Cooking up Change: DEIB Principles as Key Ingredients in Nutrition and Culinary Medicine Education.

The integration of diversity, equity, inclusion, and belonging (DEIB) principles into healthcare education is essential to ensure culturally sensitive and equitable healthcare delivery. In the domain of nutrition, food, and health, these principles are particularly vital, as diet and food choices are strongly linked to cultural identities and socioeconomic conditions. Despite a growth of DEIB initiatives in undergraduate and graduate medical education, there is a significant gap regarding guidelines for implementing DEIB principles in education around nutrition and food, including that for dietitians, allied health and medical professionals. A literature review was conducted, analyzing peer-reviewed articles and current practices in academic medical education to understand DEIB in nutrition, food, and health. The outcome was the creation of a three-tiered checklist titled "Checklist for Culturally Competent Education in Nutrition". It serves as a roadmap to cultivate culturally competent, equitable, and inclusive healthcare professionals that emphasizes avoiding bias, enhancing awareness, and building practical skills for DEIB implementation around nutrition.

Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial.

Objective: Acupuncture is an effective treatment for arrythmias and postoperative symptoms but has not been investigated after cardiac surgery. Acupuncture After Heart Surgery is a prospective, randomized, controlled pilot trial of daily inpatient acupuncture or standard care after valve surgery with the primary end point being feasibility and secondary end points being reduction in postoperative atrial fibrillation incidence and postoperative symptoms. Methods: A total of 100 patients without a history of atrial fibrillation underwent primary valve surgery via sternotomy and randomized 1:1 to acupuncture (51) or standard care (49). The acupuncture group received daily inpatient sessions starting on postoperative day 1. Postoperative symptoms (pain, nausea, stress, anxiety) were assessed once daily in the standard care group and before/after daily intervention in the acupuncture group. The groups were comparable except for age (acupuncture: 55.6 ± 11.4 years, standard care: 61.0 ± 9.3 years; P = .01). Results: The Acupuncture After Heart Surgery pilot trial met primary and secondary end points. There were no adverse events. An average of 3.8 (±1.1) acupuncture sessions were delivered per patient during a mean hospital stay of 4.6 days (±1.3). Acupuncture was associated with a reduction in pain, nausea, stress, and anxiety after each session (P < .0001), and patients receiving acupuncture had reduced postoperative stress and anxiety across admission compared with standard care (P = .049 and P = .036, respectively). Acupuncture was associated with reduced postoperative atrial fibrillation incidence (acupuncture: 7 [13.7%], standard care: 16 [32.7%]; P = .028), fewer discharges on amiodarone (acupuncture: 5 [9.8%], standard care: 13 [26.5%]; P = .03), and fewer hours in the intensive care unit (acupuncture: 30.3 ± 10.0, standard care: 37.0 ± 22.5; P = .057). Conclusions: Acupuncture after valve surgery is feasible, is well tolerated, and has clinical benefit. The reduction noted in postoperative atrial fibrillation incidence will inform larger trials designed to further investigate the impact of acupuncture on postoperative atrial fibrillation and medical outcomes.

Psychometric properties of a new self-report measure of medical student stress using classic and modern test theory approaches.

BACKGROUND: Medical students face significant stressors related to the intense rigors of their training and education. Accurate measurement of their stress is important to quickly identify, characterize and ameliorate these challenges. Existing measures have limitations that modern measurement approaches, such as item response theory (IRT), are able to address. This study presents the calibration and validation of a new IRT-based measure called the Medical Student Stress Scale (MSSS). METHODS: Following rigorous measurement development procedures described elsewhere, the authors created and tested a pool of 35 items with 348 1st - 4th year medical students along with demographic and external validity measures. Psychometric analysis included exploratory and confirmatory factor analyses, IRT modeling, and correlations with legacy measures. RESULTS: Of the original 35 items, 22 were retained based on their ability to discriminate, provide meaningful information, and perform well against legacy measures. The MSSS differentiated stress scores between male and female students, as well as between year in school. CONCLUSION: Developed with input from medical students, the MSSS represents a student-centered measurement tool that provides precise, relevant information about stress and holds potential for screening and outcomes-related applications.

Work engagement in medical students: An exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes.

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.

Cooking Up Health: A Novel Culinary Medicine and Service Learning Elective for Health Professional Students.

PURPOSE: The current investigation assessed the feasibility, acceptability, and efficacy of the Cooking Up Health (CUH) culinary medicine elective that was offered to medical students at Northwestern University's Feinberg School of Medicine. The elective included a combination of didactics, plant-based culinary sessions, and service learning, in which students translated nutrition and health connections to elementary school children in at-risk communities. METHOD: Nine medical students enrolled in cohort 1 and 12 in cohort 2. Students completed assessments before and after the course measuring confidence in nutrition and obesity counseling, attitudes toward nutrition counseling, personal dietary intake, and cooking confidence and behaviors. RESULTS: The elective showed high feasibility and acceptability with strong class attendance (96%-99%) and retention (89%-100%). Over the course of the elective, students across both cohorts showed increased confidence in nutrition and obesity counseling (ps < 0.001), cooking abilities (ps < 0.01), and food preparation practices (ps < 0.04). Cohort 1 reported decreased meat consumption (p = 0.045), and cohort 2 showed increased fruit and vegetable intake (p = 0.04). Finally, cohort 2 showed increased knowledge and confidence regarding consuming a plant-based diet (ps < 0.002). Students reported an increased appreciation for the role of nutrition in health promotion and disease prevention and an intention to incorporate nutrition into patient care. CONCLUSION: This study provided preliminary evidence demonstrating feasibility, acceptability, and efficacy of the CUH culinary medicine elective for increasing medical students' confidence in nutrition and obesity counseling of patients and in their ability to use nutrition and cooking for personal self-care. Ultimately, this program of research may provide evidence to support widespread integration of CUH into medical education and has the potential to prepare medical students to properly advise patients on nutrition to combat the rising rates of obesity, diabetes, and preventable diseases related to nutrition.

Practice Drift: Are There Risks When Integrative Medicine Physicians Exceed Their Scope?

Editor´s Note: This is the third commentary from the JACM column partnership with the Osher Collaborative for IntegrativeMedicine. These quarterly columns from leaders of the seven prominent academic centers that constitute the Collaborative are meant to stimulate and enliven thinking about the paradigm, practice, and policy to advance integrative health. In this column, two members at the Osher Center for Integrative Medicine in Chicago, Illinois and San Francisco, California, take on a challenge pioneering field face as they move from the Wild West into professional formation. Their focus is on the mosaic of integrative practices of medical doctors. The lead author hails from an integrative medicine base that is known for its clinical program. Osher Northwestern executive director Melinda Ring, MD, FACP, Clinical Associate Professor of Integrative Medicine, is also a member of the Board of Directors of the American Board of Integrative Medicine, that has set the prevailing standard for board certification. Ring´s coauthor, Sandy Newmark, MD, FAAP, holds the position of Osher Foundation Endowed Chair in Clinical Programs in Integrative Medicine at the UCSF Osher Center. Newmark is also head of that Center´s Pediatric Integrative Neurodevelopmental Program. -John Weeks, Editor-in-Chief, JACM.

Acupuncture as Adjuvant Therapy for the Management of Cervical Dystonia.

Objectives: There are no curative treatments for cervical dystonia (CD), therefore conventional management is aimed at pain relief and muscle relaxation. Many patients with CD use complementary and integrative medicine interventions to manage symptoms, yet there are limited data on the use of acupuncture for CD. The aim of the current study was to determine the feasibility, safety, and efficacy of adjuvant acupuncture. Materials and Methods: A pilot open-label study was conducted on acupuncture treatments as add-on therapy to botulinum-toxin injection sessions (3 months apart) in 5 subjects with chronic idiopathic CD. Six 1-hour acupuncture sessions were administered every other week over the 3-month period between consecutive botulinum-toxin sessions. Data from exploratory efficacy endpoints-including a visual analogue scale for pain, the Clinician Global Impression of Change, the Patient Global Impression of Change, the Toronto Western Spasmodic Torticollis Rating Scale, and the Short Form-36) Health Survey-were collected. Results: Five subjects completed the study with only 1 acupuncture session missed by 1 subject, thereby meeting the study's predetermined adherence goal. All participants reported improvement from acupuncture. Only minor adverse events were reported, with self-resolved discomfort in 1 subject and self-resolved minor bruising in 2 subjects. Conclusions: Acupuncture is feasible and safe as an adjunct treatment for chronic CD, and might be associated with subjective symptomatic benefits.

Integrative Women's Health.

This article addresses the common women's health concerns of menopause-related symptoms, premenstrual syndrome, and chronic pelvic pain. Each can be effectively addressed with an integrative approach that incorporates interventions such as pharmaceuticals, nutraceuticals, mind-body approaches, acupuncture, and lifestyle modification.

Introduction to Integrative Medicine in the Primary Care Setting.

Integrative Medicine has been described as "healing oriented medicine that takes account of the whole person (body, mind, and spirit) including all aspects of lifestyle. It emphasizes therapeutic relationships and makes use of all appropriate therapies, both conventional and alternative." National surveys consistently report that approximately one-third of adults and 12% of children use complementary and integrative medicine approaches. Although there are barriers to primary care professionals engaging in discussions about lifestyle change and complementary and integrative medicine options, there is also great potential to impact patient well-being.

Women's Health: Polycystic Ovarian Syndrome, Menopause, and Osteoporosis.

Surveys consistently show that a significantly higher percentage of women with chronic medical conditions report use of complementary and integrative medicine (CIM) approaches compared with men. A total of 54.5% of women report use of at least one CIM approach specifically for obstetric or gynecologic problems. However, primary care providers remain an underutilized resource by patients for guidance in the safe and appropriate use of integrative therapies. This article provides a practical overview of the most appropriate integrative therapies to consider in the management of commonly seen women's health conditions: polycystic ovarian syndrome, menopause, and osteoporosis.

Acupuncture-Related Quality of Life Changes Using PROMIS Computer Adaptive Tests in a Pragmatic Trial with Oncology and General Integrative Medicine Patients: The Role of Baseline Acupuncture Expectations.

INTRODUCTION: Acupuncture has been shown to alleviate symptoms and increase general well-being in different medical patient samples. A major challenge in acupuncture clinical research is the availability of comparable and standardized patient-reported outcome measurement (PRO) tools. OBJECTIVES: This study used a pragmatic design to examine longitudinal changes in quality of life (QOL) in a medical patient sample following acupuncture using PROs from the National Institutes of Health's Patient Reported Outcomes Measurement Information System (PROMIS) initiative. It also examined the role of acupuncture expectancies, as well as patient and provider perceptions of acupuncture benefit. DESIGN: Following informed consent, patients completed baseline QOL measures (T1) prior to their first acupuncture session. Subsequent assessments (up to 20) were completed immediately following ensuing acupuncture sessions. Patients completed assessments either on a touch-screen computer at the clinic or from their home computer. RESULTS: Compared with acupuncture-naïve participants, those who received prior acupuncture treatment reported significantly higher anxiety, fatigue, sleep disturbance, and lower positive affect at baseline. By the second assessment, however, these differences became nonexistent. Participants who held greater baseline acupuncture expectations (e.g., their situation would improve a lot, they would have improved coping skills, their symptoms would disappear, their energy would increase) reported significantly higher fatigue, pain interference, and problems with physical functioning. Between T1 and T2, all participants reported significant improvements in anxiety, depression, and fatigue. Exploratory longitudinal models demonstrated significant linear improvements over time in anxiety (p = 0.006), depression (p = 0.007), pain interference (p < 0.001), and sleep disturbance (p = 0.004). No linear reduction over time was found with fatigue (p = 0.587), physical function (p = 0.654), or positive affect (p = 0.247). CONCLUSIONS: Overall, PROMIS computer adaptive tests were able to assess domains of QOL briefly. Although pretreatment acupuncture expectations highlighted subgroup differences in outcomes at baseline, linear-growth models demonstrated the positive effects of acupuncture over time on anxiety, depression, pain interference, and sleep disturbance.

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.

Expanding the differential diagnosis of hemoptysis: mycotic aortic aneurysms.

The differential diagnosis of hemoptysis includes a wide spectrum of infectious, autoimmune, and neoplastic diseases as well as chest trauma. The clinical presentation of a mycotic aortic aneurysm is often nonspecific, but mortality is high, especially after aneurysmal rupture. A high index of suspicion is warranted in any patient presenting with hemoptysis and a recent past history of subacute bacterial endocarditis, intravascular interventions, known aortic aneurysm, and/or immunocompromised state. A case report is presented of a patient with an ascending aortic mycotic aneurysm eroding into the adjacent lung, leading to chest pain, dyspnea, and hemoptysis. This case report provides an important lesson of the need to expand the differential