Effect of Acupressure on Senior Nursing Students' Anxiety during the COVID-19 Pandemic: A Randomized Controlled Clinical Trial

Background: The transition to distance learning in nursing education during the COVID-19 pandemic, where clinical practice is critical, may have caused senior nursing students to experience a sense of graduating without sufficient skills and experience anxiety in addition to the anxiety caused by the pandemic. Non-pharmacological methods such as acupressure may be helpful in reducing students' anxiety. Aim: This study was conducted to determine the effect of acupressure on senior nursing students' anxiety levels during the COVID-19 pandemic. Methodology: This prospective, two-armed (1:1), randomized controlled study included fifty-two senior nursing students at a university nursing department. While the experimental group (n=26) applied acupressure to the LI4, HT7, and EX-HN3 points three times a week for four weeks, acupressure was not applied to the control group (n=26). Data were collected at baseline and at the end of four weeks using the State-Trait Anxiety Inventory (STAI). Results: At the end of four weeks, there was no significant difference between the STAI-State and STAI-Trait scores of the experimental and control groups (p>0.05). The STAI-State score of the experimental group decreased significantly in the fourth week compared to the baseline (p<0.05). Conclusion: Research findings revealed that self-administered acupressure by senior nursing students was effective in reducing moderate state anxiety during the pandemic, but not trait anxiety.

Virtual acupressure for symptom management in cancer populations during COVID-19: a retrospective analysis.

OBJECTIVE: Following the outbreak of COVID-19, access to in-person oncology acupuncture service was temporarily disrupted at Dana-Farber Cancer Institute, a National Cancer Institute (NCI)-designated cancer center. During this period, a virtual acupuncturist-guided session of patient self-acupressure was implemented to provide continuity of supportive care for cancer patients. We provide preliminary findings on the feasibility and potential impact of remotely delivered acupressure on patient-reported symptom burden in cancer populations. METHODS: This is a retrospective chart review of cancer patients who received virtual acupressure service at a single academic cancer center from May 11 to December 31, 2020. Each telehealth session consisted of a one-on-one appointment between the patient and acupuncturist. A semi-standardized set of acupoints were used, including Yintang, ST36, GB20, PC6, and HT7 as well as Relaxation Point on the ear. At the start of each session, Edmonton Symptom Assessment System (ESAS) was used to collect patient-reported symptom burden. For patients with at least one follow-up within 14 days of the baseline visit, paired t-test was used to analyze changes in ESAS scores from baseline to first follow-up. RESULTS: A total of 102 virtual acupressure sessions were administered to 32 patients. Most patients were females (90.6%) and white (84.4%), and the mean age was 55.7 (range = 26-82; SD = 15.7). The most common cancer diagnosis was breast (53.1%), followed by pancreatic (12.5%) and lung (9.4%). Baseline ESAS Total, Physical, and Emotional scores were 21.5 (SD = 11.1), 12.4 (SD = 7.5), and 5.2 (SD = 3.8), respectively. Of 32 patients, 13 (41%) had a second acupressure session within 14 days. For these 13 patients, there was a statistically significant reduction in Total symptom burden (-4.9 ± 7.6; p = 0.04) and in Physical (-3.5 ± 5.4; p = 0.04) and Emotional (-1.2 ± 1.8; p = 0.03) subscales from baseline to follow-up. CONCLUSION: Virtual acupressure was associated with significant reduction in symptom burden among cancer patients from their baseline to follow-up visits. Larger scale randomized clinical studies are needed to confirm these findings and better understand the impact of virtual acupressure on symptom burden in cancer populations.

Experience of parents in delivering pediatric tuina to children with symptoms of attention deficit hyperactivity disorder during the COVID-19 pandemic: qualitative findings from focus group interviews.

BACKGROUND: Evidence suggests that pediatric tuina, a modality of traditional Chinese medicine (TCM), might have beneficial effects on the symptoms of attention deficit hyperactivity disorder (ADHD), such as overall improvements in concentration, flexibility, mood, sleep quality, and social functioning. This study was conducted to understand the facilitators and barriers in the delivery of pediatric tuina by parents to children with ADHD symptoms. METHODS: This is a focus group interview embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for ADHD in preschool children. Purposive sampling was employed to invite 15 parents who attended our pediatric tuina training program to participate voluntarily in three focus group interviews. The interviews were audio-recorded and transcribed verbatim. The data were analyzed through template analysis. RESULTS: Two themes were identified: (1) facilitators of intervention implementation and (2) barriers to intervention implementation. The theme of the facilitators of intervention implementation included the subthemes of (a) perceived benefits to children and parents, (b) acceptability to children and parents, (c) professional support, and (d) parental expectations of the long-term effects of the intervention. The theme of barriers to intervention implementation included the subthemes of (a) limited benefits for children's inattention symptoms, (b) manipulation management difficulties, and (c) limitations of TCM pattern identification. CONCLUSION: Perceived beneficial effects on the children's sleep quality and appetite and parent-child relationships, as well as timely and professional support, mainly facilitated the implementation of parent-administered pediatric tuina. Slow improvements in the children's inattention symptoms and the possible inaccuracies of online diagnosis were the dominant barriers of the intervention. Parents have high expectations for the provision of long-term professional support during their practice of pediatric tuina. The intervention presented here can be feasibly used by parents.

Auricular Acupressure for Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: The purpose of this systematic review was to summarize the current evidence to examine the safety and effectiveness of auricular acupressure on dry eye diseases. Materials and Methods: Twenty databases were searched from their inception until November 2022. Only randomized controlled trials (RCTs) in which auricular acupressure was used for dry eye diseases were included. The selection process, data extraction and quantitative were conducted according to the guidelines. Results: Seven RCTs met the inclusion criteria. Meta-analysis showed that compared to artificial tears, auricular acupressure had a favorable effect on prolonging tear breakup time (TBUT), improving the Schirmer I test (SIT) score and the score of symptoms (SOS) of patients with dry eye disease (p < 0.05). Furthermore, compared to the artificial tears alone, auricular acupressure plus artificial tears had a significantly greater SIT score (p < 0.001) and response rate (p = 0.006), significantly longer TBUT (p < 0.001), and significantly lower Ocular surface disease index (OSDI) (p = 0.02) and SOS (p = 0.03). However, there was no statistically significant difference between the auricular acupressure plus artificial tears group and the artificial tears group in terms of cornea fluorescein staining (CFS) (p = 0.09). Conclusions: Auricular acupressure, as a sole intervention or in combination with artificial tears, may have a beneficial effect on dry eye disease. However, more high-quality RCTs need to be included in the future to further prove the positive effects of auricular acupressure on patients with dry eye disease.

Effects and safety of auricular acupressure on depression and anxiety in isolated COVID-19 patients: A single-blind randomized controlled trial.

Objective: Psychological distress such as depression and anxiety resulted from coronavirus disease 2019 (COVID-19) have attracted increasing attention. The aim of this randomized controlled trial is to evaluate the effects and safety of auricular acupressure on depression and anxiety in isolated COVID-19 patients. Methods: 68 participants diagnosed with COVID-19 pneumonia (18-80 years old, SDS ≥ 50, SAS ≥ 45) were recruited and randomly allocated to the auricular acupressure group and the sham auricular acupressure group by a computer-generated random number sequence from 9th June to 30th June 2022. The group allocation was only blinded to the participants. Those in the auricular acupressure group were attached magnetic beads against 4 auricular points Shenmen, Subcortex, Liver and Endocrine, while sham group used four irrelevant auricular points. Outcomes were measured by Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Depression Scale (SAS) before and after treatment in both groups through electronic questionnaire in mobile phones. Results: After treatment, statistically significant differences were found in scores of SAS in both groups (P < 0.001 in auricular acupressure group; P = 0.003 in sham group), and SDS scores reduced significantly in the auricular acupressure group (P = 0.002). Significant reduced SAS and SDS scores were achieved in the auricular acupressure group than that in the sham group (F = 4.008, P = 0.049, MD -7.70 95% CI: -9.00, -6.40, SMD -2.79 95% CI: -3.47, -2.11 in SDS; F = 10.186, P = 0.002, MD -14.00 95% CI: -15.47, -12.53, SMD -4.46 95% CI: -5.37, -3.56 in SAS). No adverse events were found in either group during the whole study. Conclusion: Auricular acupressure is an effective and safe treatment for alleviating symptoms of depressive and anxiety in patients with COVID-19. Clinical trial registration: https://www.chictr.org.cn//, identifier ChiCTR2200061351.

Auricular acupressure for adverse events following immunization after COVID-19 vaccine injection: A multicentre, blinded, randomized controlled trial.

BACKGROUND: Some adverse events following immunization (AEFI) were observed in potential corelation with COVID-19 vaccination but without prevention or ongoing trial for it. We aimed to investigate efficacy of auricular acupressure (AuriAc) therapy in preventing AEFI after first dosage of the vaccine. METHODS: We performed a multicentre randomized controlled trial with three arms, including AuriAc, SAuriAc (sham auricular acupressure), and TrAsU (treatment as usual) group, carried out in four medical institutions in Chengdu, China, from March 17th to April 23rd, 2021. We enrolled participants based on eligibility criteria and randomized them into three groups: AuriAc (AEFI-specific auricular points applied, n = 52), SAuriAc (n = 51) or TrAsU (n = 44) group. Primary outcomes were percentages of any AEFI and local pain, and secondary outcomes were percentages who reported other AEFI. They were followed at 1, 3, 5, 7, and 14 days, by phone or online, with severity evaluated. RESULTS: 147 participants (73.47% females) were included with median age as 31 years (25-45, IQR). One day after the injection, participants in AuriAc group reported significant reduction on percentages of any AEFI [intention-to-treat, difference of percentage (DP) = -20.13, 95%CI: - 0.39, - 0.02, p = 0.01; per-protocol, DP = -22.21, 95%CI: - 0.40, - 0.03, P = 0.02] and local pain (per-protocol, DP = -18.40, 95%CI: -0.36, -0.01, P = 0.04), compared with TrAsU group. The effects were slight at other follow-up days and for other outcomes, and with a low percentage of mild local allergic reactions. CONCLUSIONS: We firstly explored potential of AuriAc for preventing AEFI related to COVID-19 vaccine injection, which is beneficial for the vaccine recipients, but evidence is limited. TRIAL REGISTRATION: chictr.org.cn no. ChiCTR2100043210 (http://www.chictr.org.cn/showproj.aspx?proj=121519).

Use of Information and Communication Technologies to Enhance Self-Acupressure: a Literature Review.

Currently, acupressure is widely accepted as a non-pharmacological therapy for managing pain, nausea and vomiting, and mental health conditions. Since acupressure can be self-administered, clinicians and researchers' interest in information and communication technologies (ICTs) for disseminating acupressure to manage symptoms has increased. This mini review was conducted to examine clinical studies of acupressure using ICTs, with a particular focus on self-acupressure. Through a search of MEDLINE, EMBASE, and CENTRAL, all studies of self-acupressure using ICTs published before December 31, 2021 were collected. Twelve studies met the inclusion criteria. More than half of the studies published since 2020 (4/7, 54.14%) were described as being related to COVID-19. As target conditions, musculoskeletal injuries or pain, cancer-related symptoms, dysmenorrhea, mental health issues, and obesity were considered. The most frequently used acupoints were LI4, LR3, and Shenmen. Moreover, smartphone applications were the most commonly used ICT method to support self-acupressure. In addition to the basic information of self-acupressure, other tools such as timers, reminders, and schedule checkers to facilitate its implementations have been incorporated into the smartphone applications. Recently, there have been some attempts to combine acupressure and ICTs. Although these studies mainly focus on musculoskeletal pain or injuries, recent studies related to mental health have emerged in relation to COVID-19. However, few studies have been conducted to date, making it difficult to fully grasp the trends in this field. Therefore, more studies are needed to evaluate the feasibility and efficacy of combining self-acupressure and ICTs in more diverse clinical areas.

The Effects of Acupressure on Sleep Quality and Compassion Fatigue among Emergency and Critical Care Nurses during the Coronavirus Disease 2019 Pandemic: A Clinical Trial

Background: Sleep disorders and compassion fatigues are two main physical and psychological problems among nurses, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Objectives: The aim of this study was to assess the effects of acupressure on sleep quality and compassion fatigue among emergency and critical care nurses during the COVID-19 pandemic. Methods: This randomized controlled trial was conducted in 2020. Participants were eighty nurses recruited from two hospitals in Iran and randomly allocated to control and intervention groups. Acupressure on the Shenmen point was self-administered by participants twice daily for 30 days. The Pittsburg Sleep Quality Index and the Nurses' Compassion Fatigue Inventory were used for data collection before and after the intervention. Data analysis was done using the paired-sample t, independent-sample t, Chi-square, and Mann-Whitney U tests as well as the analysis of covariance. Results: The mean score of the subjective sleep quality, sleep latency, sleep duration, and sleeping medication dimensions of sleep quality significantly decreased in the intervention group (P < 0.05). Moreover, despite no significant between-group difference respecting the pretest mean scores of sleep quality and its dimensions (P > 0.05), the posttest mean scores of sleep quality and its subjective sleep quality, sleep latency, sleep disturbances, and sleeping medication dimensions in the intervention group were significantly less than the control group (P < 0.05). Conclusion: As a noninvasive technique, acupressure can be used to significantly improve sleep quality among nurses during the COVID-19 pandemic.

Determining Trajectories for Hair Wash and Head Massage Robot Based on Artificial Neural Network

The medical and healthcare field is more interesting and studied in the era of science and technology development. Hair washing helps remove dirt and healthy hair and reduces the risk of scalp diseases, and according to Vietnamese traditional medicine, massage according to acupressure points is one of the methods of treating pain and fatigue, and it helps to recover from the treatment process, reducing stress, etc. In the stage of the COVID-19 epidemic, the shortage of medical staff occurs in many hospitals that are overloaded with patient care, especially bedridden patients, who need special care and hair washing, and massage head can help them relax and help recover from some diseases. This study proposes an approach to identify acupressure points on the head, and it is used for the hair washes and head massage robot for the patient's head. Hair wash and head massage robot by using water jets is proposed, which avoids the spread of some diseases by direct contact, and it reduces the shortage of medical care workers at hospitals. The study proposes a CNN to recognize the home point of the robot mounted on the face with the accuracy of, combined with signals from sensors, to determine the necessary dimensions of the human head. The ANN is used to predict the massage trajectories for the robot to suit each different patient. The overall results are evaluated with an accuracy of 97.56% with the training dataset and 95.12% with the test data. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Uses of Energy Psychology Following Catastrophic Events.

Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper's author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.

Opportunities and Challenges of Implementing a Virtual Acupressure Service for Cancer Patients During COVID-19: A Retrospective Analysis

Methods: The study is a retrospective analysis of a virtual acupressure service administered from May to December 2020 at a National Cancer Institute-designated Comprehensive Cancer Center. A semi-standardized virtual acupressure protocol was developed, consisting of 50 min, one-on-one session between the acupuncturist and patient. At the start of each session, the acupuncturist assessed the patient's symptom burden using the Edmonton Symptom Assessment Scale (0-90), for which higher scores represent greater symptom severity. Changes in ESAS scores from baseline to follow-up were evaluated using paired t-test for patients with follow-up within 14 days of baseline. Acupuncturists held weekly group meetings to discuss challenges and ways to improve the delivery of tele-acupressure. Results: A total of 102 virtual acupressure sessions were administered to 32 unique patients. Most patients were females (90.6%) and white (84.4%), the mean age was 55.7 (range=26-82;SD=15.73), and the most common cancer diagnosis was breast (53.1%). Of 32 patients, 13 had follow up in 14 days or less. For these 13 patients, there was a statistically significant reduction in total symptom burden (-4.85±7.6;p=0.04) from baseline to follow-up. Based on the acupuncturists' experiences, various factors were discussed and considered important in implementing virtual acupressure, including effective communications (e.g., both verbal and nonverbal cues), potential technological barriers (e.g., technology literacy), and healing environment (e.g., physical space and/or virtual background appearing on the screen). Background: Oncology acupuncture service was disrupted by COVID-19, and a virtual acupuncturist-guided, patient self-acupressure intervention was implemented. We explore the potential impact of tele-acupressure on patient-reported symptoms and summarize acupuncturists' experiences on the challenges and opportunities of implementing a virtual acupressure service for cancer patients. Conclusion: Virtual acupressure may be a promising therapy for symptom management, especially when in-person acupuncture service may not be feasible, but further research is needed to rigorously evaluate its safety and efficacy among cancer patients.

Cessation of group battlefield acupuncture visits due to COVID-19: a pilot study.

BACKGROUND: Prior to the COVID-19 pandemic, battlefield acupuncture (BFA) was offered to veterans with chronic pain in multidisciplinary group visits. OBJECTIVE: We aimed to assess the impact of cessation of BFA due to COVID-19 and to determine the utility of different aspects of the group visits for chronic pain management. METHODS: Participants who had attended at least three BFA group visits completed questionnaires assessing the impact of treatment interruption on pain, overall function and desire to resume treatment. RESULTS: Thirty-nine veterans were surveyed; 49% responded to the questionnaire. Ninety percent (17/19) agreed that BFA was an important part of pain management and that their pain had worsened after treatment interruption. Seventy-four percent (14/19) responded that they were taking more pain medications since BFA had ended. Ninety-five percent (18/19) responded that BFA improved daily function; 79% (15/19) agreed that BFA improved their sleep. Ninety-five percent (18/19) were interested in resuming BFA. Camaraderie was mentioned as the most helpful aspect of the group by 8/19 (42%) of participants. Participation of health psychology and nutrition were each mentioned as a most helpful aspect of the group by 5/19 (26%) of participants. CONCLUSION: Our results suggest that participants may have believed that BFA, camaraderie, and input from nutrition and health psychology services were important contributors to their pain control. The results also suggest that veterans may have suffered worsening pain, used more pain medications, and had worsening quality of sleep and daily function during the COVID-related clinic disruption, and that they were interested in resumption of the program.

ACUPRESSURE IN HOSPITALIZED PEDIATRIC ONCOLOGY PATIENTS WITH FEBRILE NEUTROPENIA - A PILOT STUDY

Background: Chemotherapy-induced neutropenia is an expected side effect during cancer therapy. Prolonged neutropenia can lead to treatment delays and chemotherapy dose reduction. Patients with neutropenia are at increased risk for life-threatening infections, and when febrile they require hospitalization and broad-spectrum IV antibiotics. Acupuncture and related techniques have received increased interest in several clinical trials in adult oncology, where their use has resulted in improved blood cell counts. Little is known regarding the impact of needleless acupressure intervention in pediatric oncology patients. Objectives: The purpose of this pilot study was to evaluate the effects of daily treatment using predetermined acupressure points on hospitalized pediatric oncology patients with febrile neutropenia. Our primary objective was to determine if this protocol decreased the time to blood cell count recovery, a requirement for hospital discharge. The metric used for count recovery was absolute phagocyte count (APC), which is ANC (absolute neutrophil count) + AMC (absolute monocyte count). The endpoint for count recovery was APC ≥ 500/μL. Design/Method: In this pilot study, pediatric oncology patients admitted to the University of Minnesota Masonic Children's Hospital who had febrile neutropenia (ANC < 500/μL and temperature > 100.3F) were offered enrollment. Enrolled subjects received daily acupressure treatments until APC recovery. Cases were disease-matched to historical controls by treatment protocol as closely as possible. Time variables, including time to APC recovery and length of stay (LOS), were analyzed using the non-parametric Wilcoxon rank sum test. Results: Twelve cases (enrolled October 2020-September 2021) were group-matched to thirty-four historical controls (pulled from the medical records database, January 2015-October 2019). APC recovery in days was the same in both groups, with a median of 3.0 days, p = 0.352. The LOS in days was also similar: cases 4.94 vs. controls 3.43 days, p = 0.431. No enrolled patients experienced treatment-related adverse events. One patient was removed from the study early due to contracting COVID-19 when there was a limited supply of personal protective equipment. Conclusion: Acupressure presents a unique non-pharmacologic method to potentially support count recovery. Although we were unable to demonstrate a significant impact of acupressure on APC recovery in our pediatric population, we note limited sample size. Only 12 of the goal 35 patients (per initial power analysis) were enrolled. This was due, in part, to impacts of the COVID-19 pandemic, including necessary restrictions on elective research protocols during the study window. Further studies are needed to explore the role of acupressure in pediatric oncology.

Preliminary Results From an Emergency Department Pain Coach Service and Discharge Toolkit Pilot Project During COVID-19

Study Objectives: Amid the US opioid epidemic, emergency providers and patients are searching for non-opioid or nonpharmacologic pain treatment options. The challenge of managing pain without opioids was escalated by the COVID-19 pandemic with opioid related overdoses and deaths increasing by 20-40%. Most healthcare professionals have limited knowledge, resources or time for pain education, especially in the emergency department (ED). To address these needs a novel pain coaching program was designed including a menu of nonpharmacologic patient discharge toolkit materials. Study objectives were to determine descriptive patient and toolkit utilization data and challenges in the first 4 months of a novel pain program. Methods: Target population consisted of patients ≥14 years of age seen by a new ED Pain Coaching staff from January 4, 2021- April 30, 2021. The two ED sites consisted of an urban, academic center with trauma center, pediatric ED, etc. and an affiliated community ED. Patients were determined by ED rounding, ED census review and consultation by ED staff, physicians, physical therapy, palliative care and pharmacy. Summary statistics for patient demographics, pain type, REALM-SF score, educational topics, toolkit materials, challenges and other data were ed from coaching and patient notes on a daily basis using a REDCap database for analysis. Upon request, there were select inpatient and repeat coaching encounters. Results: During this 4-month pilot, 296 coaching sessions were completed on 276 unique patients;20 screen outs for severe pain, procedures, violent behavior or other obstacles. Average age was 43 with 85% between 20-70 years of age;62% female;60% African American. Pain was 46% acute, 50% acute on chronic and 4% chronic with patients often having multiple pain etiologies: musculoskeletal (74%), inflammatory (71%), post-trauma (15%), headache (14%), post-surgical (4%) and neuropathic (3%). Education topics provided with accompanying toolkit items: hot/cold gel packs (90%), car with 4 flat tires analogy (90%), pain neuroscience education (88%), aromatherapy inhalers (82%), breathing techniques (69%), virtual reality (51%), exercise (38%), stretching (35%), diet (20%), acupressure (11%). The majority of patients were seen in 2 EDs or associated trauma center (87%);however, the coach received referrals for selected inpatients (13%). Seventeen educational brochures were made available to patients with aromatherapy, managing pain, pain and stress, and nonpharmacologic management being most utilized. Challenges to coaching included medical condition (14%), too much pain (11%), time constraints (7%);52% had no challenges. Regarding patient feedback, 61% indicated the session was helpful and 39% were unsure at the time. Conclusion: Results from this novel ED pain coach and discharge toolkit model provide valuable insights for development of a national pain coach model. Coaching scripts, note template, brochures, videos, inventory and other programmatic materials will be published for further implementation. Future plans include longitudinal patient follow-up, staff satisfaction assessment and addition of new modalities.

Acupressure: An Effective and Feasible Alternative Treatment for Anxiety During the COVID-19 Pandemic.

Anxiety is highly reported during the COVID-19 pandemic. The use of acupressure for anxiety is a common practice in integrative medicine, and previous literature has shown that acupressure can be an effective and feasible alternative treatment for decreasing anxiety. Given the social distancing requirements during the COVID-19 pandemic, it appears reasonable to assume that acupressure may be especially suited to treat anxiety under these circumstances. However, there has been relatively little reported use of acupressure for anxiety during the pandemic. This viewpoint aims to highlight the possible role of acupressure as a self-administered therapeutic approach for anxiety amidst the COVID-19 pandemic and to outline key areas for future research.

Pandemic adaptation measurement of cook county health pain patients to acupuncture telehealth over a 12-month period

Background: Cook County Health (CCH) was founded in 1834 to provide health aid to the indigent residents of Cook County. Prior to the Covid-19 pandemic, this safety net for healthcare provided care to thousands of people, with over 1 million unique visits per year. In 2011, the Acupuncture Department was added to the Pain Management Center, as an Integrative Medicine approach to pain management, with Frank Yurasek appointed as Director, under the direction of Dr. Maria Torres, MD, PMC Chair. Pain Management Center patients, suffering in order of complaint, from: back, neck, hip, shoulder, knee pain, gun shot, beating and stabbing victims, workplace injuries, and motor vehicle accidents. Pre-pandemic patient levels averaged 20 to 25 treatments daily, Monday through Friday. That number went to zero in March of 2020, due to the pandemic. Telehealth Program: Following shutdown, the acupuncture department met to develop and deliver Telehealth Acupuncture services to its patients, who had come to depend on acupuncture as an opiate sparing intervention. Customized Acupuncture Telehealth visits included tailored acupressure instructions to provide pain relief, as well as exercise, stretching and breathing routines based on simplified Qi Gong practices, diet modifications, and herbal tea recommendations. Follow-up calls were made to monitor progress and modify program components as needed. The weekly flow chart, follow-up scripts, and response summaries will be reviewed in this presentation. Proposal: Acupuncture Pain Management patients have begun to return to the clinic for in person follow-up care. Completion of a proposed anonymous, short questionnaire will be discussed with acupuncture patients. Those interested in participation, will pick up the questionnaire, complete, and leave behind with the front desk Clerk. In the past, the utilization of acupuncture patient questionnaires has provided valuable feedback, and we look forward to providing the patient feedback on our Telehealth Acupuncture visits.

Virtual acupressure for symptom management in cancer populations during COVID-19: A retrospective analysis

Purpose: The COVID-19 outbreak has disrupted access to in-person acupuncture services for symptom management among cancer patients. A virtual acupuncturist-guided, patient self-acupressure intervention was implemented to help mitigate cancer-related symptoms. We provide preliminary findings on the impact of remotely delivered acupressure services on patient-reported symptom burden in cancer patients. Methods: The study population was cancer patients who received virtual acupressure intervention at a single academic cancer center from May 11 to December 31, 2020. At the start of each session, symptom burden was evaluated with the Edmonton Symptom Assessment Scale-Revised Version (ESAS-R). The ESAS-R consists of 9 symptoms, each scored on a 0-10 scale, with higher scores indicating greater symptom burden. The ESAS-R includes the physical (score 0-60) and emotional subscales (score 0-20). For patientswith at least one follow-up within 14 days of the baseline visit, paired t-test was used to analyze changes in ESAS-R scores from baseline to first follow-up. Results: A total of 102 virtual acupressure sessions were administered to 32 patients. A majority of the patients were females (90.6%) and white (84.4%), and the mean age was 55.7 (range = 26-82;SD = 15.73). The most common cancer diagnosis was breast (53.1%), followed by pancreas (12.5%) and lung (9.4%). Baseline ESAS-R total, physical, and emotional scores were 21.5 (SD = 11.05), 12.4 (SD = 7.54), and 5.2 (SD = 3.82), respectively. Of 32 patients, 13 had follow-up in 14 days or less. For these 13 patients, there was a statistically significant reduction in total symptom burden (-4.85±7.6;p = 0.04) and in physical (-3.5±5.36;p = 0.038) and emotional (-1.2±1.79;p = 0.029) subscales from baseline to follow-up. Conclusion: Virtual acupressure was associated with significant reduction in symptom burden among cancer patients from their baseline to follow-up visits. Larger-scale randomized clinical studies needed to confirm these findings and better understand the impact of virtual acupressure on symptom burden in cancer populations.

Auricular acupressure for patients with emotional distress under the COVID-19 pandemic: A randomized controlled trial

Purpose: To confirm whether self-administered AVNA treatment is effective in improving emotional distress under the COVID-19 pandemic. Methods: A smartphone-based online, randomized, controlled trial was designed from 26 February 2020 to 28 April 2020 in four study sites, including Wuhan, Beijing, Shenyang, and Guangzhou of China. Local residents who had considerable emotional distress with a score of the Hospital Anxiety and Depression Scale (HADS) ≥ 9 were recruited. Participants were randomly assigned to three times of AVNA (n = 191) per day, in morning, around noon, and in evening or usual care (UC, n = 215) once daily for 14 days. The primary outcome was the response rate, which was the proportion of participants whose Hospital Anxiety and Depression Scale (HADS) score reduced from baseline by ≥ 50%. The assessment was conducted at baseline, 3 days, and 14 days. Results: The AVNA group had a markedly higher response rate than the UC group at 3 days (35.6% vs. 24.9%, P = 0.02) and at 14 days (70.7% vs. 60.6%, P = 0.02). The AVNA group showed significantly greater reduction in scores of HADS at the two measurement points and BAI at 3 days (P ≤ 0.03), with average respective effect size of 0.217 and 0.195. Participants with AVNA spent less time falling asleep and rated their sleep quality being remarkably higher than those with UC at endpoint. Conclusion: During COVID-19 pandemic period, treatment with self-administrated AVNA was more effective than UC in reducing emotional distress of isolated populations. These findings support self-administered AVNA as a treatment option for patients with emotional distress under the COVID-19 pandemic or other emergent events.