Oregon College Of Oriental Medicine Research Articles

Super-Users at an Acupuncture and Oriental Medicine Teaching Clinic: Demographics and Unique Clinical Characteristics.

The use of acupuncture in the United States has consistently grown over the last two decades, and the National Center for Complementary and Integrative Health has recently called for greater understanding of "real life outcomes and use" by complementary and alternative medicine users. This study assesses the demographics and utilization patterns of "super-users" treated at the Oregon College of Oriental Medicine intern clinic. This was a retrospective chart review at the Oregon College of Oriental Medicine (OCOM) intern clinic, a large acupuncture and oriental medicine (AOM) school in Portland, Oregon. Participants were patients who were treated 100+ times at the OCOM between August 6, 2002, and 2012. The outcome measures were demographic and treatment characteristics, including sex, age, chief complaint, income, medication use, and visit patterns. The super-user cohort comprised approximately 1.5% of the total annual patient population and 8% of total visits at the OCOM in any given year, with an average treatment duration of 4 years from visit 1 to visit 100, and a visit frequency of 32 visits per year. Similar to other studies, the super-user cohort consisted predominantly of older, female patients seeking treatment primarily for pain (57.3%). Prescription medication use (45.2%) was also similar to other acupuncture cohorts. In contrast to typical AOM patients, OCOM super-users were older, with 64% being age ≥50 years when initiating treatment, and a majority reported low-income status (92%). Super-users represent a small yet real subset of AOM patients. They tend to be older, report lower income, and exhibit greater visit frequency than more typical AOM users. The factors motivating AOM super-user behavior may be different from those in other medical domains, notably emergency medicine, and likely include long-term management of chronic pain and other chronic conditions. Future studies into the long-term health outcomes of AOM super-users, as well as the economic impact on other health services, are warranted.

Impact of After Visit Summaries on Patient Return Rates at an Acupuncture and Oriental Medicine Clinic.

Objective: To determine whether an after visit summary (AVS) provided to patients at the conclusion of their first acupuncture treatments affects the number of times patients return for follow-up treatments, a retrospective cohort study was performed. Materials and Methods: Two random samples of 100 new patient records (N=200) at the Oregon College of Oriental Medicine's (OCOM) outpatient clinics in Portland, OR, were reviewed over a 3-month period before and after the implementation of using the AVS. Patients who had been seen previously at any of the college clinics were excluded. The number of return visits recorded in the MediSoft™ database was hand counted for each patient. Results: The use of an AVS did not significantly change the mean number of return visits for acupuncture (2-sided p-value=0.91), but there was a trend toward more frequent returns by patients who received AVS, compared to those who did not (2-sided p-value=0.0827, relative risk [RR]: 1.51, confidence interval [CI] 0.95-2.41). Conclusions: These data support the concept that the AVS has a positive influence on patient return rates. In this study, patients who received an AVS were 51% more likely to return for 5 visits than patients who did not receive an AVS.

AcuTrials®: an online database of randomized controlled trials and systematic reviews of acupuncture

BackgroundThe growing quantity of Complementary and Alternative Medicine literature requires databases enabled with increasingly powerful search capabilities. To address this need in the area of acupuncture research, a bibliographic database of randomized controlled trials (RCTs) and systematic reviews called AcuTrials® has been developed by the Oregon College of Oriental Medicine. AcuTrials® introduces a comprehensive keyword thesaurus that categorizes details of treatment protocols and research design to an extent not currently available in MEDLINE or other databases.DescriptionAcuTrials®, which went live in January of 2010 and is updated monthly, currently contains over 1250 articles from more than 300 journals. Articles included are English language RCTs and systematic reviews that report on medical conditions in human subjects treated by needle acupuncture. Study details are indexed by 14 key domains, such as acupuncture style and needling protocol, to create an acupuncture-relevant, searchable keyword catalogue. Keywords follow the National Library of Medicine (NLM) MeSH terminology when possible, and new keywords were created in cases where no appropriate MeSH terms were available. The resulting keyword catalogue enables users to perform sensitive, targeted searches for particular aspects of acupuncture treatment and research design.ConclusionsAcuTrials® provides an extensive and innovative keyword catalogue of acupuncture research, allowing users to efficiently navigate, locate and assess the evidence base in ways not currently possible with other databases. By providing a more powerful suite of search options, the AcuTrials® database has the potential to enhance the accessibility and quality of acupuncture research.

A Chart Review from an Oriental Medicine College, Comparing Patients Who Came for Only One Visit and Those Who Came for at Least Five Visits

Abstract Background: While there have been studies examining who seeks acupuncture treatments, there have not been any studies to see who returns for more treatments. Objective: This study was conducted to compare demographic, symptomatic, and syndrome differentiation among patients who came for one visit and those who came for five or more visits. Design: This was a chart review comparing 33 randomly chosen patients who came to the Oregon College of Oriental Medicine (OCOM) clinic for one visit to 39 randomly chosen patients who came for five or more visits. Setting: All patients were seen by student interns at the Acupuncture and Herbal Clinic of the OCOM. Patients: All patients were new patients to the clinic who came for their first visit during the spring and summer quarters of 2008. Outcome Measures: The two groups were compared with respect to a variety of demographic factors and presenting conditions. Results: Age was the major statistically significant difference between the two groups. There wer...

Teaching Research Literacy: A Model Faculty Development Program at Oregon College of Oriental Medicine

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Attitudes and Interests Toward Research Among Students at Two Colleges of Acupuncture and Oriental Medicine

Collaborative input from clinicians of acupuncture and Oriental medicine (AOM) is required for sound AOM research, and AOM training institutions have begun to include research education into their curriculum. However, few attempts have been made to systematically evaluate AOM practitioners' perspectives on the value of research to their profession. We conducted surveys of AOM students at two institutions that have begun to integrate research training into their curriculum, the New England School of Acupuncture and the Oregon College of Oriental Medicine. Surveys were conducted to assess current attitudes regarding the value of research and to serve as a reference point for documenting the impact of ongoing research training programs on these attitudes. Surveys at both institutions were independently developed and administered but shared seven questions that were phrased very similarly. This paper summarizes responses to these questions. Surveys at both institutions suggest interest in research among AOM students is high in first-year students; students in later years showed a lower level of interest, but the cross-sectional design of this survey does not allow any temporal effects to be inferred. Results also indicate that AOM students believe research is highly relevant to how both the public and the health insurance industry view their system of healthcare but not highly relevant to their own clinical practice of AOM. The belief that research is of limited relevance to clinical practice was associated with widespread belief that scientific methods may not be consistent with the principles of AOM. Results of these surveys provide important preliminary information about attitudes of AOM students toward research, and thus the value and future specific needs of research training programs targeting this population. Repeated implementation of validated versions of our surveys are needed to confirm the trends we report and to evaluate the impact of research training programs already in place on AOM students' attitudes toward research.

Integration of Acupuncture into Family Medicine Teaching Clinics

As growing numbers of patients use complementary and alternative medicine (CAM), improvement is needed in communication between providers of CAM and allopathic medicine. This study describes collaborative acupuncture clinics (CACs) run by providers from Oregon Health and Science University (OHSU) and the Oregon College of Oriental Medicine (OCOM) in the setting of family medicine teaching clinics. It examines patient demographics, quality of education for medical learners, referral practices of primary care physicians (PCPs), and quality of communication between acupuncturists and PCPs at these clinics. Demographic data were abstracted from electronic medical records of patients treated at least three times in the CACs between 2006 and 2007. A survey on quality of education at the CACs was given to acupuncture interns, medical students, and acupuncture supervisors. A separate survey collected information from PCPs at the family medicine clinics regarding referral practices to acupuncture and quality of communication between PCPs and acupuncturists. Of the 96 patients seen at the clinics, 74% were female, 76% were European-American, and the mean age was 45.9 years. Sixty-one percent (61%) of patients were insured through private insurance, 31.3% had Medicare or Medicaid, and 7.3% did not have insurance. Most of the 51 acupuncture providers who responded were satisfied with the quality of education at the CACs. Eighty percent of responding PCPs had referred at least one patient to the CACs. The majority of referrals was for a pain condition. Most PCPs would find a summary of the acupuncture visit helpful. Referral practices to different modalities were most influenced by patient interest and physician's belief in whether or not the modality would help. Demographics of patients at the CACs were comparable to those of patients seen in other acupuncture clinics. The collaborative structure of the CACs allowed for a unique learning experience and improved communication between providers of CAM and conventional medicine.

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

To investigate whether a training process that focused on a questionnaire-based diagnosis in Traditional Chinese Medicine (TCM), and developing diagnostic consensus, would improve the agreement of TCM diagnoses among 10 TCM practitioners evaluating patients with temporomandibular joint disorder (TMJD). Evaluation of a diagnostic training program at the Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, and the Oregon College of Oriental Medicine, Portland, Oregon. Screened participants for a study of TCM for TMJD. PRACTITIONERS: Ten (10) licensed acupuncturists with a minimum of 5 years licensure and education in Chinese herbs. A training session using a questionnaire-based diagnostic form was conducted, followed by waves of diagnostic sessions. Between sessions, practitioners discussed the results of the previous round of participants with a focus on reducing variability in primary diagnosis and severity rating of each diagnosis: 3 waves of 5 patients were assessed by 4 practitioner pairs for a total of 120 diagnoses. At 18 months, practitioners completed a recalibration exercise with a similar format with a total of 32 diagnoses. These diagnoses were then examined with respect to the rate of agreement among the 10 practitioners using inter-rater correlations and kappas. The inter-rater correlation with respect to the TCM diagnoses among the 10 practitioners increased from 0.112 to 0.618 with training. Statistically significant improvements were found between the baseline and 18 month exercises (p < 0.01). Inter-rater reliability of TCM diagnosis may be improved through a training process and a questionnaire-based diagnosis process. The improvements varied by diagnosis, with the greatest congruence among primary and more severe diagnoses. Future TCM studies should consider including calibration training to improve the validity of results.

Research Scholars Program: A Faculty Development Initiative at the Oregon College of Oriental Medicine

The Research Scholars Program (RSP) was created at the Oregon College of Oriental Medicine (OCOM) to provide faculty development in research literacy, research-informed clinical practice, and research participation skills. The RSP is part of a broad effort, funded by a National Institutes of Health/National Center for Complementary and Alternative Medicine R25 education grant, to infuse an evidence-based perspective into the curriculum at schools of complementary and alternative medicine. The RSP arose from the realization that this curriculum reform would first necessitate faculty training in both research appreciation and pedagogy. OCOM's grant, Acupuncture Practitioner Research Education Enhancement, is a partnership with the Oregon Health & Science University School of Nursing (OHSU SON). The RSP was developed initially as a collaborative effort among the OCOM Dean of Research (R.H.), OCOM Director of Research Education (S.F.), and an OHSU SON education specialist (K.L.). The 9-month, 8 hours per month seminar-style RSP provides the opportunity for a cohort of OCOM faculty and staff to explore research-related concepts and content as well as pedagogical practices that emphasize interactive, learner-centered teaching. The RSP adheres to a competency-based approach as developed by the Education Committee of the grant. As a tangible outcome, each Research Scholar designs a sustainable learning activity that infuses a research perspective into their courses, clinic supervision, or other sphere of influence at the college. In this paper, we describe the creative process and the lessons learned during the planning and initial implementation of the RSP. We view the early successes of the RSP as encouraging signs that research literacy and an evidence-based perspective are becoming increasingly accepted as needed skill sets for present-day practitioners of acupuncture and Oriental medicine.

Electrical Skin Impedance at Acupuncture Points

To test whether electrical skin impedance at each of three acupuncture points (APs) is significantly lower than at nearby sites on the meridian (MP) and off the meridian (NP). Two instruments - Prognos (MedPrevent GmbH, Waldershof, Germany), a constant-current (DC) device, and PT Probe (designed for this study), a 100-Hz sinusoidal-current (AC) device-were used to record electrical impedance at three APs (right Gallbladder 14, right Pericardium 8, and left Triple Energizer 1), and two control sites for each AP. Each AP, MP, and NP was measured four times in random order with each device. The study was conducted over a period of 4 days at the Oregon College of Oriental Medicine (OCOM). Twenty (20) healthy adults (14 women and 6 men), all recruited from the OCOM student body and faculty, participated in the study. The Prognos measurements had an intraclass correlation (ICC) = 0.84 and coefficient of variation (CV) = 0.43. The PT Probe had ICC = 0.81 and CV = 0.31. Impedance values at APs were not significantly less than at MPs or NPs. Impedance values at MPs were also not significantly less than NPs, although their individual p values were <0.05 in 4 of 6 cases. There was a significant trend of increasing impedance with repeated measurements with both the Prognos (p =0.003) and the PT Probe (p= 0.003). Within the reliability limits of our study methods, none of the three APs tested has lower skin impedance than at either of the nearby control points. These results are not consistent with previous studies that detected lower skin impedance at APs than nearby sites. Further study is necessary to determine whether MPs have lower skin impedance than nearby NPs. Our study suggests caution is warranted when developing, using, and interpreting results from electrodermal screening devices. Further studies are needed to clarify the clinically important and controversial hypothesis that APs are sites of lower impedance.

Reliability of the Prognos Electrodermal Device for Measurements of Electrical Skin Resistance at Acupuncture Points

Objectives: (1) To characterize and calibrate an electrodermal screening device, Prognos. (2) To replicate a previous test–retest reliability study of this device with measurements of electrical skin resistance (ESR) at 24 Jing-well acupuncture points (APs). (3) To determine measurement precision in three successively more exacting trial protocols on the same set of subjects. Settings: Oregon College of Oriental Medicine and Portland State University, Portland, OR. Instruments: The Prognos device was electrically characterized by a team of research engineers at the Biomedical Signal Processing Laboratory of Portland State University. They determined that Prognos measures the average direct-current (DC) resistance between a metallic wrist strap and an electrode probe tip. The probe tip is connected to a linear spring set to trigger with an optically generated signal at a deflection of 2.62 mm, which corresponds to an average applied force of 2.68 ± 0.04 N (mean ± standard deviation [SD], n = 6). They also determined that the device quantifies resistance by applying a 1.1 µA current for an average of 223 ± 3 ms (n = 7). When calibrated against a series of known resistors, Prognos measures accurately in the range of 150 kΩ to 14.3 MΩ with an error of less than 0.4%. Subjects: Thirty-one (31) healthy volunteers, 17 females and 14 males, 23–63 years of age. Results of reliability test–retest: The mean reliability of a single measurement was; 0.758 for a standard measurement protocol of four sequential sweeps of 24 Jing-well (Ting) APs; 0.851 for four sequential sweeps after ink-marking the APs; and 0.961 for four rapid repeat measurements at each inked AP. Mean absolute values of ESR decreased between the standard and marked protocols, but not between the marked and rapid repeat protocols. Conclusions: Prognos performs accurately, against known resistors over the reported range of ESR. The reliability in the standard protocol (r = 0.758) is comparable to the reliability of 0.721 demonstrated under similar conditions by other investigators. Marking APs, and performing measurements in a rapid sequence, increases reliability of ESR measurements. Increased reliability in the second and third protocols is associated with decreased mean ESR values which may be related to increased accuracy of Prognos probe placement and/or inking the APs.

Comparative Study of Titrimetric and Gravimetric Methods for the Determination of Organic Carbon in Soils

Abstract Fourty seven soil samples were collected from agriculture fields at two depths (0–15 cm and 15–30 cm). The samples were analysed to determine the total organic carbon TOC (using the dry combustion reference method), the organic carbon OC (using wet acidified Cr2−O7 and MnO− 4 oxidation) and organic matter OM (using loss on ignition). A comparison between the TOC and each of OC and OM were carried out using regression analysis. This analysis reveals an excellent linear relation between the results of wet acidified Cr2O2− 7 oxidation and dry combustion with a mean conversion factor of 1.109, while a new conversion factor of 1.841 between wet acidified MnO− 4 oxidation and dry combustion is proposed. Also, regression analysis reveals that the linear relation between loss on ignition and the dry combustion reference method gives a stronger intercept (a > 0), indicating that these are less related (the traditional equation by Walkley and Black assumed the intercept a = 0). The stronger intercept (a > ...