Policy for Therapeutic Massage in an Academic Health Center: A Model for Standard Policy Development

Context:Massage is the most common complementary and alternative medicine (CAM) therapy used in hospitals in the United States. As such, it is often the first CAM therapy to be integrated with conventional medicine. However, few academic medical centers have a written standard policy to guide this integration. This lack of standard policy may impede institutions from offering massage therapy as a clinical service, and may put health care professionals and institutions at risk through a failure to clearly address criteria for practice credentials or malpractice liability. Objective: To create a clinical policy for therapeutic massage that may be used as a template for development of policy in academic health centers. Results: We present a clinical policy for therapeutic massage, developed by the University of Michigan Health System, that defines therapeutic massage, provides guidelines for the credentialing and professional conduct of massage therapists, lists indications and contraindications for therapeutic massage, and addresses malpractice in accordance with the specific culture and needs of academic health centers. This policy was created by health care professionals after review of existing evidence and consideration of national criteria for massage therapy. This policy is intended to be used as a template for the development of a standard policy for therapeutic massage by health system administrators, medical directors, and massage professionals, to support the integration of therapeutic massage within their institutions. Conclusions: With minor modifications of this policy by individual institutions, adoption of this policy may facilitate the thoughtful integration of this CAM therapy into academic health care settings, meeting the unique requirements of academic health care institutions while serving the needs of patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63197/1/acm.2007.6323.pd

Structural and fluid-migration control on hill-hole pair formation: Evidence from high-resolution 3D seismic data from the SW Barents Sea

Hill-hole pairs are subglacial landforms consisting of thrust-block hills and associated source depressions. Formed by evacuation of material where ice sheets have been locally frozen to the substrate, they give insights into paleo-ice-sheet dynamics. The aim of this study was to document the relationships between ancient hill-hole pairs identified on a buried glacial unconformity with the structure of the underlying sedimentary deposits, and then to determine if the basin geology and glacial fluid migration pathways promoted local subglacial freeze-on during the hill-hole pair formation. The study is based on seismic geomorphological interpretation of four high-resolution 3D seismic cubes covering an area of 800 km2 in the SW Barents Sea, and fluid seepage data from 37 gravity cores. The seismic datasets allowed the identification of 55 hill-hole pairs along the buried unconformity. The hills are characterized by chaotic to homogenous seismic facies forming up to 19 m high mounds, each covering areas of 2000–644,000 m2. The holes form depressions between 1 and 44 m deep and 2000–704,000 m2 in areal extent, which cut into preglacial Mesozoic bedrock and later infilled by glacial till. The holes are often found above fault terminations. High-amplitude reflections identified along the faults and in the strata below the holes are interpreted as shallow gas migrating upward towards the glacial unconformity. Geochemical data of the seabed sediment cores further indicates an association between hill-hole pair occurrence and present-day thermogenic hydrocarbon seepage. The hill-hole pairs geometries were also used to identify five paleo-ice-flow directions along the glacial unconformity. These ice flows exhibit polythermal regimes, and four of them are parallel to ice-stream flow sets interpreted from glacial lineations. The integrated interpretation supports localized fault-related basal freezing of the Barents Sea Ice Sheet which resulted in the formation of hill-hole pairs when the ice sheet moved. In this context, the faults functioned as migration pathways for deep thermogenic fluids, possibly sourced from leaking Jurassic reservoirs.>p> This study highlights the importance of the underlying geology for ice-sheet dynamics: While hill-hole pairs above glacial till appear to be commonly associated with dispersed gas hydrates, hill-hole pairs above bedrock additionally indicate a link to underlying fault systems and hydrocarbon reservoirs. Freeze-on of underlying bedrock to the basal ice along the strike of faults in sedimentary bedrock explains deeper hill-hole pairs with smaller extents along the glacial unconformity compared to areally larger but shallow hill-hole pairs detected above glacial till on modern seabeds. Such close association between paleo-thermogenic gas seepage and the location of hill-hole pairs strongly support that hill-hole pairs are excellent markers revealing exit points of fluid migration pathways in petroleum system models

Markers of extracellular matrix remodeling and systemic inflammation in patients with heritable thoracic aortic diseases

Background: In approximately 20% of patients with thoracic aortic aneurysms or dissections a heritable thoracic aortic disease (HTAD) is suspected. Several monogenic connective tissue diseases imply high risk of aortic disease, including both non-syndromic and syndromic forms. There are some studies assessing inflammation and extracellular matrix remodeling in patients with non-hereditary aortic disease, but such studies in patients with hereditary diseases are scarce. Aims: To quantify markers of extracellular matrix (ECM) and inflammation in patients with vascular connective tissue diseases versus healthy controls. Methods: Patients with Loeys-Dietz syndrome (LDS, n = 12), Marfan syndrome (MFS, n = 11), and familial thoracic aortic aneurysm 6 (FTAA6, n = 9), i.e., actin alpha 2 (ACTA2) pathogenic variants, were recruited. Exome or genome sequencing was performed for genetic diagnosis. Several markers of inflammation and ECM remodeling were measured in plasma by enzyme immunoassays. Flow cytometry of T-cell subpopulations was performed on a subgroup of patients. For comparison, blood samples were drawn from 14 healthy controls. Results: (i) All groups of HTAD patients had increased levels matrix metalloproteinase-9 (MMP-9) as compared with healthy controls, also in adjusted analyses, reflecting altered ECM remodeling. (ii) LDS patients had increased levels of pentraxin 3 (PTX3), reflecting systemic inflammation. (iii) LDS patients have increased levels of soluble CD25, a marker of T-cell activation. Conclusion: Our data suggest that upregulated MMP-9, a matrix degrading enzyme, is a common feature of several subgroups of HTAD. In addition, LDS patients have increased levels of PTX3 reflecting systemic and in particular vascular inflammation

Teamarbeid under robotassistert kirurgi - erfaringer fra anestesipersonalets perspektiv

Master's thesis in Health and social sciencesStudiens tema er teamarbeid under robotassistert kirurgi. Etter at roboter ble introdusert som hjelpemidler i minimal invasiv kirurgi, har det oppstått nye utfordringer for teamarbeid på operasjonsstuen. I praksis opplever vi utfordringer som har konsekvenser for flyten og arbeidsmiljøet. Dette er spesielt uttalt på stuen med robotassistert kirurgi. Det er lite forskning om teamarbeid og robotassistert kirurgi, og den forskning som eksisterer fokuserer hovedsakelig på kirurgen. Det mangler forskning om teamarbeid og robotassistert kirurgi som vektlegger anestesipersonalets rolle. Denne studien tok utgangspunkt i aktuell forskning innen tema, og litteratur vedrørende teamarbeid i helse og sosialsektoren. Studien ble gjennomført med en kvalitativ, eksplorativ design, med fenomenologisk hermeneutisk tilnærming. Informanter var anestesipersonale ved et sykehus i Norge, hvorav tre var anestesileger og seks var anestesisykepleiere med erfaring med robotassistert kirurgi. Individuelle, semistrukturerte intervjuer ble brukt for å samle inn data. Dette ga oss fyldige og beskrivende data om hvordan informantene opplever teamarbeid under robotassistert kirurgi. Kvalitativ innholdsanalyse ble brukt for å analysere datamaterialet. Resultatene viste ny og viktig kunnskap vedrørende teamarbeid under robotassistert kirurgi, sett i fra anestesipersonalets perspektiv. Tekniske ferdigheter og ikke-tekniske ferdigheter ble fremhevet, med hovedfokus på ikke-tekniske ferdigheter. Det konkluderes med et behov for større fokus på teamarbeid under robotassistert kirurgi, for å forbedre pasientsikkerhet og oppnå optimal pasientomsorg. Studien består av en artikkel og en kappe. Artikkelen (del 1) består av ”front page, submission form, cover letter, author submission checklist” og artikkelen. I kappen (del 2) utdypes bakgrunn for studien, teoretisk rammeverk, metodevalg, metodiske betraktninger, i tillegg diskuteres resterende viktige funn

Teamwork in robotic assisted surgery - experiences from the anaesthetic staff members' perspective

Studiens tema er teamarbeid under robotassistert kirurgi. Etter at roboter ble introdusert som hjelpemidler i minimal invasiv kirurgi, har det oppstått nye utfordringer for teamarbeid på operasjonsstuen. I praksis opplever vi utfordringer som har konsekvenser for flyten og arbeidsmiljøet. Dette er spesielt uttalt på stuen med robotassistert kirurgi. Det er lite forskning om teamarbeid og robotassistert kirurgi, og den forskning som eksisterer fokuserer hovedsakelig på kirurgen. Det mangler forskning om teamarbeid og robotassistert kirurgi som vektlegger anestesipersonalets rolle. Denne studien tok utgangspunkt i aktuell forskning innen tema, og litteratur vedrørende teamarbeid i helse og sosialsektoren. Studien ble gjennomført med en kvalitativ, eksplorativ design, med fenomenologisk hermeneutisk tilnærming. Informanter var anestesipersonale ved et sykehus i Norge, hvorav tre var anestesileger og seks var anestesisykepleiere med erfaring med robotassistert kirurgi. Individuelle, semistrukturerte intervjuer ble brukt for å samle inn data. Dette ga oss fyldige og beskrivende data om hvordan informantene opplever teamarbeid under robotassistert kirurgi. Kvalitativ innholdsanalyse ble brukt for å analysere datamaterialet. Resultatene viste ny og viktig kunnskap vedrørende teamarbeid under robotassistert kirurgi, sett i fra anestesipersonalets perspektiv. Tekniske ferdigheter og ikke-tekniske ferdigheter ble fremhevet, med hovedfokus på ikke-tekniske ferdigheter. Det konkluderes med et behov for større fokus på teamarbeid under robotassistert kirurgi, for å forbedre pasientsikkerhet og oppnå optimal pasientomsorg. Studien består av en artikkel og en kappe. Artikkelen (del 1) består av ”front page, submission form, cover letter, author submission checklist” og artikkelen. I kappen (del 2) utdypes bakgrunn for studien, teoretisk rammeverk, metodevalg, metodiske betraktninger, i tillegg diskuteres resterende viktige funn

An Integrative Medicine Patient Care Model and Evaluation of Its Outcomes: The University of Michigan Experience

Abstract Background: The demand for integrative medicine care is increasing rapidly among patient consumers, yet the integrative medicine model is not the norm in clinical practice, nor is this approach a focus in traditional medical schools. Furthermore, patient well-being and satisfaction outcomes within an integrative care model are not common in the literature. Objectives: The purpose of this paper is to offer a summary of a model of integrative medicine patient care and its evaluation and outcomes from the University of Michigan Integrative Medicine Clinic. Methods: Using three tools to evaluate patient outcomes and satisfaction, statistically significant outcomes were noted. The SF-12 showed positive change in the physical component score, the Holistic Health Questionnaire showed improvements in all of the subscales of body, mind, and spirit, and a unique Integrative Medicine Patient Satisfaction Tool suggested high satisfaction with an integrative approach to care. Conclusions: Findings, limitations, and implications are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63379/1/acm.2008.0154.pd

Elite athletes get pregnant, have healthy babies and return to sport early postpartum

Objectives: To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. Methods: 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. Results: No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0–6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. Conclusion: Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation

Elite athletes get pregnant, have healthy babies and return to sport early postpartum

Objectives: To enhance knowledge on pregnancy and return to sport in the postpartum period in elite female athletes. Methods: 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. Independent samples T-tests or χ² tests for between-group differences and paired-samples T-tests and repeated measures analysis of variance for within group differences were used. Results: No group differences in fertility problems, miscarriage, preterm birth or low birth weight were found. Both groups decreased training volume all trimesters and the first two postpartum periods compared with prepregnancy, and more athletes returned to sport/exercise at week 0–6 postpartum. We found no group differences in complications during pregnancy and delivery, but athletes reported fewer common complaints. Four athletes experienced stress fracture postpartum. Athletes had higher BD and DT postpartum, while controls reduced DT score. Number of athletes with clinical ED was reduced postpartum, while constant in controls. Athletes were not satisfied with advice related to strength training and nutrition during pregnancy. Conclusion: Elite athletes and active controls get pregnant easily, deliver healthy babies and decrease training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes report stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation

Policy for Therapeutic Acupuncture in an Academic Health Center: A Model for Standard Policy Development

Acupuncture as a therapeutic modality offers multiple applications. Its effectiveness coupled with its general acceptance by conventional health care professionals makes it one of the first complementary and alternative medicine (CAM) modalities to be incorporated in an integrative approach to care. However, few centers that offer acupuncture have written standard policies to regulate its use. This lack of standard policies may impede provision of quality care, serve as a barrier to cross-institutional data collection and clinical application of that data, and may put health care professionals and institutions at risk when credentialing or malpractice liability has not been clearly addressed. Here we present a policy for acupuncture, created by a diverse group of health care professionals at the University of Michigan Health System. It may function as a generalizable template for standard policy development by institutions incorporating acupuncture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63360/1/acm.2006.12.1035.pd