Penny George Institute for Health and Healing

Minneapolis, United States

Penny George Institute for Health and Healing

Minneapolis, United States
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PubMed | Mount Sinai Beth Israel Medical Center, Penny George Institute for Health and Healing, University of California at San Francisco, Duke University and Yeshiva University
Type: | Journal: BMC complementary and alternative medicine | Year: 2016

Integrative medicine (IM) provides patient-centered care and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a persons health. IM is a whole systems approach that employs multiple modalities as opposed to an isolated complementary therapy. Thus, studying outcomes of IM is more challenging than evaluating an isolated intervention. Practice-based research networks (PBRNs) allow for clinicians/investigators at multiple diverse sites using common methodology to pool their data, increase participant sample size and increase generalizability of results. To conduct real-world, practice-based research, the Bravewell Collaborative founded BraveNet in 2007 as the first national integrative medicine PBRN.Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) is a prospective, non-randomized, observational evaluation conducted at fourteen clinical sites. Participants receive a non-standardized, personalized, multimodal IM approach for various medical conditions. Using the REDCap electronic platform, an anticipated 10,000 study participants will complete patient-reported outcome measures including Patient Reported Outcomes Measurement Information System (PROMIS)-29, Perceived Stress Scale-4, and the Patient Activation Measure at baseline, 2, 4, 6, 12, 18 and 24 months. Extractions from participants electronic health records include IM services received, as well as ICD diagnostic codes, and CPT billing codes associated with each IM visit. Repeated-measures analyses will be performed on data to assess change from baseline through 24 months with planned subgroup analyses to include specific clinical population and specific IM intervention or combinations.As the PRIMIER registry grows, we anticipate that our results would provide an indication of the promise of PBRN research efforts in IM. Analyses will incorporate a large sample of participants and an expected 10-year observation period and will provide the ability to evaluate the effect of IM on outcomes for specific clinical populations and specific IM interventions or combinations. As such, PRIMIER will serve as a national platform for future evaluations of IM best practices.Clinical Trials.gov NCT01754038.


Nate K.C.,Penny George Institute for Health and Healing | Griffin K.H.,Penny George Institute for Health and Healing | Christianson J.B.,University of Minnesota | Dusek J.A.,Penny George Institute for Health and Healing
Evidence-based Complementary and Alternative Medicine | Year: 2015

Background. We describe the process and challenges of delivering integrative medicine (IM) at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW), a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches. © 2015 Kent C. Nate et al.


Johnson J.R.,Penny George Institute for Health and Healing | Crespin D.J.,University of Minnesota | Griffin K.H.,Penny George Institute for Health and Healing | Finch M.D.,University of Minnesota | Dusek J.A.,Penny George Institute for Health and Healing
Journal of the National Cancer Institute - Monographs | Year: 2014

Background: Few studies have investigated the effectiveness of integrative medicine (IM) therapies on pain and anxiety among oncology inpatients. Methods: Retrospective data obtained from electronic medical records identified patients with an oncology International Classification of Diseases-9 code who were admitted to a large Midwestern hospital between July 1, 2009 and December 31, 2012. Outcomes were change in patient-reported pain and anxiety, rated before and after individual IM treatment sessions, using a numeric scale (0-10). Results: Of 10 948 hospital admissions over the study period, 1833 (17%) included IM therapy. Older patients had reduced odds of receiving any IM therapy (odds ratio [OR]: 0.97, 95% confidence interval [95% CI] = 0.96 to 0.98) and females had 63% (OR: 1.63, 95% CI = 1.38 to 1.92) higher odds of receiving any IM therapy compared with males. Moderate (OR: 1.97, 95% CI = 1.61 to 2.41), major (OR: 3.54, 95% CI = 2.88 to 4.35), and extreme (OR: 5.96, 95% CI = 4.71 to 7.56) illness severity were significantly associated with higher odds of receiving IM therapy compared with admissions of minor illness severity. After receiving IM therapy, patients averaged a 46.9% (95% CI = 45.1% to 48.6%, P <.001) reduction in pain and a 56.1% (95% CI = 54.3% to 58.0%, P <.001) reduction in anxiety. Bodywork and traditional Chinese Medicine therapies were most effective for reducing pain, while no significant differences among therapies for reducing anxiety were observed. Conclusions: IM services to oncology inpatients resulted in substantial decreases in pain and anxiety. Observational studies using electronic medical records provide unique information about real-world utilization of IM. Future studies are warranted and should explore potential synergy of opioid analgesics and IM therapy for pain control. ©The Author 2014.


Crespin D.J.,University of Minnesota | Griffin K.H.,Penny George Institute for Health and Healing | Johnson J.R.,Penny George Institute for Health and Healing | Miller C.,Abbott Laboratories | And 4 more authors.
Pain Medicine (United States) | Year: 2015

Objective: Given the risks of opioid medications, nonpharmacological strategies should be considered for total joint replacement patients. We investigated acupuncture as an adjunct therapy for postsurgical pain management in a total joint replacement program by examining which total hip and knee replacement patients elected to receive acupuncture and the effect of acupuncture on short-term pain. Design: A total joint replacement program using fast-track physiotherapy offered elective postsurgical acupuncture to all patients, at no additional cost, as an adjunct therapy to opioids for pain management. Setting: The Joint Replacement Center at Abbott Northwestern Hospital, a 630-bed teaching and specialty hospital in Minneapolis, Minnesota from 2010 to 2012. Subjects: Our sample included 2,500 admissions of total hip (THR) and total knee replacement (TKR) patients. Methods: Self-reported pain was assessed before and after acupuncture using a 0-10 scale and categorized as none/mild (0-4) and moderate/severe pain (5-10). Results: Seventy-five percent of admissions included acupuncture. Women (Odds Ratio: 1.48, 95% Confidence Interval (CI): 1.22, 1.81) had higher odds of receiving acupuncture compared to men, and nonwhite patients (Odds Ratio: 0.55, 95% CI: 0.39, 0.78) had lower odds of receiving acupuncture compared to white patients. Average short-term pain reduction was 1.91 points (95% CI: 1.83, 1.99), a 45% reduction from the mean prepain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture. Conclusions: Acupuncture may be a viable adjunct to pharmacological approaches for pain management after THR or TKR. © 2015 American Academy of Pain Medicine Wiley Periodicals, Inc.


Johnson J.R.,Penny George Institute for Health and Healing | Crespin D.J.,University of Minnesota | Griffin K.H.,Penny George Institute for Health and Healing | Finch M.D.,Finch and King Inc | And 3 more authors.
BMC Complementary and Alternative Medicine | Year: 2014

Background: Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. Methods: Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). Results: Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. Conclusions: Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations. © 2014 Johnson et al.


PubMed | University of Minnesota and Penny George Institute for Health and Healing
Type: | Journal: Evidence-based complementary and alternative medicine : eCAM | Year: 2015

Background. We describe the process and challenges of delivering integrative medicine (IM) at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW), a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches.


Griffin K.H.,Penny George Institute for Health and Healing | Johnson J.R.,Penny George Institute for Health and Healing | Kitzmann J.P.,Penny George Institute for Health and Healing | Kolste A.K.,Penny George Institute for Health and Healing | Dusek J.A.,Penny George Institute for Health and Healing
Journal of Alternative and Complementary Medicine | Year: 2015

Objective: To investigate the outcomes of resilience training (RT) in an outpatient clinical setting on symptom relief for current or recurrent depression, as well as perceived stress and state and trait anxiety. Design: Observational effectiveness study. Settings/Location: Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN. Participants: A total of 728 men and women age 18 years and older who participated in the RT program between December 1, 2007, and November 31, 2012. Of these individuals, 371 were considered study contributors and completed at least one questionnaire both before (pre-RT) and after (post-RT) completion of the program. The remaining participants were considered study non-contributors and did not complete any questionnaires. Interventions: RT is a mindfulness-based program that synergizes elements of mindfulness meditation with nutrition and exercise into a cohesive intervention. Outcome measures: Depressive symptoms, as well as state and trait anxiety and perceived stress. Results: Among the 371 RT participant contributors, depressive symptoms, perceived stress, and state and trait anxiety improved significantly from pre-RT to post-RT. Furthermore, among participants with depression at baseline, Center for Epidemiologic Studies Depression Scale-10 scores decreased by a mean of 44.0% (from 17.5 to 9.8), a value below the cutoff for significant depressive symptoms. Baseline perceived stress scores were the most predictive of program success. Conclusions: This study provides evidence that a multimodal RT program delivered in a real-world clinical setting improves symptoms of depression, anxiety, and stress. Limitations of this effectiveness study include a homogeneous population of mostly white women and a large amount of randomized, imputed, and missing data. Future work should include a randomized controlled trial and potentially studies to separate RT into the three components to determine which may be primarily responsible for the improved outcomes. © Mary Ann Liebert, Inc. 2015.


Plotnikoff G.A.,Penny George Institute for Health and Healing
Minnesota medicine | Year: 2012

Not all who adhere to vegetarian, vegan or other special diets have nutritionally sound eating habits. The clinical consequences of an insufficiently mindful vegetarian or vegan diet include many common symptoms such as anxiety, brain fog, depression, fatigue, insomnia, neuropathies and other neurologic dysfunction. Patients with such symptoms who report having a vegetarian or vegan diet, or a diet that severely restricts meat consumption, require a slightly expanded differential diagnosis. The challenge is to identify which patients require closer attention. This article lists questions to use to quickly assess for potential dietary drivers of clinical symptoms. In many cases, simple nutritional interventions, through diet and/or supplementation, can resolve or minimize problematic symptoms.


PubMed | Penny George Institute for Health and Healing
Type: Controlled Clinical Trial | Journal: Explore (New York, N.Y.) | Year: 2015

Mindfulness-based programs have been primarily used to target anxiety or the prevention of relapse in recurrent depression; however, limited research has been conducted on the use of mindfulness programs for relief of current depressive symptoms.To investigate the potential effect of resilience training (RT) on symptom relief for current or recurrent depression, and other psychological/behavioral outcomes.Wait-list comparison pilot study.Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN.A total of 40 actively working healthcare professionals age 18-65 years.RT is an eight-week mindfulness-based program that synergizes elements of mindfulness meditation with nutrition and exercise. The first 20 consecutive individuals meeting all eligibility criteria were assigned to the RT group. The next 20 consecutive eligible individuals were placed into the wait-list control group and had an eight-week waiting period before starting the RT program.Psychological/behavioral outcomes were measured before and after completion of the RT program and two months after completion. Wait-list participants also had measures taken just before starting on the wait-list.The RT group exhibited a 63-70% (P .01) reduction in depression, a 48% (P .01) reduction in stress, a 23% (P .01) reduction in trait anxiety, and a 52% (P .01) reduction in presenteeism (a per-employee savings of $1846 over the eight-week program). All outcomes were statistically significantly different from the wait-list group. Most improvements persisted up to two months after completion of the RT program.Further replication with a larger sample size, and enhanced control group is warranted.


PubMed | Penny George Institute for Health and Healing
Type: | Journal: Complementary therapies in medicine | Year: 2016

To examine the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system. This study expands upon the limited body of literature on aromatherapy use among inpatients.Retrospective, effectiveness study using data obtained from electronic health records.Ten Allina Health hospitals located in Minnesota and western Wisconsin.Nurse-delivered aromatherapy.Change in patient-reported pain, anxiety, and nausea, rated before and after receiving aromatherapy using a numeric rating scale (0-10).There were 10,262 hospital admissions during the study time frame in which nurse-delivered aromatherapy was part of patient care. The majority of admissions receiving aromatherapy were females (81.71%) and white (87.32%). Over 75% of all aromatherapy sessions were administered via inhalation. Lavender had the highest absolute frequency (49.5%) of use regardless of mode of administration, followed by ginger (21.2%), sweet marjoram (12.3%), mandarin (9.4%), and combination oils (7.6%). Sweet marjoram resulted in the largest single oil average pain change at -3.31 units (95% CI: -4.28, -2.33), while lavender and sweet marjoram had equivalent average anxiety changes at -2.73 units, and ginger had the largest single oil average change in nausea at -2.02 units (95% CI: -2.55, -1.49).Essential oils generally resulted in significant clinical improvements based on their intended use, although each oil also showed ancillary benefits for other symptoms. Future research should explore use of additional essential oils, modes of administration, and different patient populations.

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