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Eisenberg D.M.,Samueli Institute | Eisenberg D.M.,Harvard University
Academic Medicine | Year: 2015

In an era when rates of obesity, diabetes, and other lifestyle-related diseases challenge medical educators and governments worldwide, it is necessary to consider novel educational strategies, both didactic and experiential, whereby current and future health professionals can be better prepared to proactively advise and teach patients enhanced self-care skills (e.g., diet, movement, stress management, and enhanced behavioral change). In this Perspective, the authors summarize current circumstances involving rising rates of obesity and diabetes worldwide, the lack of nutrition-and lifestyle-related curricular requirements for professional medical certification, societal trends regarding modern food culture and food availability in health care settings, and the misalignment of financial incentives to promote health. The authors assess what elements of self-care should or should not be required within future curricula and certification exams. They consider how best to educate trainees about diet and how to "translate" nutrition, exercise, and behavioral science knowledge into practical advice. They explore several ideas for reforming nutrition education, including "teaching kitchens" as required laboratory classes for nutrition and lifestyle instruction, wearable technologies for tracking behaviors and physiological data relating to lifestyle choices, and the prospect of hospitals and other medical venues serving as exemplars of healthy, delicious food options. Finally, the authors argue that "salutogenesis"-the study of the creation and maintenance of health and well-being-should assume its rightful position alongside the study of "pathogenesis"-disease diagnosis and treatment-in medical education and practice.


Cook I.A.,Samueli Institute | Espinoza R.,Human Longevity | Leuchter A.F.,University of California at Los Angeles
Neurosurgery Clinics of North America | Year: 2014

Major depressive disorder is among the most disabling illnesses and, despite best practices with medication and psychotherapy, many patients remain ill even after several treatment trials. For many of these patients with treatment-resistant or pharmacoresistant depression, treatment with neuromodulation offers an alternative. Options range from systems that are implanted to others that are entirely noninvasive. This review surveys recent literature to update readers on 3 particular interventions: deep brain stimulation, transcranial magnetic stimulation, and trigeminal nerve stimulation. Additional comparative research is needed to delineate the relative advantages of these treatments, and how best to match individual patients to neuromodulation intervention. © 2014 Elsevier Inc.


Lee C.,Samueli Institute | Crawford C.,Samueli Institute | Hickey A.,Naval Hospital
Pain Medicine (United States) | Year: 2014

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care complementary and integrative medicine (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. Methods: A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature (REAL©) methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A panel of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Results: Following key database searches, 146 randomized controlled trials were included in the review, 54 of which investigated mind-body therapies, as defined by the authors. Conclusions: This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. © 2014 American Academy of Pain Medicine.


Lee C.,Samueli Institute | Crawford C.,Samueli Institute | Schoomaker E.,Uniformed Services University of the Health Sciences
Pain Medicine (United States) | Year: 2014

Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. Methods: A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Results: Following key database searches, 146 randomized controlled trials were included in the review, 30 of which investigated movement therapies, as defined by the authors. Conclusions: This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. © 2014 American Academy of Pain Medicine.


Loef M.,European University Viadrina | Loef M.,Samueli Institute | Walach H.,European University Viadrina | Walach H.,Samueli Institute
Preventive Medicine | Year: 2012

Objective: Lifestyle factors are related to mortality. Although much is known about the impact of single factors, the current evidence about the combined effects of lifestyle behaviors on mortality has not yet been systematically compiled. Method: We searched Medline, Embase, Global Health, and Somed up to February 2012. Prospective studies were selected if they reported the combined effects of at least three of five lifestyle factors (obesity, alcohol consumption, smoking, diet, and physical activity). The mean effect sizes that certain numbers of combined lifestyle factors have on mortality were compared to the group with the least number of healthy lifestyle factors by meta-analysis. Sensitivity analyses were conducted to explore the robustness of the results. Results: 21 studies (18 cohorts) met the inclusion criteria of which 15 were included in the meta-analysis that comprised 531,804 people with a mean follow-up of 13.24. years. The relative risks decreased proportionate to a higher number of healthy lifestyle factors for all cause mortality. A combination of at least four healthy lifestyle factors is associated with a reduction of the all cause mortality risk by 66% (95% confidence interval 58%-73%). Conclusion: Adherence to a healthy lifestyle is associated with a lower risk of mortality. © 2012.


Jonas W.B.,Samueli Institute | Jonas W.B.,Georgetown University
Philosophical Transactions of the Royal Society B: Biological Sciences | Year: 2011

The terms 'placebo' and 'placebo effects' cause confusion among patients, practitioners and scientists. This confusion results in both the adoption of practices that have no evidence of specificity yet considerable risk (such as surgery for low back pain) or the elimination of clinical practices proven to facilitate healing because they are not 'better than placebo' (such as acupuncture for low back pain). In this article, I discuss these issues and introduce the concept of optimal healing environment as a framework for disentangling what is useful from placebo research for adopting into clinical practice in a manner that is ethical and evidence-based. © 2011 The Royal Society.


OBJECTIVE:: This systematic review examines the efficacy of hyperbaric oxygen (HBO2) for traumatic brain injury (TBI) to make evidence-based recommendations for its application and future research. METHODS:: A comprehensive search was conducted to identify studies through 2014. Methodological quality was assessed and synthesis and interpretation of relevant data was performed. RESULTS:: Twelve randomized trials were included. All mild TBI studies demonstrated minimal bias and no statistically significant differences between HBO2 and sham arms. Statistically significant improvement occurred over time within both groups. Moderate-to-severe TBI studies were of mixed quality, with majority of results favoring HBO2 compared with “standard care.” The placebo analysis conducted was limited by lack of details. CONCLUSIONS:: For mild TBI, results indicate HBO2 is no better than sham treatment. Improvements within both HBO2 and sham groups cannot be ignored. For acute treatment of moderate-to-severe TBI, although methodology appears flawed across some studies, because of the complexity of brain injury, HBO2 may be beneficial as a relatively safe adjunctive therapy if feasible. Further research should be considered to resolve the controversy surrounding this field, but only if methodological flaws are avoided and bias minimized.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Loef M.,European University Viadrina | Loef M.,Samueli Institute | Walach H.,European University Viadrina | Walach H.,Samueli Institute
Obesity | Year: 2013

Objective: Obesity is a risk factor of dementia. Current forecasts of dementia prevalence fail to take the rising obesity prevalence into account. Design and Methods: Embase and Medline were searched for observational studies on the association between overweight (BMI 25-30 kg/m2) or obesity (BMI > 30 kg/m2) and dementia and pooled the effect sizes by meta-analysis. The population attributable risk (PAR) was calculated for different time points and adjusted them for confounders. Based on current prevalence rates of dementia and demographic forecasts, patient numbers were calculated and adjusted by the growth rates of PAR. Results: Compared to normal weight, midlife obesity increases the risk of dementia later in life (BMI 25- 30: RR = 1.34 [95% CI 1.08, 1.66], BMI > 30: RR = 1.91 [1.4, 2.62]). If obesity is included into forecast models, the prevalence of dementia is estimated to be 7.1 million (6.9, 7.3) and 11.3 million (10.9, 11.7) for the United States in 2030 and 2050, respectively. In China, the estimate is 13.1 million (12.8, 13.3) in 2030 and 26.2 million (25.1, 27.4) in 2050. These figures are 9% and 19% higher for the United States and China, respectively, than forecasts that rely solely on the demographic change. Conclusion: The past and ongoing increase in midlife obesity prevalence will contribute significantly to the future prevalence of dementia and public health measures to reduce midlife obesity are simultaneously primary prevention measures to reduce the risk of dementia.


Schwartz S.A.,Samueli Institute
Explore (New York, N.Y.) | Year: 2010

All research domains are based upon epistemological assumptions. Periodic reassessment of these assumptions is crucial because they influence how we interpret experimental outcomes. Perhaps nowhere is this reassessment needed more than in the study of prayer and intention experiments. For if positive results from this field of research are sustained, the reality of nonlocal consciousness must be confronted. This paper explores the current status of healing and intention research, citing a number of major studies and using the "Study of the Therapeutic Effects of Intercessory Prayer (STEP) in Cardiac Bypass Surgery Patients: A Multicenter Randomized Trial of Uncertainty and Certainty of Receiving Intercessory Prayer" as a case study of this line of research. The paper argues that the dose-dependent model typical of drug trials, and adopted for use in the STEP and other studies, is not the optimal model for intention-healing research, and critiques this approach in detail, citing apposite research from which we draw our recommendations and conclusions. The paper suggests that the usual assumptions concerning blindness and randomization that prevail in studies using the pharmacological model must be reappraised. Experimental data suggest that a nonlocal relationship exists among the various individuals participating in a study, one which needs to be understood and taken seriously. We argue that it is important to account for and understand the role of both local and nonlocal observer effects, since both can significantly affect outcome. Research is presented from an array of disciplines to support why the authors feel these issues of linkage, belief, and intention are so important to a successful, accurate, and meaningful study outcome. Finally, the paper offers suggestions for new lines of research and new protocol designs that address these observer-effect issues, particularly the nonlocal aspects. The paper finally suggests that if these effects occur in intention studies, they must necessarily exist in all studies, although in pharmacological studies they are often overshadowed by the power of chemical and biological agents. Copyright 2010 Elsevier Inc. All rights reserved.


Schwartz S.A.,Samueli Institute
Explore: The Journal of Science and Healing | Year: 2010

Two hundred years of reductive materialism has failed to explain the extraordinary experiences we know as moments of genius, religious epiphany, and psychic insight. This paper proposes that these three experiences are in essence the same experience, differentiated only by intention and context. It reaches this conclusion based on well-conducted experimental research across the continuum of sciencework that proposes a new interdependent model of consciousness that takes into consideration a nonlocal linkage or entanglement, as an aspect of consciousness not limited by space and time. The paper surveys some of the most important relevant research from quantum biology, physics, psychology, medicine, anthropology, and parapsychology. It proposes that more attention should be paid to the autobiographies, correspondence, and journals of men and women to whom history unequivocally accords the designation of genius, saint, or psychic, offering examples from these sources. And it presents comparisons between ethnohistorical material and spiritual traditions, suggesting they arrive at a similar worldview. Finally, it proposes that meditation research, some examples of which are cited, be seen in the context of psychophysical self-regulation, and that it offers one powerful avenue for producing these exceptional experiences. © 2010 Elsevier Inc.

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