Making sense of chronic disease using Emotional Freedom Techniques (EFT): An existential view of illness.

OBJECTIVE: This article explores chronic disease patients' personal symbolic meanings of their diseases, as emergent from their experience of Emotional Freedom Techniques (EFT) therapy. The present study is part of a larger study that explored chronic disease patients' and EFT practitioners' experiences of using EFT to support chronic disease healthcare. DESIGN: Eight chronic disease patients who had received EFT were interviewed for this study. Semi-structured interviews were conducted face to face, or via telephone, or the online videoconferencing platform, Zoom. Interviews were transcribed verbatim and data was analysed using Interpretative Phenomenological Analysis methodology. RESULTS: Three themes emerged, namely 'illness as an embodiment of unresolved emotional issues', 'illness as body's call for time-out and attention', and 'illness as a boundary from other people'. CONCLUSION: EFT offers promise as a suitable therapeutic approach to help chronic disease patients make sense of their life stories and lived experiences, and consequently, symbolic meanings of diseases. The exploration of illness symbology and meaning-making may offer therapeutic value to patients, from both an existential and a health behaviors perspective.

Health literacy education for rural health professionals: shifting perspectives.

Health literacy is a major issue for improving health outcomes of clients. In rural Victoria, Australia, the Gippsland Health Literacy Project (GHLP) educated local health services staff about health literacy and provided tools and techniques for health literacy implementation in services. This paper reports the outcomes of this project. Participants' change in knowledge was measured through pre- and post-project surveys and interviews. Descriptive analysis of survey data and analysis of interviews using qualitative description enabled exploration of individual and organisational shifts in health literacy perspectives. Healthcare professionals' knowledge of health literacy has improved as a result of the health literacy education. Health service organisations are also taking greater responsibility for health literacy responsiveness in their services. Systematic changes to policy and procedures that support health literacy are required. Although health literacy education provides more accessible health care for consumers, where projects had executive-level support the changes implemented were more likely to be successful and sustainable.

Emotional freedom techniques (EFT) as a practice for supporting chronic disease healthcare: a practitioners' perspective.

PURPOSE: The objective of the present study was to explore Emotional Freedom Techniques (EFT) practitioners' experiences of using EFT to support chronic disease patients. This was part of a larger study exploring chronic disease patients' and EFT practitioners' experiences of using EFT to support chronic disease healthcare. METHODS: A qualitative approach was deemed suitable for this study. Eight practitioners were interviewed using semi-structured interviews via telephone or Zoom (an online video-conferencing platform). Interviews were transcribed verbatim and data was analyzed using Interpretative Phenomenological Analysis methodology. RESULTS AND CONCLUSION: This article presents two super-ordinate themes which explore application of EFT for addressing emotional issues faced by chronic disease patients, and for management of physical symptoms, respectively. Chronic disease patients may benefit from a holistic biopsychosocial, patient-centered healthcare approach. EFT offers potential as a technique that may be used by health practitioners to support the psychosocial aspect of chronic disease healthcare. Implications for Rehabilitation Rehabilitation professionals should incorporate suitable psychological interventions (e.g., EFT) to improve coping and acceptance in physical chronic disease patients and alleviate their fears about the future. Rehabilitation professionals are also recommended to address in chronic disease patients, long-standing or unresolved emotional issues, including past traumas from early life, using EFT or another suitable intervention. Rehabilitation professionals should help improve patients' emotional states using EFT to enhance physical symptom management.

A cross-sectional analysis of local government health and wellbeing plans and priorities in Victoria, Australia.

The aim of this study is to explore local health and wellbeing plans and priorities by Victorian local governments (LGs), specifically to: (1) analyse how LG priority areas are described in comparison to the State-level plan; (2) identify differences between regional and metropolitan health priorities; and (3) identify differences between LGs with high and low socioeconomic status. Content analysis of 79 LG health and wellbeing plans was undertaken. Differences in health and wellbeing priorities between LGs were examined using the t-test for two proportions. In total, 20% of the plans did not specify actions to address health priorities. One in three (34%) did not specify how evaluation will be done. Alcohol and other drugs, gambling and housing were prioritised more by metropolitan LGs, whereas disease prevention was prioritised more in regional LGs. There was no significant difference in health and wellbeing priorities of LGs with high and low socioeconomic status except for gambling. State-level health and wellbeing plans should be sensitive to differences in priorities of LGs. There is a need for local plans to commit to specific actions and evaluation. This analysis provides basis for more community-reflective, State-level planning and calls for more emphasis on identifying actions and evaluation in local level planning.

Advancing medical education: connecting interprofessional collaboration and education opportunities with integrative medicine initiatives to build shared learning.

BackgroundImproved teamwork between conventional and complementary medicine (CM) practitioners is indicated to achieve effective healthcare. However, little is known about interprofessional collaboration and education in the context of integrative medicine (IM). MethodsThis paper reports the findings from a constructivist-grounded theory method study that explored and highlighted Australian medical students' experiences and opportunities for linking interprofessional collaboration and learning in the context of IM. Following ethical approval, in-depth semi-structured interviews were conducted with 30 medical students from 10 medical education faculties across Australian universities. Results Medical students recognised the importance of interprofessional teamwork between general medical practitioners and CM professionals in patient care and described perspectives of shared responsibilities, profession-specific responsibilities, and collaborative approaches within IM. While students identified that limited interprofessional collaboration currently occurred in the medical curriculum, interprofessional education was considered a means of increasing communication and collaboration between healthcare professionals, helping coordinate effective patient care, and understanding each healthcare team members' professional role and value. Conclusions The findings suggest that medical curricula should include opportunities for medical students to develop required skills, behaviours, and attitudes for interprofessional collaboration and interprofessional education within the context of IM. While this is a qualitative study that reflects theoretical saturation from a selected cohort of medical students, the results also point to the importance of including CM professionals within interprofessional collaboration, thus contributing to more person-centred care.

Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study.

The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines.

Integrating complementary medicine literacy education into Australian medical curricula: Student-identified techniques and strategies for implementation.

Formal medical education about complementary medicine (CM) that comprises medicinal products/treatments is required due to possible CM interactions with conventional medicines; however, few guidelines exist on design and implementation of such education. This paper reports findings of a constructivist grounded theory method study that identified key strategies for integrating CM literacy education into medical curricula. Analysis of data from interviews with 30 medical students showed that students supported a longitudinal integrative and pluralistic approach to medicine. Awareness of common patient use, evidence, and information relevant to future clinical practice were identified as focus points needed for CM literacy education. Students advocated for interactive case-based, experiential and dialogical didactic techniques that are multiprofessional and student-centred. Suggested strategies provide key elements of CM literacy within research, field-based practice, and didactic teaching over the entirety of the curriculum. CM educational strategies should address CM knowledge deficits and ultimately respond to patients' needs.

Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.

OBJECTIVE: Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. DESIGN: Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. SETTING: Medical school education faculties in Australian universities. RESULTS: Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. CONCLUSIONS: Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively.

Complementary medicines in medicine: Conceptualising terminology among Australian medical students using a constructivist grounded theory approach.

Terminology around the use of complementary medicines (CM) within medical discourse is ambiguous. Clear collective discourse within the medical context is required. This study reports the findings of a Constructivist Grounded Theory Method study used to explore medical students' conceptualisation of terminology and associated value components around CMs as evidenced within their discourse community. The results show that terminology surrounding CMs within medicine is politically charged and fraught with value judgements. Terms used to describe CMs were considered, many of which were deemed problematic. Categorisation of specific medicines was also deemed inappropriate in certain contexts. Conceptualisation of CM terminology, categorisation and value implications, discriminated between levels of evidence for CMs and provided insights into the social change of medicine towards emergence of an evidence-based integrative approach. The results show that terminology surrounding CM is a social construct consistent with fluid conceptualisation and operationalisation in different social contexts.

Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature.

OBJECTIVE: The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present. METHOD: English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded. RESULTS: Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases. CONCLUSION: Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.

More is more in remote Central Australia: more provision of primary healthcare services is associated with more acute medical evacuations and more remote telephone consultations.

INTRODUCTION: This study investigated whether increased numbers of primary healthcare clinical consultations in Indigenous communities in some remote areas of Australia are associated with the reduced need for urgent medical evacuations and remote telephone consultations. METHODS: A retrospective comparison study of routinely collected data utilising correlation analysis was conducted. Statistical associations have been measured using Pearson product-moment correlation coefficients. The setting was 20 primary healthcare centres in the Northern Territory servicing ≥5900 residents between July 2008 and June 2010; data were collected from Central Australia Remote Health and the Royal Flying Doctor Service-Central Operations, Alice Springs base. Main outcome measures included number of acute medical evacuations and number of remote telephone consultations relative to number of face-to-face consultations with Aboriginal health workers, remote area nurses and general practitioners. RESULTS: Statistically significant positive correlations were found between numbers of acute medical evacuations and numbers of face-to-face consultations (r = 0.659; 95% confidence interval (CI): 0.305-0.855), remote area nurse consultations (r = 0.481; 95% CI: 0.055-0.765) and general practitioner consultations (r = 0.798; 95% CI: 0.555-0.920). Significant positive correlations were also found between numbers of remote telephone consultations and numbers of face-to-face consultations (r = 0.546; 95% CI: 0.135-0.795) and general practitioner consultations (r = 0.563; 95% CI: 0.163-0.805). CONCLUSIONS: The provision of more frequent healthcare centre face-to-face consultations, including general practitioner consultations, is associated with an increased burden of acute medical evacuations and remote telephone consultation services in this remote setting.

Infantile colic: a systematic review of medical and conventional therapies.

AIM: Infantile colic is a prevalent and distressing condition for which there is no proven standard therapy. The aim of this paper is to review medical and conventional treatments for infantile colic. METHODS: A systematic literature review was undertaken of studies on medical and conventional interventions for infantile colic from 1980 to March 2009. The results and methodological rigour of included studies were analysed using the CONSORT (Consolidated Standards Of Reporting Trials) 2001 statement checklist and Centre for Evidence Based Medicine critical appraisal tools. RESULTS: Nineteen studies and two literature reviews were included for review. Pharmacological studies on Simethicone gave conflicting results and with Dicyclomine hydrochloride and Cimetropium bromide results were favourable but side effects were noted along with issues in study methodology. Some nutritional studies reported favourable results for the use of hydrolysed formulas in bottle-fed infants or low-allergen maternal diets in breastfed infants but not for the use of additional fibre or lactase. There were several issues in regards to methodological rigour. Behavioural studies on the use of increased stimulation gave unfavourable results, whereas results from the use of decreased stimulation and contingent music were favourable. These studies demonstrated poor methodological rigour. CONCLUSION: There is some scientific evidence to support the use of a casein hydrolysate formula in formula-fed infants or a low-allergen maternal diet in breastfed infants with infantile colic. However, there is little scientific evidence to support the use of Simethicone, Dicyclomine hydrochloride, Cimetropium bromide, lactase, additional fibre or behavioural interventions. Further research of good methodological quality on low-allergenic formulas and maternal diets is indicated.

Integrative medicine models in contemporary primary health care.

OBJECTIVE: To determine what models of integrative medicine (IM) are being employed in contemporary health care settings, and how and which factors affect and facilitate the success of IM in terms of the integration of complementary and alternative medicine (CAM) and conventional medicine in primary health care (PHC). DESIGN: Literature review. SETTING: Australian and international PHC settings, and hospitals. MEASURES: Australian and international peer-reviewed literature identified from database searches, reference lists, desktop searches, texts, and relevant website searches (e.g., government and health-related departments and agencies). Focus was literature with the keywords 'integrative' or 'integrated' in conjunction with 'medicine' or 'health care'. Articles were analysed for descriptions of continuous and integrative services involving contemporary IM practices, their background, characteristics, and implementation. FINDINGS AND DISCUSSION: Classifications of IM in the literature present various ways that IM can be implemented, and it appears that strategies have been successfully developed to facilitate integration. Although few of the barriers to the integration of CAM and conventional medicine have been resolved, concerns over the legitimacy of CAM in health care (e.g., safety, biomedical evidence, and efficacy) are being overcome by the use of evidence-based practice in IM delivery. There are two dominant models of IM that have been developed. One is the selective combination of both biomedical evidence and experience-based evidence of both CAM and conventional medicine. The other is the selective incorporation of exclusively evidence-based CAMs into conventional medicine. The two model types signify different levels of equity between CAM and conventional medicine in regard to the power, autonomy, and control held by each. However, the factors common to all IM models, whether describing CAM as supplementary (and subordinate) or complementary (and partnered) to conventional medicine, is the concept of a health care model that aspires to be client-centred and holistic, with focus on health rather than disease as well as mutual respect among peer practitioners. CONCLUSIONS: The growth and viability of IM will depend on evidence-based practices, non-hierarchal IM practices, and identifying the successful influences on the integration of CAM and conventional medicine for recognition of its inherent value in PHC.

Health promoting health services: a review of the evidence.

In the last 20 years, there have been many developments in health promoting hospitals and health services (HPH), particularly in Europe. In Australia, health promotion (HP) programs are being conducted in the hospital setting; however, developments related to the HPH concept have been slower. To identify the effects and benefits of a health service working under the HPH banner, and to assist HP practitioners in advocacy and planning for their health service to become an HPH, we conducted a literature review. Eight studies met the criteria of research on HPH or evaluation of HP programs within an HPH framework. Seven key themes were identified in these studies. Enablers and barriers to HPH development were analyzed and discussed within these themes. This review found a dearth of high-level research on HPH. In particular, there were few Australian studies. There is limited evidence, therefore, of the efficacy of HPH. Much more high-level research and dissemination of the findings are needed in order to encourage policy-makers and health service administrators to invest resources in HPH and to support the work of HP practitioners interested in developing their health service into an HPH.

Supporting academic publication: evaluation of a writing course combined with writers' support group.

Publication rates are a vital measure of individual and institutional performance, yet many nurse academics publish rarely or not at all. Despite widespread acceptance of the need to increase academic publication rates and the pressure university faculty may experience to fulfil this obligation, little is known about the effectiveness of practical strategies to support academic writing. In this small cohort study (n=8) comprising nurses and other professionals involved in university education, a questionnaire survey was used to evaluate the effectiveness of a one-week "Writing for Publication" course combined with a monthly writers support group to increase publication rates. Two year pre and post submissions increased from 9 to 33 articles in peer-reviewed journals. Publications (in print) per person increased from a baseline of 0.5-1.2 per year. Participants reported increased writing confidence and greater satisfaction with the publishing process. Peer support and receiving recognition and encouragement from line managers were also cited as incentives to publish. Writing for publication is a skill that can be learned. The evaluated model of a formal writing course, followed by informal monthly group support meetings, can effectively increase publication rates.

The PUC-CAM-Q: a new questionnaire for delving into the use of complementary and alternative medicines.

OBJECTIVE: This paper reports on the design and testing of a new questionnaire, "Perspectives on the Use in Communities of CAM" (the PUC-CAM-Q [questionnaire]). DESIGN: The questionnaire consisted of scales and questions for 27 concepts considered to affect complementary and alternative medicine (CAM) usage. Scales encompassed 13 beliefs about nature, scientific medicine, and the environment, as well as personal characteristics, such as stoicism and resilience. A matrix provided space for respondents to indicate their use, or likelihood of use, of 23 of the most commonly available CAM modalities. Also included were questions about the reasons for CAM use and sources of health information. LOCATION: The questionnaire was mailed to a randomly selected sample of people in a pilot study of two metropolitan and five rural localities in Victoria, Australia. RESULTS: The response rate was 40% (n = 459). The majority of the questionnaires were completed consistently, and the reliability and validity and questions were satisfactory. Seven (7) of the 13 scales that explored the beliefs and concerns about CAM use and the characteristics of the respondents had Cronbach alphas of above 0.7. Refinement of the other six scales resulted in alphas of between 0.6 and 0.7, with good corrected item-total correlations for included questions. Responses to the matrix question on the use, or likelihood of use, of individual CAM modalities were also good. However, some adjustments to the layout would provide more comprehensive information for future use of the PUC-CAM-Q. CONCLUSIONS: This questionnaire provided good data that were appropriate for the exploratory nature of this PUC-CAM study. After more attention to the scales, as well as some refinement of some nonscale questions, the PUC-CAM-Q would be a practical instrument for further studies on CAM use.

Information technology creeps into rural general practice.

This study looked at the effect of information technology on rural medical practice. Eight GPs in rural medical practice in Victoria were interviewed, and World Wide Web sites were accessed for information relevant to the rural GPs use of information technology. The results indicated that rural GPs are developing their use of information technology according to their needs. The use of information technology is changing the nature of rural medical practice, and bringing more support and information to rural GPs. However, some of the technologies now available are of little perceived use to the GPs, and GPs with good support staff are better able to take advantage of the technology than GPs with little or inadequate support. The findings of this study have implications for policies being implemented to increase the availability of information technology to support rural health care.

Video-conferencing: under-used by rural general practitioners.

The objective was to investigate the use of and value General Practitioners place on video-conferencing as a tool in providing rural health care. The participants were 8 rural general practitioners in rural Victoria towns. I found that six out of the eight GPs did not value video-conferencing as a tool to assist with patient care, and the other two GPs were interested in the technology only for certain aspects of support with patient consultations and continuing education. In conclude that there needs to be a review of whether video-conferencing equipment should continue to be implemented in the same way that it has been so far in Victoria, and of the cost-effectiveness of providing video-conferencing facilities in rural health services. In particular, there needs to be a review of whether more training and support for rural general practitioners is needed to increase the uptake of video-conferencing. Alternatively, analysis can be undertaken of the intrinsic value of using video-conferencing as an interactive tool for obtaining specialist support for patient care or undertaking continuing education via video-conferencing, and the program discontinued if it is found to be unwarranted.