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Integrative Medicine - Bridge the East and West First Chinese Medicine Residency in U.S.

Integrative Medicine - Bridge the East and West First Chinese Medicine Residency in U.S. Amy Matecki, MD. FACP, MSc . L.Ac , Chief , Division of Integrative Medicine Department of Medicine, in affiliation with UCSF Alameda Health System May 18 th , 2018. Disclosure.

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Integrative Medicine - Bridge the East and West First Chinese Medicine Residency in U.S.

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  1. Integrative Medicine - Bridge the East and West First Chinese Medicine Residency in U.S. Amy Matecki, MD. FACP, MSc. L.Ac, Chief , Division of Integrative Medicine Department of Medicine, in affiliation with UCSF Alameda Health System May 18th , 2018

  2. Disclosure • I have received no financial support for this presentation. • I am the Medical Director for Alta Bates Summit Medical Center • I am the President of International Center for Integrative Medicine (ICIM) • All Photos are consented by patient and family

  3. Objectives • Introduction of Integrative Medicine (IM) for ClinicalCancer treatment at Alta Bates Summit Medical Center • Acupuncture • Nutrition: Herbal Supplements • Pioneering Research in Integrative Medicine • Acupuncture safety and efficacy for lymphedema • Chinese Medicine Enhance Therapy in Rare Cancer • Acupuncture for Pain and Nausea in ICU • First Chinese Medicine Residency in U.S. at Highland Hospital Alameda Health System

  4. Objective # 1 Introduction of Integrative Medicine (IM) for ClinicalCancer treatment at Alta Bates Summit Medical Center • Acupuncture 2004 • Nutrition: Herbal Supplements 2005 • Qigong: 2009

  5. Integrative Medicine (IM) – “Whole Person Care” IM = Conventional + Complementary

  6. Disease – oriented Find it, fix it Reactive Sporadic Physician-directed Dogmatic Expensive Patient - oriented Identify risk, minimize symptoms Pro-active Lifelong planning Partnerships Individualized Cost -Saving Current Care Vs. Integrative Medicine

  7. Integrative Chinese Medicine for Cancer Patients – Alta Bates 2004

  8. Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial Journal of Clinical Oncology Nov. 2003

  9. Hypothalamus and Amygdala Response to Acupuncture Stimuli in Carpal Tunnel Syndrome First evidence suggesting that chronic pain patients respond to acupuncture differently than Healthy Control (HC) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997288/

  10. Acupuncture is Effective for the Treatment of Chronic PainIndividual Patient Data Meta-analysis (RCT) 17,922 patientswere analyzed) A: Osteoarthritis, C: Musculoskeletal pain B: Chronic Headache D. Shoulder pain Arch Intern Med.Published online September 10, 2012.doi:10.1001/archinternmed.2012.3654

  11. Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer A Prospective Multicenter Randomized Controlled Trial (AcCliMaT) Lesi, Grazia; Razzini, Giorgia; Musti, Muriel Assunta, et al. J Clin Oncol. 2016 May 20;34(15):1795-802.

  12. Objective #2 Pioneering Research in Integrative Medicine • Acupuncture safety and efficacy for lymphedema • Chinese Medicine Enhance Therapy in Rare Cancer • Acupuncture for Pain and Nausea in ICU

  13. Pioneer work: Acupuncture Safety and Efficacy studies in Patients with Lymphedema 2008, 2009, 2010

  14. Impact on U. S. Integrative Medicine

  15. Division of Integrative Medicine (DIM) Development The First Public Hospital in the U.S. to offer Acupuncture Service since 2011 • Clinic • 2011: Inpatient Consult • 2012: Outpatient Clinic K6 • Research • Education

  16. 2012 - IRB approved Feasibility study of Acupuncture in the ICU at Highland Hospital Concept Approach: • Could acupuncture relieve two of the most common symptoms in the ICU, pain and nausea? • Would American patients be receptive to it? • Could it lower the requirement for traditional medication? • How do you design research on a therapy as individualized as Acupuncture?

  17. Acupuncture for Pain and Nausea in ICU Started in 2012 - Published in 2017

  18. Results:

  19. p<0.05

  20. Morphine Equivalents Dosage: There was a significant decrease in the amount of morphine equivalents given four hours prior to and four hours post each treatment.

  21. Acupuncture’s Role in Solving the Opioids Epidemic

  22. NIH Supported Acupuncture Research2 million 1992 to 124.1 million 2015 3,975Acupuncture research articles were publishedfrom 1991 to 2009 Han & Ho in Neuroscience and Biobehavioral reviews, 2011

  23. Objective #3 First Chinese Medicine Residency in U.S. - Highland Hospital Alameda Health System

  24. Establishment of TCM Residency To build integrative medicine approaches for patient care Build the trust from patient and their MDs 1. Fulfill patient’s need, safety concerns from MD’s 2. Communication effectively with MD’s 3. Know the medications’ side effect and drug and herbal interactions 4. increase job opportunity

  25. Training Methods • Morning report • Noon conference • Grand Rounds weekly • Morbidity and Mortality monthly • Journal club monthly • Inpatient consultation with various specialties One on One Integrative TCM presentations (TCM Research articles vs Western Medicine diagnosis and treatment protocols)

  26. Clinic Teaching Out-patient care since 2012 Patient’s waiting time for one year

  27. Bedside Teaching Round In-patient Consultation since 2011 ICU, Surgery Floor, OBGYN, Cancer infusion center, ED

  28. TCM Resident Research PresentationInternational conference 2018

  29. Finish the Residency… Excel in “CAR” “Bridge communication between Eastern and Western Medicine” Clinical Skills, Academic and Research

  30. The First TCM ResidencyAlameda Health System

  31. Joint Commission Update Acupuncture is specifically listed as a Viable Option in Standard Primary Care. • “Effective January 2015, • The Joint Commission updated their standards for pain management to include non-pharmacological strategies for palliative care.” https://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf

  32. Conditions refer to DIM Acupuncture Treatment: • Allergy: Allergic Rhinitis • Cards: Essential Hypertension, Primary Hypotension, • Dental pain • Emergency: Acute Epigastralgia • Endocrine: DM peripheral neuropathy • Gastroenterology: nausea, vomiting, Biliary colic, Dysentery, IBS • Neurology: HA, Stroke, Facial pain • Hematology/Oncology: Adverse reactions to radiation/chemotherapy • Pulmonary: SOB, Viral Syndrome, • Psychiatry: Depression, PTSD, Anxiety • Surgery: Post-operation • Rheumatology: Rheumatoid arthritis • Nephrology: Renal colic • Orthopedic: Neck, back, knee Pain Periarthritis of shoulder, Sciatica, Sprain, Tennis Elbow, Carpal Tunnel Syndrome, • OB/GYN: Induction of labor, primary dysmenorrhea, Correction for Malposition of fetus, morning sickness, • World Health Organization United Nations, 1996, cited at http://www.essentialhealthcare.com/info_for_practitioners/efficacy.html

  33. “Ask what you can do for Chinese Medicine”

  34. Acknowledgement: • Division of Integrative Medicine Team • Dept. of Medicine, Surgery, ER, OBGYN, Orthopedic • Highland Hospital Research, Medical Staff, Nursing • Highland Hospital Administrative Staff, Public Affairs, etc. • Five Branches University • California Institute of Integral Studies (ACTCM) • International Center for Integrative Medicine (ICIM)

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