Post-COVID-19 Long Hauler Clinical Program: Change in Health-Related Quality-of-Life.

BACKGROUND AND OBJECTIVE: An Integrative Medicine Center created a post-COVID-19 myalgiac encephalomyelitis (ME) program in response to a July 2020 Centers for Disease Control and Prevention document that described fatigue and other functional symptoms. The objective is to present process improvement data on change in health-related quality-of-life (HRQOL) in patients who participated in the "long hauler" program. METHODS: For process improvement purposes, 39 consecutive patients who participated in the post-COVID-19 ME program from August 2020-August 2021 were asked to complete the 12-Item Short Form Survey (SF-12) before treatment and a month later. RESULTS: Twelve participants (31%) completed a baseline and follow-up survey. Mean SF-12 physical component summary scores improved 5 (SD 9) and mental component summary scores improved 4 (SD 9) in patients who completed baseline and follow-up surveys. Case studies of two patients who completed the SF-12 at baseline and after 4 weekly treatments illustrate the program's standardized treatment approach. CONCLUSION: Data collected for process improvement reasons describe changes in HRQOL for participants in a post-COVID-19 ME program. Follow-up practice-based clinical trials may discern optimal approaches for patients with this chronic condition.

Clinical Use of CT-Derived Fractional Flow Reserve in the Emergency Department.

OBJECTIVES: This study sought to examine the feasibility, safety, clinical outcomes, and costs associated with computed tomography-derived fractional flow reserve (FFRCT) in acute chest pain (ACP) patients in a coronary computed tomography angiography (CTA)-based triage program. BACKGROUND: FFRCT is useful in determining lesion-specific ischemia in patients with stable ischemic heart disease, but its utility in ACP has not been studied. METHODS: ACP patients with no known coronary artery disease undergoing coronary CTA and coronary CTA with FFRCT were studied. FFRCT ≤0.80 was considered positive for hemodynamically significant stenosis. RESULTS: Among 555 patients, 297 underwent coronary CTA and FFRCT (196 negative, 101 positive), whereas 258 had coronary CTA only. The rejection rate for FFRCT was 1.6%. At 90 days, there was no difference in major adverse cardiac events (including death, nonfatal myocardial infarction, and unexpected revascularization after the index visit) between the coronary CTA and FFRCT groups (4.3% vs. 2.7%; p = 0.310). Diagnostic failure, defined as discordance between the coronary CTA or FFRCT results with invasive findings, did not differ between the groups (1.9% vs. 1.68%; p = NS). No deaths or myocardial infarction occurred with negative FFRCT when revascularization was deferred. Negative FFRCT was associated with higher nonobstructive disease on invasive coronary angiography (56.5%) than positive FFRCT (8.0%) and coronary CTA (22.9%) (p < 0.001). There was no difference in overall costs between the coronary CTA and FFRCT groups ($8,582 vs. $8,048; p = 0.550). CONCLUSIONS: In ACP, FFRCT is feasible, with no difference in major adverse cardiac events and costs compared with coronary CTA alone. Deferral of revascularization is safe with negative FFRCT, which is associated with higher nonobstructive disease on invasive angiography.

Randomized Pilot Trial for a Community-Based Group Stretching Exercise Program for Chronic Low Back Pain.

Authors of meta-analyses concluded that exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low back pain (CLBP), particularly in health-care populations. Similar to health-care settings, community organizations provide wellness and lifestyle modification programs. Different versions of the Young Men's Christian Association (YMCA) Y's Way to a Healthy Back program were offered from 1974 to 2004. Champions of the YMCA program and authors of the pilot study designed a Healthy Back Curriculum to update and reintroduce the program. Objective: The research aim of this randomized pilot trial was to investigate the feasibility of a follow-up larger randomized controlled trial on the program's effectiveness for CLBP. The randomized pilot trial addressed subject recruitment, retention, and subject compliance with protocol. Methods: The pilot trial employed a 2-arm parallel group randomized design. Seventy-eight subjects aged 18 to 64 years with low back pain on at least half the days over the previous 6 months were assigned to either (1) a group stretching exercise arm with 12 weekly classes or (2) a self-care book arm. Results: Sixty participants, 30 in each group, completed the study. Out of the 130 members who accepted invitation, 60% were eligible. Retention rate over the 24-week study in the group stretching exercise arm was 30 out of 43 participants (70%). Participants in the group stretching exercise program attended an average of 5 of the 12 classes (42%). Participants completed baseline and follow-up self-report items with no missing data. Conclusion: The pilot study did not prove to be feasible based on the prespecified benchmarks. We suggest that a larger trial should include changes gleaned from the pilot study.

Change in Health-Related Quality-of-Life at Group and Individual Levels Over Time in Patients Treated for Chronic Myofascial Neck Pain.

BACKGROUND: This study evaluated change in health-related quality of life at the group and individual levels in a consecutive series of patients with chronic myofascial neck pain. METHODS: Fifty patients with chronic neck pain self-administered the Short Form-36 Version 2 (SF-36 v2) before treatment and 6 weeks later. Internal consistency reliability was estimated for the 8 scale scores and Mosier's formula was used to estimate reliability of the physical and mental health composite scores. Significance of group-level change was estimated using within-group t statistics. Significance of individual change was evaluated by reliable change index. RESULTS: Statistically significant ( P < .05) group mean improvement over time was found for all SF-36 scores. At the individual level, 20% of the possible changes were statistically significant (17% improvement, 3% decline). CONCLUSIONS: Estimating the significance of individual change in health-related quality of life adds important information in comparing different treatment modalities for chronic myofascial neck pain.

Playing-Related Problems among Musicians of the Orquesta Buena Vista Social Club® and Supporting Bands.

BACKGROUND: The Orquesta Buena Vista Social Club® is a world-renowned group of Cuban musicians accomplished in a variety of musical styles. The musicians of the Orquesta Buena Vista Social Club and supporting musicians of their orchestras represent a cohort of musicians throughout Cuba who continue to play traditional genres and perform into their older ages. PURPOSE: The purpose of the study was to (1) identify musculoskeletal conditions that occurred over the previous 12 months among the members of the Orquesta and supporting musicians and (2) to discover if these conditions, in part, were caused by or in some way affected musical performance. METHODS: The study was a convenience sample of musicians within the Orquesta Buena Vista Social Club and supporting musical groups. Thirty-six musicians completed a self-administered survey. RESULTS: Sixty-seven percent (24/36) of the total sample of musicians and 89% (16/18) of those over age 60 years had at least one musculoskeletal condition over the previous 12 months. Forty-four percent (16/36) of the total sample of musicians and 61% (11/18) of those older than 60 years of age reported that a musculoskeletal complaint was either, in part, caused by or affected their performance. CONCLUSION: Musculoskeletal conditions were prevalent among the Cuban musicians, especially in those over 60 years of age. Collaboration of medical professionals, managers, and musicians may help to generate ideas on how to prevent injuries as well as to evaluate what treatments for playing-related conditions, including both conventional and complementary and alternative therapies, are most effective.

Developing and implementing core competencies for integrative medicine fellowships.

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Transitions in illicit drug use status over 3 years: a prospective analysis of a general population sample.

OBJECTIVE: The authors examined 3-year transitions among nonuse, asymptomatic use, and problem use of illicit drugs for U.S. adults in the general household population. METHOD: Data were from the nationally representative National Epidemiologic Survey on Alcohol and Related Conditions, a study of 34,653 adults interviewed twice, 3 years apart. Respondents were categorized on three mutually exclusive categories of baseline drug status: past-year nonusers (N=32,675), past-year asymptomatic drug users (N=861), and past-year symptomatic drug users (N=1,117). Symptomatic drug use, or problem use, was defined as presence of one or more symptoms that operationalize DSM-IV drug abuse and dependence criteria. The authors assessed sociodemographic, health, substance use, and psychiatric covariates for association with 3-year transitions to different status categories. RESULTS: Among baseline nonusers, 95.4% continued to be nonusers at follow-up, 2.1% became asymptomatic users, and 2.5% developed problem use. Among baseline asymptomatic users, 66.6% had stopped using drugs at follow-up, 14.3% continued to be asymptomatic users, and 19.1% had developed problem use. Nearly half (49.0%) of those with problem use at baseline had stopped using drugs at follow-up, 10.9% had transitioned to asymptomatic use, and 40.1% continued to have problem use. Younger age, male sex, white race, and not being married were associated with progression from nonuse to use or problem use, as were alcohol and tobacco use and disorders, major depression, and schizotypal, borderline, and narcissistic personality disorders. Panic disorder and avoidant personality disorder were associated with less progression. CONCLUSIONS: Transitions in drug use status are common. The finding that alcohol and tobacco variables and co-occurring psychopathology are important correlates of transitions suggests the value of addressing all co-occurring disorders and substance use in patient assessments and treatment planning, both to prevent adverse transitions and to promote positive transitions.

Efficacy of a 0.1% capsaicin hydrogel patch for myofascial neck pain: a double-blinded randomized trial.

OBJECTIVE: The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. DESIGN: The study was designed as a double-blinded randomized controlled trial. Setting. The study was set at Kyung-hee University Hospital at Gangdong, Korea. SUBJECTS: Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions. Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. OUTCOME MEASURES: Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Beck's Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. RESULTS: Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. CONCLUSIONS: Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.

Scleroderma, stress and CAM utilization.

Scleroderma is an autoimmune disease influenced by interplay among genetic and environmental factors, of which one is stress. Complementary and alternative medicine (CAM) is frequently used to treat stress and those diseases in which stress has been implicated. Results are presented from a survey of patients with scleroderma. Respondents were a convenient sample of those attending a national conference in Las Vegas in 2002. Findings implicate stress in the onset, continuation and exacerbation of scleroderma. The implication is that CAM providers may be filling an important patient need in their provision of services that identify and treat stress and its related disorders.

Innovations in integrative healthcare education: mind-body faculty development at UCLA and the symposium for portland area research on complementary and alternative medicine.

Content on integrative healthcare and complementary and alternative medicine (CAM) 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 or Dr. Kreitzer at . Submissions should be no more than 700-800 words. Please include any Web site or other resource that is relevant, as well as contact information.

Evaluating the statistical significance of health-related quality-of-life change in individual patients.

Assessing individual change is feasible and potentially useful in clinical practice. This article provides an overview of the evaluation of statistically significant change in health-related quality of life (HRQOL) for individual patients. We review the standard error of measurement, standard error of prediction, and reliable change indices using a sample of 54 patients receiving care at the UCLA Center for East-West Medicine. The largest amount of change necessary for statistical significance was found for the reliable change index and the smallest change was needed for the standard error of measurement. The amount of change required for statistical significance was intermediate for the standard error of prediction. The median kappa for classifying change (declined, stayed the same, improved) by different indices was .82, indicating a high level of agreement. Future research is needed to determine if one index is most appropriate for evaluating the significance of individual change.

Malaria and enterobiasis among Karen Long-neck tribe in Mae Hong Son Province.

In Thailand, Mae Hong Son Province is highly endemic for malaria. Knowing this, the local Health Department has introduced a program to educate local residents about the risk factors, in particular the dangers and symptoms of malaria. This study was conducted to evaluate these efforts, by determining the number of malaria infections in a segment of the population, and also by testing for enterobiasis among a group of its children. Two villages in Mae Hong Son Province were chosen for this purpose with a combined population of about 300. Of these, 195 were screened for malaria. Two subjects were diagnosed positive for malaria by microscopy. One of these two villages was chosen to screen for Enterobius vermicularis infection in children as well. Out of 69 stool samples, five (7%) showed infection with E. vermicularis: three with a low number of eggs (1-50), and two with a high number of eggs (>100). Compared with infection rates in similar studies, the results of this study indicate that the Health Department's efforts are meeting with relative success. The low prevalence of infection indicates that the villagers are using the information they have received to help combat infection.