORADE ≤ 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care without CSM. We used propensity score matching to control for confounding variables associated with ORADEs.

Results: 372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding a risk ratio (RR) of 0.29 (95% confidence intervals [CI]: 0.25-0.32; P<.00001). Patients receiving CSM had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P<.00001])

Conclusions: This study found that adults with sciatica who received CSM had a lower risk of an ORADE compared to matched controls not receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.

P04.03

Association of High-Impact Chronic Pain with Mental Health Co-Morbidities in U.S. Veterans with Chronic Low Back Pain: Baseline Data from VERDICT

Cynthia Long ¹ , Amy Minkalis¹, Jacob McCarey¹, Stacie Salsbury¹, Robert Vining¹, Robert Wallace², Anthony Lisi³, Zacariah Shannon⁴, and Christine Goertz⁵

¹Palmer College of Chiropractic, Center for Chiropractic Research, Davenport, IA

²University of Iowa, Iowa City, IA

³Yale University, New Haven, CT

⁴Palmer College of Chiropractic, Davenport, IA

⁵Duke University School of Medicine, Durham, NC

Contact: Cynthia Long, [e-mail]

Abstract

Purpose: High-impact chronic pain (HICP) is pain that regularly limits daily life or work activities with reported prevalence rates ranging from 6.9% to 7.8% in U.S. adults. We present demographic, HICP, sleep disturbance and mental health co-morbidities collected at baseline in the Veterans Response to Dosage in Chiropractic Therapy (VERDICT) pragmatic trial.

Method(s): Veterans ≥18 years who reported chronic low back pain (LBP), defined as LBP persisting for ≥3 months with pain on at least half the days in the past 6 months, were recruited from 4 Veterans Affairs facilities. Demographic data were obtained from the electronic health record and self-report measures were collected in REDCap. HICP was defined as pain on most days or every day and pain limiting life or work activities on most days or every day over the past 3 months, or not working or unable to work due to pain. We modeled the cross-sectional data with logistic regression.

Results: 766 veterans were enrolled in VERDICT. Demographics included: mean age 51 (22-87) years, 21% females, 12% Hispanic, 17% Black and 70% White. 65% of participants reported HICP, including 28% not working due to pain. Co-morbidities included 52% sleep disturbance, 42% depression, 36% anxiety and 33% post-traumatic stress disorder (PTSD). HICP was not associated with age, sex, ethnicity or race. HICP was associated with sleep disturbance (odds ratio 2.9; 95% confidence interval 2.1 to 4.0), depression (3.5; 2.5 to 4.9), anxiety (2.5; 1.8 to 3.8) and PTSD (2.5; 1.8 to 3.5). When considered in a multivariable regression model, HICP was independently associated only with sleep disturbance (2.3; 1.7 to 3.2) and depression (2.8; 2.0 to 4.1).

Conclusions: HICP was highly prevalent in veterans enrolled in a clinical trial of chiropractic care for chronic LBP and was associated with sleep disturbance and mental health co-morbidities, especially depression.

P04.04

Chiropractic Management of a 71-Year-Old Veteran With Chronic Low Back Pain & Grade 1 Spondylolisthesis Utilizing Low-Force Sacral-Occipital-Technique

Angel Hong¹

¹VA Health Care System, Orlando, FL

Contact: Angel Hong, [e-mail]

Abstract

Purpose: The purpose of this case report was to present the treatment of a geriatric patient who was never been treated with Chiropractic manipulation with chronic lower back pain due to grade 1 spondylolisthesis, utilizing SOT(Sacral Occipital Technique) as a primary intervention for pain management.

Method(s): An anterior thoracic block or sacrum block placed under the location below the segment of the anteriolisthsis while patient is in a supine position with both knees flexed. This created a biomechanical correction which it reduced the pressure to the spinal nerves.

Results: Outcome assessment at the initial consultation of 9/10 with VAS scale at the worst; the phase I of ten treatments with outcome assessment at 0/10 with VAS scale. Patient reported after ten sessions over a 6-week period, the pain has subsided.

Conclusions: SOT was a beneficial chiropractic approach to the management of a geriatric patient with chronic low back pain with grade 1 spondylolisthesis.

P04.05

Complementing Stroke Recovery with Osteopathic Care

Jorge Murillo ¹ , William Brooks², Guillermo Palchik³, Michelle Dossett², and Alan Yee²

¹U.C. Davis Health School of Medicine, Sacramento, CA

²University of California, Davis, Sacramento, CA

³Sutter Health, San Francisco, CA

Contact: Jorge Murillo, [e-mail]

Abstract

Purpose: There remains a paucity of high-quality evidence that use of routine rehabilitation interventions improves physical function or reduces immobility among chronic stroke survivors. Current physical diagnostic tools used to assess post-stroke immobility have significant limitations. The Functional Pathology of the Musculoskeletal System (FPMSS) model is an osteopathic diagnostic paradigm that evaluates the MSS as an integrated whole organ system, prioritizing restoration of proportionate available motion using standardized, quantifiable metrics. We sought to describe: (1) novel application of a systematic osteopathic diagnostic methodology in the assessment of musculoskeletal dysfunction among chronic stroke survivors with hemiparesis, and (2) response to osteopathic manipulative treatment (OMT).

Method(s): Retrospective analysis of chronic (> 6 months) stroke patients with hemiparesis who underwent systematic musculoskeletal assessment and received OMT was performed. Timed gait and standardized stroke outcome metrics were recorded. MSS dysfunction (termed “somatic dysfunction”; SD) was defined as restricted motion at a joint (or specified group of joints) identified by passive assessment and quantified using FPMSS criteria. Differences in motion restriction (Wilcoxin rank test) and timed gait before and after OMT were analyzed.

Results: 16 patients were examined (mean age, 54 years (range 38-72); 81% were male). Mean National Institute of Stroke Scale score, modified Rankin at discharge, and Ashworth spasticity severity scale scores were 8, 3, and 1.7, respectively. 11 of 16 patients underwent 2 or more assessments followed by OMT. Mean SD severity scores improved between initial and final treatment visits along with 6-meter timed gait (11.5 versus 9.2 seconds; p=0.001).

Conclusions: Impairment in musculoskeletal mobility can be systematically quantified among chronic stroke survivors with hemiparesis. OMT is associated with reduction in motion restriction severity and improved time-based walking. Osteopathic therapy may have a role in improving function in chronic stroke recovery.

P04.06

Observer Reliability and Early Musculoskeletal Palpatory Changes Following Acute Ischemic Stroke: The SOMADC-AC Study

Alan Yee ¹ , William Brooks¹, Navneet Bassi², Kevin Nasre¹, Corinna Fazzio¹, Ruth Lee³, Guillermo Palchik⁴, Machelle Wilson¹, and Michelle Dossett¹

¹University of California, Davis, Sacramento, CA

²Sutter Health, Sacramento, CA

³Cleveland Clinic Foundation, Cleveland, OH

⁴Sutter Health, San Francisco, CA

Contact: Alan Yee, [e-mail]

Abstract

Purpose: Stroke is a leading cause of severe musculoskeletal disability. Its complications (e.g., pain, spasticity, immobility) are similar to those commonly addressed with osteopathic manipulative treatment. Osteopathic therapy aims to correct musculoskeletal dysfunction (“somatic dysfunction”; SD) identified by palpatory examination. We sought to (1) assess the reliability of a novel, systematic osteopathic examination model to identify SD among healthy, transient ischemic attack (TIA), and acute ischemic stroke patients, and (2) quantify the severity of SD between groups.

Method(s): This prospective cohort study assessed the reliability of the Functional Pathology of the Musculoskeletal System (FPMSS) model to quantify SD. Seven providers underwent consensus training prior to performing blinded paired assessments, and inter-rater agreement was measured . SD was defined as restricted motion at a joint (or specified group of joints) identified by passive assessment and quantified using FPMSS criteria, and differences between groups were analyzed (ANOVA). Additionally, standardized stroke outcome metrics were recorded.

Results: 94 subjects were examined (healthy, n=20; TIA, n=16; stroke, n=59. Mean ages were 40, 61, and 65 years, respectively). Acceptable levels of inter-rater agreement were seen testing all body regions (spine, arm, innominate, hip, leg, and ankle/foot) in stroke (ICC range: 0.41-0.8), TIA (ICC range: 0.72-0.88), and 4 of 6 regions in controls (ICC range: 0.70-0.84). Among stroke patients, mean National Institute of Stroke Scale motor scores and discharge modified Rankin Scale scores were 2.8 and 1.8, respectively. 73% had hemiparesis; 30% were discharged with moderate or worse disability. There were significant differences in mean SD scores for each body region between groups (p<.05). Hemiparetic patients exhibited the greatest SD severity across all body areas.

Conclusions: SD can be reliably quantified applying FPMSS criteria. Patients with hemiparesis from stroke exhibit the greatest SD severity followed by TIA and healthy individuals.

P04.07

Pretest Posttest with Guatemalan Lay Midwives about Acupressure Use for Preeclampsia

Lisa Taylor-Swanson ¹ , Cheryl Armstrong¹, Jill Johnson², Eli Iacob¹, Claudia Citkovitz³, Zena Kocher⁴, Kayla Madsen¹, Emily Flynn⁵, Ashlee Nelson¹, and Kimberly Garcia⁶

¹University of Utah College of Nursing, Salt Lake City, UT

²Utah Valley University, Orem, UT

³New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA

⁴Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN

⁵Intermountain Health Care’s Primary Children’s Hospital, SALT LAKE CITY, UT

⁶Planned Parenthood Association of Utah, Millcreek, UT

Contact: Lisa Taylor-Swanson, [e-mail]

Abstract

Purpose: Preeclampsia is the second leading cause of maternal death in Guatemala where the maternal mortality rate was 96 deaths per 100,000 births in 2020. Part of the issue is most women birth at home with lay midwives (LMs) who are not allowed to provide medication to treat disorders, such as preeclampsia. Acupressure, which can decrease blood pressure, is a promising treatment LMs could offer while transferring hypertensive patients to hospitals. The purpose of this study was to determine if educational sessions about acupressure use for preeclampsia would change LM knowledge.

Method(s): Educational sessions regarding acupressure use for preeclampsia were held in 11 locations in the remote Peten department. The 179 LMs who participated in the educational sessions were given a pretest and posttest before and after being taught six acupressure points to address preeclampsia. LMs were given laminated Reminder Cards with drawings of the six acupressure points to address preeclampsia to reinforce knowledge retention.

Results: LMs experienced a significant increase in knowledge scores (possible 0-6) from pretest (M=0, SD=0) to posttest (M=4.29, SD=1.722), paired t-test p<0.001. No LMs were aware of any acupressure sites on the pretest (0%) compared to >71% who identified at least one site on the posttest.

Conclusions: Given no LMs knew acupressure sites to address preeclampsia before the educational sessions, a change in knowledge is not surprising, albeit significant. Providing LMs with useful tools, such as acupressure, to address preeclampsia could help reduce the MMR in Guatemala. Educating LMs about acupressure points to treat other pregnancy-related issues would expand the care pregnant patients could receive.

P04.08

Spinal Manipulative Therapy vs. Primary Care: Risk of Adverse Outcomes in Older Adults With Neck Pain

James M Whedon ¹

¹Southern California University of Health Sciences, Whittier, CA

Contact: James M Whedon, [e-mail]

Abstract

Purpose: The prevalence of NP increases with age, and older adults are vulnerable to the use of high-risk analgesics. Clinical practice guidelines discourage use of prescription drug therapy (PDT) in favor of non-pharmacological therapies including spinal manipulative therapy (SMT). We designed a cohort study of Medicare claims data to compare the risk of adverse outcomes for adults aged 65-99 with a new episode of NP.

Method(s): The SMT cohort received spinal manipulation from a chiropractic physician and no primary care. Patients in the PDT cohort visited a primary care physician, filled a prescription for an analgesic within seven days of the initial visit, and received no SMT. The primary care only (PCO) cohort was defined identically to the PDT cohort, except that the patient did not fill a prescription for an analgesic within seven days. We calculated incidence rates ratios for adverse outcomes over 24-months.

Results: Compared to PCO, the risk of any adverse outcome was 14% lower for SMT and 8% higher for PDT.

Conclusions: For Medicare Part B beneficiaries with new onset NP, initial care with spinal manipulative therapy is associated with lower risk of adverse outcomes than primary medical physician care.

P04.10

The Effectiveness of Chiropractic Applied Clinical Neuroscience Care on Self-Reported Depression and Cognition for Medication-Resistant Depression

Stephanie Sullivan ¹ , Michael Longyear², Dominic Fetterly¹, Emily Drake¹, Mitchell Ferguson¹, and Dylan Saulsbery³

¹Life University, Marietta, GA

²Brain Optimization Institute, Jacksonville, FL

³The Brain Health Clinics, Tampa, FL

Contact: Stephanie Sullivan, [e-mail]

Abstract

Purpose: Evaluate study implementation and treatment effectiveness of a team-based chiropractic applied clinical neuroscience (ACN) approach for individuals with medication-resistant depression.

Method(s): Individuals with medication-resistant depression were randomized to immediate treatment (IT) or wait-list control (WL) groups, each receiving 6 weeks of ACN care. Monthly, ACN clinicians met with a multidisciplinary advisory team. Primary outcomes were the Depression, Anxiety, and Stress Scale (DASS-42), Oxford Happiness Questionnaire (OHQ), and event-related electroencephalography (P300), administered at weeks 0, 6, 12, and 18.

Results: Twelve of twenty-one (57%) participants (10F, 2M; average age 38) completed the study; no adverse events were reported. Mean DASS-42 and OHQ scores improved over time in both groups. Following treatment, IT demonstrated an average improvement in depression scores (DASS-42) from severe to moderate (27.2±12.9 to 18.2±5.9) while WL improved from moderate to mild (17.3±10.5 to 11.3±10.4). Eight baseline and 6-week datasets met P300 data quality standards. IT (n=4) demonstrated decreased latency (6 milliseconds) and amplitude (0.93 microvolts) for P300. WL P300 (n=4) demonstrated decreased latency (110 milliseconds) and increased amplitude (0.33 microvolts).

Conclusions: Although future studies should address recruitment and data quality challenges, participants demonstrated self-reported improvement and P300 changes following ACN care.

Topic Area 05 – Clinical: Mind Body

P05.01

A 4-Minute Mindfulness Intervention Decreased Patients’ Pain in an Orthopedic Clinic’s X-Ray Waiting Room: Results from a Randomized Controlled Trial

Kennedi Childs ¹ , Robert Gibson¹, Allison Davis¹, Phillip Worts², and Adam Hanley¹

¹Florida State University, Tallahassee, FL

²Tallahassee Orthopedic Clinic, Tallahassee, FL

Contact: Kennedi Childs, [e-mail]

Abstract

Purpose: Idle gaps exist in many medical care pathways that could be leveraged for therapeutic benefit. Time in the clinic waiting room is one such example. With brief mindfulness interventions capable of quickly decreasing clinical symptoms, embedding a brief mindfulness intervention in a clinic waiting room has the potential to transform idle time into time for healing. The purpose of this single-site, two-arm, randomized controlled trial was to examine whether a 4-minute, audio-recorded, mindful pain management intervention could decrease patients’ pain while waiting for an X-ray in an orthopedic walk-in clinic.

Method(s): Over 4 weeks, 340 patients were invited to participate in this study; 249 (71%) agreed to participate and 99 (29%) declined. Of those who agreed to participate, 163 (68%) were able to listen to a sufficient dose (i.e. at least half of the audio recording) before being called for their X-ray. However, two of these participants provided no survey data, and two others reported no pain. These four participants were removed from the subsequent analyses leaving 159 participants in the final sample, with 79 randomized to mindfulness and 80 to an injury management control condition.

Results: Results indicated participants in the mindfulness condition reported significantly less pain unpleasantness (F=5.49, p=.021) and pain intensity (F=13.76, p=<.001) post-intervention relative to controls. Pain intensity decreased by an average of 20% among mindfulness participants, with one in three reporting a minimal clinically meaningful decrease in pain.

Conclusions: Thus, a brief, audio-recorded mindfulness intervention has the potential to help patients waiting for an x-ray feel better. Now, strategies for increasing patient engagement and implementing this effective strategy in more diverse communities are needed.

P05.02

Changes in Body Awareness in Yoga Interventions: A Systematic Review

Camille Garnsey ¹ , Katherine Gnall¹, Erika Osherow¹, and Crystal Park²

¹University of Connecticut, Storrs, CT

²Department of Psychological Sciences, University of Connecticut, Storrs, CT

Contact: Camille Garnsey, [e-mail]

Abstract

Purpose: Research increasingly highlights associations between body awareness and physical and mental health conditions (i.e., PTSD, eating disorders, chronic pain). The notion that yoga can enhance body awareness is embedded into spiritual, religious, and philosophical understandings of the practice. Yet, the empirical literature base examining changes in body awareness subsequent to yoga interventions has not been reviewed.

Method(s): A systematic search of PubMed, PsycINFO, Scopus, CINAHL, and Proquest Dissertation and Theses was conducted from database inception to September 2024. English language intervention studies evaluating the effect of yoga interventions on body awareness were included.

Results: Twenty-five studies met inclusion criteria. Fourteen studies reported significant increases in body awareness following the yoga intervention. Eight studies with a comparison/control group reported significant differences in favor of yoga following the intervention. Studies that reported changes in body awareness did not systematically differ from those that did not in terms of the sample size or population sampled, the type of control or comparison group used, or the duration and design of the yoga intervention, underscoring the mixed state of the literature. Studies that assessed body awareness as a multi-dimensional construct more consistently reported changes in body awareness.

Conclusions: Results from this review are mixed, but there is some evidence that yoga interventions have some influence on improving body awareness. Recommendations for future research include developing greater consensus on the conceptualization/measurement of body awareness in yoga interventions and conducting more rigorous trials with larger sample sizes and active comparison groups. Improving our understanding of the impact of yoga on body awareness is clinically significant given the link between body awareness and health conditions, and is an important first step in considering whether changes in body awareness account for some of the alleviation of symptoms observed after yoga interventions in clinical populations.

P05.03

Comparing Distress and Well-Being Between Cancer Curvivor and Metavivor Caregiving Dyads Enrolling in a Mind-Body Resiliency Trial

Lucy Finkelstein-Fox ¹ , Brett Goshe², Giselle Perez¹, Anna Barata², Joanna Cloutier², Isabelle Miranda², Emelia Farnam², Nora Horick², Areej El-Jawahri², and Elyse Park²

¹Massachusetts General Hospital/Harvard Medical School, Boston, MA

²Massachusetts General Hospital, Boston, MA

Contact: Lucy Finkelstein-Fox, [e-mail]

Abstract

Purpose: Transitioning to post-treatment survivorship presents myriad stressors for cancer survivor-caregiver dyads, whether survivors were treated with curative intent (“curvivors”) or are living with cancer (“metavivors”). As little is known about adjustment differences between curvivor and metavivor caregiving dyads, this analysis explores distress (depression, anxiety, and past-week distress) and positive well-being (resiliency, self-compassion, and relationship quality) indices among cancer survivors (curvivor and metavivor) and caregivers enrolling in a simultaneously-delivered pilot trial of a mind-body resiliency group program.

Method(s): From 07/23- 04/24, 47 survivor-caregiver dyads (62% metavivors) provided baseline data upon enrollment in the parent trial (NCT05702723). Survivors and caregivers completed indices of distress (depression (PHQ-2), anxiety (GAD-2), past-week distress (single-item VAS)) and positive well-being (self-compassion (SCS-SF-12), resiliency (CES), and relationship quality (original 5-item measure)). Analyses included between-groups t-tests with Hedges’ g as a standardized effect size for curvivor/metavivor differences (0.2 = small, 0.5 = medium, 0.8 = large), reported separately for survivor/caregiver groups. As this pilot study was underpowered to detect group differences, all findings are exploratory.

Results: Among survivors (Mean age = 62.2, 46.8% female, 87.2% White, 85.1% non-Hispanic), distress (gs = 0.01 –0.14, ps > .62) and positive well-being (gs = -0.03 – 0.15, ps > .61) indices did not statistically differ by curvivor/metavivor designation. Caregivers (Mean age = 56.8, 66.0% female, 87.2% White, 85.1% non-Hispanic) also reported statistically similar distress (gs = -0.01 – 0.14, ps > .62) and positive well-being (gs = -0.15 – -0.08, ps > .61) indices regardless of their survivor’s curvivor/metavivor designation.

Conclusions: Upon enrollment in a mind-body resiliency trial, cancer survivor and caregiver distress and well-being did not vary greatly by curvivor/metavivor designation. Larger, fully-powered studies must replicate these exploratory findings. Next steps also include evaluating differential effects of simultaneously-delivered mind-body group programming (including relaxation, mindfulness, and coping) on distress and well-being for curvivor and metavivor dyads.

P05.04

Effect of Complementary and Alternative Medicine CAM Interventions on PTSD in Veterans and Veteran Family Members: A Meta-Analysis

Kieran Cooley¹

¹Canadian College of Naturopathic Medicine, Toronto, ON

Contact: Kieran Cooley, [e-mail]

Abstract

Purpose: Despite growing interest in CAM interventions for treating Veterans with PTSD, comprehensive evidence is lacking. We aimed to synthesize evidence on CAM interventions for mental health and quality of life among Veterans with PTSD in Five Eyes countries.

Method(s): MEDLINE, PsycINFO, and AMED were searched for studies that enrolled Veterans with PTSD and their families from Five Eyes countries, evaluated CAM interventions, and assessed changes in mental health outcomes using validated scales or assessed cost-effectiveness. RCTs >10 participants/arm and observational studies with >30 participants were included. The search strategy was defined and pilot tested with support from established search language and descriptions of CAM by the NCCIH. Screening took place in duplicate; data extraction and risk of bias (Cochrane RoB 2; ROBINS-I) were assessed. Estimates of efficacy & effectiveness were pooled when reported by >1 study. PRISMA guidance & GRADE protocols were followed.

Results: 26 RCTs and 14 observational studies with 3,321 participants (84.4% male, median age 51.4 years) were included from 3,565 unique records identified. 23 (88%) of RCTs and all 14 (100%) of observations studies were assessed as high risk of bias. Moderate-quality evidence suggests meditation (WMD: -10.66, 95% CI: -15.00 to -6.32), Emotional Freedom Technique (EFT) (MD: -27.00, 95% CI: -32.09 to -21.91), and Sudarshan Kriya Yoga (SKY) (MD: -20.50, 95% CI: -28.81 -12.19) reduces PTSD symptoms > than the minimal important difference). Meditation and EFT improves depression & anxiety, while SKY improves depression >1 MID. High to moderate-quality evidence for mantram repetition and moderate-quality evidence for MBSR result in reductions in PTSD and depression symptoms that are <1 MID, with similar improvement in QoL.

Conclusions: Meditation EFT and SKY may result in clinically meaningful reductions in PTSD depression and anxiety in Veterans although there is a dearth of evidence assessing effects in families of Veterans with PTSD or cost-effectiveness.

P05.05

Effect of Body and Breath Regulation in Tai Chi Movements on Enhancement of Blood Circulation

Shin Lin ¹ , Jad Nehme², Jeremiah Susanto², Ethan Tran², Sharon Shang², Yuxiao Liang², Yingren Cao², Lily Chen², Helen Xu², Kristina Yang², and Gena Younies²

¹Dept. of Developmental & Cell Biology and Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, CA

²University of California, Irvine, Irvine, CA

Contact: Shin Lin, [e-mail]

Abstract

Purpose: Many Chen Style Tai Chi movements follow the principle of “within the Yin, there is Yang.” This pilot study investigated how body and breath regulation in such exercises can enhance blood circulation.

Method(s): Subjects were 6 healthy males/females of college age with no Tai Chi experience. Blood flow/perfusion/circulation was measured as “flux” at the PC-8 acupoint of the right palm by laser Doppler flowmetry (Moor DRT-4 monitor). Subjects were instructed to press the right hand downwards on a handle of a rope connected to various weights on a pulley and then raising the hand upwards without weight to simulate “White Crane Opening Wings.” Subjects also breathed normally at 12-14 cycles/minute or as deeply as possible at 5 cycles/minute while performing these movements.

Results: There was a consistent pattern of increasingly higher blood flow associated with the hand pressing against increasingly higher levels of weight in all subjects (n=6), averaging a baseline flux of 100% with no hand movement, and 193% moving against 0.0-lbs, 265% against 2.5-lbs, 337% against 5.0-lbs, 362% against 7.5-lbs, and 394% against 10.0-lbs of weight. There was also a uniform pattern of enhanced blood flow with deep breathing in all subjects (n=5), and this added to the effect of the hand pressing downwards against weight, averaging (a) baseline flux (hand stationary at waist level) of 100%; (b) 160% with deep breathing and without hand movement; (c) 302% with normal breathing and up-down hand movement against no weight; (d) 460% same as (c) but hand movement against 2.5-lbs weight; (e) 484% same as (d) but with deep breathing.

Conclusions: This pilot study shows apparent trends of the slow (“Yin”) up-down hand movement of Tai Chi increasing blood flow measured locally, and the addition of force and deep breathing (“Yang”) to this exercise further enhancing the effect on this health marker.

P05.06

Effects of Mongolian Mind-Body Interactive Therapy on the Rehabilitation of Cancer Patients

Nagongbilige He¹, Hongyun Wu², and Yu Du ³

¹Chinese & Mongolian Medicine Research Institute of Inner Mongolian Autonomous Region, Hohhot, Neia Mongol, China

²Renmin University, Beijing, Beijing, China

³University of Colorado Denver, Denver, CO

Contact: Yu Du, [e-mail]

Abstract

Purpose: Mongolian Mind-Body Interactive Therapy (MBIT) offers a novel, culturally rooted therapeutic model that focuses on the holistic treatment of cancer patients, emphasizing both psychological and physical rehabilitation. To investigate the effects of Mongolian Mind-Body Interactive Therapy (MBIT) on the rehabilitation of cancer patients and to determine how this therapy influences various aspects of their recovery, including physical symptoms, psychological well-being, positive emotions, medical knowledge, and overall life conditions.

Method(s): A total of 1590 cancer patients participated in a survey utilizing a self-designed questionnaire that evaluated the impact of MMBIT across six domains: physical symptoms, psychological symptoms, positive emotions, life conditions, medical knowledge, and treatment methods. Statistical analyses, including t-tests and correlation analyses, were conducted to evaluate the relationship between therapy sessions and patient-reported outcomes.

Results: The results indicated significant improvements in all six domains following participation in MMBIT, with particularly high scores in medical knowledge (mean = 4.547) and positive emotions (mean = 4.350). The number of therapy sessions was strongly correlated with improvements, especially in treatment effectiveness (r = 0.338) and self-rated health (r = 0.503). The therapy was well-received, with 95% of participants reporting satisfaction.

Conclusions: Mongolian Mind-Body Interactive Therapy (MBIT) has been shown to significantly enhance both the physical and psychological well-being of cancer patients, improve their quality of life, and deepen their medical and health knowledge. It also strengthens the effectiveness of conventional medicine, supporting its role as a complementary therapy in cancer rehabilitation. Further research is recommended to explore long-term benefits and optimize therapy protocols for greater efficiency.

P05.07

Engaging Cancer Caregivers in a Virtual Mind Body Resiliency Program: Strategies and Lessons Learned

Giselle Perez¹, Brett Goshe ² , Lucy Finkelstein-Fox¹, Elizabeth Waldron², Joanna Cloutier², Emelia Farnam², Wren Hager², Anna Barata², Areej El-Jawahri², and Elyse Park²

¹Massachusetts General Hospital/Harvard Medical School, Boston, MA

²Massachusetts General Hospital, Boston, MA

Contact: Brett Goshe, [e-mail]

Abstract

Purpose: Cancer caregivers are susceptible to experiencing chronic stress as they grapple with the challenges of caring for their loved one. While providing support to caregivers is critical, few programs exist that are designed to help them manage their personal wellbeing.

Method(s): From 7/2023-3/2024, we piloted a 9-week, group-based mind-body resiliency intervention for survivors and their caregivers. Curvivors (completed curative treatment <5-years) and metavivors (metastatic illness >3-months) were asked to identify a caregiver (family member/friend) to participate. Enrolled dyads participated in caregiver/survivor-only groups. We assessed caregiver engagement by examining enrollment and session participation. At study exit, we conducted interviews with a subset of caregivers to understand their experiences and programmatic needs.

Results: Of 488 eligible patient-caregiver dyads, only 136 (27.9%) remained eligible due to patient refusal. Among these, 47 enrolled (∼34.6%; caregiver background: partners=80%, female=66%; Mage=56) and were randomized to resilience training (n=24) or enhanced usual care (support group; n=23). Reasons for caregiver refusal included time demands, perceived lack of needs, and disinterest in group-based interventions. Most caregivers randomized to resilience training (75%) participated in 7/9 sessions; withdrawals were largely due to declining patient health or time concerns. Interviews revealed scheduling concerns/competing demands and discomfort with group settings as challenges to participation. However, a desire to improve coping, contribute to caregiver research and help their loved one encouraged participation. Lessons learned include the utility of connecting directly with caregivers, rather than relying on patients as intermediaries, to enhance participation/engagement.

Conclusions: Caregivers are willing to engage in resilience programs, but time constraints limit their ability to participate. Patients’ competing demands and protectiveness over their caregiver create additional challenges for caregiver involvement. Our findings underscore the importance of developing creative outreach and engagement strategies for this underserved group. This work will discuss lessons learned with engaging caregivers in a simultaneously-delivered dyadic intervention.

P05.08

Evaluating the Feasibility and Efficacy of an Online Yoga Program for Managing Symptoms of Post-Treatment Lyme Disease Syndrome (PTLDS)

Zulkayda Mamat ¹ , Adriel Brown¹, Louise Mahoney², Santiago Allende², Jasmin Francisco², Annie Lau², and Peter Bayley³

¹Stanford University, Stanford, CA

²VA Palo Alto Health Care System, Palo Alto, CA

³VA Palo Alto Health Care System/Stanford University, Palo Alto, CA

Contact: Zulkayda Mamat, [e-mail]

Abstract

Purpose: This study evaluated the feasibility and efficacy of a 12-week synchronous online yoga program for managing post-treatment Lyme disease syndrome (PTLDS) symptoms, focusing on pain, physical functioning, and cognitive performance.

Method(s): Thirteen participants with PTLDS (aged 21-60 years; 92% female) were enrolled in a 12-week online yoga program using HIPAA-compliant telehealth software. The program included 75-minute weekly sessions led by certified yoga instructors, with 15-20 minutes of daily homework on five non-treatment days. The protocol incorporated seated, standing, supine postures, breathing exercises, and meditation, with modifications for limited mobility. Outcome measures were assessed via the Health-Related Quality of Life - Short Form (SF-36), Brief Pain Inventory (BPI), and the Cambridge Neuropsychological Test Automated Battery (CANTAB).

Results: The primary feasibility goals were met with a retention rate of 92.50%, treatment adherence of 82.70%, and a treatment satisfaction score of 3.4/5. The missing data rate was low at 3.90%. Significant improvements were observed in pain levels, as indicated by the SF-36 pain scale (t = -3.19, p = 0.01, d = -0.92), and pain interference significantly decreased during daily activities, as measured by the BPI (t = 2.61, p = 0.02, d = 0.75). Participants also reported fewer physical limitations during personal activities (t = -2.46, p = 0.03, d = -0.71; SF-36). Cognitive improvements were shown by a significant reduction in errors on the CANTAB Spatial Working Memory task (t = 3.11, p = 0.02, d = 1.04). Although other CANTAB tasks assessing memory and sustained attention showed trends toward improvement, these results did not reach statistical significance.

Conclusions: The online yoga program demonstrated feasibility and was associated with significant reductions in pain, improved physical functioning, and enhanced cognitive performance among participants with PTLDS. These findings suggest that online yoga may be a scalable, accessible, and effective intervention for managing PTLDS symptoms.

P05.09

Exploring Attitudes Toward Psychedelic-Assisted Therapy in Oncology Care: A Mixed-Methods Study

Haley Schuman¹, Tina Nguyen¹, Sofia Barkova¹, Raef Mina¹, Julie Deleemans¹, and Linda Carlson ¹

¹University of Calgary, Calgary, AB

Contact: Linda Carlson, [e-mail]

Abstract

Purpose: The potential of Psychedelic-Assisted Therapy (PAT) as a treatment for psychosocial symptoms in cancer patients (PLWC) is generating growing interest. This study seeks to gather insights into the attitudes of PLWC, healthcare providers (HCPs) and policymakers regarding PAT with the aim of informing future research and implementation in oncology contexts.

Method(s): A 98-item quantitative survey was developed to assess several domains: attitudes toward current treatments for psychosocial symptoms, perceived knowledge and beliefs about PAT, perceived safety and therapeutic potential of PAT, personal experience with psychedelics, perceived barriers to use, preferences for potential implementation, and clinical preparedness for using psychedelics (for HCPs only). Demographic, clinical, and psychosocial health data were also collected. The survey was administered to PLWC (n=545) HCPs (n=180) and policy makers (n=36). Additionally semi-structured interviews were conducted with selected PLWC (n= 17) and HCPs (n= 12) and analyzed using thematic analysis.

Results: Participants were 55% female and 57% White, encompassing individuals from nine provinces, indicating good sample diversity. A majority (71%) reported being “somewhat” to “very” knowledgeable about the use of psychedelics for PLWC. About 63% agreed that administering psychedelics to PLWC is safe when treatment conditions are carefully controlled. The most significant barrier to PAT was perceived safety concerns (43%). Among specific psychedelic compounds, psilocybin was rated most favorably, with 79% perceiving it as “somewhat” or “very” effective in treating psychosocial symptoms in PLWC. Only 16% of participants had prior personal experience with psilocybin; of these, 84% indicated a positive experience. Notably, 94% of PLWC expressed a desire for access to PAT in their healthcare region.

Conclusions: The study reveals high levels of interest and support for PAT, with generally positive attitudes toward psilocybin-assisted therapy. These findings highlight the necessity for further clinical research to investigate the efficacy and feasibility of integrating PAT into the healthcare system for oncology care.

P05.10

Impact of Whole Health Wellness Offerings on Veteran Health and Wellness

Rosalie Diaz ¹ , and Katherine Dignan²

¹Louis Stokes Cleveland VA Medical Center, Cleveland, OH

²Veteran Affairs Administration, Cleveland, OH

Contact: Rosalie Diaz, [e-mail]

Abstract

Purpose: Whole Health promotes Veteran health and well-being, focusing on the importance of Complementary and Integrative Health (CIH) modalities. These CIH modalities are critical in empowering veterans to take charge of their health by providing whole person approaches that address both physical and mental health needs. This review examines the potential benefits of non-traditional wellness offerings, including Healing with Horses, Food as Medicine, Healing Arts, and Cardio Drumming. These unique programs provide opportunities for veterans to engage in meaningful activities.

Method(s): This review covers Whole Health activities provided between September 2023 and October 2024, focusing on the impact these programs had on veterans’ health, wellness, and social engagement. Statistical analysis was conducted using the Scantron system, including descriptive statistics of mean and standard deviation, to measure the effectiveness of these wellness offerings.

Results: Results indicate a self-reported positive shift in leading a meaningful and purposeful life before and after attendance of programming, with a 3 (SD 1.9) to 2.1(0.9 SD) in Food as Medicine and 3.3 (SD 1.5) to 2.5 (SD 0.7) in Healing with Horses. A positive shift in rating of physical health occurred with Healing with Horses and Food as Medicine. A positive shift in rating of mental health occurred in Food as Medicine with a noted improvement from 3.1 (SD 0.8) to 2.3 (SD 0.7). Cardio drumming results indicate reported improvement in physical health. Healing Arts results indicate Personal Development and Power of the Mind were most highly rated as areas of most importance.

Conclusions: In conclusion, Whole Health Wellness Offerings have results consistent with List 1 CIH modalities regarding overall benefit for Veteran’s health and wellness. Continued data collection for larger sample size may continue to build evidence to support such programing in the future.

P05.11

Medical Intuition: Expanded Perception to Support Whole Health

Wendie Colter ¹ , and Tracy Poff²

¹The Practical Path, Inc., Tujunga, CA

²Sofia University, Palo Alto, Oakland, CA

Contact: Wendie Colter, [e-mail]

Abstract

Purpose: Medical intuition is a skill of using intuitive perception to observe the physical systems of the body and its subtle energy systems. Medical intuition may be particularly helpful to licensed health care providers who are presented with cases that are difficult to diagnose or when patients have not responded to treatment. The aim of this poster is to increase familiarity with medical intuition by highlighting results of two recent studies and a national survey.

Method(s): Colter and Mills (2020) recruited 67 participants, including a cohort from UC San Diego Health. Each participant was read by one of five Certified Medical Intuitive Practitioners. Poff (2024) used a qualitative approach to explore the lived experience of 15 self-identified medical intuitives who were recruited primarily through personal networking and direct request of publicly known practitioners. National Organization for Medical Intuition (Gentile et al., 2022) sent an online survey by email to self-identified professional medical intuitives in the U.S.

Results: Assessing the Accuracy of Medical Intuition (Colter & Mills, 2020). Ninety-four percent of participants reported that the medical intuitive accurately located their main physical issue. Lived Experience and Worldviews of Medical Intuitives (Poff, 2024) Medical intuitives described a worldview in which all that exists is interconnected, seemingly within an invisible field. Survey: Use of Medical Intuition in Healthcare (Gentile et al., 2022). Results showed that 82% of participating medical intuitives have assisted licensed healthcare professionals with medical intuition.

Conclusions: The holistic perspective of medical intuitives aligns with a Whole Health approach to healthcare. Trained medical intuitives have high accuracy rates in identifying and assessing physical complaints or illnesses. Recipients of medical intuition sessions may feel empowered and more confident in their next steps. A majority of U.S. medical intuitives are working directly with health-care professionals and are sometimes healthcare professionals themselves.

P05.12

Medical Qi Gong for People Living with Cancer

Alex Feng ¹ , and Amy Ying Li Matecki¹

¹International Center for Integrative Medicine, Oakland, CA

Contact: Alex Feng, [e-mail]

Abstract

Purpose: A nonprofit organization and a community hospital collaborated in 2009 to develop and implement a curriculum for medical qi gong for people living with cancer. This presentation describes the curriculum design, implementation strategies, and outcome measures. The participants are oncology patients, their families, caregivers and the support community. Referrals came from the community hospital’s comprehensive cancer center and word of mouth. The partnership between the two organizations was pivotal to the success of this 15 year old endeavor. An accomplished TCM practitioner with extensive qi gong teaching experience was employed to design the course and adapt it to the needs of the participants. Collaborative marketing was effectively used to promote the classes. Since 2009, the course has enrolled over 1,000 participants across the continuum of cancer from prevention through diagnosis and treatment. Approximately a third of the attendees have been family or community members and caregivers. The classes went to a virtual platform during the pandemic and are now taught in hybrid form - virtual platform and in person at the community hospital’s cancer center. The recordings are maintained in a library that can be accessed free of charge by the enrolled participants. Surveys were periodically conducted with participants. The presentation will address potential areas for research, and the opportunity to do a clinical trial that compares outcomes of qi gong class participants and non participants by using data collected by the cancer center team.

Method(s): Educational principles were used to set the foundation for this program that combines TCM with qi gong and tai ji concepts. The adaptation was based on the fluctuating stamina and flexibility levels of cancer patients.

Results: Outcomes included increased stamina and endurance, improved sleep, decreased anxiety and cognitive fogginess.

Conclusions: This design has been effective in producing results and retaining an active, engaged class.

P05.13

Mindfulness Practices for Cardiovascular Disease Risk Reduction for Older People Living with HIV: A Qualitative Study of Feasibility and Acceptability

Jacklyn Foley ¹ , Madison Davis¹, Julia Scheinbach¹, Abigail Batchelder², Conall O’Cleirigh¹, and Gloria Yeh³

¹Massachusetts General Hospital, Boston, MA

²Massachusetts General Hospital/Harvard Medical School, Boston, MA

³Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Contact: Jacklyn Foley, [e-mail]

Abstract

Purpose: Mindfulness-based interventions (MBIs) have a strong empirical basis for supporting positive health behavior changes among people with and at risk for cardiovascular disease (CVD). MBIs have not been studied as a strategy for reducing CVD risk specifically among people with HIV (PWH). This is a critical gap in growing equitable access to integrative healthcare, particularly as PWH are often marginalized as well as disproportionately burdened by CVD compared to the general population. This qualitative study assessed perceived feasibility and acceptability of mindfulness practices among PWH to inform its inclusion in a CVD risk reduction intervention.

Method(s): Four focus group discussions (N=23) were conducted. The facilitator shared a mindfulness of the breath and body scan practice and asked for participant feedback. All focus groups were audio-recorded, transcribed, and transferred to Dedoose for content analysis.

Results: The sample had a mean age of 61 (standard deviation=6.6) with majority identifying as cisgender men (57%), non-heterosexual (52%), White (52%), with some college education (35%), and an annual income >=$20,000 (60%). For feasibility, most participants indicated they would be able to carry out these or similar mindfulness practices; however, potential barriers included trouble sustaining attention during a provider led practice, and low motivation for self-led practice. For acceptability, both positive (e.g., relaxation) and negative (e.g., hyper focus on pain areas) effects of the practices were reported. Participants also identified several ways mindfulness practices could help them manage psychological distress and engage in heart healthy behaviors, including disconnecting from stressors, defusing from unhelpful thoughts, increasing attentional control, regulating emotions, engaging in prosocial behaviors, engaging in non-judgmental awareness, and fostering a sense of togetherness.

Conclusions: Mindfulness practices were feasible and acceptable among older PWH, warranting their inclusion in a CVD risk reduction intervention to ultimately increase access to integrative healthcare for PWH vulnerable to CVD.

P05.14

Mindfulness-Based Cognitive Therapy, Taking It Further (MBCT-TIF): A Mixed Methods Assessment of an Intervention Development Pilot Study

Chelsea J. Siwik ¹ , Jessica M. Harrison², Willem Kuyken³, Zindel Segal⁴, Patricia Moran², Jenn Felder⁵, Stuart Eisendrath⁵, Veronica Goldman⁵, Wendy Hartogensis², Rick Hecht⁵, and Shelley Adler⁵

¹Department of Wellness and Preventative Medicine, Cleveland Clinic, Cleveland, OH

²Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

³University of Oxford, Oxford, Oxfordshire, United Kingdom

⁴Department of Psychological Clinical Science, University of Toronto, Toronto, ON

⁵University of California, San Francisco, San Francisco, CA

Contact: Chelsea J. Siwik, [e-mail]

Abstract

Purpose: Mindfulness-Based Cognitive Therapy (MBCT) reduces depression relapse, yet graduates have expressed a need for structured guidance after the program to maintain mindfulness practice and sustain/deepen benefits. To address this, we created a novel program, MBCT-Taking it Further (MBCT-TIF). The current pilot study tested MBCT-TIF and obtained participant feedback through surveys and focus groups.

Method(s): All participants in the first cohort (n=14) received MBCT-TIF, consisting of four weekly booster group sessions, followed by monthly group sessions delivered via videoconferencing. The second cohort of participants (n=20) were randomized 1:1 to MBCT-TIF or waitlist control. Surveys were completed by all participants at baseline, 1 month (post-weekly classes), and 4 months. Two focus groups (n=7 in each) were conducted via videoconferencing to explore participants’ experiences with MBCT-TIF. We used descriptive and summary statistics to analyze survey data and thematic content analysis to identify patterns in the focus group transcripts.

Results: Of the participants offered MBCT-TIF (n=25), 100% attended all weekly sessions and 76% attended at least 75% of the monthly sessions; 77.1% found the weekly sessions very/extremely helpful and 66.7% found the monthly sessions very/extremely helpful. The following themes emerged: (1) participants emphasized the importance of the group for the social connection, support, and community of practice that elevated their meditative experience, helped improve their mental health, and facilitated accountability; (2) MBCT-TIF provided mental health benefits, including tools to soften the negative impact of depression/anxiety, broaden connections to the world, and enhance positive experiences; (3) participants’ home practice was reinvigorated during the weekly MBCT-TIF sessions, but thereafter fell short of their goals.

Conclusions: MBCT-TIF was well attended and rated very/extremely helpful by most participants. The program holds promise for improving outcomes for MBCT graduates and warrants further testing. Steps to help participants maintain home practice requires further attention.

P05.15

Neural Effects of Core Shamanic Drumming Music on Chronic Pain

Brock Pluimer ¹ , Apeksha Sridhar¹, Alessandra Anzolin², Ahmad Mahan¹, Huiyi Bao¹, Sarah Abraham¹, MiaChanel Nguyen¹, Jacqueline Yen¹, and Richard Harris¹

¹University of California, Irvine, Irvine, CA

²Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA

Contact: Brock Pluimer, [e-mail]

Abstract

Purpose: This case study investigates the therapeutic and pain-relieving effects of Core Shamanic (CS) drumming on individuals with fibromyalgia (FM). Building on prior research (Huels, 2021), which demonstrated that this paradigm reliably induces altered states of consciousness, we aim to explore its potential for chronic pain relief.

Method(s): One female FM patient and one shamanic practitioner (SP) participated in five CS sessions over two months. Psychometric data and hyperscanning electroencephalography (EEG) were recorded during the first and fifth sessions. Baseline data were collected during eyes open/closed periods and while listening to classical music (CL) as a negative control. Questionnaires assessed factors including spirituality, pain levels, emotional well-being, sleep quality, cognitive function, altered states of consciousness, and therapeutic alliance. EEG data were collected using the BrainVision system (64 channels total, 32 per person).

Results: The patient’s average daily self-reported pain, measured on a Visual Analogue Scale, decreased from 8 to 6 between the first and fifth sessions. FM patient theta power increased similarly for both CS and CL conditions, from approximately 0.2 to 0.4. However, the patient’s frontal alpha power (8-13 Hz) showed a marked difference: it remained nearly unchanged for CL (1.53 to 1.58) but nearly tripled for CS (1.26 to 3.48). This increase in alpha power is consistent with recent chronic pain relief studies (Rustamov, 2022). Interestingly, relative beta power (13-30 Hz) coherence between the patient and SP decreased for CL between the first and fifth sessions but increased for CS, possibly indicating enhanced top-down alignment (Palacios-García, 2021).

Conclusions: The findings from this case study, suggest that Core Shamanic drumming may be a promising non-invasive intervention for managing chronic pain in fibromyalgia patients. While these results are encouraging, we are currently recruiting a larger sample of FM patients and practitioners to substantiate these findings.

P05.16

Nursing Attitudes and Narratives on a Nurse-Led Integrative Health Consult Service for Patient Care

Giselle Pena¹, Benjamin Bass¹, Fariza Alendy¹, Kathleen Zavotsky¹, Barbara Delmore¹, Kathleen DeMarco¹, and Emma Millon ¹

¹NYU Langone Health, New York, NY

Contact: Emma Millon, [e-mail]

Abstract

Purpose: Hospitals utilize integrative health (IH) approaches as adjunctive therapies to patient care. At NYU Langone Health, nurses lead the IH consult service and can also place referrals for bedside consults. This environment offers a unique opportunity to study nurse attitudes about IH and how this relates to their use of IH for patient care, which remains poorly understood. This study identified relationships between nurses’ autonomy and attitudes about IH, and dominant themes in nurse narratives on IH for patient care.

Method(s): 23 nurses were surveyed and interviewed on their utilization, familiarity, and attitudes about IH and the IH consult service. Qualitative data were coded in ATLAS.ti and quantitative data were analyzed in R.

Results: Nurses who reported greater autonomy at work also reported that integrative health was more integral to their practice (t (10)=3.37, p=0.007. Qualitative interviews revealed several benefits, barriers, and challenges to providing IH in an inpatient setting. Improvements in clinician-patient relationships, patient comfort at the bedside, and stress relief were common benefits of IH interventions. Nurses also reported patients and staff lack education on the purpose and utility of IH interventions, which was partly informed by their misconceptions about IH. Suggested improvements to the consult service include expanding services to outpatient settings and educating clinicians throughout the hospital on which IH modalities are most effective for specific patient diagnoses.

Conclusions: Patients benefit from access to a nursing-led IH consult service that provides interventions for pain and stress management. Findings from this project will inform further refinement of the IH consult model and inform personalized interventions for inpatients that improve their quality of life in the hospital. The benefits, barriers, and challenges of an IH consult service will serve as a roadmap for other academic medical centers looking to adopt IH interventions for patient care in their hospitals.

P05.17

Participants’ Experiences with Qi and Long COVID Symptom Changes in a Pilot Clinical Trial of External Qigong: A Qualitative Analysis

Monica Joy¹, Nicole Adams², Michael Yanuck³, and Michelle Dossett ⁴

¹University of California Davis School of Medicine, Sacramento, CA

²University of California Davis, Department of Internal Medicine, Sacramento, CA

³Sacramento VA Medical Center, Mather, CA

⁴University of California, Davis, Sacramento, CA

Contact: Michelle Dossett, [e-mail]

Abstract

Purpose: Commonly known as “long COVID”, post-acute sequelae of COVID-19 (PASC) is a chronic condition with no validated treatment that significantly impacts the quality of life of those affected. External qigong is a Traditional Chinese Medicine (TCM) practice that may serve as a possible therapeutic approach for PASC. This study explored participants’ experiences with qi, and its perceived impact on PASC symptoms, following participation in a series of group-based, external qigong sessions.

Method(s): A qualitative study of 26 individuals who participated in a pilot feasibility trial of external qigong for PASC symptoms was performed. Participants engaged in six weekly, two-hour sessions of external qigong delivered in a group-based format. Upon completion of the intervention, all participants were interviewed using a semi-structured interview guide. The interviews were transcribed, coded and analyzed using a content analysis approach to explore participants’ perceptions and understanding of qi, qigong, and the overall impact of the sessions on their well-being and PASC symptoms.

Results: Participants’ understanding and explanations of qi varied. Almost all participants (92%) reported feeling qi during the sessions, and a variety of different sensations associated with perception of qi were described. Approximately three-quarters of participants experienced improvement in one or more PASC symptoms, most commonly improvements in fatigue, “brain fog”, and sleep quality, and 85% reported improved well-being. Additionally, participants frequently cited the group-based nature of the intervention as a positive aspect of their experience.

Conclusions: External qigong was well-received by participants, with the majority perceiving qi and reporting improvements in PASC-related symptoms and overall well-being. These findings suggest that many individuals may be able to perceive qi and that group-delivered external qigong may be a beneficial complementary therapy for managing PASC symptoms. Further research is warranted to evaluate the effects of external qigong in this patient population.

P05.18

Pilot Study of Meditative Movement (MM) Effects on Breast Cancer Survivors’ (BCSs) Anxiety, Depression, Sleep Quality and Cognitive Function and Association

Francisco Munoz ¹ , Taylor Lehner², Linda Larkey³, and Richard Lee⁴

¹City of Hope Orange County, Irvine, CA

²University of Colorado Anschutz, Aurora, CA

³University of Arizona, Tempe, AZ

⁴Cherng Family Center for Integrative Oncology, Irvine, CA

Contact: Francisco Munoz, [e-mail]

Abstract

Purpose: BCSs frequently report anxiety, depression, poor sleep quality, and cognitive impairment. A MM program, Qigong/Tai Chi Easy, combines meditation and low-intensity exercise, often used to improve those symptoms. The BDNF and APOE genes may associate with cognitive functioning and other symptoms.

Method(s): Using a single group, pre- to post-intervention assessment design, a pilot study was conducted among BCSs to examine effects of an 8-week MM intervention on anxiety, depression and sleep quality. We used validated measures for symptom and gene expression.

Results: Fourteen BCSs (mean age = 61) completed the MM intervention with mean practice time of 729 min (sd=369). Anxiety [mean (sd), 9.2 (7.7)] to [4.2 (3.7)], p=.05] and depression scores [4.1 (4.9)] to [2.0 (3.0), p=.08] decreased and poor sleep quality improved (decreased scores) [1.5 (0.8) to 0.9 (0.7), p=.03]. Cognitive function domains: perceived cognitive impairment (Cog PCI) and cognitive impairment impact on QOL (Cog QOL) improved with decreased scores, Cog PCI: [25.4 (14.2) to 17.3 (10.5), p=.01] and Cog QOL: [3.7 (3.8) to 1.8 (2.2), p=.04]. Analysis indicated a significant increase in BDNF gene expression from pre-intervention [mean (sd), .11 (.9)] to post-intervention, [.30 (.7), r=.63, p=.017]. This significant BDNF increase was significantly associated with changes in Cog PCI (p=.003); Cog QOL (p=.020); anxiety (p=.043), sleep quality (p=.037); and associated with depression (p=.060). Gene expression increased in the expected direction for APOE [.039 (.08)] to [.144 (.24)] with small effect size, Cohen’s d=.263. This APOE increase was significantly associated with changes in Cog PCI (p=.004); Cog QOL (p=.032); anxiety (p=.049), sleep quality (p=.018); and associated with depression (p=.075). Simple linear regression analysis indicated that APOE gene changes explained 62.6% (R2=.791) of BDNF significant gene expression change (F=1(12), 20.1, p<.000).

Conclusions: The MM intervention and gene expression changes were shown to change scores on symptoms for BCSs.

P05.19

Providing the Tools for Longevity: A Feasibility Project in Veteran Adults

Katherine Dignan ¹ , Rosalie Diaz², and Davinder Bhullar²

¹Veteran Affairs Administration, Cleveland, OH

²Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH

Contact: Katherine Dignan, [e-mail]

Abstract

Purpose: Blue zones are geographical areas where people live to be nonagenarians and centenarians with notably better rates of physical and mental health compared to average American. The purpose of this project was to determine the effectiveness of a Longevity Clinic implemented in the Veteran population. The program focused on providing nine unique evidence-based concepts of the blue zone areas introducing a holistic approach to well-being, addressing physical health, deeper aspects of fulfillment and connection. Participants were provided with valuable insight into lifestyle factors such as healthy nutrition, exercise, stress management, and social connections, to help change their own behaviors that align with the Blue Zone recommendations.

Method(s): Key Stakeholders created a workgroup that included a physician psychologist dietitian health and wellness coach physical therapist and chaplain. Participants engaged in 5 education and skill development sessions followed by 6 support sessions (6 motivational interviewing sessions) with their Health and Wellness.

Results: The Longevity Clinic opened in May 2024. A post-implementation data review included 18 unique participants. The average of participants rated their physical health 3.2 and Mental health 2.7, out of a possible 5. A lower rating indicating excellent and a higher number indicating poor. Individuals also reported a fair rating (3) when asked regarding their emotional and social support they had. Participants represented were predominantly men (83%), female (17%), and all 50 years of age or older (mean age of participants would be better, e.g., 67+-12 years). Majority (83%) reported they do not follow any dietary plan or nutrition style.

Conclusions: Implementation of a Longevity Clinic empowered Veterans to improve their physical, mental, and emotional health through scientific education and skill building for self-care.

P05.20

Remotely Delivered Tai Chi and Wellness Interventions for Posttraumatic Stress Disorder and Pain: Results from a Randomized Feasibility Trial

Barbara Niles ¹ , DeAnna Mori², and Chenchen Wang³

¹VA Boston Healthcare System, National Center for PTSD, and Boston University School of Medicine, Boston, MA

²VA Boston Healthcare System and Boston University School of Medicine, Boston, MA

³Center for Integrative Medicine at Tufts Medical Center, Tufts University School of Medicine, Boston, MA

Contact: Barbara Niles, [e-mail]

Abstract

Purpose: A rapidly growing evidence base indicates that mind-body interventions are appealing and effective treatments for chronic medical and mental health conditions, such as posttraumatic stress disorder (PTSD) and musculoskeletal pain. Tai Chi, an ancient Chinese martial art, has been shown to enhance physical functioning and mental health and improve quality of life for individuals with a variety of chronic conditions.

Method(s): The current study examines Tai Chi and investigates the feasibility of delivering two fully remote integrative interventions for PTSD and pain. In a small randomized controlled trial to demonstrate feasibility for Veterans with PTSD and chronic pain, two fully remote 12-week, twice weekly interventions were developed and delivered: Tai Chi and Wellness. In Phase I, treatment manuals and procedures were established and piloted with 13 Veterans. In Phase II, 42 Veterans were recruited and randomly assigned to Tai Chi or Wellness groups over 3 cohorts. Assessments were conducted at baseline, post-treatment and 3-month follow-up. Qualitative interviews were conducted at post-treatment assessments.

Results: Participation and adherence with the interventions was high with 67% of Veterans receiving a full treatment dose (at least 18 of 24 sessions) and 78% completing the post-treatment assessment. Qualitative interviews conducted at post-treatment and 3-month follow-up indicate that Veterans perceived the interventions to be powerful and helpful in managing PTSD symptoms. Participants noted that remote delivery was very convenient and allowed increased participation for working, traveling, and rural Veterans.

Conclusions: A fully remote randomized trial of integrative interventions for Veterans was successfully developed and piloted. Mind-body treatments such as Tai Chi are feasible and acceptable for Veterans with PTSD and telehealth delivery allows convenience and promotes increased access.

P05.21

Study Protocol: Remote Tai Chi for Knee Osteoarthritis - an Embedded Pragmatic Trial

Chenchen Wang ¹ , Robert Saper², Eric Roseen³, Helen Lavretsky⁴, Weijun Zhang⁵, Brian Mittman⁶, Lance Laird⁷, and Ludovic Trinquart⁸

¹Center for Integrative Medicine at Tufts Medical Center, Tufts University School of Medicine, Boston, MA

²Cleveland Clinic, Cleveland, OH

³Boston University School of Medicine and Boston Medical Center, Boston, MA

⁴UCLA, Los Angeles, CA

⁵UCLA Center for East-West Medicine, Los Angeles, CA

⁶Kaiser Permanente Southern California, Pasadena, CA

⁷Boston University, Boston, MA

⁸Tufts Medical Center, Boston, MA

Contact: Chenchen Wang, [e-mail]

Abstract

Purpose: Symptomatic knee osteoarthritis (OA) is a leading cause of disability and increasing medical costs. There is a critical shortage of treatment options. The American College of Rheumatology clinical practice guidelines strongly recommend Tai Chi mind body practice for knee OA. However, critical gaps remain as to the real-world effectiveness of remote Tai Chi for knee OA and its implementation across multiple Health Care Systems.

Method(s): We designed a pragmatic, individually randomized group-treatment trial that will compare the effects of a 3-month twice weekly remotely delivered Tai Chi intervention versus routine care. The trial is embedded in four Health Care Systems (Tufts Medical Center, Boston Medical Center, University of California Los Angeles Health, and Cleveland Clinic Ohio and Florida). We will enroll 480 patients with a clinical diagnosis of knee OA. The remote Tai Chi sessions will last 60 minutes, twice a week, for 3 months (24 sessions). The Routine Care participants will be encouraged to continue their ongoing care for knee OA by their providers. Participants will be evaluated at baseline and 3 months, with additional follow-up at 6 and 12 months.

Results: We will determine if the addition of remote Tai Chi to Routine Care improves knee-related pain (WOMAC Pain Score at 3 months - primary outcome), function, pain interference, health-related quality of life and healthcare utilization. We hypothesize that implementation of remotely delivered Tai Chi is feasible across four Health Care Systems.

Conclusions: A Demonstration Project of the NIH Pragmatic Trials Collaboratory, our innovative study is the first rigorous multi-site, pragmatic trial of a remote Tai Chi program for knee OA designed to improve patient-centered outcomes. Upon successful completion, we anticipate the study results will foster widespread adoption of mind-body approaches for knee OA across Health Care Systems and lay the groundwork for future trials comparing different implementation strategies.

P05.22

Survey of Physical Therapists’ Knowledge, Attitudes, and Behaviors Regarding Mindfulness-Based and Relaxation Interventions

Natasha Parman ¹ , Dana Dharmakaya Colgan², Carina Staab³, and Donald Fogelberg¹

¹University of Washington, Seattle, WA

²OHSU, Portland, OR

³National University of Natural Medicine, Portland, OR

Contact: Natasha Parman, [e-mail]

Abstract

Purpose: To describe physical therapists’ self-perceived knowledge, attitudes, and behaviors regarding mindfulness-based and relaxation interventions.

Method(s): From August 2024 to September 2024, physical therapist (PT) members of the Academy of Orthopaedic Physical Therapy were recruited to complete a web-based, cross-sectional survey. Topics included respondent demographics and professional characteristics, and self-perceived knowledge, attitudes, and behaviors regarding mindfulness-based and relaxation interventions. Responses were characterized using descriptive statistics.

Results: 166 PTs completed the first section of the survey, with an attrition rate of 28% over the course of the survey. Respondents’ median age was 48 (IQR: 36-57) years, with most identifying as female (59%), non-Hispanic or Latino (92%), and White (86%). The median time since licensure was 19 (IQR: 7-33) years, and 84% worked as clinicians primarily. The interventions with which respondents were familiar or very familiar included diaphragmatic breathing (93.5%), massage for relaxation (68.4%), and mindfulness (67.8%). The most used interventions included diaphragmatic breathing (96%), progressive muscle relaxation (66%), and mindfulness (64%). The interventions with which respondents were not familiar or somewhat familiar were clinical hypnosis (93.5%) and autogenic training (90.2%). The least used interventions were autogenic training (12%) and clinical hypnosis (1%). Nearly all respondents (93%) agreed that mindfulness-based and relaxation interventions fall within the scope of practice for PTs, though 30% indicated clinical hypnosis should not be used by PTs, regardless of training.

Conclusions: Most respondents in our survey believe that mindfulness-based and relaxation interventions are within the scope of practice for PTs. However, there is limited knowledge and utilization of certain interventions. There is an opportunity to educate PT professionals on complementary and integrative health interventions that are within the scope of PT practice but are not well-known or utilized. Caution should be interpreted to generalize these findings given the small sample size and sources of bias common in survey research.

P05.23

The First Year of Multiple Sclerosis: Quantifying Anxiety, Depression, and Early Integrative Treatment Needs To Inform Care for Patients and Partners

Heena Manglani-Terranova ¹ , Ariel Emrani², Anastasia Prussakova², Eric Klawiter², Gloria Yeh³, and Ana-Maria Vranceanu¹

¹Harvard Medical School/Massachusetts General Hospital, Boston, MA

²Massachusetts General Hospital, Boston, MA

³Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA

Contact: Heena Manglani-Terranova, [e-mail]

Abstract

Purpose: Multiple sclerosis (MS) affects both people with MS (PwMS) and their care partners, with elevated emotional distress increasing the risk for disease progression. We aimed to quantify emotional distress in PwMS and their partners during the first-year post-diagnosis and explore early needs for integrative psychosocial treatments.

Method(s): We administered an online battery assessing emotional distress using the 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) scales for depression and anxiety, and engagement in integrative treatments. We also conducted one focus group to explore the impact of MS on mental health and PwMS’ engagement in and preferences for mind-body treatments. We analyzed quantitative data using descriptive statistics and transcribed and coded qualitative data using a hybrid inductive-deductive thematic analysis approach.

Results: Our sample includes 29 PwMS (Mage = 35.6 years, 20 females) and 11 partners (Mage = 43.8 years, 7 females). The focus group included 4 females (Mage = 37.3 years). Compared to the normative mean (T-score = 50, SD = 10), partners reported higher anxiety (M = 65.0) than PwMS (M = 57.9), with both groups scoring (1.5 and >0.5 SD) above the normative sample. Depression was also higher in partners (M = 59.8) than PwMS (M = 54.8). The percentage of the sample of PwMS engaging in the following mind-body treatments included: disease-modifying therapies (55.2%), physical therapy/exercise programs (48.3%), stress-management programs (27.6%), nutritional counseling (27.6%), and psychotherapy (24.1%). In the focus group, PwMS reported positive experiences with guided meditation (Headspace), MS-adapted yoga (YogaGo), dietary changes, and social support. Participants expressed a desire for “wraparound care,” preventative tools, dyadic interventions, and access to MS-experienced psychotherapists.

Conclusions: Elevated anxiety and depression in PwMS and their partners indicates a need for holistic, tailored care early after diagnosis. There is strong interest in integrative and accessible interventions for individuals and dyads.

P05.24

The Impact of Meditation on Instantaneous Respiration Rate and Amplitude: A Secondary Data Analysis

Ryan Wexler ¹ , Dan Klee², Joshua Kaplan², and Barry Oken²

¹National University of Natural Medicine (NUNM), Portland, OR

²Oregon Health & Science University, Portland, OR

Contact: Ryan Wexler, [e-mail]

Abstract

Purpose: Respiration is a posited biomarker of stress reactivity that may be linked to health consequences including cardiovascular events. Stress reactivity is reportedly affected by mind-body practices such as meditation. Therefore, the current analysis aimed to evaluate responses to cognitive stress in individuals of various meditation experience levels.

Method(s): Respiration was recorded during 4 conditions in a set sequence: Tones (simple auditory discrimination task), breath counting meditation (Med1), a cognitive stressor task based on the Montreal Imaging Stress Test (MIST), and a subsequent breath counting meditation (Med2). Respiration was measured with a piezoelectric chest belt and managed in BrainVision Analyzer (Brain Products, Germany). Breathing peaks were automatically labeled by BrainVision and reviewed for accuracy by research staff. Labeled peaks were used to determine participants’ breath-to-breath interval (BBI) and breath amplitude. Consistent with previous analyses, novice (less than 1,000 hours of regular) and expert meditators (more than 1000 hours) were collapsed into a single group for comparison against study controls, i.e., no meditation practice (i.e., meditators vs. non-meditators).

Results: Mediators and non-mediators exhibited decreased breath amplitude and BBI for MIST as compared to Med1 and Med2 (p = 0.005 and p < 0.001, p = 0.002 and p < 0.001; respectively). In the Med1 and Tones tasks, meditators had significantly increased breath amplitude (p = 0.048 and p = 0.036, respectively) and approached significance for the Med2 condition (p = 0.054), but was non-significant for the MIST task (p = 0.271). There were no differences across groups for any condition for BBI. Subsequent factorial ANOVA revealed a significant effect for group (p < 0.001) and task (p < 0.001), but not group*task interaction (p = 0.928).

Conclusions: Meditators exhibited significantly greater breathing amplitude, but not BBI, over non-mediators across the Med1 and Tones tasks. No group differences were seen in during the cognitive stressor condition.

P05.25

The Mindful-Gut Trial Protocol: Exploring Mindfulness-Based Cancer Recovery’s Impact on Gut Health and Psychosocial Well-being in People with Cancer

Jamie Petersson ¹ , Julie Deleemans¹, Athina Spiropoulos¹, and Linda Carlson¹

¹University of Calgary, Calgary, AB

Contact: Jamie Petersson, [e-mail]

Abstract

Purpose: Chemotherapy has enduring effects on cancer survivors’ gut microbiota, which are associated with psychosocial symptomatology. Considering the chronic gastrointestinal (GI) and psychosocial symptoms observed in cancer survivors, investigating interventions to improve gut health and psychosocial well-being is critical. This remains unstudied; hence, this study aims to determine if an integrative whole health program, mindfulness-based cancer recovery (MBCR), impacts the gut microbiota and alleviates GI symptoms.

Method(s): The study design is a pilot proof-of-concept single group pre-post cohort study. The intervention is a 9-week MBCR program. Target sample size is 15 participants. Stool samples along with GI, mindfulness, and psychosocial measures will be collected pre- and post-intervention. Gut microbiota composition will be analyzed through 16S rRNA gene sequencing on stool samples. The primary outcome is feasibility of recruitment/retention and data collection. The secondary outcomes are gut microbiota composition, mindfulness, GI and psychosocial symptoms.

Results: Recruitment and retention rates, completeness of data collection, and effect sizes of the MBCR intervention on outcome measures will be assessed. We hypothesize that MBCR will result in: (1) significant alterations in gut microbiota composition; (2) a decline in the prevalence and severity of GI and psychosocial symptoms and improved mindfulness, and: (3) significant correlations between specific bacteria and GI-, mindfulness-, and psychosocial-related outcomes.

Conclusions: This novel study will investigate the potential impact of a readily accessible, cost-effective integrative medicine program on gut microbiota and GI symptoms, extending our knowledge of MBCR effects beyond measures of psychosocial health to include the gut microbiome for the first time. Thus, this research has the potential to demonstrate that an evidence-based mindfulness intervention can contribute to whole health, impacting both the gut and the brain, while being offered in a free-of-cost, online format, making wellness accessible to all people living with cancer.

P05.26

Therapist Self-Transcendence While Guiding Mindfulness Increases Patients’ Pain Relief

Kennedi Childs ¹ , Eric Garland², and Adam Hanley¹

¹Florida State University, Tallahassee, FL

²University of California San Diego (UCSD), La Jolla, CA

Contact: Kennedi Childs, [e-mail]

Abstract

Purpose: Mindfulness interventions are fundamentally relational: therapists guide patients through mindfulness practice. While guiding mindfulness, a therapist can choose to 1) imply provide the practice instructions or 2) provide the instructions and follow them themselves. If the therapist chooses to follow the mindfulness instructions, it is conceivable that their sense of self could be temporarily altered, allowing for a deeper sense of connection, or even “oneness”, with the patient. The purpose of this single-site, two-arm, randomized controlled trial was to examine whether a therapist’s experience of profound connection (i.e. self-transcendence) while guiding a mindfulness practice has therapeutic value.

Method(s): Participants (n=95) were adults with chronic pain on long-term opioid therapy that received four, 30-minute mindfulness training sessions over the course of 4 weeks. Data from 320 unique sessions was available. Participants completed measures of pain intensity, decentering, and self-transcendence immediately before and after each session. Study therapists reported their level of participation in the mindfulness practice, sense of connection with the participant, and self-transcendence after each session.

Results: Repeated measures ANOVA revealed that mindfulness was associated with significant reductions in pain intensity (F_1,319=259, p<.001). Pain intensity decreased by 29%, which is a clinically meaningful reduction. Hierarchical regression analysis identified two variables as unique predictors of decreases in pain intensity among participants: 1) the participants’ self-reported increase in self-transcendence while practicing mindfulness, and 2) the therapists’ self-reported self-transcendence while guiding mindfulness practice.

Conclusions: In conclusion, as a therapist has a greater experience of self-transcendence, the more profound the analgesic effect of mindfulness practice becomes for patients. These results warrant further examination of the brain-to-brain concordance between a therapist and patient during mindfulness training sessions.

P05.27

Visual Mind-Body Mapping: A Therapeutic Tool to Cultivate Connections in Integrative Psychiatry

Rachel Corren ¹ , and Selena Chan²

¹School of Medicine, University of California, San Francisco, San Francisco, CA

²Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

Contact: Rachel Corren, [e-mail]

Abstract

Purpose: Therapeutic relationships often rely on verbal communication, which can limit how patients and clinicians understand mental and physical health. Visual mind-body mapping—a graphical representation of a patient’s experiences and evolving narrative—introduces a creative, collaborative tool in integrative psychiatry. This method complements verbal exchanges, allowing patients and clinicians to co-create a holistic, dynamic picture of diagnoses and treatments. It offers new insights for actionable next steps and promotes shared decision-making for whole-person care.

Method(s): We present three case studies from an integrative psychiatry clinic, demonstrating how visual mind-body mapping was used in patient care. Patients were selected based on traits indicating an appreciation for complexity, metaphorical thinking, and readiness to reflect on mind-body signals. Each case includes a brief patient history and path to integrative psychiatry, along with indications and contraindications. We provide a step-by-step overview of how visual maps were co-created during a 50-minute session.

Results: Visual mapping revealed new insights and guided treatment strategies. Outcomes included identifying gaps in treatment, recognizing symptom patterns in family histories, and tracking changes in wellbeing. This method proved effective for history-taking, diagnosis, treatment planning, and strengthening the therapeutic alliance, ultimately improving health outcomes.

Conclusions: Visual mapping enhances integrative care by reconnecting mental and physical health. It fosters co-creation between patients and providers, bridging gaps in understanding and highlighting patients’ strengths. The process of creating mind-body maps becomes part of the treatment itself, fostering meaningful therapeutic relationships and empowering patients and clinicians to approach mind-body syndromes collaboratively. This approach also advances health equity by reducing stigma and centering human-to-human connection.

P05.28

Yoga for Achieving United Nations (UN) Sustainable Development Goals (SDGs): An Explorative Study

Aarti Jagannathan ¹ , Pooja More¹, Vinod Kumar², Lakshmi Nishitha J, Nagendra H.R³, Gangadhar B.N, and Raghavendra Rao⁴

¹National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India

²Yogayur Chikitsa, Yoga and Ayurveda Therapy for Psychosomatic and Lifestyle Disorders, Bangalore, Karnataka, India

³Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA Yoga University), Bangalore, Karnataka, India

⁴Central Council for Research in Yoga and Naturopathy (CCRYN), New Delhi, Delhi, India

Contact: Aarti Jagannathan, [e-mail]

Abstract

Purpose: The SDGs highlight the connections between the environmental, social and economic aspects of sustainable development”. Yoga can be used as a powerful method to not only help develop one’s physical and mental resilience to deal with environmental calamities, but also to develop positive feelings towards one’s environment to help protect it from destruction. The aim is to understand how yoga can be used to achieve community and environment sustainability with objectives of brainstorming sessions with yoga, community and environment experts and to draft a policy statement to implement Yoga to achieve UN SGDs.

Method(s): The study was conducted in three phases, Phase 1 included preparation of MeSH terms with yoga and 17 SDGs using various search engines. Phase 2 included contacting and discussion with experts from yoga, community health, social work, Medicine from all over India and across the globe. Phase 3 included drafting the recommendations to be submitted to the CCRYN based on the results from Phase 2.

Results: In Phase 1, 320 research articles were screened, 217 articles were included and 103 were excluded. Phase 2 was conducted in three sessions with the different experts. The recommendations were finalized after receiving consent from each expert involved from these sessions. Phase 3 included finalizing the recommendations and drafting the policy statement.

Conclusions: Yoga has an important role in achieving UN SDGs. The recommendations if implemented throughout the country helps solve the issues endangering the nature and ecosystem. Thus yoga builds a harmony between human and nature.

Topic Area 06 – Clinical: Other

P06.01

A Pilot Study of the Impact of Massage Therapy in Infusion

Christy DiCristofano ¹ , Elyssa Kim¹, Phi Tran¹, Judith Rose¹, Sarah Ku¹, Jamie Fertal¹, Nicol Hedgpeth¹, Frank Munoz¹, Robert Jacobsen¹, and Richard Lee²

¹City of Hope, Irvine, CA

²Cherng Family Center for Integrative Oncology, Irvine, CA

Contact: Christy DiCristofano, [e-mail]

Abstract

Purpose: Massage therapy is a popular integrative therapy sought by patients with cancer, but often limited by patient accessibility to the service. This pilot study assesses the therapeutic effects of massage therapy on patients during infusion.

Method(s): Patients during infusion therapy at comprehensive cancer center were presented, from December 2023 to September 2024, with the option of a hand and/or foot massage. The patients completed a consent to treat form and a pre- and post-questionnaire, a modified ESAS using a numerical scale from 0-10. The questionnaires assessed nausea, pain, tiredness, anxiety, depression, shortness of breath, appetite, sleep, neuropathy, and overall well-being.

Results: In this pilot program, 213 patients received massage therapy, with 451 hand and/or foot massages provided. Among the participants in the pilot study, 57 (26.8%) were male and 156 (73.2%) females. Patients had a median age of 61 years old and mostly identified as being White (55.4%), Asian (22.1%), and Hispanic/Latino (10.3%). The most common types of cancer were breast (19.7%), lymphoma (10.7%), and ovarian (8.0%). The number of massage sessions ranged from: 2 (40 patients), 3 (19 patients), ≥4 (27 patients). Out of those 451 sessions, 68 chose hand massage, 53 chose foot, and 310 chose both hand and foot massage. The results indicated a significant improvement in pre-post scores for the following: nausea -0.61 (p<0.001), pain -0.93 (p<0.001), tiredness -1.16 (p<0.001), anxiety -1.19 (p<0.001), depression -0.60 (p<0.001), shortness of breath -0.49 (p<0.001), and neuropathy -1.47 (p<0.001). The pre-post surveys revealed an improvement in well-being scores, with the average shifting to -1.14 (p<0.001).

Conclusions: Based on this pilot study, MT is a beneficial adjunctive treatment for chemotherapy induced symptoms, with no reported complications. Massage proved useful in managing symptoms such as anxiety, pain, shortness of breath, nausea, and neuropathy. Further research is needed to comprehensively evaluate the benefits of this intervention during infusion.

P06.02

Acoustic Resonance Therapy for Nasal Congestion: Exploring Mechanisms Through Parallels with Yogic Breathing in Chronic Rhinitis Management

Amber Luong¹, Michael Yong¹, Peter Hwang², Bryant Lin², Paramesh Gopi², Darshan Mehta ³ , Vivek Mohan², Yifei Ma⁴, Jacob Johnson⁵, David Yen⁶, Richard DeMera⁷, and Benjamin Bleier⁸

¹McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, TX

²SoundHealth, Palo Alto, CA

³Osher Center for Integrative Health at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

⁴Stanford Medicine, Palo Alto, CA

⁵San Francisco Otolaryngology Group, San Francisco, CA

⁶Specialty Physician Associates, Bethlehem, CA

⁷DeMera Allergy, Fresno, CA

⁸Massachusetts Eye & Ear Infirmary, Boston, MA

Contact: Darshan Mehta, [e-mail]

Abstract

Purpose: Acoustic resonance therapy (ART) has demonstrated significant efficacy in reducing nasal congestion and improving total nasal symptoms in patients with chronic rhinosinusitis. This study explores the underlying mechanism for ART’s success by looking at Bhramari pranayama, a breathing exercise known to improve chronic sinusitis symptoms.

Method(s): This is a sham-controlled, randomized trial involving 52 participants with daily ART treatments over two weeks.

Results: This study found a greater reduction in the nasal congestion sub-score (-0.87 vs. -0.44) and composite Total Nasal Symptom Score (TNSS) (-2.85 vs. -1.32) in ART as compared to the sham treatment. Additionally, ART exhibited a higher response rate (80.8% vs. 46.2%) with no reported adverse events, making it a promising non-pharmacologic treatment for nasal congestion.

Conclusions: Yogic breathing exercise’s effects on improving sinonasal function through modulated airflow and pressure may parallel the mechanism of ART, where acoustic vibrations enhance mucosal clearance and reduce inflammation. These shared pathways suggest that ART may work similarly by promoting sinus drainage and reducing nasal obstruction, offering a non-invasive, vibration-based alternative to breathing exercises for managing nasal congestion.

P06.04

Baseline Association of Suicidality with Pro- and Anti-inflammatory Immune Factors in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)

Taryn Machingo ¹ , Jeni Johnstone¹, Alisha Bruton¹, Hayleigh Ast¹, Irene E. Hatsu², Priya Srikanth¹, Lisa M. Robinette², Brenda Leung³, L Eugene Arnold², Jennifer Loftis¹, and Jason Chen⁴

¹Oregon Health & Science University, Portland, OR

²OSU, Columbus, OH

³University of Lethbridge, Lethbridge, AB

⁴VA, Portland, OR

Contact: Taryn Machingo, [e-mail]

Abstract

Purpose: To examine the relationship between immune factors and self-reported suicidal ideation in adolescents with ADHD, we conducted a secondary data analysis.

Method(s): Samples were collected as part of a multi-site randomized controlled trial, Micronutrients for ADHD in Youth (MADDY) study. Participants were children ages 6-12 years old who met DSM-5 criteria for ADHD as assessed by the Child and Adolescent Symptom Inventory, version 5 (CASI-5) parent-report questionnaire and had symptoms of irritability or anger. The Columbia-Suicide Severity Rating Scale (C-SSRS) Screening version was used to asses suicidality at baseline. Additionally, twenty-five immune factors that include leptin, human growth factor (HGF), vascular endothelial growth factor-A (VEGF-A), and interleukins that have shown a putative role in psychiatric pathology and treatment response were assessed at baseline.

Results: Results will provide information about the association between suicidality and immune factors in adolescents with ADHD.

Conclusions: Findings may direct future clinical decision-making regarding diagnosis and treatment efficacy. Findings will also direct future research in potential inflammatory biomarkers in ADHD.

P06.05

Changes in the Use of Complementary Health Approaches Among U.S. Veterans from 2002 to 2022: A Prevalence and Sex-Stratified Analysis

McKenzie Watson ¹ , Zhi Chen², Kaushal Nanavati¹, and Jamie Romeiser¹

¹SUNY Upstate Medical University, Syracuse, NY

²University at Albany School of Public Health, Albany, NY

Contact: McKenzie Watson, [e-mail]

Abstract

Purpose: U.S. veterans experience an increased burden of conditions such as anxiety, insomnia, chronic pain, and pre-diabetes. Evidence for using complementary health approaches (CHA) to help manage these conditions has grown, and utilization has risen within veterans. However, as use can occur within or outside of VA facilities, we used nationally representative survey data to estimate changes in the prevalence of using CHA among veterans from 2002 to 2022, and described differences in use over time by sex.

Method(s): We used data from the 2002 and 2022 National Health Interview Survey (NHIS). All veterans surveyed with valid data for CHA use were included in the analysis. Survey weighted prevalence estimates were age-standardized using the 2010 U.S. census population for time comparisons. Estimates were generated for any self-reported CHA use, mind-body approaches (yoga, guided imagery, meditation), and manipulative approaches (chiropractor, acupuncture, massage). Estimates were further stratified by sex. Analyses were conducted using chi-square tests and logistic regression.

Results: There were 3,428 and 2,365 veterans surveyed in 2002 and 2022, respectively. The prevalence of using any of the 6 CHAs increased from 19.0% to 37.3% over time (p<0.001). Prevalence of manipulative and mind-body approaches were both 11% in 2002; by 2022, manipulative therapies increased to 20.0%, while mind-body use rose to 26.9%. Prevalence of all 6 CHA significantly rose over time (p<0.01), with the largest absolute changes seen for yoga (10.7%) and meditation (10.2%). This was consistent for both men and women. Females had higher baseline CHA use then males (29.7% vs 17.6%), but absolute change was similar over time (+18.9% vs +17.8%).

Conclusions: Overall prevalence of CHA use nearly doubled over the last 20 years among veterans. Further analysis to assess effectiveness and motivation for use of specific therapies may guide strategies for gender sensitive care, promotion, funding, and support.

P06.06

Clinical Management of Insomnia in Oncology

Anup Bhandiwad ¹ , Jill Schneiderhan¹, and Melissa Greenblatt¹

¹University of Michigan, Ann Arbor, MI

Contact: Anup Bhandiwad, [e-mail]

Abstract

Purpose: Review clinical management of insomnia in oncology. Sleep disturbances are a complex, multifactorial challenge affecting quality of life, especially for patients with cancer. Our purpose is to peel back on that complexity and explore IM management strategies highlighting their evidence so that providers can collaborate with patients to offer support.

Method(s): Literature overview of prevalence of insomnia in oncology and clinical management including CBT, supplements, herbals, mind-body medicine and body work therapies.

Results: Overview of clinical management of insomnia in oncology.

Conclusions: N/A.

P06.07

Integrating Ayurvedic Pulse Diagnosis in an Integrative Medicine Fellowship Program to Expand Clinical Diagnostic Skills to Support Whole Person Care

Sankari Wegman ¹ , Charles Elder², Leslie Elder³, and Arti Prasad⁴

¹Maharishi University of Management, Fairfield, IA

²Kaiser Permanente Center for Health Research, Portland, OR

³Maharishi International University, Fairfield, IA

⁴Hennepin HealthCare, Minneapolis, MN

Contact: Sankari Wegman, [e-mail]

Abstract

Purpose: The Fellowship in Integrative Medicine and Ayurveda at Maharishi International University (MIU) is the first Fellowship approved by the American Board of Integrative Medicine (ABOIM) to integrate Ayurveda as a specialty in its curriculum. Fellows learn pulse diagnosis, one of Ayurveda’s eight-fold methods of examinations, which helps reveal the root causes and nature of imbalances by detecting subtle changes in the doshas (psycho-physiologic markers) through the radial pulse. This non-invasive method is not only diagnostic but also inherently therapeutic as it enlivens the inner intelligence of the physiology. The transcending quality of the technique enables the practitioner to maintain and enhance their well-being and assess the patient’s balance or imbalance across the mind, senses, body, and environment with greater precision. A unique aspect of Ayurvedic pulse reading is that the practitioner and patient experience a “consciousness effect”—a heightened sense of harmony and balance during the pulse diagnosis process.

Method(s): The two-year online Fellowship includes 21 courses, with one residential clinical week each year at MIU’s campus clinic. Ayurvedic pulse diagnosis is introduced from the start, alongside foundational teachings of Integrative Medicine and Ayurveda. Year two emphasizes integrative approaches for each organ system and a deeper understanding of Ayurvedic pathogenesis through pulse reading. The curriculum includes didactic material in the history, techniques of pulse taking, and 126 hours of live clinical training.

Results: Fellows submit weekly self-pulse logs and document patient pulse assessments as part of case studies for presentations. Two cohorts in the program (25 Fellows) are successfully integrating pulse diagnosis into their healthcare practices and have offered profound insights for whole-person care for their patients.

Conclusions: Ayurvedic pulse diagnosis provides insights into the root cause of imbalances and stress-related conditions, complementing modern diagnostic methods. This technique fosters personalized and preventive care, enriching practitioners’ clinical skills and personal wellness.

P06.08

Integrative Health Care for Musculoskeletal Manifestations of Long-COVID

Samon Oomen-Lochtefeld ¹ , Charles Hood¹, Bernard Chedekel¹, and Chenchen Wang²

¹Tufts University School of Medicine, Boston, MA

²Center for Integrative Medicine at Tufts Medical Center, Tufts University School of Medicine, Boston, MA

Contact: Samon Oomen-Lochtefeld, [e-mail]

Abstract

Purpose: Long-COVID affects 65 million people worldwide and is associated with multisite musculoskeletal pain, fatigue, and psychological distress. To date, no effective treatment has been established. We conducted a comprehensive review to evaluate whether integrative health approaches can be effective in treating long-COVID symptoms to inform clinical practice.

Method(s): We performed a comprehensive search in MEDLINE and EMBASE until June 2024. We included randomized trials investigating integrative health approaches for long-COVID symptoms including multisite musculoskeletal pain, fatigue, or psychological distress (with sample size ≥20). Data extraction was undertaken by three reviewers. We summarized demographic information, interventions, duration, and main results.

Results: We screened 316 abstracts and identified 23 eligible randomized trials from 11 countries, totaling 2,390 subjects. Mean age 38-67 years; female 0-85%; study duration 4-17 weeks. We summarized the trials evaluating integrative health approaches for long-COVID symptoms, including mind-body practices (n=4), physical exercise (n=4), respiratory muscle training (n=4), transcranial direct current stimulation (n=3), psychosocial interventions (n=2) and their combinations. Out of 9 trials evaluating musculoskeletal pain, 4 reported significant reductions in pain and somatic symptoms following interventions including cognitive behavioral therapy, psychosocial support with exercise, sound therapy with guided meditation, or home-based exercise. Of 20 trials evaluating fatigue, 13 demonstrated significant improvements. Notably, trials evaluating psychological support (n=3) or respiratory muscle training (n=4) all reported significant reductions in fatigue. Of 16 studies evaluating psychological distress, 12 reported reductions in anxiety, depression, and stress, mainly through mind-body practice and respiratory muscle training approaches. Overall, 21 of the 23 trials showed positive beneficial effects on long-COVID symptoms. No major adverse events were reported, suggesting that these therapies are generally safe.

Conclusions: Initial evidence indicates that integrated therapies including physical exercise, mind-body interventions, behavioral therapy, and psychological support are safe and promising treatments for patients with complex musculoskeletal manifestations of long-COVID.

P06.10

Knowledge, Attitudes, and Practices of Medical Students in Jordan Toward Healthcare Worker Vaccinations: A Cross-Sectional Study

Suhel Batarseh¹, Majd Awwad², and Paolo Varela ³

¹Jordan University of Science and Technology, Amman, Amman, Jordan

²Jordan University of Science and Technology, Irbid, Irbid, Jordan

³Humanitas University, Milan, Italy

Contact: Paolo Varela A., [e-mail]

Abstract

Purpose: Medical students are healthcare workers (HCWs) and thus have a greater risk of developing generalized infections; therefore, there is a need for them to undertake current vaccinations for their protection. It is important to understand the perspective and attitudes of Jordanian medical students towards vaccines since there is a prevalent problem of vaccine hesitancy among many HCWs, which affects vaccine uptake and decision-making. According to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) vaccinations such as Hepatitis B, MMR, and Influenza and their booster doses must be provided to HCWs to maintain immunity. We aim to determine the knowledge, attitude, and practices of medical students in Jordan concerning the recommended vaccines, with a key focus on COVID-19 and flu.

Method(s): In this cross-sectional study, knowledge, attitudes, and practices about HCWs recommended vaccinations were assessed using a structured, pilot-tested, self-administered questionnaire for medical students. We studied undergraduate medical student population in Jordan during the year 2024–2025. The postgraduates and those who took multiple types of COVID-19 vaccines were excluded. The team provided informed electronic consent and a questionnaire form, and we considered the following in the questionnaire: socio-demographics, knowledge and practice about booster vaccinations, attitude toward vaccination in general, and attitude toward specific vaccines.

Results: Among the 323 participants, knowledge levels about vaccinations were distributed as follows: 36.8% high knowledge, 33.7% intermediate, and 29.5% poor knowledge. There were no statistically significant differences in knowledge levels across universities (P=0.092), sex (P=0.872), or educational grade (P=0.322). Decisional influence about booster vaccines: scientific facts were the predominant influence for both Basic (60%) and Clinical students (80%), with significant differences based on educational grade (P<0.012) and sex (P<0.012). There were no significant associations between vaccine efficacy perceptions (P = 0.973), vaccine hesitancy (P = 0.186), or safety concerns (P = 0.060) across educational grades.

Conclusions: This study indicates that there is a knowledge gap on the recommended vaccines among medical students in Jordan since just 36.8% manifested high knowledge. The educational interventions are important in enhancing awareness and revealing hesitancy, especially about COVID-19 and flu vaccines, to improve vaccination uptake.

P06.11

Randomized Controlled Trial Protocol: Effect of an Inpatient Integrative Medicine Consult Service on Readmission Rates & Length of Stay

Katherine Makaroff ¹ , and Andrew Shubov¹

¹UCLA Health, Los Angeles, CA

Contact: Katherine Makaroff, [e-mail]

Abstract

Purpose: The UCLA Center for East-West (EW) Medicine is a busy (approximately 30,000 patient visits per year) group of clinics with a 30-year history of treating patients using a combination of TCM and Western modalities. In 2018, an inpatient EW consult service was launched at UCLA Santa Monica Hospital in what was one of the first physician-led inpatient Integrative Medicine services in the country. A 2022 retrospective observational study of the program demonstrated that patients receiving EW consultation services had profound reductions in 30-day readmission rates when compared to aggregate self-matched patient control data from the prior 2 years (4.6% vs. 33.0%, P < .001, odds ratio 0.10, 95% confidence interval 0.06–0.17), while lengths of stay increased (7.03 days vs. 5.40 days, P < .001).

Method(s): The purpose of the present study is to further validate these effects, minimize bias, and establish a causal relationship between the intervention and outcomes by conducting a prospective randomized clinical trial (RCT) as the program launches at the flagship UCLA Ronald Reagan Hospital. This prospective, two-armed RCT will be conducted with hospitalized patients at UCLA Ronald Reagan Medical Center and referred to the EW consult service. Patients will be randomized to either receive an EW consult visit or usual care (no EW consult).

Results: The primary outcomes will be the difference between the average 30-day readmission rates and lengths of stay between those participants who received at least one EW consult service visit and those who did not. The secondary outcomes will examine variables related to patient care including pain scores, opioid usage, as well as qualitative survey data.

Conclusions: This study will provide high-quality evidence regarding the value of adding an inpatient Integrative Medicine consult service to the multidisciplinary care team of an academic healthcare setting.

P06.12

Use of Complementary Medicine Among US Adults With Post-COVID-19: Results From the 2022 National Health Interview Survey

Mirela-Ioana Bilc ¹ , and Holger Cramer¹

¹University Hospital Tübingen, Tübingen, Baden-Wuerttemberg, Germany

Contact: Mirela-Ioana Bilc, [e-mail]

Abstract

Purpose: The aim of this study was to investigate the prevalence and type of complementary medicine (CM) use as well as potential factors related to CM use in a representative sample of US adults with self-reported post-COVID-19.

Method(s): This secondary data analysis was based on data from the 2022 National Health Interview Survey 2022 (NHIS) regarding presence of post-COVID-19 symptoms and CM use in a representative adult sample (weighted n = 89,437,918).

Results: Our estimates indicate that 19.7% of those who reported having a symptomatic SARS-CoV-2 infection experienced post-COVID-19 symptoms and 46.2% of those reported using any type of CM in the last 12 months. Specifically, post-COVID-19 respondents used most often mind-body medicine (32.0%), followed by massage (16.1%), chiropractic (14.4%), acupuncture (3.4%), naturopathy (2.2%) and art and/or music therapy (2.1%). Reporting post-COVID-19 was associated with an increased likelihood of using any CM in the last 12 months (AOR = 1.18, 95% CI , p = 0.014) and specifically to visit an art and/or music therapist (AOR = 2.56, 95% CI , p < 0.001). The overall use of any CM was more likely among post-COVID-19 respondents under 65 years old, females, those with an ethnical background other than Hispanic, African-American, Asian or Non-Hispanic Whites, having a higher educational level, living in large metropolitan areas and having a private health insurance.

Conclusions: Our findings show a high prevalence of CM use among post-COVID-19 respondents which highlights the need for further investigations on effectiveness, safety and possible mechanisms of action.

Topic Area 07 – Culinary Medicine/Nutrition

P07.01

Dietary Counselling Plus Omega-3 Supplementation in the Treatment of Generalized Anxiety Disorder: Qualitative Analysis of the EASe-GAD Trial

Monique Aucoin ¹ , Domenique Barbaro¹, Laura LaChance¹, and Kieran Cooley¹

¹Canadian College of Naturopathic Medicine, Toronto, ON

Contact: Monique Aucoin, [e-mail]

Abstract

Purpose: Preliminary clinical evidence suggests that diet modification and omega-3 supplementation can improve symptoms of depression. The Eating and Supplementation for Generalized Anxiety Disorder study (“EASe-GAD”) was the first trial to assess the impact of these interventions on anxiety symptoms among people with a clinical anxiety disorder. This randomized, wait-list controlled, pilot study aimed at assessing the feasibility and acceptability of a dietary counselling and omega-3 supplementation intervention delivered to 50 women with GAD. The primary objective of the present follow-up project was to gather and analyze qualitative data about the acceptability, participant experience, impact, strengths, and weaknesses of the EASe-GAD program, as experienced by the study participants, while also identifying opportunities for improvement.

Method(s): This study involved the conduct of focus. All EASe-GAD participants who consented to being contacted for further research were invited to participate. The focus groups took place virtually on Zoom and were 60–90-minutes in length. They involved a semi-structured interview approach with a set of pre-determined questions. The sessions were recorded and transcribed for data analysis purposes. Transcribed data were analyzed by thematic analysis using direct question and general thematic analysis approaches.

Results: Three focus groups were completed with a total of 13 participants. Participants reported a high level of overall satisfaction with the study. They reported a range of components that they found helpful as well as positive outcomes. They reported components of the program that were less enjoyable and opportunities for improvement. Many participants reported that cost implications of a diet intervention were an important consideration.

Conclusions: This project provided valuable insight into the participant experience and impact of the pilot program and identified opportunities for improvement of subsequent clinical trials delivering dietary counselling plus supplementation to people with generalized anxiety disorder.

P07.02

Elimination Diet Education in the Treatment of Chronic Migraines: A Pilot Feasibility Study

Jenny Sayaseng¹, Monica Joy ¹ , Thanh Thanh Vo¹, Amanda Jan¹, Jeffrey Duong¹, Elizabeth Ekpo², Emily Andrada-Brown², and Michelle Dossett²

¹University of California, Davis School of Medicine, Sacramento, CA

²University of California, Davis, Sacramento, CA

Contact: Monica Joy, [e-mail]

Abstract

Purpose: To assess understanding of migraines, and the impact of diet on migraines, among students at a large public university and explore the feasibility of implementing an elimination diet in this population.

Method(s): 66 higher education students (≥18 years) who self-reported migraines were enrolled; 33 completed the study. Participants completed baseline questionnaires to assess migraine frequency and severity (MIDAS) and determine their understanding of migraines and the elimination diet. After completing self-paced, asynchronous learning modules, participants completed questionnaires to assess changes in migraine and elimination diet knowledge. Two months after module completion, participants submitted a follow-up MIDAS and were asked whether they implemented an elimination diet.

Results: Migraine knowledge scores increased from a mean of 16.4 at the start of the study to 18.5 after completing the learning modules (+2.1, p < 0.001). Similarly, elimination diet knowledge scores increased from a mean of 5.6 to 7.5 (+1.9, p < 0.001). MIDAS scores in the 19 participants (58%) that had a high adherence to the elimination diet improved from 43.3 at the beginning of the study to 24.9 two months after module completion (difference –18.4, p=0.11). MIDAS scores in the 14 participants (42%) that had a low adherence to the elimination diet improved from 41.8 at the beginning of the study to 33.4 two months after module completion (difference –8.4, p=0.54).

Conclusions: Completing self-paced, asynchronous learning modules significantly increased migraine and elimination diet knowledge in higher education students. There was no significant difference in MIDAS scores in participants that had a high versus low adherence to the elimination diet, however this pilot study was underpowered to detect a difference. Delivering asynchronous education on the elimination diet to higher education students who experience migraines is feasible and may enhance access to this information for this population.

P07.03

Prevalence and Risk Factors of Gastroesophageal Reflux Among Jordanians: A Cross-Sectional Study

Amjad Almansi¹, Shahd Alqato², Suhel Batarseh³, Abdelrahman Sulieman³, Dina Massad, Zaina Giabatti, Abdallah Bakeer, Tariq Alhunaiti⁴, and Paolo Varela ⁵

¹Prince Hamza Hospital, Amman, Amman, Jordan

²Department of Internal Medicine, Arab Medical Center, Amman, Amman, Jordan

³Jordan University of Science and Technology, Amman, Amman, Jordan

⁴Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan, Alsaalt, Madaba, Jordan

⁵Humanitas University, Milan, Italy

Contact: Paolo Varela, [e-mail]

Abstract

Purpose: One of the main conditions affecting the upper gastrointestinal tract that lowers quality of life and may contribute to morbidity in nearby areas is gastro-esophageal reflux disease (GERD). We could not find any research that assessed how GERD affected Jordanian health outcomes, including its potential impact on mortality rates. It is vital to understand the prevalence of GERD and its risk factors to create a successful public health intervention. This will help to clarify the importance of GERD in Jordanian healthcare.

Method(s): We carried out a cross-sectional study among Jordanians between December 2023 and January 2024 using an online survey. We used a convenience-testing sampling strategy and obtained informed electronic consent before collecting data. Cohen’s Perceived Stress Scale, lifestyle and nutritional risk factors, gastro-esophageal reflux disease, and sociodemographic were among the four questionnaires that were provided.

Results: We studied 530 Jordanians with a median age of 30 years and 53.8% females. The prevalence of GERD was 34.3%, and it was considerably greater in people who were obese and had a family history of the condition. We also looked at the links between GERD and specific behaviors, such as avoiding sitting or walking right after meals and eating a diet high in fiber and low in vegetables.

Conclusions: In Jordan, we observed a significant prevalence of GERD and linked risk variables like obesity, family history, and specific eating patterns. This demonstrates the Important need for a policy initiative and advocacy campaign to raise awareness of GERD and its avoidable risk factors in Jordan.

Topic Area 08 – Delivery Models

P08.01

Health & Wellness Coaching: Simulation into Practice

Ashley Rush ¹ , and Laura Marchica²

¹VHA, Orlando, FL

²Veterans Affairs, Palm Beach Gardens, FL

Contact: Ashley Rush, [e-mail]

Abstract

Purpose: The VHA has professionalize the position of Health & Wellness Coaching (HWC) and Orlando VAHCS has hired 25 coaches. The HWC engages individuals in client-centered processes that empowers clients to develop self-determined goals. As the HWC position evolves an interdisciplinary team created an interactive and skill-based training utilizing simulation to support growth of HWC competencies.

Method(s): An interdisciplinary team: Director of Simulation, 2 HWC Mentors, 2 HWCs, 1 HWC Supervisor, 1 QM Specialist, and 1 Field Implementation Consultant was established to plan an 8-hour training day consisting of 4 hours of HWC simulations incorporating the HWC skills and competencies. An additional 4 hours of team building was designed to enhance team communication by incorporate DiSC assessments, simulations & role-plays. 24 HWCs attended in 2023 and 24 HWCs, 1 Pathway Partner, 1 Whole Health Clinical Director, 1 Clinical Psychologist & 1 Clinical Social Worker attended in 2024. Simulations were lead by the Director of Simulation & facilitated with HWC Mentors.

Results: The growth of HWC within the Orlando VA is apparent with a FY24 coaching Uniques 4,887 and 10,671 encounters. 15 team members responded to a MS Teams anonymous survey provided in 2024 for feedback. 11 respondents indicated “I feel as though this Simulation & Team Training Event helped me to understand my role as a HWC more clearly” & 12 respondents indicated “I feel as though this Simulation & Team Training Event helped me to understand my role on this team more clearly.” 3 HWC have obtained their NBHWC since this event occurred.

Conclusions: VA Orlando’s team values the HWC implementation and training for professional development. The partnership with director of simulation, quality management, and Whole Health is an innovative approach around simulation events focusing on role clarity and obtaining real time feedback to enhance skill sets.

P08.02

Implementation of Whole Health Modalities in Veteran Administration (VA) Community Based Outpatient Clinics (CBOC)

Patricia Kiefer ¹ , Rosalie Diaz¹, Katherine Dignan², Darice Somple-Jay³, and Victoria Hamary³

¹Louis Stokes Cleveland VA Medical Center, Cleveland, OH

²Veteran Affairs Administration, Cleveland, OH

³VANEOHS, Cleveland, OH

Contact: Patricia Kiefer, [e-mail]

Abstract

Purpose: Whole Health is the VA’s holistic approach to supporting Veteran’s well-being. To expand awareness, VA staff act as advocates and leaders in this model. Outpatient nursing staff identified a gap in Whole Health offerings at CBOCs, prompting collaboration with Whole health and Patient Education teams to provide training and increase Veteran engagement during clinic visits.

Method(s): Key stakeholders formed a workgroup to determine which Whole Health modalities nursing staff could integrate into Veteran clinic visits. Aromatherapy and guided imagery were selected. Staff education was developed, resources and equipment were secured, and standard operating procedures along with EMR documentation were created. CBOC nursing staff received multiple virtual training sessions, equipping them to introduce and implement these Whole Health initiatives during primary care and mental health appointments.

Results: The primary endpoint of this process was to increase Veteran awareness and usage of Whole Health modalities supporting their health and wellbeing. Staff training started in May of 2024. A post-implementation data review of 13 patient locations in September 2024 showed 476 Veterans experienced guided imagery and 216 patients were given aromatherapy sticks during their appointments. These numbers reflect an increase in new Veteran engagement in Whole Health modalities.

Conclusions: While early, nursing staff and providers are continuing to introduce Whole Health modalities to Veterans in the outpatient clinics. Limitations: Although we are seeing an increase in use, not every location is using both modalities at optimal levels.

P08.03

VIP Boot Camp: Bridging Whole Health and Evidence-Informed Mental Health Care in VA

Gina Foltz¹, Carolyn Davidson², Meghan Rooney ³ , and Stephen Graham⁴

¹OPCC&CT, Slippery Rock, PA

²Department of Veterans Affairs, Chattanooga, TN

³Department of Veterans Affairs, Louisville, KY

⁴Tennessee Valley VA Medical Center, Veterans Healthcare Administration, Nashville, TN

Contact: Meghan Rooney, [e-mail]

Abstract

Purpose: The Veterans’ Intensive PCMHI (VIP) Boot Camp is an innovative, evidence-informed virtual group program providing transdiagnostic mental health treatment to Veterans with complex care needs within the Primary Care Mental Health Integration (PCMHI) setting. Veterans connect with their values and partner in developing shared well-being goals. VIP Boot Camp combines techniques from Complementary and Integrative Health with evidenced-based treatments through a Whole Health approach. Participants are equipped with practical tactics for self-management outside of sessions. The provision of support at this interim level of care combined with empowering Veterans to take ownership of their health, has important downstream impacts on healthcare, utilization, and access. The importance of addressing sleep and pain issues early in treatment is emphasized as, when left untreated, have been shown to exacerbate mental health conditions and lead to increased risk of suicide. Exploratory evaluations by the Center for Evaluating Patient-Centered Care (EPCC.pdf (va.gov) suggests an association between engagement in a Whole Health approach and Veterans’ likelihood to complete evidence-based psychotherapy treatment protocol.

Method(s): Two feasibility studies utilizing chart reviews explored the potential impact of VIP Boot Camp attendance on need for additional referrals to a higher level of mental health care.

Results: The initial pilot feasibility study sampled 14 Veterans who completed VIP Boot Camp. Chart reviews revealed that 79% of the Veterans did not require further escalation to higher levels of mental health care. A second larger comparison feasibility study was conducted, sampling 46 veterans who completed VIP Boot Camp, found 83% of Veterans did not require escalation to a higher levels of mental health care.

Conclusions: By utilizing a stepped-care approach, the program not only improves access to evidence-informed, Whole Health-infused, effective treatment, but also transforms mental health care delivery across the VA system, reducing reliance on specialty services and mitigating suicide risk among Veterans.

P08.04

What Matters Most: A Sustainable Approach to Patient Centered Care in Women’s Health

Jennifer Rouchka ¹

¹VA, Louisville, KY

Contact: Jennifer Rouchka, [e-mail]

Abstract

Purpose: The purpose of this project was to adopt a patient centered approach by starting conversations about patients’ values in a Women’s Health VA outpatient primary care clinic and measuring the clinical impact of a Whole Health approach in the care of Women Veterans.

Method(s): These conversations were started with Women Veterans during new patient primary care visits. The number of Whole Health conversations initiated, influence on treatment plan, impact on clinical time, and provider satisfaction were measured for 12 months. Women Veterans were offered more information on Whole Health and if interested were scheduled for health and wellness coaching. Anxiety/depression, quality of life, and pain assessments were completed at 3, 6, 9 and 12 months, as long as the Woman Veteran was active in the coaching program.

Results: Starting the conversation about Whole Health was easy to implement; influenced the treatment plan and did not impede clinical time. Provider satisfaction remained stable. Women Veterans who participated in coaching had improvements in anxiety/depression, quality of life, and pain levels. Study participants reported feeling heard, respected, and not rushed during their healthcare appointments. They commented on the provider’s attentive listening and thoughtful engagement. This increased the confidence in their care and created a positive healthcare environment.

Conclusions: Having value-based discussions is challenging in a busy Women Veterans’ primary care practice. Asking “What matters most to you?” during Women Veterans’ primary care visits is a simple approach to providing patient centered care that becomes easier with time. This can positively impact mental health, quality of life and pain. One Woman Veteran said it best “Whole Health is the best service that the VA offers.”

Topic Area 09 – Economics/Cost Effectiveness

P09.01

A Cost-Utility Analysis of Pharmacopuncture for Chronic Lower Back Pain, A Cost-Utility Analysis of Pharmacopuncture for Chronic Lower Back Pain: A Multicenter, Pragmatic Randomized Controlled Trial

Ye-Seul Lee ¹

¹Jaseng Medical Organization, Seoul, Seoul Teugbyeolsi, South Korea

Contact: Ye-Seul Lee, [e-mail]

Abstract

Purpose: Lower back pain (LBP) is a significant global health issue, contributing to disability and economic strain. Nonpharmacological treatments, including acupuncture and pharmacopuncture, have gained attention for their potential to alleviate the burden of chronic LBP. This study aimed to evaluate the cost-effectiveness of pharmacopuncture compared to physical therapy (PT) for managing chronic LBP from both healthcare system and societal perspectives.

Method(s): A multicenter, two-arm randomized controlled trial was conducted across four medical centers, involving 100 patients with chronic LBP. Patients were randomized into either the pharmacopuncture group or the PT group, receiving 10 treatment sessions over five weeks. Utility was measured using the EuroQol 5-Dimension 5-Level scale (EQ-5D-5L) and Short-Form 6-Dimensional health state (SF-6D) to calculate quality-adjusted life years (QALYs), and costs were evaluated from healthcare and societal perspectives, including medical costs and productivity loss. Productivity loss was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the differences in costs by the differences in QALYs between the two groups, with multiple imputation methods employed to account for missing data. Bootstrapping and sensitivity analyses were performed to assess the robustness of the results.

Results: The study found that pharmacopuncture was more cost-effective than PT, particularly from a societal perspective where it demonstrated lower overall costs and improved QALY, indicating pharmacopuncture was dominantly cost-effective than PT. From a healthcare system perspective, the ICER of pharmacopuncture was $16,575 per QALY, which was below the willingness-to-pay threshold, indicating cost-effectiveness. Sensitivity analyses confirmed the robustness of these findings.

Conclusions: This study highlights pharmacopuncture as a potentially cost-effective alternative to conventional PT for chronic LBP, though further research with larger sample sizes and extended follow-up is recommended to validate these results.

P09.02

Design and Pilot Testing of a Diet Cost Calculation Process for the EASe-GAD Study

Monique Aucoin ¹ , Melissa Murphy², Hainan Yu³, Nicole Yoannou¹, Laura LaChance¹, and Kieran Cooley¹

¹Canadian College of Naturopathic Medicine, Toronto, ON

²Bastyr University, California State University, San Bernadino, CA

³Ontario Tech University, Canadian Memorial Chiropractic College, Oshawa, ON

Contact: Monique Aucoin, [e-mail]

Abstract

Purpose: Randomized controlled trials have demonstrated an antidepressant effect of dietary counseling and a recent pilot study (the EASe-GAD study) has provided early evidence that people with anxiety can benefit from dietary counseling as well. However, one barrier to diet counseling that is often cited, is the cost of healthy food. There is inconsistent evidence on the cost implications of dietary interventions and a need for more research. There is limited guidance for how to calculate the food costs attributed to a diet intervention. The development and testing of rigorous methods are needed. The aim of this project is to develop, and pilot test a process to capture diet data and calculate diet cost associated with a diet intervention. This process will be used in calculating the cost of food consumed by study participants prior to and during a subsequent dietary counseling intervention study assessing the impact of dietary patterns on symptoms of generalized anxiety disorder.

Method(s): We designed a draft diet collection process and recruited participants from the EASe-GAD study. The participants recorded their diet data during seven consecutive days. They completed a semi-structured interview to provide feedback on their experience. Interviews were recorded, transcribed and are undergoing thematic analysis. Two methods will be used to calculate diet cost in order to assess feasibility.

Results: Fifteen participants have enrolled; 13 have returned a complete diet diary and completed the interview. Calculation of diet cost from the available data is underway. Complete data will be available at the time of the conference including a comparison of the two methods of calculating costs.

Conclusions: Publication of the approach developed (including templates, instructions, and resources) and findings from this project will help inform future research on diet intervention studies that assess diet cost as an outcome.

P09.03

Identifying Insurance-Based Initiatives to Increase the Use of Acupuncture Therapy: A Study Protocol

Molly Candon ¹ , Arya Nielsen², and Jeffery Dusek³

¹University of Pennsylvania, Philadelphia, PA

²Icahn School of Medicine at Mount Sinai, New York, NY

³University of California, Irvine, Irvine, CA

Contact: Molly Candon, [e-mail]

Abstract

Purpose: Our previous work has shown that insurance coverage for acupuncture therapy is increasing but remains low compared to modalities like physical therapy and chiropractic care. A better understanding of how insurers make coverage decisions for acupuncture, including limits on visits and restrictions on indications, will help identify ways that insurance can be leveraged to improve access to acupuncture.

Method(s): This study is two-fold. First, we will present results from a scoping review of the literature of insurance-based initiatives that could facilitate health care access. Second, we will perform semi-structured interviews with a snowballed sample of key informants employed by insurers, focusing on their coverage decisions about acupuncture and whether the insurance-based interventions identified in the literature review are relevant for acupuncture. We will identify three insurers and, within each organization, recruit subjects through standard referral processes. Interviews will focus on the current coverage of acupuncture, institutional barriers in making alterations to coverage, and the potential of insurance-driven initiatives identified in the scoping review. We will use established measures from implementation science, including the Feasibility of Intervention Measure.

Results: The scoping review has identified many insurance-driven initiatives, and a variety of frameworks through which they can be conceptualized. For example, the Behaviour Change Wheel can serve as a conceptual model for patient-focused initiatives by insurers, including changing copays, a type of enablement, communicating information about whether acupuncture is covered, a type of education, and establishing pain management support services in workplaces, a type of service provision. Provider-focused initiatives by insurers include prior authorization for acupuncture use, a type of restriction, and changing payment models for pain management (e.g., bundled payments), a type of environmental restructuring.

Conclusions: The overarching goal of this study is to identify concrete ways that we can enhance insurance coverage for and extend access to integrative therapies like acupuncture.

P09.04

Wellness on Wheels: A Complete Blueprint for Cost-Effective, Sustainable, Self-Care Resource Carts for Healthcare Workers, Patients, and Caregivers

Darah Kristine Salmaggi ¹ , Shari Esquenazi-Karonika¹, Rosemarie Yurcak¹, Areyanna McCarthy1, Emma Millon¹, and Kathleen DeMarco¹

¹NYU Langone Health, New York, NY

Contact: Darah Kristine Salmaggi, [e-mail]

Abstract

Purpose: In an era of transformative shifting towards professionalizing self-care, the demand for cost-effective, sustainable self-care resources has never been more pressing. Hospitals are becoming vital hubs for empowering patients, caregivers, and healthcare workers alike in prioritizing their well-being. Inspired by this reality, NYU Langone Health developed “Self-Care Resource Carts” to deliver evidence-based, integrative modalities directly to these priority populations. The following project explored whether the delivery of self-care resources by volunteers throughout an academic medical center would be feasible, and whether it could improve well-being for users, and the volunteers themselves.

Method(s): Programming was disseminated across 2 hospitals and 1 ambulatory site. Utilization data was collected, including details about users’ perceived interest, availability, leadership’s support, impact, and testimonials. Additionally, surveys were conducted to understand volunteer perceptions and user experience(s).

Results: 23 unique Self-Care kits were developed. 16 volunteers were onboarded. Each kit cost∼$.50. Volunteer facilitation was valued at $40/hr. Over one year, volunteers worked 1,721 hours, delivering kits to 5,524 healthcare workers, summing to $68,840 in cost-savings of a workforce. Frequently utilized kits were “Tea for the Soul”, “Aromatherapy”, and “Ear Seeds”. Key survey results indicated that leadership’s support was essential for cart engagement and that the scheduling process could be improved. Pleasantly, volunteers reported enhancements in their own self-care practice as well.

Conclusions: Programming was cost-effective and impactful for volunteers and users. Challenges included accessibility (overnight shifts), volunteer coverage, and inventory storage/maintenance. Separately, a pilot project that provided self-care kits for caregivers reported decreases in caregiver anxiety after 3 months (data reported elsewhere). Additionally, expanded programming and evaluations are underway among a pilot antepartum patient population. A formal QI project has begun. Others who are interested in launching their own sustainable Self-Care Resource Carts can scan the QR code to view our free, practical instructional documents for turnkey programming.

Topic Area 10 – Education Research

P10.01

Integrative Health Equity in Fellowship Seminars: The Development, Implementation, and Assessment of Equity Focused Objectives

Karina Viloria Rodriguez ¹ , Vincent Minichiello¹, Sara Arscott², and Christina Swords¹

¹University of Wisconsin, Madison, WI

²Osher Center for Integrative Health at the University of Wisconsin-Madison, Madison, WI

Contact: Karina Viloria Rodriguez, [e-mail]

Abstract

Purpose: In alignment with the national vision of integrative health equity (IHE) and in response to local feedback, the University of Wisconsin (UW)-Madison Academic Integrative Health fellowship program developed and implemented learning objectives and assessment tools to evaluate the role that equity-focused seminar learning objectives play in supporting fellows’ education.

Method(s): We drafted learning objectives for (1) fellowship seminars and (2) seminar instructors that integrated IHE, providing guidance for instructors’ learning sessions. The authors reviewed them with current IH fellows and collaborated with the UW-Madison Department of Family Medicine and Community Health (DFMCH) DEI Committee to refine and implement. A Fellowship representative led a pre-seminar review of the learning objectives with individual instructors, who had the opportunity to ask questions and provide feedback. To assess the feasibility of these IHE-focused learning objectives, fellow and instructor feedback surveys were created.

Results: The seminar objectives emphasize experiential learning of clinically effective, culturally relevant, patient-centered healing practices, IH therapy accessibility, and identifying relevant cultural misappropriation. The instructor objectives emphasize expertise, the cultural context of the therapy discussed (e.g., how is the culture of origin acknowledged), the instructor’s professional lineage, and the population they serve. The fellows’ seminar assessment invites reflection on what objectives were met, while the instructor seminar assessment encourages reflection on seminar content and conversations, and the personal/professional impact. Fellows shared that all but one seminar to date completely met the new objectives. Seminar instructors reported the pre-seminar meeting and the objectives were helpful while preparing their presentations and positively impacted them personally and professionally.

Conclusions: IHE-focused fellowship seminar and instructor learning objectives and assessment tools were developed in response to national and local priorities. Positive feedback suggests that this process can serve as a model for other IH fellowship programs seeking to center IHE.

P10.02

Exploring Integrative Medicine: Insights from a Weeklong Curriculum for First-Year Students

Peyton Groves ¹ , Sean Sweat¹, and Michelle Thompson²

¹University of Pittsburgh School of Medicine, Pittsburgh, PA

²University of Pittsburgh Medical Center, Pittsburgh, PA

Contact: Peyton Groves, [e-mail]

Abstract

Purpose: Despite growing interest in integrative medicine (IM) among medical students, a gap remains in formal education on healing modalities beyond allopathic medicine. This project aimed to address this gap through a week-long curriculum incorporating didactic and experiential learning, modeled after the Consortium’s LEAPS retreat. The objectives were to increase IM learning opportunities, enhance students’ comfort and knowledge, and assess the curriculum’s impact on student learning.

Method(s): At University of Pittsburgh School of Medicine (UPSOM), a week-long course was offered to first-year students during a week dedicated to exploring various fields. Twelve of fifteen enrolled students participated in pre- and post-surveys designed by the principal investigator (PG). Surveys were administered via Qualtrics and consisted of 10 Likert-scale items (1-7), assessing self-perceived knowledge and attitudes toward curriculum topics. Topics included mind-body medicine, acupuncture, nutrition, Ayurveda, aromatherapy, and sound healing. Data was analyzed using descriptive statistics, including survey items’ mean and median, with pre- and post-survey differences analyzed for changes. This project didn’t require IRB approval but was reviewed by UPSOM’s Research on Medical Students Review Committee.

Results: Mean and median scores for each item were calculated and compared between the pre- and post-surveys. Knowledge increased significantly, with 7 of 10 items showing a 90% or greater improvement in mean and median scores. The most substantial gains were in knowledge of metabolism (mean increase: 254%), mind-body medicine (170%), and meditation (280%). Attitudes showed modest increases, ranging from 0% to 40%, with an average mean difference of 27.69% for attitudes and 182.96% for knowledge. Given the small sample size, no statistical significance was assessed.

Conclusions: A week-long curriculum integrating both didactic and experiential components can improve medical students’ knowledge of IM modalities, with moderate effects on attitudes. Future directions could include longitudinal IM training, and research on long-term retention of knowledge and its impact on clinical practice.

P10.03

The Use of Therapy Dogs to Enhance Learning of Complementary and Alternative Medicine While Promoting Self-Care and Addressing a Knowledge Gap

Katie Lothe ¹ , and Tracy Saladar¹

¹University of Wisconsin Madison - School of Nursing, Madison, WI

Contact: Katie Lothe, [e-mail]

Abstract

Purpose: The purpose of this two part investigation and intervention was to understand the attitudes and knowledge of Doctor of Nursing Practice (DNP) students regarding holistic, complementary, and alternative health care. After identifying a knowledge gap, students experienced the benefit of animal therapy while learning about holistic, complementary and alternative medicine, and self-care promotion.

Method(s): A validated 11 question tool evaluated attitudes and beliefs about holistic, complementary, and alternative medicine (CAM) via anonymous electronic study. Students also ranked their knowledge of CAM modalities. Students then attended scheduled class used as a celebratory self care day. A therapy dog was present with students during a lecture on CAM treatments including reiki, massage, and aromatherapy. Students were given the opportunity to make aromatherapy heating packs and discussed ways to maximize their holistic self care.

Results: Most students showed favorable beliefs and attitudes toward CAM and holistic health. Most students ranked their knowledge of CAM modalities as low. There was an overwhelmingly positive response to the self-care day. All students agreed they had enhanced learning and decreased stress after class.

Conclusions: Students report favorable beliefs and attitudes toward CAM but generally low knowledge levels. Many patients are using CAM and more work needs to be done to bridge this knowledge gap. DNP students experience high levels of stress during their education. They reported benefit from a class focused on self-care and stress reduction, supported by a therapy animal and self care activity.

P10.04

Under the Radar: Creative Infusion of Integrative Medicine into Medical Education

Melinda Ring ¹ , Anna Shannahan¹, and Lori Walsh¹

¹Osher Center for Integrative Health at Northwestern University, Chicago, IL

Contact: Melinda Ring, [e-mail]

Abstract

Purpose: Integrative medicine (IM) remains underrepresented in conventional medical education. This initiative explores creative strategies to introduce IM concepts into medical school curricula by embedding them within required medical humanities seminars at Northwestern University Feinberg School of Medicine (FSM). The aim is to expose a broader array of students to integrative health principles in a non-traditional, interdisciplinary format.

Method(s): For the 2024-2025 academic year, FSM approved two sets of humanities seminars: IM for second-year medical students (M2) and Culinary Medicine (CM) for first-year students (M1). The FSM humanities seminars are required classes that offer a platform to explore healthcare through disciplines like literature, art, and ethics, fostering a broader perspective on the medical profession. Faculty from the Osher Center developed novel programming to introduce IM concepts within these humanities frameworks. The CM seminar focuses on five themes: -Food as Medicine in Traditional Healing Systems -Culinary Traditions and Community Health -Literature and the Healing Power of Food -Mindful Eating and Art: The Intersection of Perception and Nourishment -Food Sustainability and Ethical Choices in Medicine The IM themes include: -Bridging Science and Spirit -Power of the Mind/Body Connection -Cultural Perspectives on Supplements -Global Healing Traditions -Reflections on Healing The seminars are being offered in Fall 2024 and early Winter 2025. Feedback from student participants will be collected and analyzed.

Results: Two new seminar series have been developed for Northwestern’s mandatory humanities course, and interest in both is anticipated to be high. Each series consists of five 2-hour sessions that combine experientials, discussion, reflection and didactics. Data on student engagement and the impact of the seminars will be gathered and presented at the Congress.

Conclusions: This innovative approach demonstrates that embedding integrative medicine concepts into standard medical education, particularly through creative interdisciplinary methods like the humanities, can enhance student engagement and broaden the reach of IM.

P10.06

Update: Cross-Institutional Curriculum for Integrative Medicine Training

Sara Arscott ¹ , Lisa Howard², Anna Shannahan³, Melinda Ring³, Elizabeth Walsh⁴, Iman Majd⁵, Darshan Mehta⁶, Vincent Minichiello⁷, Anand Dhruva², and Anisha Durve⁸

¹Osher Center for Integrative Health at the University of Wisconsin-Madison, Madison, WI

²University of California, San Francisco, San Francisco, CA

³Osher Center for Integrative Health at Northwestern University, Chicago, IL

⁴Vanderbilt University Medical Center, Nashville, TN

⁵Osher Center for Integrative Medicine, University of Washington, National Certification Commission for AOM (NCCAOM), Medical Acupuncture Research Foundation, Seattle, WA

⁶Osher Center for Integrative Health at Harvard Medical School and Brigham & Women’s Hospital, Boston, MA

⁷University of Wisconsin, Madison, WI

⁸University of Miami, Miami, FL

Contact: Sara Arscott, [e-mail]

Abstract

Purpose: The Osher Collaborative for Integrative Health have been contributing to a shared integrative health curriculum to be deployed at our 10 US-based Osher Centers. This flexible and modular curriculum covers core integrative modalities such as mind-body medicine, nutrition, lifestyle medicine - as well some emerging priority areas such as planetary health. Our goal with this curriculum is to create a set of content that can be used for a variety of programs across our Centers depending on their needs - from 2-week medical student electives, resident rotation didactic training, allied health professional training to employee onboarding. We have shared this work earlier in the process and will provide an update on the current status, opportunities, and challenges.

Method(s): Focus groups comprised of Osher Center (OC) faculty have curated a curriculum of foundational integrative medicine topics, created template materials, held informal review meetings and developed a formal curriculum review process. Individual centers have developed asynchronous curriculum content on a centralized learning platform that includes robust learning objectives, video lectures, peer-reviewed scientific articles, experiential activities, community resource engagement, and assessment tools. The goal is eventual dissemination and evaluation at 10 Osher Center sites.

Results: We are finding great interest and engagement in creation of this shared curriculum content. We can report successful collaboration on content across institutions. Approaching the curriculum with a flexible perspective allowing for individual institutions to meet their needs with the content rather than creating a curriculum with a single option for deploying locally has increased engagement.

Conclusions: At this point in our effort we can conclude there are opportunities for cross-institutional creation of education content which will allow for the individual centers’ effort to be minimized while accessing robust integrative medicine educational content from experts. This increases the ability to bring content to learners in a variety of stages of training.

Topic Area 11 – Expressive Therapies

P11.01

Bridging Cultural Sensitivity and Mental Health Equity: A Community-Based Art Therapy Approach for Older Chinese Immigrants

Qianyun Wang ¹ , and Weijun Zhang²

¹UCLA, Los Angeles, CA

²UCLA Center for East-West Medicine, Los Angeles, CA

Contact: Qianyun Wang, [e-mail]

Abstract

Purpose: This study proposes a community-based art therapy program aimed at addressing mental health disparities among older Chinese immigrants in Los Angeles. Rooted in the Photovoice methodology, the program empowers participants, aged 65 and older and who have experienced the loss of a significant other, to articulate their grief and bereavement experiences through photography. The purpose of this initiative is to promote healing, reduce mental health stigma, and foster community empathy through culturally sensitive interventions.

Method(s): The methodology includes the use of Photovoice techniques, where participants capture images that reflect their grief experiences. These images are shared and discussed in guided group sessions facilitated by culturally aligned mental health professionals. The program integrates educational workshops on mental health, incorporating traditional Chinese health practices like Tai Chi and Chinese medicine theories to engage participants meaningfully. These workshops aim to enhance mental health literacy and reduce stigma.

Results: The anticipated outcomes of the study include increased mental health awareness reduced social isolation and enhanced emotional expression among older Chinese immigrants. The study also aims to advocate for culturally sensitive mental health services by showcasing participants’ photographic work in community exhibitions. These exhibitions

Conclusions: The proposed community-based art therapy program, utilizing Photovoice techniques, aims to address critical mental health disparities among older Chinese immigrants in Los Angeles by creating a culturally sensitive and empowering platform for grief expression. By combining therapeutic art practices with culturally relevant mental health education, this program fosters healing and mutual support among participants while raising public awareness through community exhibitions. The program not only enhances the mental well-being of older Chinese immigrants but also advocates for health equity by demonstrating the importance of culturally appropriate mental health services. Ultimately, this initiative underscores the potential of innovative, community-centered approaches to bridge gaps in healthcare access and promote social justice for aging immigrant populations.

P11.02

Creativity in Medicine: Liberating Trauma Through Music & Graphic Expression

Janis Gruska ¹

¹Bastyr University, San Diego, CA

Contact: Janis Gruska, [e-mail]

Abstract

Purpose: Those who are able to regain or maintain positive emotional states are less likely to become ill and are more likely to be resilient in stressful life experiences. New scientific discoveries have identified that chronic stress from negative attitudes and feelings can actually induce tumorigenesis and promote cancer development or decrease our lifespan by altering DNA telomeres. Healthcare professionals who offer interventions that help people process and confront traumatic life events produce significant improvements in their physical health and longevity.

Method(s): Listening to music and expressing our feelings and emotions through drawing is a safe and a meaningful way to connect with our inner essence and the complexity of our thoughts and feelings. Music taps into memories and emotions, while drawing allows the expression of feelings or emotion not otherwise expressible. The Catharsis Application Program (CAP) is an original therapeutic approach blending music listening and graphic expression offering a creative solution to release trauma and difficult emotions we avoid to protect ourselves from pain and discomfort.

Results: Trauma and emotional expression influence our physical & psychological wellbeing. Multiple areas of the brain are stimulated with music listening & graphic expression altering physiological processes positively. Combining graphic expression under musical induction assists in overcoming emotional blocks & allows unconscious emotions to safely emerge.

Conclusions: Repressed emotions has consequences on our global health. They can alter hormones, deplete brain chemicals, and have a damaging impact on our immune system. Firmly grounded in current neuroscience research and trauma theory, the Catharsis Application Program helps to transform challenging emotions into powerful and creative energy which supports positive change leading to balance and vitality.

P11.03

Effects of Various Exercise Interventions in Insomnia Patients: A Systematic Review and Network Meta-Analysis

Zhijun Bu¹, Fengshuang Liu², Md. Shahjalal³, Yike Song⁴, Mengchi Li⁵, Ronger Zhuo⁵, Qinhong Zhong⁶, Yawen Du⁵, Chenge Lu², Zihan Yang⁶, Hanyu Yang², Pu Zhong⁷, Jianping Liu¹, and Zhaolan Liu ⁴

¹Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

²Acupuncture and Bone Injury College, Hubei University of Traditional Chinese Medicine, Wuhan, Hubei, China

³Department of Public Health, North South University, Dhaka, Dhaka zila, Bangladesh

⁴Beijing University of Chinese Medicine, Beijing, Beijing, China

⁵School of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China

⁶School of Management, Hubei University of Traditional Chinese Medicine, Wuhan, Hubei, China

⁷School of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, Beijing, China

Contact: Zhaolan Liu, [e-mail]

Abstract

Purpose: To provide evidence-based recommendations on the most effective exercise interventions for insomnia.

Method(s): An electronic search was performed in six databases: PubMed, CENTRAL, Embase, Web of Science, SPORTDiscus, and PsycINFO. The search covered all dates until March 8, 2024. A methodological evaluation was performed using the Cochrane Risk Bias Tool 2.0. The study quality of evidence was evaluated through the Confidence in Network Meta-Analysis platform (CINeMA).

Results: A total of 22 randomized controlled trials involving 1,348 insomnia patients were included in the NMA. These studies involved 13 therapeutic interventions, including 7 exercise modalities. The Risk of Bias 2.0 assessment indicated that most included studies were of low methodological quality. NMA results showed that, compared to the active control (AC) (e.g., usual care), yoga significantly reduced Pittsburgh Sleep Quality Index (PSQI) scores (mean difference [MD]: -5.71; 95% confidence interval [CI]: -9.04 to -2.37) and improved total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL), as recorded in sleep diaries. Among all exercise interventions, yoga was the most effective in reducing PSQI scores (surface under the cumulative ranking curve [SUCRA]: 74.7%, very low-quality evidence) and also yielded the greatest improvements in TST (SUCRA: 98.3%, moderate-quality evidence), SE (SUCRA: 85.2%, moderate-quality evidence), and WASO (SUCRA: 82.9%, moderate-quality evidence). Walking or jogging (WJ) demonstrated the greatest potential for reducing Insomnia Severity Index scores (SUCRA: 93.2%, low-quality evidence). Mixed aerobic exercises (MAC) were most effective in improving SOL, as measured by sleep diaries (SUCRA: 72.8%). Meta-regression analyses indicated that neither the proportion of female participants nor the average age significantly influenced the NMA results, suggesting the robustness of the findings.

Conclusions: This study underscores the effect of yoga and TC in improving multiple sleep-related outcomes in insomnia patients and provides evidence-based support for including these interventions in clinical guidelines.

P11.04

Impact of Sociodemographic, Clinical, and Intervention Characteristics on Pain Intensity within a Single Music Therapy Session

Samuel Rodgers-Melnick ¹ , Douglas Gunzler², Thomas Love³, Siran Koroukian², Mark Beno⁴, Jeffery Dusek⁵, and Johnie Rose²

¹University Hospitals Connor Whole Health, Cleveland, OH

²Case Western Reserve University School of Medicine, Cleveland, OH

³Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH

⁴Cleveland Institute for Computational Biology, Cleveland, OH

⁵University of California, Irvine, Irvine, CA

Contact: Samuel Rodgers-Melnick, [e-mail]

Abstract

Purpose: To investigate which sociodemographic, clinical, and intervention characteristics are associated with clinically significant reductions in pain intensity (i.e., numeric rating scale reduction ≥2 units) within a single music therapy (MT) session among hospitalized patients.

Method(s): We conducted a retrospective electronic health record review of 2039 MT sessions conducted across a large health system among 1203 adult patients reporting a pre-session pain NRS score ≥4 and a complete post-session pain score. We employed a logistic mixed effects model to predict the binary pain reduction response (≥2 units vs. <2 units) where patients were considered nested within therapists. The model included the following fixed covariates: (1) MT intervention type (i.e., receptive only, recreative, compositional/creative , or receptive + relaxation/imagery), (2) Other MT characteristics including session length, goal, and therapist experience; (3) sociodemographic variables (e.g., age, sex, race/ethnicity, insurance status, census tract-level social vulnerability index); and (4) clinical characteristics (e.g., total Elixhauser comorbidities, sickle cell disease, receipt of opioids in 12 hours prior to session).

Results: Covariates in the model associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.367 [1.004, 1.861]) and relaxation/imagery MT interventions (1.482 [1.014, 2.167]) as compared to receptive; (2) 15-minute increases in session length (1.402 [1.223, 1.607]); (3) 1-unit increases in pre-session pain intensity (1.190 [1.106, 1.281]), (4) 5-unit increase in Elixhauser comorbidities (1.295 [1.047, 1.602); and (5) a documented MT session goal of pain management (3.581, [2.640, 4.856]). Male sex, Medicaid insurance status, and sickle cell disease diagnoses were associated with lower odds of pain reduction ≥2 units.

Conclusions: MT interventions involving singing or active instrument play and relaxation/imagery interventions involving guided relaxation, imagery, or breathing exercises may be more effective for reducing pain intensity than interventions only involving live or recorded music.

P11.05

The Bodily and Sound Artistic Mediator as a Tool of Communication Facilitation: Body-Sound Narration of the End of Life and Its Emotional Impact

Antonio Diroma ¹ , Sandra Fortuna², Rosa Bruni³, Barbara Santoro⁴, Giole Coccia⁴, Davide Integlia⁴, Eugenia Belmonte¹, Alessia Fiandra¹, and Italo Penco¹

¹Health and Research Foundation - Rome Foundation, Rome, Italy

²Conservatorio Santa Cecilia, Rome, Italy

³University Biomedical Campus, Rome, Italy

⁴Integrated Strategies for Health Enhancing Outcomes (ISHEO), Rome, Italy

Contact: Antonio Diroma, [e-mail]

Abstract

Purpose: Over the past 10 years, numerous scientific works have explored the role of the arts in communicating complex bioethical messages that are difficult to disseminate in health care settings. It has been shown how through the phenomenon of mirror neurons people are sensitive to the connection between body movement signals and sound signals when the interpreter of the movement shows expressive behaviors. Therefore, the association of bioethics with various artistic forms can diffuse issues that are difficult to explain through the verbal channel alone (non-self-sufficiency, incurable illness, end of life, acceptance of prognosis), configuring, thus, “visual bioethics” based on an integration of visual-body signals (embodiment theory).

Method(s): To assess the impact of a dance-theater-video-sound-product on the communication of these themes, a multidisciplinary team (palliative-physician-pianist, geriatrician-classical-dancer, psychiatrist-teacher-of-Mindfulness-and-self-compassion, life-coach-soprano and contemporary-choreographer-adapted motor activity worker), under the auspices of the Third Sector, developed a social and psychometric analysis of the perception of the above themes and psychological resonances in individuals. The choreographer performed an “artistic internship” at a palliative care facility to inspire the bodily creative process on experiences of illnesses lived together with operators in the sector. The choreography will be soundtracked with the participation of teachers of Music-Psychology and Electronic-Music. Semi-structured interviews were also carried out with personalities from the world of entertainment with disabilities. The story-telling thus constituted will be proposed to a heterogeneous sample by demographic characteristics; 30 days before and 30 days after his vision, psychometric analysis will be administered.

Results: The results of the dance-theater-video-sound-product on the modification of psychomotric indicators and on raising awareness on the issue of illness and the end of life are being developed.

Conclusions: This pilot study is a first step in raising awareness of scientific and musical societies on the communicative power of the intersection of medicine-music-corporeality.

Topic Area 12 – Group Medical Visits

P12.01

“They Healed Me a Lifetime’s Worth”: Group-Based Integrative Approaches To Address Stigma Among Primary Care Safety Net Patients With Chronic Pain

Christa M Fernando ¹ , Ariana Thompson-Lastad², Jhia Jackson³, Julia Wu², Denise Ruvalcaba², Jesse Wennik⁴, Pam Swedlow⁴, and Maria Chao¹

¹Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

²UCSF Osher Center for Integrative Health, San Francisco, CA

³University of California, San Francisco, San Francisco, CA

⁴Department of Public Health, San Francisco, San Francisco, CA

Contact: Christa M Fernando, [e-mail]

Abstract

Purpose: People with chronic pain commonly experience stigma, which adversely impacts their healthcare and pain outcomes. This mixed-methods study explores an integrative group care program designed to improve pain management, including pain-related stigma.

Method(s): We piloted a 2x2 randomized factorial trial of integrative group medical visits (IGMV) and group acupuncture. Patients with chronic pain ≥3 months were referred from safety net primary care clinics. IGMV included mind-body practices, psychoeducation, and social support; acupuncture treatments were offered in a group setting. We assessed pre/post changes of the Internalized Stigma of Chronic Pain subscales using ANCOVA models controlling for baseline scores. Qualitative data sources included participant-observation of interventions, post-intervention interviews, and focus groups; these were analyzed with flexible coding, an established analytic approach.

Results: Randomized participants (n=44, 25 English, 19 Spanish) were 59% female, mean age=57 (SD=15); 21% identified as African American/Black, 52% Latine, 21% non-Latine White, and 5% ≥1 race; all low-income. Through qualitative data, participants described experiencing intersectional stigma relating pain with identities including age, race and ethnicity, language, socioeconomic status, gender identity, and actual or perceived substance use. Many IGMV participants found group interactions validated their pain experiences, reducing internalized stigma and empowering self-advocacy both in and out of healthcare settings. Several expected to feel ‘like a guinea pig’ as part of a research study but instead described the interventions as the best healthcare they had received. On quantitative analysis, acupuncture participants reported decreased alienation compared to participants who did not receive acupuncture (mean difference between group -0.47, 95% CI=-0.85, -0.10). The percentage of intervention participants reporting perceived discrimination due to chronic pain decreased from 47% at baseline to 38% at 3 months.

Conclusions: Group-based integrative healthcare is a promising approach to reduce intersectional stigma among diverse populations with chronic pain.

P12.02

Feasibility and Acceptability of a Pilot Virtual Personalized Group Visit Program for Patients with Poorly Controlled Type 2 Diabetes Mellitus

Roshini Srinivasan ¹ , Felicia Williams², Samir Soneji³, Christie Clipper⁴, and Susan Spratt²

¹Duke University Department of Medicine, Durham, NC

²Duke University Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC

³Duke University Department of Population Health Sciences, Durham, NC

⁴Duke University Center for Personalized Health Care, Durham, NC

Contact: Roshini Srinivasan, [e-mail]

Abstract

Purpose: Personalized health planning in group settings may improve clinical outcomes in type 2 diabetes mellitus. Teaching mindfulness practice within diabetes education may impact diabetes distress and empowerment. This pilot examined the feasibility and acceptability of a telehealth personalized group visit (PGV) program for individuals with poorly controlled type 2 diabetes mellitus and its impact upon diabetes distress, diabetes empowerment, and clinical outcomes.

Method(s): The PGV program included eight, biweekly, 90-minute sessions on topics from diabetes education to medications to stress management. Sessions were led by experts, including Registered Dietitians, Pharmacists, and Endocrinologist; each included curated mindfulness practices, interactive education, and goal progress reflection. Each participant met with a health coach to set personalized goals. Adults with type 2 diabetes mellitus and HbA1c 8-12% (n=56) were randomly assigned to the PGV program or standard care. Attendance and post-intervention surveys were collected to explore feasibility and acceptability. HbA1c, triglycerides, blood pressure, and BMI; Diabetes Distress Scale and Diabetes Empowerment scale; and self-reported goal achievement were measured pre- and post-intervention.

Results: Participants were typically older (median age=57 years), female (73%), and identified as Black (45%) or white (41%). An average 81% attended each session and more than 64% described a high degree of satisfaction. Linear regression analysis showed an average 0.66-point decrease in DDS scores (p =0.01) and 0.34-point increase in the DES (p =0.08) in intervention participants compared to controls. All participants met medication adherence goals. A greater proportion of intervention participants demonstrated clinically significant improvements versus controls for all outcomes except SBP: HbA1c, 39.1% vs. 27.3%; SBP, 26.1% vs. 30.3%; DBP, 30.4% vs. 27.3%; triglycerides, 47.8% vs. 42.8%; BMI, 30.4% vs. 12.1%.

Conclusions: Results support the feasibility and acceptability of this proactive, interactive pilot PGV program and trend towards improving diabetes distress and empowerment. Large-scale randomized controlled trial data would better assess clinical effectiveness.

Topic Area 13 – Health Equity and Health Disparities

P13.01

A Mixed-Methods Study of Resource Caravans that Promote Perinatal Well-being Among Low-SES Individuals

Charlotte Farewell ¹ , and Jenn Leiferman¹

¹University of Colorado Anschutz Medical Campus, Aurora, CO

Contact: Charlotte Farewell, [e-mail]

Abstract

Purpose: Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at an elevated risk of poor mental health. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step towards achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado.

Method(s): In an explanatory mixed methods study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was rooted in constant comparison analysis, and we took both a deductive and inductive approach to identify multi-level resources that promoted basic psychological needs (perinatal competence, autonomy, and relatedness). We conducted subgroup analyses using ATLAS.ti to investigate differences in patterns of multi-level resources based on tertiles of WEMWBS scores.

Results: Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group.

Conclusions: Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step towards achieving equity in perinatal health. Our findings highlight the potential utility of nature-based interventions as a multi-level psychosocial resource intervention to promote well-being among low-resourced perinatal groups.

P13.02

Checklist for Promoting Health Equity in Research by the RAND REACH Center

Nipher Malika ¹ , Stacie Salsbury², Ian Coulter¹, Kieran Cooley³, Margaret Chesney⁴, Marcia Prenguber⁵, Kim Tippens⁶, and Michele Maiers⁷

¹RAND Corporation, Santa Monica, CA

²Palmer College of Chiropractic, Center for Chiropractic Research, Davenport, IA

³Canadian College of Naturopathic Medicine, Toronto, ON

⁴University of California, San Francisco, San Francisco, CA

⁵University of Western States, Portland, OR

⁶Public Health – Seattle & King County (PHSKC), Seattle, WA

⁷Northwestern Health Sciences University, Bloomington, MN

Contact: Nipher Malika, [e-mail]

Abstract

Purpose: Health equity is the principle of ensuring that all individuals have optimal opportunities to attain the best health possible, addressing disparities in access, outcomes, costs, quality, and appropriateness of care. This focus on health equity is important in healthcare research, driven by the need to investigate systemic injustices and foster fair health outcomes for all, regardless of background or circumstances. Researchers have an ethical imperative to focus on issues relevant to populations bearing the highest burdens of illness and inequities. To address the gap in structured guidance for incorporating health equity principles in health-related research, this study aims to introduce a comprehensive health equity checklist developed by the RAND REACH Center. The checklist is designed to ensure that every stage of the research process prioritizes and integrates health equity considerations.

Method(s): The RAND REACH Center, in collaboration with complementary and integrative health (CIH) academic institutions across the United States, Canada and Puerto Rico, developed a health equity checklist. They combed through literature to assess existing guidances and developed the checklist based on gaps in literature and the specific needs identified through consultations with community partners and stakeholders.

Results: This checklist emphasizes creating a health equity research culture, involving community partners, designing inclusive research/interventions, securing equitable funding, and engaging diverse participants. It also advocates for equitable intervention delivery, data collection, analysis, and effective dissemination and sustainability of research findings. The health equity checklist provides a practical guide for researchers, community partners, and participants to reflect on inclusivity, cultural relevance, and social justice in health research. By implementing this checklist, researchers can ensure that their studies are both inclusive and impactful in advancing health equity across all areas of health-related research.

Conclusions: Achieving health equity in research requires a comprehensive approach and significant investment in building sustainable partnerships. The RAND REACH Center’s recommendations provide a framework to ensure research advances scientific understanding while actively contributing to health equity. This paradigm shift necessitates support from funding agencies and a long-term commitment to creating equitable health outcomes.

P13.03

Climate Change Threatens Participation in Culturally and Regionally Relevant Physical Activities with Health, Wellbeing, and Equity Consequences

Leah Grout ¹ , Catherine Pirkle², Simone Schmid², Esme Yokooji², Hee Jae Lee³, and Tetine Sentell²

¹Southern California University of Health Sciences, Whittier, CA

²University of Hawai’i at Mānoa, Honolulu, HI

³Independent Consultant, Saipan, Mariana Islands

Contact: Leah Grout, [e-mail]

Abstract

Purpose: Climate change will reduce physical activity (PA) participation. Limited consideration has been given to an array of activities entwined in local cultures. Culturally or regionally relevant physical activities (CRRPAs), such as spearfishing, deliver health benefits to individuals and communities globally. Health promotion approaches that prioritize cultural strengths and community values are increasingly recognized as critical for improving health outcomes and equity. Aims are to (i) synthesize evidence of climate change’s impact on CRRPA participation, and (ii) identify and describe causal pathways linking climate change, CRRPA, and potential health impacts.

Method(s): PubMed was searched for relevant literature following a critical review methodology. Search terms included “physical activity”, “exercise”, or “sport”, and one of: “culturally relevant”, “traditional”, “folk”, “indigenous”, “ethnic” or “culture”. We also searched for specific activities known to be culturally and/or regionally relevant (e.g., reindeer herding, canoeing). We identified CRRPAs likely to be impacted by climate change, and mechanisms of impact. We developed a conceptual model of causal pathways linking climate change, CRRPA participation, and potential health impacts.

Results: Climate change will impact many CRRPAs. Rising sea levels, and changing weather patterns and currents will impact water sports (e.g., surfing). Snow/ice-based sports (e.g., skiing) and traditional hunting and fishing activities will also be affected. Decreased participation will have direct (e.g., decreased PA) and indirect health and wellbeing impacts (e.g., decreased social cohesion, less time in nature). In many indigenous cultures, aspects of nature have personhood; thus, loss of CRRPAs will likely be accompanied by other important cultural impacts.

Conclusions: CRRPAs have considerable value for health promotion, but climate change may decrease participation. Climate adaptation, mitigation, and action are critical considerations for health promotion interventions to maintain the benefits that CRRPAs confer across multiple dimensions of health. The planet’s health is intrinsically linked to individual and collective health through CRRPA.

P13.04

Effects of Ecological Restoration of Parks on C-Reactive Protein in Residents of Low-income Neighborhoods in Detroit

Teresa Horton ¹ , Julianna Perez², Joseph Gardiner³, Karin Pfeiffer³, Rachel Buxton⁴, and Amber Pearson⁵

¹Northwestern University, Evanston, IL

²Loyola University of Chicago, Chicago, IL

³Michigan State University, East Lansing, MI

⁴Carleton University, Ottawa, ON

⁵Michigan State University, Flint, MI

Contact: Teresa Horton, [e-mail]

Abstract

Purpose: One factor contributing to racial and ethnic disparities in the incidence of cardiometabolic disease (CMD) is limited access to greenspace. Following significant declines in population and reductions in tax base, the City of Detroit partners with other organizations to convert land into useful greenspace with low maintenance costs. One project, Detroit Bird City (DBC) restores parks into wildflower meadows. The population of Detroit is 77.8% Black, with a median household income (2018-2022 in 2022 dollars) of $37,761; a demographic at high risk for CMD. From 2018-2023 the Study of Active Neighborhoods in Detroit (StAND)) partnered with DBC to examine changes in biomarkers of cardiometabolic disease in response to increasing greenspace. Herein we report the effects on concentrations of the inflammatory marker C-Reactive Protein (CRP).

Method(s): In this longitudinal natural experiment, 4 parks underwent restoration. Demographically matched neighborhoods surrounding an additional 7 parks served as controls. One adult resident per household in neighborhoods surrounding the parks was recruited from 2018 through 2022. At annual health screenings, blood was collected from a finger-stick as dried blood spots for analysis of C-Reactive Protein (CRP). CRP was measured using a high-sensitivity CRP ELISA.

Results: CRP was measured from 417 unique participants (Control = 271; Intervention = 146). Residents of Control and Intervention neighborhoods had similar concentrations prior to park restoration (2018 & 2019) (CNT 1.65 mg/L, SD 1.65 mg/L vs INT 1.5 mg/L, SD 1.46 mg/L) and after (2023) (CNT 1.75 mg/L, SD 1.70 mg/L vs INT 1.70 mg/L, SD 1.87 mg/L).

Conclusions: Residents of low-income neighborhoods in Detroit exhibit low concentrations of CRP, levels that are not indicative of chronic mild inflammation (>3.0 mg/L) that is often associated with cardiometabolic disease. Further analysis will explore these results using regression modeling to test for longitudinal changes associated with length of time after park restoration.

P13.05

Geographic Variability in Initial Provider Consultations for New Neck Pain Among Medicare Beneficiaries, 2021

Alexis Hannah ¹ , Brian Anderson², and Leah Grout³

¹Palmer College of Chiropractic, Port Orange, FL

²Palmer College of Chiropractic, Davenport, IA

³Southern California University of Health Sciences, Whittier, CA

Contact: Alexis Hannah, [e-mail]

Abstract

Purpose: Neck pain (NP) is a significant cause of disability among the Medicare population but remains under-explored from an epidemiological perspective. NP management involves a range of healthcare professionals, including chiropractors (DC), primary care physicians (PCPs) and medical specialists. This research highlights critical barriers to equitable NP care: geographic variability in provider availability and utilization.

Method(s): This study, conducted as part of an NCCIH-funded R15 grant, compared the management of NP through spinal manipulation versus prescription drugs, utilizing Medicare Part B claims. Rates of new-onset NP and provider type at the index visit were calculated per 1000 beneficiaries. Geographic variation was visualized using GeoDa software, and the non-parametric Spearman’s correlation test was employed to examine the relationship between provider utilization and availability.

Results: The mean rate of DC utilization for new NP episodes was 4-fold higher than PCPs and 6-fold higher than pain management (PM) providers. Regional trends showed that the Western and Midwestern regions had higher rates of DC utilization and lower rates of PCP utilization, while the opposite trend was observed in the Northeastern and Southern states. Pain management utilization was most prevalent in the West South Central and South Atlantic regions. Spearman’s test revealed a strong positive correlation between DC utilization and availability (rho=0.725, p<0.001), suggesting that higher local supply of providers may drive increased use, independent of patient need or preference. In contrast, weaker correlations were found between utilization and availability for both PM (rho=0.323, p=0.029) and PCPs (rho=0.348, p=0.013).

Conclusions: Medicare beneficiaries with NP may encounter limited treatment options due to geographic variability in the distribution of healthcare providers raising concerns about equitable access. Future research is needed to examine how sociodemographic factors impact NP management options as well as to explore how the relationship between provider availability and utilization influences the delivery of equitable guideline-concordant care of NP.

P13.06

Integration of Whole Health Into the SUS: Expanding Access and Equity Through Integrative Practices

Mariana Frasnelli Matias Fernandes ¹ , and Priscilla Alessandra Fiorelli Cantarino²

¹Hospital Israelita Albert Einstein, São Carlos, Brazil

²Hospital Israelita Albert Einstein, São Paulo, Brazil

Contact: Mariana Frasnelli Matias Fernandes, [e-mail]

Abstract

Purpose: This study proposes a framework for integrating the Whole Health model into Brazil’s Unified Health System (SUS) to expand access to Integrative and Complementary Practices (PICS). The goal is to deliver a more equitable and sustainable healthcare system by addressing social determinants of health (SDH) and improving outcomes for vulnerable populations.

Method(s): A narrative review was conducted using peer-reviewed articles, government policies, and epidemiological reports from databases like PubMed and SciELO. The study analyzed best practices for implementing integrative care models within public health systems and explored how Whole Health principles can be adapted to the Brazilian context. Barriers to PICS implementation and the role of digital tools like SUS Digital and telemedicine were assessed.

Results: The Whole Health model aligns with SUS’s principles of equity and universality, especially when integrated with Popular Health Education and the Family Health Strategy. Regions piloting PICS and Whole Health strategies showed improvements in chronic disease management, mental health, and preventive care, reducing hospital readmissions and increasing patient satisfaction. Barriers included infrastructure limitations, financial constraints, and resistance from healthcare professionals. Cultural misconceptions also limited the expansion of PICS. Digital tools like SUS Digital and telemedicine improved access, particularly in underserved regions, enhancing patient engagement, health literacy, and treatment adherence, contributing to the scalability and sustainability of PICS within SUS.

Conclusions: Integrating Whole Health principles into SUS through digital tools and educational programs has the potential to create a more equitable and sustainable healthcare system. By addressing SDH, this model can reduce health disparities and improve population outcomes. Pilot programs should be implemented to evaluate long-term impacts on healthcare.

P13.07

Living with HIV and Chronic Pain in Canada: A Community-Based, Mixed-Methods, Multi-Sectoral, Interdisciplinary, and Intersectional Study

Kieran Cooley ¹ , Sarmitha Sivakumaran², Guy-Henri Godin³, Colleen Price3, Claudette Cardinal⁴, Darren Lauscher³, Michael Parsons⁵, Breklyn Bertozzi⁶, Kath Webster⁷, Éric Fortin⁸, Manon Choinière⁹, Madeleine Durand¹⁰, Kelly O’Brien², Anaïs Lacasse¹¹, Kathleen Rice¹², Gabrielle Pagé⁹, Kyle Vader¹³, Alice Tseng¹⁴, Denise Kreutzwiser¹⁵, Jaime Vera¹⁶, Benjamin Evans-Durán², Jaris Swidrovich², and Francisco Ibáñez-Carrasco²

¹Canadian College of Naturopathic Medicine, Toronto, ON

²University of Toronto, Toronto, ON

³Community Advisory Committee, CIHR Canadian HIV Trials Network, Montreal, QC

⁴Division of Epidemiology and Population Health, Centre for Excellence in HIV/AIDS, West Vancouver, BC

⁵Communities, Alliances & Networks, ON

⁶McMaster University, ON

⁷Simon Fraser University, Vancouver, BC

⁸COCQ-SIDA, QC

⁹Université de Montréal, Montreal, QC

¹⁰Research Center, Centre hospitalier de l’Université de Montréal, Montreal, QC

¹¹Université du Québec en Abitibi-Témiscamingue, QC

¹²McGill University, QC

¹³Northern Ontario School of Medicine University, ON

¹⁴Toronto General Hospital, University Health Network, Toronto, ON

¹⁵St. Joseph’s Health Care London, London, ON

¹⁶Brighton and Sussex Medical School, Aberdeen City, United Kingdom

Contact: Kieran Cooley, [e-mail]

Abstract

Purpose: The experience of pain is a prevalent co-occurring condition, arising as a complex consequence of HIV infection itself and as a side effect of antiretroviral therapy among the 60,000 Canadian individuals living with HIV/AIDS (PLHAs), adversely affecting PLHAs’ sleep, mood, cognition, emotional health, social and workplace participation, and overall quality of life. The International Association for the Study of Pain defines chronic pain as a distressful sensation linked to tissue harm, persisting for over three months. To cope with pain, PLHAs utilize a range of approaches, including standard medical care, alternative healing methods, and body-mind practices. The research we plan to present is the result of extensive participatory work involving peer researchers, clinicians, social behaviorists, and educators.

Method(s): This investigation adopts an exploratory sequential design mixed-methods approach, beginning with a bilingual nationwide online survey and followed by a series of national workshops employing Q-sorting to categorize and prioritize statements based on participant agreement and relevance. 500 diverse participants self-identifying with the IASP definition of chronic pain (i.e., pain > 3 months) and consenting to fill out a self-report questionnaire with a stipend offered. The study received funding from the Canadian Institutes of Health Research and the HIV/AIDS and STBBI Community-Based Research Program, and received ethical oversight from the University of Toronto.

Results: In-progress data will be available in March, providing enhanced understanding of chronic pain among PLHAs.

Conclusions: To be determined.

P13.08

Multimodal Integrative Approach in Symptoms of Trauma: Case of a Geriatric Survivor of Conflict

Umair Ashraf ¹ , and Mikhail Kogan¹

¹George Washington University, Washington, DC

Contact: Umair Ashraf, [e-mail]

Abstract

Purpose: To demonstrate the effectiveness of a multimodal, integrative medicine approach—incorporating acupuncture, meditation, mindfulness, and other holistic practices—in improving symptoms of trauma-related cognitive decline, anxiety, and depression in a geriatric immigrant population.

Method(s): The patient received an integrative treatment protocol, which included: Acupuncture for managing fibromyalgia-related pain and stress reduction. Meditation and mindfulness-based practices to address chronic anxiety, racing thoughts, and improve emotional regulation. Holistic dietary counseling and nutritional supplements (e.g., Vitamin D and B12) targeting potential deficiencies contributing to cognitive impairment. Cognitive-behavioral therapy (CBT) focusing on trauma-processing and emotional regulation. Sleep hygiene strategies including compliance with CPAP for obstructive sleep apnea, aimed at improving overall energy and cognitive function. The patient’s response to treatment was assessed using standardized neuropsychological tests (e.g., MoCA), anxiety scales (GAD-7), PTSD symptom checklists (PCL-5), and depression inventories (BDI-2).

Results: The patient showed marked improvement in mood stability, emotional regulation, and functional abilities following the integrative interventions. Neuropsychological testing revealed stabilization in cognitive decline with sustained scores on memory recall and executive function tasks. Her anxiety (GAD-7 score) and PTSD symptoms (PCL-5 score) also showed significant reductions, and depressive symptoms lessened, as noted by BDI-2 scores. Key therapeutic factors included: Increased mindfulness and emotional awareness aiding in PTSD-related avoidance and hypervigilance. Acupuncture contributed to reductions in somatic tension and improved physical relaxation. Meditation promoted increased focus and concentration, reducing her reliance on constant distraction to manage internal thoughts.

Conclusions: This case demonstrates the profound impact of multimodal integrative medicine in addressing trauma cognitive dysfunction and emotional distress in a geriatric immigrant population. Comprehensive interventions including both physical and psychological modalities can significantly enhance quality of life and emotional well-being in elderly patients with complex trauma histories. This integrative approach provides a model for improving mental health outcomes in similar vulnerable populations highlighting the necessity for culturally sensitive holistic care

P13.10

Utilizing Census-Level Data to Evaluate the Appropriateness of Food Access Program Locations in a Central Pennsylvania Health System

Courtney Landis ¹ , Zach Zook², Ashley Visco³, Laurie Crawford¹, Susan Veldheer¹, and Terrah Keck-Kester³

¹Penn State College of Medicine, Hershey, PA

²Central Pennsylvania Food Bank, Harrisburg, PA

³Penn State Health, Hershey, PA

Contact: Courtney Landis, [e-mail]

Abstract

Purpose: The Affordable Care Act requires non-profit health systems to conduct community health needs assessments and mobilize resources to address identified needs. Tools such as Geographic Information Systems (GIS) can allow health systems to identify high need communities using publicly available census-level data, thereby ensuring resources are appropriately allocated. The purpose of this study was to identify whether existing health system programs are in high need census tracks based on rates of food insecurity, child poverty, and chronic health conditions.

Method(s): First, we identified census tracts (CTs) within our 6-county catchment area with high childhood poverty rates (>40%) and food insecurity (>20%). We then overlaid these CTs with Penn State Health food access locations (FAL). The distance from the center of a CT to a PSH FAL was calculated for three categories: 15- and 30-minute walks and a 15-minute drive. Scatterplots of CTs were mapped in relation to their distance from a FAL, food insecurity rate, and health variables, including CT diabetes, hypertension, and obesity rates.

Results: The scatterplots comparing CTs food insecurity and child poverty revealed 22/76 (28.9%) CTs have high rates of both child poverty and food insecurity. All 22/22 (100%) of these CTs have a FAL or have one within a 15-minute drive. Eight (36.4%) have a FAL within a 15-minute walk, 4/22 (18.2%) within a 30-minute walk, 3/22 (13.6%) within a 15-minute drive, and 7/22 (31.8%) within their borders. CTs with the highest rates of diabetes, hypertension, and obesity have FALs present.

Conclusions: PSH FALs are well-targeted toward areas with high rates of food insecurity, child poverty, and chronic health conditions. CTs that do not have existing FALs indicate targets for future growth. The methods and results from this study can be used by other health systems to ensure that their programming is appropriately located in high need areas.

Topic Area 14 – Health Outcomes

P14.01

Intuitive Eating Is Associated With Lower Body Adiposity Among LatinX Youth, Particularly in Males

Michele Nicolo¹, Fatimata Sanogo², Claudia Toledo-Corral³, and Marc Weigensberg ⁴

¹California State University Los Angeles, Los Angeles, CA

²Keck School of Medicine of USC, Los Angeles, CA

³California State University Northridge, Los Angeles, CA

⁴University of Southern California, Los Angeles, CA

Contact: Marc Weigensberg, [e-mail]

Abstract

Purpose: Intuitive eating (IE), an eating practice that replaces food restriction with a more mindfulness-based approach to eating, is associated with improved health outcomes. However, most studies of IE include exclusively white, college-educated adult females, without representation of groups at greater risk for chronic obesity-related disease, such as Latinx adolescents. Our objectives were to describe the relationship between IE and adiposity among LatinX adolescents.

Method(s): Cross-sectional data from healthy adolescents (n=215, 16.4 yrs. (0.63), 65% female, 95% Latinx, 40% overweight or obese) were included. Intuitive Eating Scale-3 (scores 1-5, with 5 reflective of greater IE behaviors) was used to assess Total IE (TIE) and subcategories: unconditional permission to eat (UP), eating for physical rather than emotional reasons (PE), reliance on hunger, and satiety cues (HS), and body-food choice congruence (BF). Adiposity measures: BMI, BMI-z, body fat percentage (BF%), and waist circumference (WC). Mann-Whitney U test assessed mean score differences and linear regression analyses to assess the relationship between IE and adiposity for the entire sample controlling for age and gender, and then females and males separately controlling for age.

Results: Significant inverse associations were observed among TIE and adiposity [BMI (β=-2.72 (0.9), p=0.003), WC (β =-7.72 (2.20), p=0.001), BF% (β =-3.73 (1.65). p=0.020], and subcategories [ UP [BMI (β =-1.21 (0.58), p=0.03), BMI-z (β =-.029 (0.12), p=0.01), and WC (β =-3.7(1.14), p=0.01)]; PE (BMI (β =-1 (0.49), p=0.04) and WC (β =-2.63 (1.1), p=0.02)]. Mean TIE was lower for females (3.38(0.43) vs.3.66 (0.42), p<0.001). Among females, TIE and WC were associated (β -5.46 (2.58), p=0.03). Among males, TIE was inversely associated with BMI (β = - 4.13 (1.69), p=0.01), BMI-z (β =-0.78 (0.28), p=0.008), WC (β =-10.09 (4.11), p=0.01), and UP with BMI (β =-2.10 (1.04), p=0.04), BMI-z (β = -0.43 (0.17), p=0.01), and WC (β =-5.32 (2.5), p=0.04).

Conclusions: Among LatinX adolescents greater

Topic Area 15 – Implementation Science

P15.01

Build Workforce Capacity to Implement Culturally Tailored, Community-Preferred Non-Drug Mental Health Services in Local Communities

Weijun Zhang ¹ , Jiayan Huang², Qin Shu³, Nina Yuen-Loc⁴, Di Liang², Yan Ding⁵, Katie Hu⁶, Grant Chu¹, Edward Hui¹, and Ka-Kit Hui⁷

¹UCLA Center for East-West Medicine, Los Angeles, CA

²Fudan University School of Public Health, Shanghai, Shanghai, China

³Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China

⁴Chinatown Service Center, Los Angeles, CA

⁵Weifang Community Health Service Center; Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China

⁶UCLA, Los Angeles, CA

⁷UCLA Department of Medicine, Center for East-West Medicine, Los Angeles, CA

Contact: Weijun Zhang, [e-mail]

Abstract

Purpose: Common mental disorders (CMDs) significantly contribute to the global health burden. Despite their prevalence, over 90% of individuals with CMDs in China have never sought treatment, and Asian Americans exhibit the lowest mental health care utilization rates in the United States. This project aims to develop culturally tailored, community-preferred non-drug mental health services for Chinese populations while raising awareness to ensure effectiveness and relevance.

Method(s): Each year, six Tang scholars were selected from three partner universities, bringing diverse backgrounds to enhance collaboration and peer support. The scholars were required to (1) complete a 10-week online capacity-building course covering 10 evidence-based non-drug approaches for CMDs (e.g., auricular acupuncture, mindfulness, Tai Chi, Yoga, Qigong, music therapy, and art therapy) and their successful applications in various health settings; (2) conduct community assessments to identify locally preferred non-drug approaches tailored to specific mental health needs; (3) collaborate with community providers to pilot these identified services; and (4) organize community activities to raise awareness of the developed services. Data were collected through surveys assessing knowledge, awareness and attitude toward the piloted services among health system leaders, community providers, and patients.

Results: This three-year project is expected to train 18 Tang scholars, over 100 health profession students from three universities, and approximately 60 community-based providers across Greater Los Angeles and Shanghai. The first cohort of 6 scholars has successfully piloted five non-drug mental health services in both cities with outcome analyses currently underway.

Conclusions: Evidence-based non-drug therapies are often not categorized as ‘mental health treatment,’ making them more appealing to individuals with CMDs who may fear the stigma associated with seeking mental health care. Capacity-building training can enhance the workforce’s ability to implement these culturally relevant, community-preferred non-drug mental health services, which align with whole person health and hold promise for addressing mental health concerns.

P15.02

Effectively Meeting the Needs of Community First Responders Where They Are: True Whole Health

Maryanna Klatt ¹ , Yulia Mulugeta², Beth Steinberg³, Jacqueline Caputo², Slate Bretz³, Mindy Gabriel⁴, Marcus Williams², Anne-Marie Duchemin⁵, and Catherine Quatman-Yates⁶

¹Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

²The Ohio State University, Columbus, OH

³The Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

⁴Columbus State Community College, Columbus, OH

⁵Stress, Trauma and Resilience Program, Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH

⁶School of Health and Rehabilitation Sciences, Division of Physical Therapy, The Ohio State University, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: High levels of chronic and recurrent workplace stressors impact the physical, mental, and emotional health of frontline first responders (FRs). Mindfulness-based interventions (MBIs) can be effective in reducing negative stress-related health outcomes. Facilitators for implementing MBIs into specific worksite populations include embedding the intervention into the work setting to meet the needs, timing, and delivery preferences that appeal to the specific population. Study aim was to improve and sustain the health and wellness of FRs to mitigate and prevent downstream consequences of chronic stress. Mindfulness in Motion (MIM), an eight-week evidence-based mindfulness curriculum was adapted and delivered with intentional stakeholder-driven (FR) mental and physical enhancements, targeting the unique needs of FRs.

Method(s): Input from FR stakeholders informed development of MIM for firefighters and Emergency Medical Services (EMS) personnel, referring to this adaptation of MIM as “MIM for First Responders” (MIM-FR). MIM-FR was delivered to firefighters/EMS (n=29) via in-person and online synchronous delivery, meeting the needs of their 24-hour on/off schedules. The program included weekly group sessions, and meditations/movement practices delivered through a mobile app. Outcomes were assessed at baseline and immediately following the 8-week intervention via the Perceived Stress Scale (PSS), Connor Davidson Resiliency Scale (CDRS), Utrecht Work Engagement Scale (UWES), and the Modified Nordic Questionnaire, assessing pain levels in the body.

Results: Firefighter/EMS (n=29) demonstrated significant reduction in Perceived Stress (p=0.0006), significant increase in resilience (p=0.0339), and significant increase in work engagement (p=0.0473) compared to baseline. Post-program, the number of reported pain areas decreased significantly (p=0.0184) and the percentage of participants with no pain increased from 11% to 17% post intervention.

Conclusions: MIM-FR successfully identified specific physical, mental, and emotional stressors of firefighters/EMS to support the creation of an accessible video-based facilitator driven model of MIM-FR. Results illustrate the program’s effectiveness and support further efforts to implement MIM-FR into fire station training/curriculum.

P15.04

Effectiveness Evaluation for an Integrated Diabetes Care Program in Primary Care Settings in China: A Mixed Methods Study

Zheyi Fang¹, Di Liang², Yuwen Wang ¹ , and Jiayan Huang²

¹Fudan University, Shanghai, Shanghai, China

²Fudan University School of Public Health, Shanghai, Shanghai, China

Contact: Yuwen Wang, [e-mail]

Abstract

Purpose: China and other countries face common challenges in diabetes management due to limited support for primary healthcare providers (PHCPs). To address this, an integrated diabetes care (IDC) program was implemented in a Chinese county. This program combines an eHealth platform, a quality assurance system, and multidisciplinary collaboration mechanisms. This study aims to evaluate how the IDC model can improve clinical outcomes in primary healthcare settings.

Method(s): The study used a cohort design and key informant interviews to assess the outcomes of the IDC program (intervention group) versus usual care (control group) for type 2 diabetes over two years. Fasting blood glucose (FBG), blood pressure, and BMI were used as indicators. Propensity score matching (PSM) and difference-in-differences (DID) approaches were applied, with subgroup analysis for severe cases. The study conducted key informant interviews with medical staff, patients, and administrators to identify the mechanisms and key elements contributing to the program’s effectiveness.

Results: Among 681 intervention and 13,675 control patients, the intervention group showed significantly greater reductions in FBG, systolic blood pressure (SBP), and diastolic blood pressure (DBP) (DID = -0.42 mmol/L, -7.73 mmHg, -3.53 mmHg, respectively). Subgroup analyses yielded similar results. Key informant interviews highlighted the eHealth platform’s critical role in the program’s success.

Conclusions: The IDC program significantly improved patients’ clinical outcomes, largely due to the eHealth platform’s support for multidisciplinary care, decision-making, and self-management. This model could enhance primary healthcare in China and other countries with similar needs.

P15.05

Thoughtful Approach to Leading Change for Increased Integrative Medicine Productivity

Amanda Biddle ¹ , Kelsey Rahenkamp¹, and Hayley Paradero¹

¹University of Kentucky, Lexington, KY

Contact: Amanda Biddle, [e-mail]

Abstract

Purpose: Without benchmarking, productivity norms, or easily traceable data for Music Therapy providers, it was impossible for leadership to manage the team’s productivity, allowing a low-yielding team to exist. A structured productivity expectation was created with the plan to grow our footprint across the enterprise and make a larger impact on our patient population. A multi-tiered plan was rolled out that included developing productivity targets, creating reports, leading change, and validating the targets throughout the project

Method(s): This multi-tiered project started by manually combing through lists to obtain current state data for the team and a literature review of the limited data available was completed. Information was used to develop an appropriate productivity target. The target created was a weighted system that gave varying levels of credit for varying work. A thoughtful approach was taken to rolling out the target to ensure team buy-in and allow for sensitivity to a significant change in the team’s culture and previous expectations. The approach started with written communication outlining the details of the weighted system. This written communication was then followed-up with one-on-one meetings with every individual to collect feedback. The feedback was then reviewed, and the target was modified. The final target was communicated via a written format. A group meeting was held shortly after to allow for questions to be asked and clarifications to be made. While leadership was confident in the target set, there were lingering concerns from team members. To help alleviate these concerns, a time study was performed to validate the appropriateness of the target. Throughout these steps, focus was also placed on creating mechanisms for easy reporting within the EMR.

Results: The target encouraged the team to analyze the efficiency of their work and find solutions to increase productivity while also pushing them to prioritize patient care over other administrative tasks that had previously taken up unnecessary time. Initial results showed a 89% increase in patient volumes and continued increases are expected. A clear plan for data measuring and reporting will support long-term sustainability and productivity data visibility to the team is a priority.

Conclusions: The work completed not only increased the amount of integrative care across our enterprise, but it also helps to set the foundation for creating expectations and benchmarks across the country for integrative modalities. The hope of this work is not only that it bolsters the work done by this team within our own community, but it helps support similar work being done across the country.

P15.06

Using Active Surveillance to Track Adverse Events in Three Chiropractic Settings: An Evaluation of Implementation Through the RE-AIM Framework

Katherine Pohlman ¹ , Kent Stuber¹, Zak Monier¹, William Owens², Sidney Rubinstein³, and Martha Funabashi⁴

¹Parker University, Dallas, TX

²National Spine Management, Buffalo, NY

³Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands

⁴Canadian Memorial Chiropractic College, Toronto, ON

Contact: Katherine Pohlman, [e-mail]

Abstract

Purpose: Providers participating in clinical research are typically responsible for reporting adverse events (AEs). Mild AEs are frequently observed in manual therapies, commonly used for musculoskeletal conditions. Systematically characterizing these AEs helps researchers better understand associated risks, which can inform the development of mitigation strategies. Improved understanding can lead to better patient adherence to treatment plans and enhanced outcomes. This study assessed the capacity for active surveillance to collect AEs in three chiropractic settings—a personal injury clinic, a general practice, and a teaching clinic—using the RE-AIM framework (Reach, Effectiveness, Adoption, and Implementation).

Method(s): An electronic active surveillance system was implemented to gather data on patient symptom changes before and two days after treatment. Any new or worsening symptoms were classified as AEs. The RE-AIM framework evaluated its implementation in each clinical setting.

Results: All clinics could participate, but recruitment and protocol variations were observed across settings. Reach was completed but had limitations, as some patients consented but didn’t complete the before-treatment survey (n=15). For Effectiveness, AE rates were successfully recorded, ranging from 6.5% to 33.3%, with pain and stiffness as the most common worsening symptom. Follow-up survey completion rates were between 32.1% and 55.3%, which is what has been found in prior active surveillance studies. Adoption and Implementation were successful, with some modifications tailored to each setting, e.g., general practice clinics needed more frequent contact points, while personal injury clinics required hands-on guidance. Modifications included allowing returning participants to skip the informational letter and access surveys via a QR code to a survey link on iPads to improve engagement.

Conclusions: The RE-AIM framework facilitated the evaluation of active surveillance’s capacity in different chiropractic clinic settings. Tailored strategies are needed to ensure accurate and sustainable AE data collection, demonstrating that this methodology can be implemented with appropriate adaptations.

Topic Area 16 – Lifestyle Medicine

P16.01

An Exercise Program for Individuals with Neurodegenerative Disease A Case Study 2010 - 2024

Sarah Ingersoll¹

¹University of Southern California, Pasadena, CA

Contact: Sarah Ingersoll, [e-mail]

Abstract

Purpose: This abstract highlights the essential elements of a long-term exercise program for individuals with Parkinson’s disease and other neurodegenerative disorders. Context: Individuals with neurodegenerative disease frequently lack the motivation to participate in exercise, despite advice. The 5K Training Team, a free program primarily for individuals with Parkinson’s disease, but open to all, has met weekly since 2010 (except 2020) in a public park. In 2024 the team added a weekly session in a local gym. Every year the team’s goal is support for and participation in a 5K community footrace. The team’s popularity has been sustained largely via peer support. From a recent trial: “Older adults who talked with peers about their exercise program were able to...sustain physical activity levels.”

Method(s): The results of earlier surveys have been reported in a prior Consortium presentation and have documented the importance of the social aspect of the experience. Recent metrics are focused on attendance, MailChimp metrics, 5K records and media reports. Perhaps most importantly, the light lunch post-exercise facilitates socialization. We have made a virtue of necessity (limited funds) and serve a popular lentil stew every week along with coffee.

Results: Attendance increased until the pandemic interruption; post-pandemic attendance has increased steadily since 2021. There are now over 40 individuals per week at the Thursday session in the park, and over 15 individuals at the Monday session at the gym. The MailChimp distribution list has increased to over 400, with an open rate, per week, of 47-49%. Participation in the annual 5K community footrace has increased to an all-time high of 36 in 2024.

Conclusions: Individual encouragement can result in substantial uptake of an invitation to exercise, but the social interaction with peers is key to sustaining participation. The opportunity to socialize over a shared meal may be the distinctive feature of this program.

P16.02

Comprehensive Inpatient Metabolic Rehabilitation Followed by Outpatient Functional Medicine Interventions: A Case Study on Cardiometabolic Syndrome

Clayton Moss ¹ , Evan Stermer¹, Michelle Schlesinger², Matthew Larsen¹, and Joseph Standley¹

¹University of South Florida/James A. Haley VA Hospital, Tampa, FL

²James A. Haley VA Hospital, Tampa, FL

Contact: Clayton Moss, [e-mail]

Abstract

Purpose: This case study evaluates a multidisciplinary inpatient metabolic rehabilitation program followed by outpatient functional medicine interventions, targeting a 60-year-old male patient with metabolic syndrome (including T2DM, hypercholesterolemia, hypertension, and OSA). With chronic diseases accounting for $4.3 trillion in U.S. healthcare costs annually and only 6.8% of U.S. adults metabolically healthy, the need for integrative, cost-effective interventions is critical. This study underscores the potential of personalized, whole-health approaches in addressing metabolic dysfunction.

Method(s): The patient participated in a 1-week inpatient metabolic rehabilitation boot camp at James A. Haley Veterans Hospital, designed to optimize metabolic health through a combination of nutrition, physical activity, stress management, supplementation, and sleep optimization. Outpatient care provided continued support to maintain lifestyle changes and monitor key metabolic markers.

Results: Within 36 days of program initiation, significant metabolic improvements were observed without any addition of new medications: - Weight: Decreased from 195 lbs (BMI 31.54) to 186.5 lbs (BMI 30.16). - Hemoglobin A1c: Reduced from 6.6% to 6.5%. - Triglycerides: Dropped from 140 mg/dL to 55 mg/dL. - LDL cholesterol: Reduced from 130 mg/dL to 66 mg/dL. - Fasting glucose: Lowered from 145 mg/dL to 121 mg/dL. Additionally, functional biomarkers showed improvements: - Homocysteine: Decreased from 9.6 µmol/L to 4.3 µmol/L, indicating better cardiovascular health. - Vitamin D (25-OH): Increased from 42.5 ng/mL to 47.9 ng/mL following supplementation. - Magnesium: Improved from 2.1 mg/dL to 2.3 mg/dL. The patient also experienced a 36.8% reduction in subjective negative symptoms, as measured by the IFM Multisymptom Questionnaire at 8-week follow-up.

Conclusions: This case underscores the efficacy of an inpatient metabolic rehabilitation program followed by outpatient functional medicine interventions in improving metabolic health reducing symptoms and enhancing overall quality of life. The results demonstrate how integrative care models targeting the root causes of chronic disease can provide significant cost-effective improvements in patient outcomes aligning

P16.03

Feasibility of Virtual Small Group Cognitive Behavioral Therapy for Insomnia in Gynecologic Oncology Patients

Abigail Low ¹ , Katherine Van Deventer², Jena Cooreman³, Matthew Ponzini⁴, Machelle Wilson⁵, Codi Cole⁶, Rachel Ruskin⁷, Michelle Dossett⁵, and Hui Chen ⁶

¹UC Davis School of Medicine, Sacramento, CA

²Valley View Hospital, Glenwood Springs, CO

³UC Davis Comprehensive Cancer Center, Supportive Oncology and Survivorship Services, Sacramento, CA

⁴University of California, Davis, Department of Public Health Sciences, Sacramento, CA

⁵University of California, Davis, Sacramento, CA

⁶University of California, Davis, Department of Obstetrics and Gynecology, Gynecologic Oncology, Sacramento, CA

⁷Independent Researcher, Sacramento, CA

Contact: Abigail Low, [e-mail]

Abstract

Purpose: Cognitive behavioral therapy for insomnia (CBT-I) is considered first-line therapy for cancer-related insomnia. This pilot study evaluated the feasibility and acceptability of CBT-I delivered virtually in small groups to patients with gynecologic cancers.

Method(s): Gynecologic cancer patients in treatment or surveillance at an academic institution were screened for insomnia. Subjects were recruited through electronic medical record, direct referrals, and the study website. Eligibility criteria included being over 18 years old, English-speaking, having access to the internet, and moderate-severe insomnia (Insomnia Severity Index (ISI) score of ≥15). Patients taking prescription sleep medication or having other reasons for poor sleep were excluded. Participants completed a 6-week virtual, small-group CBT-I program. Data on attendance, engagement, and internet connectivity were collected. Health-related quality of life and insomnia symptoms were assessed using the FACT-G7, Pittsburgh Sleep Quality Index (PSQI), and ISI assessment. Participants used the Insomnia Coach Explorer App daily to monitor their sleep efficiency. Follow-up assessments were completed 4, 12, and 24 weeks after the program’s completion.

Results: Between 1/4/2024 and 3/12/2024, 209 gynecologic oncology patients were approached. After completing a two-tier screening process, five eligible participants were enrolled in this study. One participant withdrew from the study after the second session. The study met its feasibility and acceptability criteria: 60% of participants attended at least 4 sessions (95% CI: 0.17, 0.93) and 100% of participants rated the sessions as acceptable. During the program, participants’ ISI scores decreased 0.92 points on average per week (95% CI: -1.47 – -0.37, p=0.002) and FACT-G7 scores increased 0.51 points on average per week (95% CI: 0.18–0.83, p=0.004).

Conclusions: Virtual small-group CBT-I is feasible and acceptable for patients with gynecologic cancers. Participants showed improvements in insomnia symptoms and quality of life despite the small sample size. This intervention can help overcome barriers in accessing insomnia treatments.

P16.04

Implementation of Health and Wellness Coaching in the VA: Insights From the Frontlines

Ekaterina Anderson ¹ , Zenith Rai², Brianne Molloy-Paolillo³, Kimberlee Flike⁴, Jamie Douglas⁵, Eileen Dryden³, Matthew Martel³, Alex Kloehn⁵, Steven Zeliadt⁶, and Justeen Hyde⁷

¹Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA

²VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA

³VA Center for Health Optimization and Implementation Research, Bedford, MA

⁴Univeristy of Massachusetts Lowell Zuckerberg College of Health Sciences, Lowell, MA

⁵VA Puget Sound Health Care System, Seattle, WA

⁶VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

⁷Veterans Health Administration, Bedford, MA

Contact: Ekaterina Anderson, [e-mail]

Abstract

Purpose: Health and Wellness (H&W) Coaching holds great promise for health systems interested in person-centered, holistic approaches to improving patient outcomes, as H&W Coaches are adept at empowering patients to pursue lifestyle changes. The Veterans Health Administration (VA) is actively scaling up its H&W Coach workforce. We sought to understand the current state of the H&W Coach role in the VA, as a way to gain insight into barriers and facilitators of sustainably integrating H&W Coaching into health systems.

Method(s): In Spring 2024, as part of a non-research quality improvement mixed-methods evaluation, we distributed an electronic survey to H&W Coaches and Supervisors employed across the VA (N=462). The survey contained structured and open-ended questions about Coaches’ backgrounds, characteristics and structure of professional tasks and workload, organizational context, perceptions of integration and job satisfaction, and recommendations for improvement. Responses to structured questions were summarized using descriptive statistics; rapid qualitative analysis was applied to free-text responses.

Results: Data analysis of the final sample (N=277) yielded the following insights: (1) Coaches’ caseloads/workloads and responsibilities varied widely (0-154 Veterans coached per month, 50.2% time spent exclusively on coaching). (2) The majority of coaches reported working with primary care (72%), mental health (41%), and pain clinics (32%), commonly receiving referrals to help manage specific conditions. (3) Slightly more than half (52%) reported feeling well-integrated on clinical teams. (4) Formal supervision was associated with greater perceived integration and job satisfaction (ps ≤.03); yet some coaches reported insufficient amount and/or quality of supervision.

Conclusions: Our findings point to the following insights for the VA and other organizations interested in offering H&W Coaching: (1) Introduce clearer guidance around Coaches’ roles and responsibilities; (2) Foster integration of Coaches into clinical teams and services; (3) Prioritize high-quality, accessible formal supervision for Coaches.

P16.06

Positive Impact on Employee and Patient Wellbeing: Comprehensive Whole Health Lifestyle Project

Davinder Bhullar¹, Elizabeth Kempe², Rosalie Diaz¹, and Katherine Dignan³

¹Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH

²Northeast Ohio VA Health System, Cleveland, OH

³Veteran Affairs Administration, Cleveland, OH

Contact: Davinder Bhullar, [e-mail]

Abstract

Purpose: Comprehensive integrative clinical care programs provide evidence based self care education with appropriate integrative health modalities as a personalized health care plan. The goal of this study is to see the impact of such program on employees and veterans.

Method(s): At the VA Northeast Ohio Healthcare system, enrolled 29 patients and 27 employees completed an initial detailed lifestyle evaluation including assessment of anxiety (GAD7), depression (PHQ9), Life satisfaction Scores (LSS), Neuroplasticity (AAQ-11), and VA pain scores. During a 14 week period each participant received a Whole Health lifestyle evidence based intervention with nutrition, exercise, and mindfulness prescriptions. They received relevant resources such as grocery lists, healthy plate illustrations, recipe books and exercise equipment. The participants attended Shared Medical Appointments (SMA’s) with science based education including culinary education was provided by subject matter experts including physicians, Whole Health coach and dietician. Paired t-tests were used to compare the scores of before and after the intervention.

Results: Paired Samples t-tests indicated significant improvements in mental health scores of both veterans and employees (p<.02), depression decreased by 45%, anxiety decreased by 50%, neuroplasticity increased by 22% and pain scores decreased by 18%.

Conclusions: Implementation of whole health lifestyle program if regularly offered to employees and patients has a potential to improve overall health outcomes

Topic Area 17 – Natural Products/Supplements

P17.01

Citrus Peel – Shifting Paradigms in Integrative Brain Health

Mark Liang¹, and Jody Rawles¹

¹University of California, Irvine, Irvine, CA

Contact: Mark Liang, [e-mail]

Abstract

Purpose: Citrus Peel (Chen pi, 陈皮) plays an important role within integrative medicine in Asia as a warm qi-regulating herb. Researchers have in the past attempted to isolate and market specific compounds (i.e., Nobilex) within evidence-based contexts of improving cognitive function and mental health. These formulations are often talked about in the Western pharmaceutical narrative devoid of cultural or political context. We sought to conduct a systemic review and literature analysis to evaluate how research around citrus peel have evolved across time.

Method(s): The PubMed, Cochrane, and Web of Science databases were queried for all full-text English studies evaluating the use of citrus peel in brain health from 2000 onwards. The primary endpoints of interest were assessment of cognitive function, brain imaging, and mental health outcomes. Additionally, Factiva, a global news monitoring database, was assayed for references to citrus peel in both English and Chinese within media in the same period.

Results: Fifty-one articles were identified. 15 of those studies were human trials, using proprietary compounds, essential oil, orange juice, or self-reported intake of citrus. No English-language study was conducted in humans using citrus peel as it is traditionally prepared. However, interest in citrus peel grew in public media, especially within mainland China and after the year 2013.

Conclusions: Interest in citrus peel as a modulator in brain health has grown from 2000 onwards, although research largely focuses on specific, isolated substances rather than the product as a whole. Complimentary aspects (ex. fiber benefits, synergistic interactions with other compounds, One Health regards) are perhaps lost in these preparations. Additionally, citrus peel continues to evolve as a commercial product, especially in China where it is assigned nationalist value. Future research should focus on expanding the methodology that citrus peel is studied within, using N-of-1 studies for example, or using less processed product.

P17.02

Hemp and Cannabis: Emerging Uses and Products for Health and Wellness

Ryan Buck¹, Jessica Montalvo ² , and Rebecca Abraham²

¹Plesio Health, Northwestern University Feinberg School of Medicine, Skokie, IL

²Plesio Health, Chicago, IL

Contact: Jessica Montalvo, [e-mail]

Abstract

Purpose: This talk will describe the physiologic mechanisms of the endocannabinoid system and how it is important for a wide variety of functions and many disease processes. It will discuss commonly known and emerging phytocannabinoids and other botanical products that interact with this system, as well as a wide variety of hemp derived and extracted products that are widely available, but may come with significant risks.

Method(s): N/A

Results: Endogenous cannabinoids Anandamide (AEA) and 2-AG interact with CB1 and CB2 receptors throughout the entire body. Phytocannabinoids found in the Cannabis sativa plant including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) interact with this system to have significant effects. There is also emerging understanding and science related to many other “minor” phytocannabinoids that all have unique properties that can be utilized to treat a variety of conditions. Additionally there are many other botanic compounds present outside of the cannabis plant that interact with the endocannabinoid system - including Salvia, N-alkylamide found in Echinacea species, and β-caryophyllene. As interest in using cannabis has grown, so has the number of products - which can be confusing to both providers and patients. This talk will also describe the differences between “hemp” and “cannabis” and delineate the differences and safety considerations between many of the hemp-derived products in the market - including delta-8 THC, hemp extracted delta-9 THC products, Hexahydrocannabinol (HHC), and THC-0-acetate.

Conclusions: The endocannabinoid system is a rapidly growing area of health and wellness which has huge implications for the management of a host of chronic conditions, and botanic medicine has the potential to disrupt current healthcare models and allow for more effective, efficient, and equitable care. It is a complex and dynamic system, and one in which patients need expert education and guidance for it to be effective and to minimize adverse outcomes.

P17.03

The Chemo-Gut Probiotic Trial: Investigating a Probiotic To Support Gastrointestinal and Mental Health in People With Cancer – Progress Report

Julie Deleemans¹, Athina Spiropoulos¹, Raylene A. Reimer¹, Safiya Karim², Bill Richardson³, and Linda Carlson¹

¹University of Calgary, Calgary, AB

²University of Calgary/Alberta Health Services, Calgary, AB

³Patient and Family Advisory Network Cancer Care Alberta, Calgary, AB

Contact: Julie Deleemans, [e-mail]

Abstract

Purpose: Survivors of cancer experience chronic gastrointestinal (GI) and psychosocial symptoms, and reduced gut microbial diversity. No studies have investigated probiotics for addressing these issues in people with cancer post-treatment. This ongoing study investigates the effects of a probiotic vs. placebo on abdominal pain and depressive symptoms, GI (bloating, diarrhea, constipation) and psychosocial symptoms (anxiety, cognitive function, fatigue, and general health), and gut microbiota composition.

Method(s): This ongoing double-blinded 2-arm RCT will recruit N=66 participants for a 12-week trial. Adult survivors diagnosed with a solid tumour or blood cancer who completed chemotherapy and show elevated GI or psychosocial symptoms will be included. The probiotic capsule contains Lactobacillus and Bifidobacterium strains, ingested orally once daily. Stool samples are collected at baseline and week-12. GI and psychosocial surveys are completed at baseline, week 6, and week 12. Descriptive statistics, frequencies, paired samples t-tests, linear mixed models, and Spearman’s correlations analyses will be used.

Results: Since May 2024, 36 people have been pre-screened, 17 have undergone full screening, and 4 were enrolled. Ineligibility was primarily due to not receiving chemotherapy or failing to meet the GI/psychosocial minimum symptom threshold. Enrolled participants are females with a mean age of 54 (range 37 to 66). Intervention compliance, retention, and data completion are all 100%. No adverse events have been reported. Participants indicate elevated GI and psychosocial symptoms, particularly for cognitive function and fatigue at baseline. Updated preliminary findings on intervention adherence, GI, and psychosocial outcomes at baseline and post-intervention will be presented at the conference.

Conclusions: Patients are interested and eager to explore probiotics as a potential solution to address their post-treatment symptoms. Findings from the completed trial may guide clinical practice and symptom management, and will be mobilized through patient-centered knowledge translation materials to empower patients to make informed decisions about their health.

Topic Area 18 – Policy

P18.01

Connecting Veterans with Co-Occurring Chronic Pain and PTSD to Virtual VA Whole Health Care

Martha Michel ¹ , Charles Engle², David Reed³, and Steven Zeliadt¹

¹VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, WA

²Department of Veteran Affairs, VA Puget Sound, Seattle, WA

³University of Washington, Seattle, WA

Contact: Martha Michel, [e-mail]

Abstract

Purpose: Virtual healthcare is now common across Veterans Health Administration (VA) settings. As VA’s Whole Health (WH) transformation continues, ensuring that WH is being delivered virtually is critical. The objective of the current study is to examine the degree to which Veterans with co-occurring chronic pain and PTSD, a population that could benefit from VA WH’s mind-body focus, are using virtual WH care and the corresponding demographic and health characteristics of virtual WH use.

Method(s): The current study is a retrospective data analysis focused on Veterans using WH in primary care (n=3001; January-June 2021) who had 1) past-year chronic pain and PTSD diagnoses and 2) clinically significant symptoms of anxiety, depression, and/or PTSD. Chi-square analyses and T-tests were run to determine demographic and health characteristic differences between Veterans who used virtual WH during their first WH visit and those who did not.

Results: Most Veterans used virtual WH care (74%). Notable group differences included: Veterans who lived in rural settings were less likely to use WH (13% v. 19%; SMD=0.17), as were those with a drug abuse diagnosis (26 v. 39%; SMD=0.29) or an alcohol abuse diagnosis (35 v. 47%; SMD=0.25). In addition, Women (28% v. 18%; SMD=0.26) and Veterans who were obese (61% v. 54%, SMD=0.15) were more likely to use virtual care.

Conclusions: Overall, Veterans with co-occurring chronic pain and PTSD appear to be engaging in virtual WH care, a finding consistent with research demonstrating a shift to virtual care. There were minimal differences across healthcare delivery groups, although a compelling result showed rural Veterans were less likely to use virtual WH. As WH is used in primary care to connect Veterans to specialty mental health care, it is important for WH practitioners and policy makers to be aware that WH is a viable virtual option.

P18.02

Top 100 Medical Journals’ Guidance on Use of AI in Peer Review

Zhiqiang Li ¹ , Huijuan Cao², Zhaolan Liu¹, Jianping Liu², and Yutong Fei²

¹Beijing University of Chinese Medicine, Beijing, Beijing, China

²Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, Beijing, China

Contact: Zhiqiang Li, [e-mail]

Abstract

Purpose: The exponential growth in medical literature and preprint availability is challenging the peer review, potentially leading to a scarcity of qualified reviewers and delayed review times. There is a critical need for innovative solutions to enhance the efficiency and equity of the peer review, with generative AI emerging as a potential tool. However, the integration of GenAI into peer review varies by journal policy, necessitating a survey of medical journals’ guidelines to gauge attitudes towards AI assistance and the reasons.

Method(s): The top 100 medical journals, as listed by Scimago.org, were reviewed for their AI-related peer review policies. Data extraction focused on specific AI guidance, and journals recommending or linking to publisher policies were included if they lacked explicit AI guidance. Descriptive statistics were used to analyze the data.

Results: Of the 78 (78%) journals providing AI guidance, 46 (59%) explicitly prohibited AI use in peer review, while 32allowed its use under certain conditions. Internationally-based journals were more likely to permit limited AI use compared to those based in the USA or Europe. The majority of journals prohibited uploading manuscript content to AI, but some allowed restricted use with disclosure requirements. AI tool mentions were common, with varying references to publisher and ethical guidelines, despite some contradictions. This divergence in policy of different publisher may be the ultimate reason of the observed variations in guidance.

Conclusions: The study reveals a spectrum of attitudes among mainstream medical journals towards AI-assisted peer review, highlighting the need for clear AI-related guidance to prevent misuse and ensure the integrity of the peer review process. Continuous monitoring and assessment of AI’s impact are essential for updating guidelines and maintaining high-quality peer review.

Topic Area 19 – Practice-Based Research

P19.01

Effectiveness of Music Therapy on Utilization Outcomes within Inpatient Palliative Care: A Propensity-Score Matched Cohort Study

Samuel Rodgers-Melnick ¹ , Thomas Love², Siran Koroukian³, Douglas Gunzler³, Mark Beno⁴, Jeffery Dusek⁵, and Johnie Rose³

¹University Hospitals Connor Whole Health, Cleveland, OH

²Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH

³Case Western Reserve University School of Medicine, Cleveland, OH

⁴Cleveland Institute for Computational Biology, Cleveland, OH

⁵University of California - Irvine, Irvine, CA

Contact: Samuel Rodgers-Melnick, [e-mail]

Abstract

Purpose: To examine the impact of music therapy (MT) on length of stay and opioid utilization among inpatients receiving palliative care.

Method(s): A retrospective cohort study was conducted among adults admitted ≥120 hours within a large health system who received palliative care and either reported mean pain intensity scores ≥4 or received ≥1 opioid within their first 48 hours. Covariates used to calculate the propensity for having received MT included socio-demographics (e.g., age, sex, race, neighborhood-level social vulnerability index); pain-related variables (e.g., pain intensity, receipt of opioids in first 48 hours); major diagnostic criteria; receipt of psychosocial services; and mental health and Elixhauser comorbidities. This propensity score was then applied within a 1:1 matching algorithm (0.1 caliper). A linear mixed effects model was used to estimate the effects of MT on log-transformed length of stay and the mean morphine milligram equivalents (MME) administered per day after 48 hours.

Results: Prior to matching, there were several meaningful between-group differences (p < .001) between patients receiving 2-10 MT sessions (n = 340) and Usual Care (n = 1886). These included differences (MT vs. Usual Care) in mean pain intensity (4.20 vs. 3.49), total MME administered in first 48 hours (109.4 vs. 69.7) and rates of female sex (60.9% vs. 47.3%), depression (36.5% vs. 21.7%), and anxiety (46.5% vs. 27.5%). In the analysis of 298 matched pairs, the estimated effect of MT was 1.47 for length of stay and 0.96 for MME administration.

Conclusions: Among inpatients who receive palliative care, receipt of MT appears to be associated with longer length of stay but no meaningful difference in opioid administration. Findings inform clinical factors (e.g., mood disorders) for which MT may be indicated. More research is needed to examine why MT is associated with increased length of stay.

P19.02

Acupuncture Treatment for Service Members with Co-Morbid Sleep Disorder Symptoms and Posttraumatic Stress Symptoms

Jane Abanes ¹ , and Sorana Raiciulescu²

¹University of California, San Francisco, South San Francisco, CA

²Uniformed Services University, Bethesda, MD

Contact: Jane Abanes, [e-mail]

Abstract

Purpose: The goals of this research are to determine if there is an association between sleep disorder symptoms (SDS) and posttraumatic stress symptoms (PSS) and if the presence of SDS influenced the treatment response between the two groups who received either a combined acupuncture and cognitive behavioral therapy for insomnia (CBTi) or CBTi only.

Method(s): This study is a secondary outcome analysis of a randomized controlled trial in active duty service members stationed in Okinawa, Japan. The study was approved by Naval Medical Center San Diego and the Vanderbilt University Institutional Review Board. The measures used were the Global Sleep Assessment Questionnaire (GSAQ) and the Post-traumatic Stress Disorder Checklist (PCL). To determine the relationship between SDS and PSS treatment outcomes, a Pearson correlation coefficient was calculated.

Results: Findings showed that a relationship exists between GSAQ components and PCL total and PTSD cluster scores and that SDS influenced the PSS treatment response in service members.

Conclusions: Associations exist between GSAQ components (sadness, anxiousness, involuntary movements in sleep, excessive daytime sleepiness, and working conditions causing inadequate sleep) and PCL total and PTSD cluster scores (negative cognition and mood, hyperarousal, and avoidance). SDS (probable obstructive sleep apnea, insomnia, depression, anxiety, and stressful working conditions such as shift work) influenced PSS treatment responses.

Topic Area 20 – Research Methodology

P20.01

As Seen on TikTok: A Protocol for Characterizing Conventional and Complementary and Integrative Health Modalities Shared in #PCOS Content

Roshini Srinivasan ¹ , Matt Crowley², Anastasia-Stefania Alexopoulos², and Matthew Sparks³

¹Duke University Department of Medicine, Durham, NC

²Duke University Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC

³Duke University Department of Medicine, Division of Nephrology, Durham, NC

Contact: Roshini Srinivasan, [e-mail]

Abstract

Purpose: TikTok ranks among the most popular social media platforms globally, with 41% of users between 16 and 24 years of age. Polycystic ovarian syndrome (PCOS) is a common metabolic disorder often diagnosed in adolescence, affecting up to 13% of reproductive-aged people. Complementary and integrative health (CIH) use is popular among people with PCOS. Many users turn to TikTok for information regarding conventional and CIH approaches to PCOS management, including medications, supplements, and other therapies. Neither attitudes towards conventional and CIH approaches among TikTok users, nor specific CIH modalities shared in PCOS-related content, have been systematically studied.

Method(s): This cross-sectional content analysis aims to characterize attitudes towards conventional and CIH approaches to PCOS, and to summarize the most prevalent CIH modalities recommended across PCOS-related TikTok posts.

Results: Based upon a published approach, hashtags of “PCOS” and “polycystic ovarian syndrome” will be searched. An internet data extraction tool (data scraper) will be utilized to identify the top 100 highest-ranked (a composite sorting of most recent and most liked) videos longer than one minute with each hashtag from August 1, 2023 to August 1, 2024. Videos of advertisements, less than one minute long, with zero likes, or with content repetition will be excluded. Date of posting, engagement metrics (number of likes, comments, and shares), and account characteristics will be recorded. Content analysis of attitudes and modalities will be performed through a joint inductive and deductive approach. The prevalence of CIH modalities shared will be summarized using descriptive statistics.

Conclusions: With the increasing popularity of PCOS-related health information shared on TikTok, characterizing attitudes towards conventional and CIH modalities constitutes a valuable opportunity for healthcare providers to understand patient perspectives, treatment preferences, and modalities sought for PCOS management. Additionally, this work may contribute novel methodological innovation and value to the study of women’s health represented in social media.

P20.02

Whole Systems Intervention Adaption and Optimization For Multi-site Clinical Trials

Anand Dhruva ¹ , Jennifer Schneider², Blake Locher², Cairn Wu³, Peea Kim-Hassel¹, and Charles Elder⁴

¹University of California, San Francisco, San Francisco, CA

²KPNW, Portland, OR

³Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA

⁴Kaiser Permanente Center for Health Research, Portland, OR

Contact: Anand Dhruva, [e-mail]

Abstract

Purpose: 1) To assess barriers and determine solutions to study participation for underrepresented patients; 2) To adapt and optimize a multi-component integrative Ayurvedic medicine intervention prior to an NIH/NCCIH-funded multi-site clinical trial.

Method(s): We took two inter-related steps to accomplish study aims: 1) We conducted in-depth interviews with underrepresented female breast cancer survivors who had completed treatment. Interviews were approximately 60 minutes, audio recorded, and content analyzed using rapid qualitative techniques. 2) We conducted a Delphi process of experts in Ayurvedic medicine leading to Ayurvedic diagnostic calibration and testing.

Results: 1) We completed interviews with 9 breast cancer survivors, average age 54 (range 40-69). Survivors were willing to participate in the Ayurvedic intervention citing a desire for personalized support from a natural medicine provider that focused on recovery activities such as nutrition, gentle movement, and managing emotional and long-term impacts of cancer treatment. Notably, participants expressed that Ayurvedic practitioners should be aware that people of color may experience symptoms, reactions, and recommendations differently. 2) A key recommendation of the Delphi process was to conduct more calibration and testing of the Ayurvedic diagnostic process focusing on vikruti (current imbalances) and ama (digestion and metabolism) diagnoses. The training and calibration with study practitioners revealed 75% diagnostic concordance for vikruti and 100% concordance for ama.

Conclusions: We found that an Ayurvedic intervention for breast cancer survivors was received favorably in qualitative interviews by underrepresented patients. Input from survivors and Delphi experts guided us in making important adaptations in recruitment, engagement, and content elements of the Ayurvedic intervention to improve appeal and participation in the study. Diagnostic testing and calibration resulted in good agreement among Ayurvedic practitioners. A multi-faceted approach to intervention optimization prior to multi-site trials yielded important insights into recruitment of underrepresented patients and study intervention adaptation.

Topic Area 21 – Student/Trainee/Staff/Practitioner Well-Being and Wellness

P21.01

A Comparison of Anxiety, Depression, and Imposter Syndrome in Osteopathic Medical Students and Physical Therapy Doctorate Students

Kalyanii Kennedy ¹ , Targol Mehrazar¹, Sophia Voronoff¹, Madeleine Takahashi¹, Emily Gresner¹, Chadbourne Zitek¹, Edie Sperling¹, and Mandilin Hudson¹

¹Western University of Health Sciences, Lebanon, OR

Contact: Kalyanii Kennedy, [e-mail]

Abstract

Purpose: Although previous studies have been completed on medical students’ rates of depression, anxiety, and imposter syndrome, significantly fewer studies compare medical students’ mental health to other healthcare students’ mental health. There are also relatively few studies comparing rates of depression, anxiety, and imposter syndrome between rural vs. urban healthcare students.

Method(s): We completed a cross-sectional survey-based study with students from the Western University of Health Sciences’ (WesternU) two campuses, an urban campus in Pomona, CA, and a rural campus in Lebanon, OR. 1,682 students enrolled in the Doctor of Osteopathic Medicine (DO) and the Doctor of Physical Therapy (DPT) programs were sent an anonymous survey containing the Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9, depression), Clance Imposter Scale, and sociodemographic questions. Target response was n=334 from power analysis and anticipated 20% response rate.

Results: N=337 participants responded; 43.7% urban DO students, 31.0% rural DO students, 13.6% urban DPT students, and 11.7% rural DPT students. GAD-7 scores had a mean of 6.4 (SD= 5.4); PHQ-9: M = 6.3 (SD =5.9); and Clance Imposter Scale: M=61.7 (SD=17.4). Average scores among all students indicated moderate levels of anxiety and depression and high levels of imposter syndrome. No significant differences were noted between DO and DPT students. All fourth-year DO students had significantly lower depression (F=4.68, p &lt; 0.01) and anxiety scores (F=4.40, p=0.02) then all first-year students. All students identifying as female had significantly higher imposter syndrome scores than males (F=3.65, p=0.02), and students identifying as gay, queer, or asexual had significantly higher imposter syndrome than those identifying as heterosexual (F=4.0, p=0.05).

Conclusions: Results suggest interventions targeting imposter syndrome, particularly among women and those with marginalized sexual orientations, may be beneficial to both medical and physical therapy students in a variety of settings. Further research on a larger population is warranted.

P21.02

Cultivating a Whole Health Approach through a Holistic Integrative Health Nursing Fellowship Program

Katrina Vigo ¹ , Annie Kaplon¹, Marci Resnicoff¹, and Kathleen DeMarco¹

¹NYU Langone Health, New York, NY

Contact: Katrina Vigo, [e-mail]

Abstract

Purpose: Whole Health (WH) is an approach to health care that empowers and equips individuals to take charge of their health and wellbeing. The Veterans Health Association (VHA) strategic plan states that focusing on overall wellbeing is a core responsibility of the healthcare system and requires planning, action, and evaluation along with a system wide recognition on this focus for both patients and staff (Kliger, et al., 2022). The aim of the Holistic Integrative Health Nursing Fellowship is to incorporate the components of WH as well as foster a systemic shift that prioritizes wellbeing for patients, caregivers, and staff.

Method(s): A nine-month holistic integrative health nursing fellowship program was launched, featuring a group of 10 healthcare professionals. Fellows participated in a 172-hour curriculum including live, virtual, and self-directed learning incorporating American Nurses Credentialing Corporation approved courses, professional mentoring, holistic skill development, experiential learning, reflective and wellness practices, and project development and implementation. Fellows completed baseline and post-fellowship surveys, post-module surveys, and exit interviews.

Results: Fellows implemented 10 holistic based quality improvement initiatives across a vast range of specialty areas, impacting over 453 patients and caregivers and 240 healthcare professionals. Outcomes of the fellowship include an 82% increase in holistic nursing and integrative health utilization in professional practices. Additionally, fellows reported up to an 89% increase in their knowledge, skill, and confidence levels related to holistic nursing, integrative health, the mind-body connection, and implementation of quality improvement or research initiatives.

Conclusions: Transforming our system towards a WH approach requires a dedicated, strategic, and multifaceted plan that incorporates focus on personal wellness and reflection, practice integration, and change management and leadership skills. The outcomes of this fellowship demonstrate significant improvements in knowledge, skill, and confidence related to holistic nursing, integrative health, the mind-body connection, and quality improvement or research initiatives, validating the effectiveness of the program.

P21.03

Dedicated Worksite Respite Spaces to Support Healthcare Worker Mindfulness Practices

Beth Steinberg¹, Jacqueline Caputo ² , Yulia Mulugeta², Slate Bretz¹, and Maryanna Klatt³

¹The Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

²The Ohio State University, Columbus, OH

³Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

Contact: Jacqueline Caputo, [e-mail]

Abstract

Purpose: Mindfulness-based interventions are effective at decreasing stress and improving resilience for HCWs. Worksite respite spaces can offer a private and peaceful environment for HCWs to practice mindfulness while on duty, however, implementation of respite spaces within established healthcare facilities can be complicated by space limitations, fire and safety codes, and epidemiological concerns. Following development and implementation of stand-alone respite spaces that offer embedded audio-visual mindfulness programming, we describe their use as an intervention to support HCW well-being within our academic medical center.

Method(s): HCW badge swipe data, for each of four respite spaces located across medical center locations, was evaluated descriptively. Overall frequency and shift variations in use were analyzed for each respite space. Engagement with organizationally endorsed mindfulness programming while using the respite spaces was also analyzed descriptively and included minutes of mindfulness practices viewed per visit and preferences for individual practices.

Results: HCWs averaged 132 visits to worksite respite spaces per month with 74.2% of visits occurring during day shift (7am-7pm) while 25.8% of visits occurred during night shift (7pm-7am). Locations of the respite spaces determined frequency of use with the respite space located in a more central medical center location receiving more than double the HCW visits. Mindfulness content available within the spaces averaged 58 views per month with an average watch time of four minutes. The most frequently viewed videos were those offering relaxing music, seated spinal twists, and guided breath practices.

Conclusions: Dedicated worksite respite spaces can provide a tranquil and private place for HCWs to practice mindfulness, unwind, and rejuvenate during long work shifts. Placement of respite spaces are ideally located near clinical worksites, however, placement in more central worksite locations may prompt increased use due to their visibility. The implementation of worksite respite spaces can support an overall culture of organizational health and well-being.

P21.04

EASE+CALM: Facilitating Sustainable Wellness Practices Among Interdisciplinary Hospital-Based Teams

Heather Menzer¹, Jennifer DiBiase¹, and Fedline Lysius ¹

¹NYU Langone Health, New York, NY

Contact: Fedline Lysius, [e-mail]

Abstract

Purpose: The wellness needs of newly hired nurses are critical for health systems, as the transition from nursing school to practice is often overwhelming and impacts retention. New nurses face higher stress levels than their senior counterparts, driven by long hours and heavy workloads. Emotional support, including self-care and self-compassion, has been shown to reduce stress and turnover rates, but it requires dedicated time and space for implementation. On-site, in-person wellness programs can address the challenges of inpatient healthcare work.

Method(s): Two interdisciplinary staff wellness pilots were launched in acute care units to address stress and enhance resilience. The EASE (Empower, Adapt, Sustain, Encourage) Program, led by social workers, focused on team well-being through interventions such as debriefs, mindfulness activities, and grief rituals. Assessments included the Maslach Burnout Inventory, interviews with nurse managers, and staff surveys. Weekly supervision was provided to the EASE social workers. The CALM (Center, Awareness, Listen, Meaningful) Program, led by an integrative health nurse, promoted mindfulness and improved sleep habits through tailored support sessions and breathing techniques. Post-intervention surveys were collected from participants.

Results: Feedback was overwhelmingly positive, though limited data prevented full assessment. Participants described the sessions as helpful and calming.

Conclusions: Both programs will continue and expand. The EASE Program has extended to evening and night shifts, with additional staff enabling service to five units per cycle. The wellness survey has been revised, and an IRB application is in process to study outcomes. The CALM Program has expanded to operating room and pediatric units, and a booking system now allows night shift teams to schedule sessions independently.

P21.05

Enhancing Employee Well-Being Through Qigong

Brenda Loew ¹ , Aiko Bailey², Dan Cherkin³, and Iman Majd⁴

¹University of Washington, Department of Family Medicine, Osher Center for Integrative Health, Seattle, WA

²University of Washington, Osher Center for Integrative Health, Seattle, WA

³Osher Center for Integrative Health, Dept of Family Medicine, University of Washington, Seattle, WA

⁴Osher Center for Integrative Medicine, University of Washington, National Certification Commission for AOM (NCCAOM), Medical Acupuncture Research Foundation, Seattle, WA

Contact: Brenda Loew, [e-mail]

Abstract

Purpose: Employee well-being is vital for organizational success. Stress harms mental and physical health, reduces productivity, and increases healthcare costs. Healthcare employees in high-pressure settings are especially susceptible. Stress management techniques and wellness culture can mitigate these negative impacts. Qigong is an ancient Chinese practice that involves slow, gentle movements and breathing techniques. The initiative’s goals were to reduce stress among employees, improve overall physical and mental health, and foster a sense of community.

Method(s): Pilot experiential education involving short qigong sessions held twice a week during employee lunch breaks over three weeks, for a total of six sessions. Twenty-four surveys were collected from class participants and Qigong handouts with a different focus (including resources) were handed out weekly.

Results: Demographic data showed that 65% of the participants’ roles involved direct patient care, 35% indicated care management/support staff roles. At the conclusion of the six short sessions, survey results indicated an overall improvement in well being. (Future programming will include follow-up surveys.)

Conclusions: Even abbreviated programs such as our pilot Qigong series are a beneficial addition to academic medical institutional wellness offerings.

P21.06

Fit a Bit of Wellness: Employee Driven Innovative Wellness Pilot Program

Candace McNulty¹

¹VHA, Orlando, FL

Contact: Candace McNulty, [e-mail]

Abstract

Purpose: Fit a Bit of Wellness stemmed from my experience on the frontline and my observations as a Nursing supervisor for a dire need to address nursing burnout and compassion fatigue. A disconnect was identified between the well-being needs of the direct care staff and the current employee whole health offerings available. We needed to make wellbeing.

Method(s): A Wellness Peer Leader within the nursing unit received mind-body skills training and 4 hours per month of dedicated time to plan and implement wellbeing initiatives for the team. Wearable fitness devices were issued to encourage fitness, mindfulness, and group exercise challenges. The devices came with access to an administrative dashboard showing aggregate data for the team. We measured resting heart rate, sleep, steps and activity and use of the meditation modules. Whole Health Tools and Equipment items for relaxation, fitness and well-being were available to the team (aromatherapy, workout videos, yoga mats, blender, VR Headsets, Red Light Therapy, tea kettle etc.)

Results: Baseline data indicated that 44% of nurses in the pilot program felt their organization was dedicated to their health and wellness. After 90 days of implementation, this figure rose to 96%. The annual all employee survey also showed that 90% of the participating nurses consider their workplace to be among the best, contrasting sharply with the VA national average of 68%. Additionally, after 90 days, the group demonstrated improvements in steps taken, overall activity, and resting heart rate.

Conclusions: This employee-driven innovative wellness program is changing the work environment for nurses within VHA and is currently in spread phase to other VA hospitals such as VA Puerto Rico and within other teams at Orlando VA.

P21.07

Harnessing the Power of Monday: Foundational Steps for Tailoring and Expanding the Original Monday Campaigns for Dissemination in Hospital Ecosystems

Shari Esquenazi-Karonika¹, Robin Ortiz¹, Hannah Swartz¹, Abigail Woods¹, Allie Saul J. Berkowitz¹, Areyanna McCarthy¹, Carol McGuffin¹, and Kathleen DeMarco¹

¹NYU Langone Health, New York, NY

Contact: Shari Esquenazi-Karonika, [e-mail]

Abstract

Purpose: There is timely need for wellness programming that supports the whole person needs of various populations within the hospital ecosystem. The fast-paced nature of the work, long, often unpredictable shifts, and the inherently intense nature of caring for patients and families can weigh heavily on the well-being of healthcare workers. Patients and caregivers experience similar stressors as they navigate treatment with potential uncertainties. Health promotion programming that incorporates integrative modalities offers the opportunity to support an individual’s overall well-being. We carefully reviewed the existing, generalized Monday Campaigns and identified novel opportunities for expansion.

Method(s): To better understand the nuanced influences over individual-level well-being and interventional opportunities, we developed a socioecological model of a hospital. Then, we developed a basic spreadsheet to organize existing campaigns and their assets as well as our suggestions for expanded and new programs that leverage a “Monday”-style cue for healthier behaviors. Our reviews included the considerations of literacy levels, practicality, relatability, and format (in-person/online/hybrid).

Results: The reviewed campaigns and assets (n=116) require modification to better align with our priority populations. For example, physical activity programming for admitted patients recovering in a hospital bed should have adapted, accessible exercises. We identified opportunities to leverage institutional technology (e.g., MyWall, MyChart, and Care Companion) to bring programming directly to users. Further, we identified several topical gaps that should be filled in order to meet other needs of our target audiences, including sleep, vaping cessation, and excessive screen time.

Conclusions: The Monday Campaigns offer a strong foundation for cultivating well-being through its vast programming. There is a unique opportunity to enhance these programs by incorporating evidence-based integrative modalities. Refreshed programming will be piloted across various hospital settings, with QI projects planned to gather information about programmatic facilitators and barriers. We intend to develop a catalog of turnkey programs for limited resource healthcare systems.

P21.08

Impact of a Brief, Tailored Eight-Week Mindfulness Intervention for Emergency Department Personnel

Katie MacVittie ¹ , Adam Beucler¹, Meriden McGraw², Harini Pallerla³, Sanjay Shewakramani⁴, Caroline Freiermuth⁴, and Sian Cotton⁵

¹University of Cincinnati College of Medicine, Cincinnati, OH

²University of Cincinnati Osher Center for Integrative Health, Cincinnati, OH

³University of Cincinnati, Cincinnati, OH

⁴University of Cincinnati Department of Emergency Medicine, Cincinnati, OH

⁵University of Cincinnati College of Medicine; Osher Center for Integrative Health, Cincinnati, OH

Contact: Katie MacVittie, [e-mail]

Abstract

Purpose: Burnout among physicians is alarmingly prevalent, with 57% of emergency medicine physicians affected. Research on stress management in emergency departments (EDs) has increased with a focus on mindfulness-based interventions (MBIs). The purpose of this study was to evaluate the impact of an eight-week MBI tailored to ED well-being.

Method(s): ED providers and staff in an urban, level one trauma center completed a survey before and after an eight-week mindfulness series consisting of daily, pre-recorded, five-minute videos. Validated measures for perceived stress (PSS-10), mindfulness (FFMQ-15), burnout (MBI-2), and resiliency (BRS-6) were used. Statistics were computed using SPSS-29 and thematic analysis was performed on open-ended questions.

Results: Out of the 58 participants, 35 (60% female, 91% white, Mage=45 yrs, 68% MD) completed both pre and post evaluations for the MBI. Significantly increased mindfulness (Mpre=46.6; Mpost=51.3, p<0.001), decreased perceived stress (Mpre=18.5; Mpost=15.4, p=0.006), and decreased depersonalization (Mpre=3.7; Mpost=2.8, p<0.001) were found. Increased mindfulness was significantly associated with decreased stress (-0.654(33), p<0.001) and increased resilience (0.475(33), p=0.004). The top three reported motivators for taking the MBI were to learn adaptive coping skills, improve mental health, and support others in the workplace. The three most impactful takeaways were increased awareness of self and surroundings, ability to pause and reset, and emotional stability.

Conclusions: This study illustrates the positive impact of a brief, tailored MBI on the well-being of ED personnel. Given the healthcare burnout crisis, EDs might consider implementing similar MBIs to support mental and emotional health.

P21.09

Team-Based Management of High-Priority In-Basket Messages - Pilot

Anup Bhandiwad ¹ , John Holkeboer², Lauren Marshall², and Gregory Shumer¹

¹University of Michigan, Ann Arbor, MI

²University of Michigan Department of Family Medicine, Ann Arbor, MI

Contact: Anup Bhandiwad, [e-mail]

Abstract

Purpose: A great contributor to primary care physician (PCP) burnout is the inability to “unplug” from the electronic health record (EHR) for fear that urgent patient messages may be missed. If a PCP is not checking the EHR regularly, urgent patient concerns may go unanswered for more than 24 hours, leading to adverse outcomes and patient dissatisfaction. To mitigate this problem, our Integrative Medicine group created a team-based, rotating in-basket management system. Following our pilot, we are implementing this process to other teams within our department.

Method(s): To reduce burden on the high-priority physician, we agreed on a narrow set of in-basket categories requiring same-day attention: high-priority patient call encounters, high-priority patient portal messages, and medication refill requests

Results: A post-implementation survey revealed that all 4 team physicians agreed participating in this pilot reduced their feelings of burnout.

Conclusions: In our published pilot, the data revealed that distributing EMR responsibility among team physicians can have a meaningful impact on burnout. Presented would be our broader distribution of our model.

P21.10

Mindfulness in Motion at the Medical Center: Insights from Oncology Nursing Staff on How to Achieve an Organization’s Whole Health

Jacqueline Caputo ¹ , Beth Steinberg², and Maryanna Klatt³

¹The Ohio State University, Columbus, OH

²The Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

³Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

Contact: Jacqueline Caputo, [e-mail]

Abstract

Purpose: Nursing staff (nurses and nurse practitioners) make up the largest percentage of healthcare professionals (HCPs) within a health system and face high levels of work-related burnout. Mindfulness in Motion (MIM) is an 8-week evidence-based program that teaches techniques in mindfulness, breath-work, gentle yoga, and meditation to HCPs. The program significantly reduces burnout and perceived stress and significantly improves work engagement and resiliency for nursing staff. The study aimed to explore the width and depth of MIM techniques that oncology nursing staff have implemented in their personal and professional lives, since participating in MIM, as well as the ways the medical center can better support their staff at an organizational level to improve employee whole health.

Method(s): Qualitative semi-structured interviews with past MIM oncology nursing staff participants were conducted. Participants answered a demographic survey and completed a 30-minute interview. Qualitative analysis was completed by first identifying overarching themes, and then developing suggestions for MIM and the medical center.

Results: 10 nurses completed interviews with 22.5 years of average experience. Breast cancer was the most common type of cancer patient cared for by interviewees. Main findings were threefold: 1. Participants must feel supported by their organization to participate in MIM, 2. Hospital displays reminding staff to attend to their well-being are crucial, and 3. Shorter meditations that can be easily embedded into the clinical workflow help continued participation.

Conclusions: Whole health at an organization is crucial to the well-being of the staff. While it is important for an individual to invest in their own health, the medical center environment must hold space for ways employees can attend to their own whole health. If mindfulness programming can be offered at the system level to provide wellbeing resources for nursing staff, we can improve the chances for the staff, and thus the system, to achieve whole health.

P21.11

Obsessive-Compulsive Symptoms Among Medical Students in Egypt and Their Effect on Quality of Life: A Nationwide Cross-Sectional Study

Paolo Varela A. ¹ , Mostafa Shaheen², Mohamed Morshed², Farah Amasha², Nada Moustafa², Ali Salem², Maram Elsayed², Ahmed Yasin², Omar Ali², Esraa Elzeny², Yahya Al-sarhi², and Heba Sheta²

¹Humanitas University, Milan, Italy

²Faculty of Medicine Mansoura University, Mansoura, Ad Daqahllyah, Egypt

Contact: Paolo Varela A., [e-mail]

Abstract

Purpose: Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by symptoms of obsessive thoughts and compulsive actions. These obsessive compulsive symptoms (OCS) are often associated with anxiety, depression, and lower quality of life (QoL). Medical students are particularly vulnerable to developing OCS due to the stress and triggers they’re exposed to in medical school. This study aimed to assess the prevalence of OCS and its effect on the mental well-being of medical students in Egypt.

Method(s): A nationwide cross-sectional study was conducted across 15 Egyptian medical schools. Using convenience sampling, 1850 students participated by completing a self-administered questionnaire that utilized validated scales. We assessed OCS with the Revised Obsessive-Compulsive Inventory, QoL with the Quality of Life Enjoyment and Satisfaction Questionnaire, and Anxiety and depression with the 4-item Patient Health Questionnaire. Descriptive statistics and logistic regression were employed.

Results: More than half of the participants reported OCS (51%), with a significantly higher prevalence among females (OR = 1.34, p = 0.002). OCS were significantly higher among first and second-year students compared to fifth-years (OR = 1.42, 1.80, and p = 0.04, <0.001, respectively). Significantly higher odds of OCS were examined in participants with both personal and family histories of mental health disorders and participants with only a personal history of mental illness (OR = 2.35, 1.97, respectively, p < 0.001). OCS was significantly associated with low QoL (OR = 2.07, p < 0.001), both anxiety and depression (OR = 6.03, p < 0.001), anxiety alone (OR = 3.49, p < 0.001), and depression alone (OR = 2.67, p < 0.001).

Conclusions: OCS are prevalent among medical students in Egypt, with a significant adverse effect on their QoL and mental well-being. Students experiencing OCS should be provided with adequate social support as well as cognitive-behavioral therapy to learn to cope with the OCS.

P21.12

Impact of Mindfulness Modalities in Employee Whole Health

Katherine Dignan ¹ , and Rosalie Diaz²

¹Veteran Affairs Administration, Cleveland, OH

²Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH

Contact: Katherine Dignan, [e-mail]

Abstract

Purpose: The objective of this review is to determine the impact of the various modalities Employee Whole Health has implemented to promote mindfulness during the employee work day for reduction in burnout, and improved management of stress and resiliency.

Method(s): All adult participants were over 18 years old and worked at VA Northeast Ohio Healthcare System. Each of the 347 participants attended employee activities on a voluntary basis and could participate in unlimited activities provided by Employee Whole Health from September 2023 to October 2024. Programs reviewed include a mindfulness pod, use of relaxation space, and virtual mindfulness sessions. Statistical analysis was completed using the Scantron system and includes descriptive statistics of mean and standard deviation.

Results: Participants anonymously self-reported stress before and after at each session, with 1 being no stress and 10 being high stress. Results indicate employees dropped from a stress level of 6.7 (SD 2) to 4.1 (SD 2) with use of a relaxation space, 6.7 (SD 2.5) to 5 (SD 1.7) with use of meditation pod, and 6 (SD 2.2) to 3.7 (SD 2) in a virtual live mindfulness class. Although each participant could determine how long they remained active in the offering, the average time spent in the relaxation space was 14 minutes, meditation pod was 11 minutes, and the live mindfulness session was 10 minutes.

Conclusions: In conclusion, all modalities helped to significantly decrease stress while employees were at work. This review helps to support the growing body of evidence that Employee Whole Health interventions can support the health and well-being of our healthcare providers.

P21.13

The Effect of Resilience Training for Medical Students: A Systematic Review and Meta-Analysis

Brook Manion ¹ , Emily Gresner², Ashley Labarre¹, Peyton Krych¹, and Edie Sperling²

¹Western University of Health Sciences College of Osteopathic Medicine of the Pacific Northwest, Lebanon, OR

²Western University of Health Sciences, Lebanon, OR

Contact: Brook Manion, [e-mail]

Abstract

Purpose: Medical students have high levels of stress, which is associated with higher incidents of burnout, depression, and suicide compared to age-matched peers. Resilience interventions have often shown increased resilience and reduced stress among medical students. This systematic review and meta-analysis examine if resilience interventions have an overall effect on resilience or stress outcomes in medical students, particularly given a wide diversity of interventions. Interventional studies to promote resilience among medical students in any country were included if they had an outcome measure of resilience and/or stress.

Method(s): A comprehensive literature search was completed to include multiple databases, ancestry, and hand-searching. 15 studies met inclusion criteria. Standardized mean difference was used to calculate the effect sizes using a random-effects model for changes in resilience and stress levels among medical students. Moderator analyses were performed to explore variations in effect size by participant and intervention characteristics.

Results: Resilience interventions had a moderate effect in improving resilience among medical students in the nine studies that measured resilience (k = 11, d = 0.34, p = 0.001). Resilience interventions had a large effect in improving perceived stress among medical students in the six studies that measured stress (k = 7, d = 0.63, p = 0.05). Moderator analyses were not significant for differences in number of sessions, duration of sessions, mean age of participants, or between U.S. and international students.

Conclusions: This study indicates that while both resilience and stress interventions may be effective at increasing resilience in medical students, stress reduction interventions may outperform resilience interventions. Further investigation to determine the most effective intervention delivery (in person vs virtual, group vs individual training, etc.) would be beneficial to maximize improvements in medical students’ resilience and stress.

P21.14

Using a Consumer-Grade Stress Tracking Device for Monitoring Mind-Body Health

Shin Lin¹, Jad Nehme², Yunqi Zhang², Gena Younies², Oscar Chang², Jett Sandoval², Samantha Phan², and Kay Su²

¹Dept. of Developmental & Cell Biology and Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, CA

²University of California, Irvine, Irvine, CA

Contact: Shin Lin, [e-mail]

Abstract

Purpose: The purpose of this study is to investigate whether a consumer-grade device with “stress tracking mode” can be influenced by variation in respiratory rates and postural positions similar to we previously reported using research-grade Heart Rate Variability (HRV) technology.

Method(s): Subjects were a handful of healthy males/females of college age. A Garmin vívosmart® 5 Fitness Tracker was worn on the subjects’ wrists. The “stress level” scores (1-100) calculated from HRV and heart rate data with company software were obtained from a Garmin App. For the breathing experiment, subjects were instructed to breath at the specified rate for a 3-minute interval. For the postural experiments, the subjects were in each position for a 10-minute interval.

Results: There was a consistent pattern of “stress level” scores decreasing within minutes among all subjects (n=5) when they were instructed to change their breathing rate, averaging values normalized to 100% at baseline (normal breathing around 12 cycles/minute), 119% at 18 cycles/minute, 108% at 12 cycles/minute, and 102% at 6 cycles/minute. There was also a uniform pattern of variation among all subjects (n=5) when they breathed normally but changed their postural position, averaging “stress level” scores of 62 standing, 46 sitting, and 32 lying down.

Conclusions: We had previously used Fast Fourier Transformation spectral analysis to obtain HRV expressed as Hz and found in humans and ventilated and anesthetized rabbits a direct relationship between HRV frequency and the respiration rate, independent of psychological stress. We also found that HRV was highest when the human subject was standing, lower when sitting, and lowest when lying down. The present study shows an apparent trend of the “stress level” score from the Garmin device also affected by the breathing rate and postural position. Therefore, these confounding factors should be taken into account when using this device for evaluation of psychological state.

P21.16

Yoga: Three Week Feasibility Study of a Yoga Interventions and Associations Internal and External Factors in Military and Veteran Students

Nicholas McGuire ¹

¹University of Washington, Harborview Injury Prevention and Research Center, Seattle, WA

Contact: Nicholas McGuire, [e-mail]

Abstract

Purpose: Veterans are a highly susceptible population to mental illnesses including stress. College students may also experience stress during the academic semester. The American Institute of Stress (2023) ranked stress as the fourth primary mental health condition for college students. Student veterans potentially experience social anxiety and financial stress (Olsen et al., 2014). Yoga is an ancient Indian practice that has become increasingly popular in the United States to improve mental and physical health outcomes. This study investigates the impacts yoga has as a stress coping mechanism for student veterans, and what internal and external factors influence the feasibility to practice yoga for student veterans.

Method(s): This study provides a qualitative description using a Social Ecological framework to explore internal factors including perceived stress and perceptions, and how the organizational environment may affect the feasibility of practicing yoga. A modified Perceived Stress Scale-4 (PSS-4) was used to measure perceived stress, and semi-structured interviews were used to assess internal and external factors at pre-intervention and was facilitated again at post-intervention. The intervention was one 60-minute yoga class per week for two weeks. The initial sample consisted of 3 male student veterans at SCSU for the pre-intervention interviews and the final sample ended up being 2 students

Results: The pre-intervention survey results indicate perceived low stress levels. Pre-intervention interviews indicated mixed results from advanced, moderate, to minimal knowledge of yoga. Participants indicated that they believe yoga has multiple physical and mental health benefits. Participants also indicated that their jobs make it more difficult for them to find time to practice yoga compared to their academic workload.

Conclusions: In conclusion, implementing a yoga intervention for student veterans will require a sufficient amount of time, resources, and funds. Participants had a favorable perception of yoga and described more understanding of yoga upon completing the intervention.

Topic Area 22 – Technology and Data Science

P22.01

Data Science Teaching Leaders What Health Providers Want to Learn

Maryanna Klatt ¹ , Jacqueline Caputo², Slate Bretz³, Yulia Mulugeta², and Beth Steinberg³

¹Center for Integrative Health, The Ohio State University College of Medicine, Columbus, OH

²The Ohio State University, Columbus, OH

³The Ohio State University Center for Integrative Health, College of Medicine, Department of Family and Community Medicine, Columbus, OH

Contact: Maryanna Klatt, [e-mail]

Abstract

Purpose: Mindfulness in Motion (MIM), an 8-week resilience building program for healthcare professionals (HCPs), that significantly reduces stress and burnout, and significantly increases resilience and work engagement. Individual practice necessary for program success initially was website delivered, then replaced by a mobile application. Study purpose was to determine if the mode of practice delivery (website vs app) impacted program outcomes, level of optimal daily engagement, and consistency of favored practices across implementation sites.

Method(s): Pre/post intervention outcome surveys included: Maslach Burnout Inventory (MBI), Connor-Davidson Resilience Scale (CDRS), Perceived Stress Scale (PSS), and the Utrecht Work Engagement Scale (UWES). Paired samples t-tests were used to compare the mean differences in outcome measures pre to post program between website and app program practice delivery. Mobile app usage data was obtained and analyzed to evaluate how often participants were engaging with the content and which videos were most watched.

Results: Differences in burnout, measured by MBI, and resilience, measured by CDRS, were significantly greater for the mobile app users (n=171) compared to website users (n=590; p=0.0144 and 0.0191). PSS and UWES results were not significantly different between app and website users (p=0.0655 and p=0.1440). Data on app usage showed that reducing the number of videos pushed to app users/day increased as the number of videos decreased (watch time increased from 1.7 hrs/intervention to 2.8/intervention). Content data analysis revealed differences between implementation sites regarding most watched videos.

Conclusions: The app mean differences on all measures were greater than all website pre/post differences, showing the app to be preferable for daily program practice. Analyzing the app usage data and video content by healthcare system showed organizations have unique video content preferences. Analysis of organizational app usage data provides insight into how to address individual system needs, the learner teaching the leader what they need.

P22.02

Integrating Health Trackers and Lab Analysis with Tibetan Medicine’s Vital Principles

Yulia Yusipova

European University of Longevity, Miami, FL

Contact: Yulia Yusipova, [e-mail]

Abstract

Purpose: This study aims to explore the correlation between Tibetan medicine’s vital principles (Lung, Tripa, Badhkan) and data obtained from modern health trackers (HRV, sleep quality, activity levels) and laboratory tests (hormones, inflammatory markers, insulin resistance). The goal is to evaluate how the integration of modern technology with ancient knowledge can enhance diagnostic accuracy and therapeutic efficacy in personalized health care.

Method(s): Health data were collected using trackers, monitoring heart rate variability (HRV), sleep quality, heart rate, and activity levels. Simultaneously, laboratory tests were performed to assess cortisol, melatonin, insulin, leptin, and inflammatory markers like C-reactive protein (CRP). These parameters were analyzed in relation to the Tibetan medicine concepts of the three vital principles: Lung (Wind), Tripa (Bile), and Badhkan (Phlegm). Tibetan diagnostic methods for determining imbalances in the vital principles were compared with physiological data to establish correlations between traditional and modern diagnostics.

Results: Preliminary results show a clear correlation between modern health data and traditional Tibetan concepts. For instance, variations in HRV and stress markers accurately reflect the state of Lung, which governs movement and stress. Higher activity levels and metabolic indicators, such as body temperature, correlate with Tripa’s influence on digestion and energy production. Finally, sleep quality, melatonin levels, and recovery parameters from trackers align with Badhkan, which is responsible for accumulation and restoration. Laboratory tests confirm imbalances that are identified through traditional Tibetan diagnostic techniques, validating the applicability of these ancient concepts in modern health monitoring.

Conclusions: Integrating modern health-tracking technology with traditional Tibetan medical systems provides an enhanced framework for personalized health care. Trackers offer real-time objective measures of physiological states while traditional medicine provides a holistic understanding of body-mind balance. This synergy allows for improved diagnostics and therapeutic interventions bridging the gap between high-tech monitoring and soft-touch healing. This approach opens new avenues for disease prevention and management

P22.04

Updating a System for Accumulating Clinical Data from Kampo Medicine Clinics in Japan

Tetsuhiro Yoshino ¹ , Ayako Maeda-Minami², Yuko Horiba¹, and Koichi Fukunaga¹

¹Keio University, Shinjuku, Tokyo, Japan

²Tokyo University of Science, Noda, Chiba, Japan

Contact: Tetsuhiro Yoshino, [e-mail]

Abstract

Purpose: Since 2008, we have been developing and operating a system to collect clinical data on traditional Japanese Kampo medicine, funded by a national research grant. The system has accumulated clinical data from nearly 10,000 patients, enabling us to predict traditional medical diagnoses. Machine learning algorithms for this purpose have been previously reported. However, the existing system required local servers at each facility, posing cost and data integration challenges.

Method(s): To address these issues, we developed a cloud-based system that allows patient data to be collected and accessed using mobile devices. This eliminates the need for facilities to install individual servers, thus facilitating research participation.

Results: The new system enables secure sharing of clinical data among researchers, streamlining research collaboration. We aim to expand participation from more institutions and create algorithms that predict prescription choices of Kampo specialists.

Conclusions: This system has improved data management and research collaboration, paving the way for predictive models in Kampo medicine.

Author Index

A

Abanes, Jane: P02.03, P19.02

Abel, Erica: OA10.01

Abraham, Rebecca: P17.02

Abraham, Sarah: P05.15

Abu Narr, Lana: P19.04

Adams, Nicole: P05.17

Adler, Shelley: OA01.02, P05.14

Agrawal, Amulya: OA02.04

Aguemi, Adalberto: OA16.03

Ajani, Sanober: OA12.03

Al-sarhi, Yahya: P21.11

Albin, Jaclyn: OA02.04

Alendy, Fariza: P05.16

Alexopoulos, Anastasia-Stefania: P20.01

Alghamdi, Azhar: OA17.03

Alhunaiti, Tariq: P07.03

Ali, Omar: P21.11

Allard, Rhonda: OA05.02

Allen, Jennifer: OA15.02

Allen, Kelli: OA21.04

Allende, Santiago: P05.08

Almansi, Amjad: P07.03

Alqato, Shahd: P07.03

Amasha, Farah: P21.11

Anderson, Brian: OA16.01, P13.05

Anderson, Ekaterina: OA14.01, P16.04

Anderson, Timothy: OA19.02

Andrada-Brown, Emily: P07.02

Anheyer, Dennis: OA05.01, OA06.03, OA15.03

Anheyer, Melanie: OA06.03

Anzolin, Alessandra: P05.15

Aras, Shravan: OA20.03

Armstrong, Cheryl: P04.07

Arnold, L Eugene: P06.04

Arnsten, Julia: OA13.04

Arscott, Sara: P10.01, P10.06

Arvind, Sriram: OA22.01

Ashraf, Umair: P13.08

Ast, Hayleigh: P06.04

Atreya, Chloe: OA18.02

Aucoin, Monique: OA01.03, P07.01, P09.02

Awwad, Majd: P06.10

B

B.N, Gangadhar: P05.28

Baek, Gilgeun: P03.01, P03.04

Bail, Becky: OA03.03

Bailey, Aiko: P02.09, P21.05

Bakeer, Abdallah: P07.03

Baker, Justin: OA04.01

Bangerter, Ann: OA21.04

Bao, Huiyi: P05.15

Barata, Anna: P05.03, P05.07

Barbaro, Domenique: P07.01

Barkova, Sofia: OA17.01, P05.09

Barreto, Esteban: OA02.01

Bass, Benjamin: P05.16

Bassi, Navneet: P04.06

Batarseh, Suhel: P06.10, P07.03

Batchelder, Abigail: P05.13

Batson, Richard D: OA01.03

Baydoun, Mohamad: OA17.01

Bayley, Peter: P05.08

Becker, William: OA10.01, OA13.03

Bell, Austin: OA05.02

Belmonte, Eugenia: P11.05

Benjamin, Logan: OA10.05

Beno, Mark: P11.04, P19.01

Berkholz, Tina: OA03.03

Berkowitz, Allie Saul J.: P21.07

Bertozzi, Breklyn: P13.07

Besser, Micaela: OA07.01

Beucler, Adam: P21.08

Bhandiwad, Anup: P06.06, P21.09

Bhullar, Davinder: P05.19, P16.06

Biddle, Amanda: P15.05

Bilc, Mirela-Ioana: P06.12

Birnie, Katie: OA17.01

Black, Anne: OA10.01

Bleier, Benjamin: P06.02

Block, Seneca: OA11.01, OA11.04

Bokhour, Barbara: OA08.04, OA09.02, OA14.01, OA14.04, OA21.03

Bora, Suhani: OA01.02

Borkowski, Nancy: OA12.03

Bradley, Ryan: OA16.01

Bradley, Ryan: P03.03

Bretz, Slate: OA13.02, P15.02, P21.03, P22.01

Brewer, Claudia: OA08.03

Bronfort, Gert: OA21.04

Brooks, William: P04.05, P04.06

Brown, Adriel: P05.08

Bruni, Rosa: P11.05

Bruton, Alisha: P06.04

Bu, Zhijun: P11.03, P15.03

Buck, Ryan: P17.02

Burgess, Diana: OA05.04, OA10.03, OA10.04, OA21.04

Busby, Kenneth: OA04.01

Buxton, Rachel: P13.04

C

Cabral Schveitzer, Mariana: OA16.03, OA19.01

Callan, Nini: P03.03

Calvert, Collin: OA10.04, OA21.04

Candon, Molly: OA05.03, P09.03

Cao, Huijuan: P18.02

Cao, Yingren: P05.05

Caputo, Jacqueline: OA13.02, P15.02, P21.03, P21.10, P22.01

Cardinal, Claudette: P13.07

Carlson, Judy: OA06.04

Carlson, Linda: OA12.01, OA17.01, P05.09, P05.25, P17.03

Casselman, April: OA10.02

Chakraborty, Sharmistha: OA20.02

Chamberlin, Steve: P01.03

Chan, Selena: P05.27

Chang, Oscar: P21.14

Chao, Maria: OA02.02, OA18.02, OA18.03, P12.01

Chedekel, Bernard: P06.08

Chen, Hui: P16.03

Chen, Jason: P06.04

Chen, Lily: P05.05

Chen, Zhi: P06.05

Cheney, Ann: OA18.01

Cherkin, Dan: P02.09, P21.05

Chesney, Margaret: P13.02

Chiasson, Ann Marie: OA01.02

Childs, Kennedi: P05.01, P05.26

Chin, Isabel: OA04.04

Cho, Yu-Min: P01.01, P02.06

Choinière, Manon: P13.07

Chu, Grant: P15.01

Chu, T. Julian: P06.03

Citkovitz, Claudia: P04.07

Clayman, Marla: OA14.01

Clipper, Christie: P12.02

Cloutier, Joanna: P05.03, P05.07

Coccia, Goile: P11.05

Coggeshall, Scott: OA05.04, OA08.04, OA10.04, OA21.03, OA22.02

Cohen, Lorenzo: OA20.02

Cole, Codi: P16.03

Coleman, Lisa: OA13.02

Colgan, Dana Dharmakaya: OA21.02, P05.22

Colter, Wendie: P05.11

Conboy, Irina: P02.05

Conboy, Lisa: P02.05, P03.02, P03.05

Conboy, Michael: P02.05

Cook, Aaron: P02.04

Cooley, Kieran: P05.04, P07.01, P09.02, P13.02, P13.07

Cooreman, Jena: P16.03

Corren, Rachel: P05.27

Cotton, Sian: P21.08

Coulter, Ian: P13.02

Cramer, Holger: OA05.01, OA06.03, OA15.03, P06.12, P19.04

Crawford, Laurie: P13.10

Crosier, Abigail: OA05.02

Cross, Lee: OA10.03, OA21.04

Crowley, Matt: P20.01

Cupler, Zachary: P04.02

Cusimano, Andrew: OA20.02

D

Dahmer, Stephen: OA13.04

Dalseth, Marge: OA07.01

Davidson, Carolyn: P08.03

Daviglus, Martha: OA04.04

Davis, Allison: P05.01

Davis, Christine: OA11.02

Davis, Madison: P05.13

Del Toro, Kimberly: OA18.01

DeLa Cruz, Ruth: OA02.01

Deleemans, Julie: P05.09, P05.25, P17.03

Delmore, Barbara: P05.16

Delorme, Arnaud: OA20.02

DeMarco, Kathleen: P05.16, P09.04, P21.02, P21.07

DeMera, Richard: P06.02

Deng, Defeng: OA20.02

Deuster, Patricia A: OA20.03

Devarney, Danielle: OA22.03

Dhruva, Anand: OA01.02, OA12.04, OA18.02, P10.06, P20.02

Diaz, Rosalie: P02.07, P05.10, P05.19, P08.02, P16.06, P21.12

DiBiase, Jennifer: P21.04

DiCristofano, Christy: P06.01

DiFrancesca, Giovanna: OA13.04

Dignan, Katherine: P05.10, P05.19, P08.02, P16.06, P21.12

Ding, Yan: P15.01

Diroma, Antonio: P11.05

Dones, Makayla: OA14.01

Dossett, Michelle: OA15.01, P04.05, P04.06, P05.17, P07.02, P16.03

Douglas, Jamie: OA08.04, OA09.02, OA10.01, OA14.04, OA18.04, P16.04

Drake, Emily: OA20.01, P04.10

Dryden, Eileen: P16.04

Du, Yawen: P11.03

Du, Yu: P05.06

Duchemin, Anne-Marie: OA13.02, P15.02

Dumitru, Elisa: P14.02, P14.03

Dunklebarger, Tammy: OA07.01

Duong, Jeffrey: P07.02

Durand, Madeleine: P13.07

Durieux, Natalie: OA17.02

Durve, Anisha: P02.01, P10.06

Dusek, Jeffery: OA05.03, P09.03, P11.04, P19.01

Dvorak, Theresa: OA01.04

E

Eck, Chase: OA14.04

Eisendrath, Stuart: P05.14

Ekpo, Elizabeth: P07.02

El-Jawahri, Areej: P05.03, P05.07

Elder, Charles: P06.07, P20.02

Elder, Leslie: P06.07

Eliasen, Kathryn: OA05.02

Eliassen, A. Heather: OA04.04

Elsayed, Maram: P21.11

Elzeny, Esraa: P21.11

Emrani, Ariel: P05.23

Emrich, Mariel: OA04.04

Engel, Charles: OA08.04

Engle, Charles: P18.01

Esquenazi-Karonika, Shari: P09.04, P21.07

Etingen, Bella: OA08.04, OA09.02

Evans, Roni: OA02.03, OA21.04

Evans-Durán, Benjamin: P13.07

F

Fang, Jin: OA12.02

Fang, Zheyi: P15.04

Farewell, Charlotte: P13.01

Farnam, Emelia: P05.03, P05.07

Faryar, Kiran A.: OA11.02

Faydenko, Jocelyn: OA09.04

Fazzio, Corinna: P04.06

Fei, Yutong: P18.02

Felder, Jenn: P05.14

Feng, Alex: P05.12

Ferguson, John: OA21.04

Ferguson, Mitchell: P04.10

Fernandes, Mariana Frasnelli Matias: P13.06

Fernando, Christa M: P12.01

Ferreira, Arthur: OA19.01

Fertal, Jamie: P06.01

Fetterly, Dominic: P04.10

Fiame, Belkys: OA06.04

Fiandra, Alessia: P11.05

Fields, Chris: OA20.02

Filbin, Patricia: OA08.02

Finkelstein-Fox, Lucy: OA02.01, OA17.02, P05.03, P05.07

Finnell, John: OA09.04, OA10.02

Finney, Anisa: P03.02

Fiorelli Cantarino, Priscilla Alessandra: P13.06

Fishel, Tobi: OA09.03

Flike, Kimberlee: P16.04

Flynn, Emily: P04.07

Fogelberg, Donald: P05.22

Foley, Jacklyn: P05.13

Follestad, Payton: OA08.02

Foltz, Gina: P08.03

Fortin, Éric: P13.07

Fortuna, Sandra: P11.05

Foss, Angelique: OA11.01, OA11.04

Francisco, Jasmin: P05.08

Frates, Beth: OA22.03

Freiermuth, Caroline: P21.08

Friedman, Jessica: OA10.03

Frochen, Stephen: OA10.04, OA22.02

Fukunaga, Koichi: P22.04

Funabashi, Martha: P15.06

G

Gabriel, Mindy: P15.02

Gajtani, Zen: OA17.01

Gang, Weijuan: OA22.04, P02.08

Garcia, Kimberly: P04.07

Gardiner, Joseph: P13.04

Garland, Eric: OA13.01, P05.26

Garnsey, Camille: OA04.04, P05.02

Gauthier, Amythest: OA13.02

Gentile, Nikki: P02.09

Geyer, Rachel: P02.09

Ghelman, Ricardo: OA16.03, OA19.01

Ghiroli, Megan: OA03.04

Giabatti, Zaina: P07.03

Gibson, Robert: P05.01

Ginther, Jane: OA13.02

Gnall, Katherine: OA04.04, P05.02

Godin, Guy-Henri: P13.07

Goertz, Christine: OA10.05, OA21.01, P04.03

Goldenberg, Joshua: OA01.03

Goldman, Veronica: P05.14

Goldsmith, Elizabeth: OA13.03

Golianu, Brenda: OA04.01

Goode, Adam: OA10.05

Gopi, Paramesh: OA11.03, P06.02

Goshe, Brett: OA02.01, P05.03, P05.07

Graham, Stephen: P08.03

Gray, Nora: P01.03

Greenblatt, Melissa: P06.06

Gregory, Steph: OA07.02

Gresner, Emily: P21.01, P21.13

Griffith, Kelly: OA12.02

Grout, Leah: OA19.03, P13.03, P13.05

Grover, Kristie: OA16.04

Groves, Peyton: P10.02

Gruska, Janis: P11.02

Gunzler, Douglas: P11.04, P19.01

Gutierrez, Gabriela: OA08.03, OA18.02

Guzman, Allison: OA04.03

H

H.R, Nagendra: P05.28

Hagel Campbell, Emily: OA21.04

Hager, Wren: P05.07

Haley, Alexander: OA21.04

Hall, Allyson: OA12.03

Hall, Daniel: OA17.02

Haller, Heidemarie: OA15.03

Hamary, Victoria: P08.02

Hammett, Patrick: OA13.03

Hanley, Adam: P05.01, P05.26

Hannah, Alexis: P13.05

Hanson, Linda: OA02.03

Haridas, Keerthana: OA15.02

Harper, Elleson: P04.02

Harris, Richard: P05.15

Harrison, Jessica M.: P05.14

Hartogensis, Wendy: P05.14

Hassett, Afton: OA03.03

Hatsu, Irene E.: P06.04

He, Nagongbilige: P05.06

Hearld, Kristine Ria: OA12.03

Hecht, Rick: P05.14

Hedge, Anantkumar: P01.02

Hedgpeth, Nicol: P06.01

Hegde, Ilaadevi: P01.02

Hegde, Prajna: P01.02

Hegde, Vrushali: P01.02

Heil, Dan: OA19.03

Helfrich, Christian: OA14.01

Herman, Patricia M: OA16.01

Hogan, Timothy: OA08.04

Holkeboer, John: P21.09

Hong, Angel: P04.04

Hood, Charles: P06.08

Horiba, Yuko: P22.04

Horick, Nora: P05.03

Horowitz, Bruriah: OA17.03

Horton, Teresa: P13.04

Hosek, Ronald: OA20.01

Howard, Lisa: P10.06

Hribar, Mary Beth: OA03.04

Hu, Katie: OA01.02, P15.01

HU, XIAOYI: OA22.04, P02.08

Huang, Jiayan: P15.01, P15.04

Hudson, Mandilin: P21.01

Hui, Edward: P15.01

Hui, Ka-Kit: P15.01

Humbert, Andrew: P02.09

Huston, Alissa: OA12.02

Hwang, Peter: OA11.03, P06.02

Hyde, Justeen: OA14.01, P16.04

I

Iacob, Eli: P04.07

Ibáñez-Carrasco, Francisco: P13.07

Ichigotora, Kris: P03.05

Ingersoll, Sarah: P16.01

Integlia, Davide: P11.05

Iqbal, Shafaqmuhammad: OA20.02

Isralowitz, Richard: OA01.01

J

Jackson, Jhia: OA02.02, P12.01

Jacobsen, Robert: P06.01

Jaffe, Atara: OA08.02

Jagannathann, Aarti: P05.28

Jamieson, Paige: P03.03

Jan, Amanda: P07.02

Jang, Andrew: OA07.04, P02.02

John, Sydney: OA12.02

Johnson, Jacob: P06.02

Johnson, Jill: P04.07

Johnstone, Jeni: P06.04

Jones, Jennifer: OA12.01

Joseph, Jessica: OA13.02

Joy, Monica: OA15.01, P05.17, P07.02

K

Kanaya, Alka: OA04.04

Kang, Manho: P03.01, P03.04

Kaplan, Joshua: P05.24

Kaplon, Annie: P21.02

Karim, Safiya: P17.03

Kasom, Danna: OA10.03

Katti, Kattesh: OA17.04, P01.02

Katti, Kavita: OA17.04, P01.02

Kazman, Josh B.: OA20.03

Keck-Kester, Terrah: P13.10

Kedilaya, Sujatha: P04.01

Kempe, Elizabeth: P16.06

Kennedy, Douglas: OA02.03

Kennedy, Kalyanii: P21.01

Kent, Blake: OA04.04

Kerns, Robert: OA10.01

Kerr, Bradley: OA22.01

Khoobchandani, Menka: OA17.04

Kiefer, Patricia: P08.02

Kim, Elyssa: P06.01

Kim-Hassel, Peea: P20.02

Klatt, Maryanna: OA13.02, P15.02, P21.03, P21.10, P22.01

Klawiter, Eric: P05.23

Klee, Dan: P05.24

Kleppe, Maranda: P04.01

Kloehn, Alex: OA18.04, P16.04

Knowles, Abigail: OA02.04

Ko, Heejoo: OA02.02

Kocher, Zena: P04.07

Kogan, Mikhail: P13.08

Kogan, Mikhail: OA01.01, OA01.02

Kohatsu, Wendy: OA01.02

Koroukian, Siran: P11.04, P19.01

Kotleski, Kristin: OA22.01

Kraemer, Kristen: OA19.02

Krebs, Erin: OA13.03

Kreutzwiser, Denise: P13.07

Krstic, Sanja: OA15.03

Krych, Peyton: P21.13

Ku, Sarah: P06.01

Kuhlthau, Karen: OA02.01

Kumar, Vinod: P05.28

Kushida, Clete: OA11.03

Kuyken, Willem: P05.14

L

L. Friedly, Janna: P02.09

Labarre, Ashley: P21.13

Lacasse, Anaïs: P13.07

LaChance, Laura: P07.01, P09.02

Laird, Lance: P05.21

Landis, Courtney: P13.10

Larkey, Linda: P05.18

Larsen, Matthew: P16.02

Lau, Annie: P05.08

Lauscher, Darren: P13.07

Lavretsky, Helen: P05.21

Lawal, Oluwaseyi: OA12.01

Lee, Hee Jae: P13.03

Lee, Hyungchul: P03.01, P03.04

Lee, Nakyoung: P03.01, P03.04

Lee, Richard: P05.18, P06.01

Lee, Ruth: P04.06

Lee, Ye-Seul: OA07.03, P02.10, P09.01

Lee, Yujin: P03.01, P03.04

Lehner, Taylor: P05.18

Leiferman, Jenn: P13.01

Leininger, Brent: OA02.03

Leung, Brenda: P06.04

Leung, Ivan: OA18.02

Li, Aizhong: OA12.02

Li, Anqi: OA16.02

Li, Mengchi: P11.03

Li, Zhiqiang: OA19.04, P18.02

Liang, Di: P15.01, P15.04

Liang, Mark: P17.01

LIANG, YUXIAO: P05.05

Lin, Bryant: OA11.03, P06.02

Lin, Kevin: OA11.03

Lin, Shin: P05.05, P21.14

Lindenberg, Julia: OA19.02

Lisi, Anthony: OA06.02, P04.03

Liu, Fengshuang: P11.03

Liu, Zhaolan: P11.03, P15.03, P18.02

Locher, Blake: P20.02

Locke, Amy: OA01.04

Loew, Brenda: P21.05

Loftis, Jennifer: P06.04

Long, Cynthia: OA21.01, P04.03

Longyear, Michael: P04.10

Look, Mele: OA19.03

Lopez, Karen: OA02.01

Lothe, Katie: P10.03

Love, Thomas: P11.04, P19.01

Low, Abigail: P16.03

Low Dog, Tieraona: OA01.02

Loy, Michelle: OA15.04

Lu, Chenge: P11.03

Luberto, Christina: OA17.02

Luo, Gang: OA05.04, OA14.04

Luong, Amber: P06.02

Lurie, Jon: OA10.05

Lutz, Danielle: OA09.02

Lysius, Fedline: P21.04

M

Ma, Yifei: OA11.03, P06.02

Machingo, Taryn: P06.04

MacVittie, Katie: P21.08

Madigan, Dana: OA09.04

Madsen, Kayla: P04.07

Maeda-Minami, Ayako: P22.04

Maggia, Ashley: OA22.01

Mahaffey, Brittain: OA02.01

Mahan, Ahmad: P05.15

Mahoney, Louise: P05.08

Maiers, Michele: P13.02

Majd, Iman: P02.09, P10.06, P21.05

Makaroff, Katherine: P06.11

Makineni, Pratheek S.: OA06.01

Malika, Nipher: P13.02

Mamat, Zulkayda: P05.08

Manglani-Terranova, Heena: P05.23

Manion, Brook: P21.13

Marchica, Laura: P08.01

Marcovitz, Jenna: OA04.03

Marino, Ryan: OA11.02

Mark, John: OA04.01

Marshall, Lauren: P21.09

Martel, Matthew: P16.04

Martins Ribeiro, Maria Claudia: OA19.01

Massad, Dina: P07.03

Matecki, Amy Ying Li: P05.12

Mathur, Mala: OA04.02, OA22.01

Matthews, Jenifer: OA04.02

Matthias, Marianne: OA21.04

McCann, Marissa: OA19.02

McCarey, Jacob: OA21.01, P04.03

McCarthy, Areyanna: P09.04

McCarthy, Areyanna: P21.07

McGowan, Michael: OA10.03

McGraw, Meriden: P21.08

McGuffin, Carol: P21.07

McGuire, MPH, Nicholas: P21.16

McNulty, Candace: OA14.03, P21.06

Mehrazar, Targol: P21.01

Mehta, Darshan: OA01.02, OA11.03, P06.02, P10.06

Meibert, Jörg: OA15.03

Meibert, Petra: OA15.03

Meis, Laura: OA21.04

Melbourne, Julie: OA14.02

Mendes Abdala, Carmem Veronica: OA16.03, OA19.01

Menzer, Heather: P21.04

Merrill, Joseph: OA03.01

Metz, Tom: P03.03

Michel, Martha: OA18.04, P18.01

Milan, Stephanie: OA08.01

Milea, Ion: P14.02, P14.03

Millon, Emma: P05.16, P09.04

Millstein, Rachel: OA02.01

Mina, Raef: P05.09

Minichiello, Vincent: OA01.02, P10.01, P10.06

Minkalis, Amy: P04.01, P04.03

Miranda, Isabelle: OA02.01, P05.03

Mishra, Kavita: OA18.02

Mittman, Brian: P05.21

Mohan, Vivek: OA11.03, P06.02

Molloy-Paolillo, Brianne: P16.04

Monier, Zak: P15.06

Montalvo, Jessica: P17.02

Moonaz, Steffany: OA03.04

Moran, Patricia: P05.14

More, Pooja: P05.28

Moreira, Jacqueline: OA18.01

Moreno, Camille: OA07.01

Mori, DeAnna: P05.20

Morris, Lindsay H.: OA06.01

Morshed, Mohamed: P21.11

Morvant, Alexis: OA04.01

Moss, Clayton: P16.02

Moustafa, Nada: P21.11

Mullur, Rashmi: OA04.03, OA15.02

Mulugeta, Yulia: OA13.02, P15.02, P21.03, P22.01

Munoz, Francisco: P05.18

Munoz, Frank: P06.01

Murillo, Jorge: P04.05

Murphy, Melissa: P09.02

N

Nahvi, Shadhi: OA03.04

Nanavati, Kaushal: P06.05

Nasre, Kevin: P04.06

Nehme, Jad: P05.05, P21.14

Nelson, Ashlee: P04.07

Nelson, Monica: OA20.02

Ng, Jeremy Y.: OA05.01, P19.04

Nguyen, MiaChanel: P05.15

Nguyen, Phuong: OA20.02

Nguyen, Tina: P05.09

Nicolo, Michele: P14.01

Nicolosi, Gabriella: OA02.01

Nielsen, Arya: OA05.03, P09.03

Niles, Barbara: P05.20

Niranjan, Soumya: OA12.03

Nishitha J, Lakshmi: P05.28

Nourse, Pam: OA02.01

Nunokawa, Courtnee: OA06.04

O

O'Brien, Kelly: P13.07

O'Cleirigh, Conall: P05.13

Oberoi, Devesh: OA12.01

Oken, Barry: P05.24

Olson, Juli: OA07.02, OA10.04

Oltean, Roxana: P14.02, P14.03

Oomen-Lochtefeld, Samon: P06.08

Ortiz, Robin: P21.07

Osherow, Erika: P05.02

Owens, William: P15.06

P

Pagé, Gabrielle: P13.07

Palchik, Guillermo: P04.05, P04.06

Pallerla, Harini: P21.08

Palmer, Julia: OA03.01

Palmer-Kelly, Elizabeth: OA13.02

Pang, Dorothy: P02.03

Paradero, Hayley: P15.05

Park, Crystal: OA04.04, OA08.01, P05.02

Park, Elyse: OA02.01, OA17.02, P05.03, P05.07

Park, Juheon: P03.01, P03.04

Park, Sunghwan: P03.01, P03.04

Parman, Natasha: OA21.02, P05.22

Parsons, Michael: P13.07

Patel, Darshana: P02.07

Patel, Nikita: OA12.04

Pawlik, Timothy: OA13.02

Pearson, Amber: P13.04

Pena, Giselle: P05.16

Penco, Italo: P11.05

Perez, Giselle: OA17.02, P05.03, P05.07

Perez, Jaime: P04.02

Perez, Julianna: P13.04

Perez, Tyson: OA20.01

Perlmutter, Austin: OA08.02

Pescatello, Linda: OA08.01

Peterson, Thomas: OA05.02

Petersson, Jamie: P05.25

Petzold, Margaret: OA01.04

Pfeiffer, Karin: P13.04

PHAN, SAMANTHA: P21.14

Pheiffer, Laura: OA13.02

Piedalue, Katherine-Ann: OA12.01

Pike, Kenneth: OA03.01

Pirkle, Catherine: OA19.03, P13.03

Pluimer, Brock: P05.15

Poff, Tracy: P05.11

Pohlman, Katherine: P15.06

Polusny, Melissa: OA21.04

Ponzini, Matthew: P16.03

Portella, Caio: OA16.03, OA19.01

Prakash, Deepa: P01.02

Prasad, Arti: P06.07

Prathikanti, Sudha: OA08.03

Pratt, Michael: OA19.01

Prenguber, Marcia: P13.02

Price, Colleen: P13.07

Price, Cynthia: OA03.01

Prussakova, Anastasia: P05.23

Q

Qian, Alyssa: P19.04

Qinaʻau, Joanne: OA18.03

Quatman-Yates, Catherine: P15.02

Quesada, Megan: OA11.02

R

Rahenkamp, Kelsey: P15.05

Rai, Zenith: P16.04

Raiciulescu, Sorana: P19.02

Ramos, Luiz: OA19.01

Randall, Jesse: OA17.03

Rao, Raghavendra: P05.28

Rao, Santosh: OA11.01

Raphael Karikachery, Alice: OA17.04, P01.02

Rawles, Jody: P17.01

Razzak, Rab: OA11.04

Reddy, Kavitha: OA09.02

Reed, David: OA08.04, P18.01

Reimer, Raylene A.: P17.03

Renner, Carine: OA04.02

Resnicoff, Marci: P21.02

Rice, Kathleen: P13.07

Richardson, Bill: P17.03

Rindfleisch, Adam: OA01.02

Ring, Melinda: OA01.02, P10.04, P10.06

Rinne, Seppo: OA14.01

Rippey, Rosalie: OA02.01

Risser, Kayleigh: OA11.04

Rist, Pamela: OA06.02

Robinette, Lisa M.: P06.04

Rodgers-Melnick, Samuel: OA11.02, OA11.04, P11.04, P19.01

Romeiser, Jamie: P06.05

Rooney, Meghan: P08.03

Rose, Gail: OA09.05

Rose, Johnie: P11.04, P19.01

Rose, Judith: P06.01

Roseen, Eric: P05.21

Rosen, Rachel: OA17.02

Ross, G. Webster: OA06.04

Rosser, Ethan: OA05.04, OA08.04, OA21.03, OA22.02

Rouchka, Jennifer: P08.04

Rubinstein, Sidney: P15.06

Ruby, Kayla: P03.05

Runyon, J. Ray: OA20.03

Rupp, Tracy: OA05.02

Rush, Ashley: OA14.03, P08.01

Ruskin, Rachel: P16.03

Ruvalcaba, Denise: OA02.02, P12.01

S

Saladar, Tracy: P10.03

Salem, Ali: P21.11

Salmaggi, Darah Kristine: OA09.01, P09.04

Salsbury, Stacie: OA10.05, P04.03, P13.02

Sanchez, Mala: OA14.02

Sandhu, Amandeep Sandhu: OA17.03

Sandoval, Jett: P21.14

Sanogo, Fatimata: P14.01

Santoro, Barbara: P11.05

Saper, Robert: P05.21

Saulsbery, Dylan: P04.10

Sayaseng, Jenny: P07.02

Schafer, Judy: OA18.04

Scheinbach, Julia: P05.13

Schlesinger, Michelle: P16.02

Schmid, Simone: OA19.03, P13.03

Schneider, Jennifer: P20.02

Schneiderhan, Jill: OA01.02, OA03.03, P06.06

Schröter, Marleen: OA15.03

Schult, Tamara: OA09.02

Schuman, Haley: OA17.01, P05.09

Seal, Karen: OA13.03

Segal, Zindel: P05.14

Segall, Tracy: OA11.04

Sentell, Tetine: OA19.03, P13.03

Shah, Aimun Qadeer: P19.04

Shaheen, Mostafa: P21.11

Shahjalal, Md.: P11.03

Shang, Sharon: P05.05

Shannahan, Anna: P10.04, P10.06

Shannon, Zacariah: OA21.01, P04.03

Shen, Chen: P03.06, P19.03

Sheng, Xiaoming: OA07.01

Sheta, Heba: P21.11

Shewakramani, Sanjay: P21.08

Shi, Zeyang: P15.03

Shields, Alexandra: OA04.04

Shieu, Bianca: P01.01, P02.06

Shin, Marlena: OA10.03, OA21.03

Shu, Qin: P15.01

Shubov, Andrew: P06.11

Shumer, Gregory: P21.09

Sico, Jason: OA06.02

Siler, Milette: OA02.04

Sinnott, Sinead: OA08.01

Siriwardhana, Chathura: OA06.04

Sivakumaran, Sarmitha: P13.07

Siwik, Chelsea J.: P05.14

Skanderson, Melissa: OA06.02

Slawek, Deepika: OA13.04

Sliwka, Margaret: OA20.01

Smalheer, Alecia: P02.07

Smith, Alyssa: OA09.05

Somple-Jay, Darice: P08.02

Soneji, Samir: P12.02

Song, Lixin: P02.06

Song, Yike: P11.03, P15.03

Soriano, Scarlet: OA01.02

Sparks, Matthew: P20.01

Speca, Michael: OA12.01

Sperling, Edie: P21.01, P21.13

Spiropoulos, Athina: OA17.01, P05.25, P17.03

Spratt, Susan: P12.02

Sridhar, Apeksha: P05.15

Srikanth, Priya: P06.04

Srinivasan, Roshini: P04.02

Srinivasan, Roshini: P12.02, P20.01

Staab, Carina: P05.22

Standley, Joseph: P16.02

Starrels, Joanna: OA03.04, OA13.04

Steinberg, Beth: P15.02, P21.03, P21.10, P22.01

Stermer, Evan: P16.02

Sternberg, Esther M.: OA20.03

Stevens, Jan Frederik: P03.03

Stockwell, Randi: OA22.01

Stuber, Kent: P15.06

Su, Kay: P21.14

Sulieman, Abdelrahman: P07.03

Sullivan, Stephanie: OA20.01, P04.10

Sun, Jialin: P15.03

Susanto, Jeremiah: P05.05

Swartz, Hannah: P21.07

Sweat, Sean: P10.02

Swedlow, Pam: P12.01

Swidrovich, Jaris: P13.07

Swords, Christina: P10.01

T

Takahashi, Madeleine: P21.01

Taylor, Brent: OA10.04, OA21.04

Taylor, Stephanie L.: OA05.04, OA10.03, OA10.04, OA21.03, OA21.04, OA22.02

Taylor-Swanson, Lisa: OA07.01, P02.05, P04.07

Teba, Catalina: OA11.04

Temple, Leslie Mendoza: OA01.01

Thayer, Julian F: OA20.03

Thipe, Velaphi: OA17.04, P01.02

Thompson, Dr Michelle: P10.02

Thompson-Lastad, Ariana: OA02.02, OA18.02, P12.01

Thongchanh, Sakuna: OA14.02

Tippens, Kim: P13.02

Toledo-Corral, Claudia: P14.01

Toyama, Joy: OA21.03, OA22.02

Tracy, Erin: OA05.02

Trager, Robert: OA06.01, P04.02

Tran, Ethan: P05.05

Tran, Phi: P06.01

Treadway, Anna: OA03.01

Treasure, Michelle: P02.07

Trinquart, Ludovic: P05.21

Tseng, Alice: P13.07

Tu, Wen: OA07.01

Twist, Elissa: P04.01

Tyrrell, Caitlin: OA06.04

U

Uebelacker, Lisa: OA03.04

Uhley, Olivia: OA13.04

V

Vader, Kyle: P13.07

Van Deventer, Katherine: P16.03

Varela A., Paolo: P06.10, P07.03, P21.11

Vatovec, Christine: OA16.04

Veldheer, Susan: P13.10

Vera, Jaime: P13.07

Victorson, David: OA17.03

Vigo, Katrina: OA09.01, P21.02

Vilela Braga, Alexandre: OA14.01

Villanueva, Jamie: OA21.02

Viloria Rodriguez, Karina: P10.01

Vining, Robert: OA21.01, P04.01, P04.03

Visco, Ashley: P13.10

Vo, Thanh Thanh: P07.02

Voronoff, Sophia: P21.01

Voyles, Claudia: OA07.02

Vranceanu, Ana-Maria: P05.23

W

Wachholtz, Amy: OA03.02

Waldron, Elizabeth: P05.07

Wallace, Robert: P04.03

Walsh, Elizabeth: P10.06

Walsh, Lori: P10.04

Wang, Brianna: OA19.02

Wang, Chenchen: P05.20, P05.21, P06.08

Wang, Kaicheng: OA06.02

Wang, Min: P02.06

Wang, Qianyun: P11.01

Wang, Xuefeng: P15.03

Wang, Yuwen: P15.04

Watson, McKenzie: P06.05

Wayne, Peter: OA06.02, OA12.01

Weber, Natalie: OA13.02

Webster, Kath: P13.07

Wegman, Sankari: P06.07

Wei, Daoyan: OA20.02

Weigensberg, Marc: P14.01

Wennik, Jesse: P12.01

Wenninger, Maren: OA07.04

Wesolowicz, Danielle: OA10.01

Westervelt, Karen: OA09.05

Wexler, Ryan: P05.24

Whedon, James M: OA16.01, P04.08

Whitley, Margaret: OA09.04

Wiener, Renda: OA14.01

Williams, Felicia: P12.02

Williams, Marcus: P15.02

Williams, McKenna: P02.04

Williams, Renee: OA02.01

Williamson, Timothy J.: OA06.01

Wilson, Machelle: P04.06, P16.03

Winklosky, Brian: OA02.01

Woldesenbet, Selemawit: OA13.02

Wong, Willis: OA02.04

Woods, Abigail: P21.07

Worts, Phillip: P05.01

Wu, Cairn: P20.02

Wu, Hongyun: P05.06

Wu, Julia: P12.01

X

Xiu, Wencui: P02.08

Xu, Helen: P05.05

Y

Yam, Scott: P06.03

Yang, Hanyu: P11.03

Yang, Kristina: P05.05

Yang, Peiying: OA20.02

Yang, Zihan: P11.03

Yanuck, Michael: OA15.01, P05.17

Yasin, Ahmed: P21.11

Yee, Alan: P04.05, P04.06

Yeh, AnnMing: OA04.01

Yeh, Chao Hsing: P01.01

Yeh, Gloria: OA19.02, P05.13, P05.23

Yen, David: P06.02

Yen, Jacqueline: P05.15

Ylli, Alban: OA19.03

Yoannou, Nicole: P09.02

Yokooji, Esme: P13.03

Yong, Michael: P06.02

Yoon, Sanghun: P03.01, P03.04

Yoon, Young suk: P02.02

Yoshino, Tetsuhiro: P22.04

Younies, Gena: P05.05, P21.14

Yu, Hainan: P09.02

Yu, Haitong: OA11.04

Yuen-Loc, Nina: P15.01

Yurcak, Rosemarie: OA09.01, P09.04

Yusipova, Yulia: P22.02

Z

Zacharias, Michael: OA11.04

Zanovelo Fogaça, Lissandra: OA19.01

Zappa, Melissa: P02.01

Zavotsky, Kathleen: P05.16

Zeliadt, Steven: OA05.04, OA08.04, OA09.02, OA10.01, OA10.04, OA14.01, OA14.04, OA18.04, OA21.03, OA22.02, P16.04, P18.01

Zeng, Sihang: OA05.04

Zhang, Chenshu: OA13.04

Zhang, Jing: P02.09

Zhang, Weijun: P05.21, P11.01, P15.01

Zhang, Xiaoyi: OA14.04, OA21.03

Zhang, Yu-Qing: OA16.02

Zhang, Yunqi: P21.14

Zheng, Wei: P15.03

Zhong, Pu: P11.03

Zhong, Qinhong: P11.03

Zhou, Xiao: P15.03, P19.03

Zhuo, Ronger: P11.03

Zitek, Chadbourne: P21.01

Zolotov, Yuval: OA01.01

Zook, Zach: P13.10

Zuidema, Kile: OA17.03

Zuniga, Esteban: OA18.04

Zuniga, Samara: OA10.01

Zwickey, Heather: OA01.03, OA08.02