Transcript Slide 1

“Research is a wholly
separate world compared to
what I have lived in. It has
its own language and
thought process.”
-Student in CAM Research Course
Bringing Community CAM
Practitioners into the
Research Process:
Bridging the Gap
Between Practice and Research
Suzie Zick ND MPH, Rita Benn, PhD
Linda Diane Feldt RPP, NCTMB
Geri Day, MSN
Overview of Presentation
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Philosophy
Purpose of the course
Course description and design
CAM research projects
Course evaluation
Future directions
Resources
Philosophy Behind the Course
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Popularity and use of CAM
Funded studies needed to demonstrate safety
and efficacy of CAM
Research can lead to policy development for:
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Government regulations and initiatives
Insurance decisions
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Programs in medical institutions
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Researchers are MDs and PhDs and may not
be trained as CAM practitioners
Career Development of CAM
Practitioners
UM-CAMRC P50 Grant
(S. Bolling, PI, S. Warber, Co-PI)
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Recognized the importance of meaningful CAM
participation in the design and implementation of
research
Planned for CAM practitioners to create original
research studies
Included plans for teaching CAM practitioners
about research
Research your Passion In CAM
Course Goals:
 To teach CAM practitioners to critically
evaluate the research literature
 To facilitate CAM providers giving accurate
scientific information about CAM
 To provide additional training to CAM
practitioners who had an interest in
participating in research and teaching at the
university level
Recruitment & Selection
of Course Participants
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Advertisements
Developed criteria for participation
Practitioners completed an application
packet
11 practitioners with varying
backgrounds chosen
Course Structure &Description
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Two instructors, different backgrounds
Course offered as a two-part sequence
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Focus of section one: Evaluation of Literature
Focus of section two: Grant Proposal Design
7 Classes, Fall semester 2002
Variety of instructional methods
Adult learning principles
Reading and homework assignments
Knowledge and Skill Competency Areas
Knowledge Concepts
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Human subjects requirements
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Funding mechanisms
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Research terms
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Research designs
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Research biases
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Funding
 Role of research personnel
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Measurement tools
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Appropriate placebo/control groups
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Role of research in CAM
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Study sample and recruitment issues
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Introduction to study statistics
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Sample size and power
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Mixed methods research
Acquired Skills
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How to conduct an electronic
literature search
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How to use academic libraries
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How to identify research
collaborators
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How to use scientific language
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How to write sections of
research proposals
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How to critique research
studies
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How to identify and choose an
appropriate measurement tool
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How to write hypotheses
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How to write specific aims
Research Course Session Topics
• Scientific Study: Research Design and Terms
• Evaluating the Scientific Literature
• Designing Research Questions: Formulation
and Process
• Developing a Grant Proposal
• Writing Background and Significance Sections
• Study Design: Sample, Instruments, Placebo
• Basic Statistics and Human Subjects
Learning how to do
computer literature
searches was an
important part of the
class.
Example of Session Content
Session 5: Background & Significance
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Writing a background and significance
for your research question
Scientific Writing Style
Finding Research Partners
Homework
Research Project Themes
of CAM Practitioners
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Energy Healing for Treatment of Terminally Ill Patients
Effect of Peppermint on Post-Operative Nausea in Orthopedic
Patients
Self-Massage Compression for Carpal Tunnel Syndrome
The Effects of CAM Therapies on Quality of Life in a
Chiropractic Practice
The Effects of Chair Massage in the Workplace
Mushrooms for Patients With San Joaquin Valley Fever
The Use of Art Therapy for Improving Quality of Life of
Cancer Patients
Hands of Light Energy Healing Treatment of Sexually Abused
Women
The Use of Hypnosis for the Treatment of Pain in Severe Burn
Patients
Course Continuation
Request to continue course by students in
order to complete the writing of an entire
grant proposal
 Consultation model
-Monthly sessions, 2 hours in length
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-Discussion of one or two proposals per session
-Email/phone support in-between sessions
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4 students, winter and spring semester, 2003
Peppermint & Its Effect on Post
Operative Nausea
PROTOCOL FOR PEPPERMINT & PONV STUDY
Patient experiences an episode of nausea or vomiting
If nauseated, patient rates using VAS
Nurse puts on mask and offers aromatherapy holding bottle 2 inches beneath patient’s nose instructing to take 3 deep breaths
Is nausea/vomiting
reduced/relieved?
YES
NO
The patient is offered the same aromatherapy process
Patient rates the nausea at the 10-minute interval
Is nausea/vomiting
reduced/relieved?
YES
NO
The patient is offered aromatherapy or conventional treatment until relieved
Patient is relieved
Self-Massage Compression
for Carpal Tunnel Study
A DB, RCT pilot study.
Outcomes:
1. hand strength.
2. pain and numbness.
Arms:
Control: Placebo
Experimental: Self massage
compression.
Compression
Points
Initial Areas of Interest for
Research
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Malpresentation in labor - using Cranialsacral
Therapy to help the baby turn
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Yellow Dock Rumex crispus oil used for healing
tissue trauma
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Carpal Tunnel Syndrome relief through self
administered massage compression
Impact of Class
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Clarified which project was achievable
Gained skills to design research
Making progress towards pilot study
Using skills in teaching, professional reading and
evaluating techniques and products
Able to advise on research issues within professional
associations
Better source of information for conventional
practitioners (e.g. MD referrals)
Inform clients about studies in popular literature
Next Steps
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Include greater detail in protocol
Confirm PI
Complete IRB application
Apply for funding (possible sources already
identified)
Launch the pilot study
Publish results and go from there
Course Evaluation Approach
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National Academy of Science Model :
- What occurred? What were the outcomes?
What explains the outcomes?
Mixed Methods
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Rating Assessment of skills & knowledge
Pre-Post Assessment of Personal Learning Goals
Qualitative Responses to Questions
Course Evaluation Ratings
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16 questions related to knowledge and skills
Sample Examples of Questions
-Understanding different study designs
-Understanding the role of bias in research
-Knowledge of health research measurements
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Mean Course Value in Meeting Goals=4.56
75% of items at least as 4 or 5, none below 3
Examples of Qualitative Questions
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Please tell us what the term “research” means to you
now.
Did you find yourself thinking about the implications
of scientific research during or after the classes?
What were those?
What “aha” moment did you have about research, if
any, during this course?
In what ways did your understanding of research
change throughout the course?
How do you hope to use what you have learned in
this course?
What, if anything, did you find conflicting with your
understanding of CAM?
Qualitative Themes
Five Major Areas:
 Acquiring a New Language
 Slow Process of Scientific Research
 The Dilemma of the Scientific Method
 Increased Confidence Levels
 Enjoyment of Relationship with Colleagues
“I think any culture with its own inherent
rules of behavior needs a lingo to help order
the behavior inherent to the context.”
“The idea of pinpointing one symptom and
trying to find the silver bullet to fix it was
solidified in my mind. At some point, when
this one treatment has proven itself on many
people, then it is recognized as a viable
treatment. The process, to me, is very slow,
expensive and tedious. History and nature are
faster (and better) ‘teachers’ than science.”
“We are doing narrow studies to answer
multifactorial questions. CAM is about holism,
and the ‘gold standard’ research study is far
from holistic.”
“I don't believe that double blind, randomized,
placebo controlled studies are sufficient to do
good nutritional research…The idea of
researching one component to affect one
endpoint with statistical significance as
compared to a control group can miss the main
point. We are multiple pathway organisms that
have ‘upstream’ modulators that don't
communicate in a unidirectional path.”
“That a person with only a bachelor’s degree and
a lot of chutzpah and brains can make a
research study that they’re passionate about
happening. That was truly a revelation for
me...This class was a boon to me in many
ways – I felt supported in expressing my ideas
that have previously been met with skepticism
or impotence.”
Recommendations for Improvement
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Shorten length of the class
Increase the number of classes and course
duration)
Continue to break the course into 2 sections:
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one focusing on understanding, communicating about, and
critiquing research and grants
second focusing on writing a research proposal
Invite teachers with expertise in areas, such as
animal research
Increase the use of assigned readings
Identify and use a CAM research methodology
textbook
Future Directions
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Develop NIH and/or University-Based
Fellowship for Community based CAM
practitioners
Outreach to CAM professional
associations
Resources
Power Point on APHA conf. web site & LDF site
Look for Article in Alternative Therapies and Health
in press
Contact Us:
Suzie Zick [email protected]
Linda Diane Feldt [email protected]
www.holisticwisdom.org/hwpages/powerpoint.html
Rita Benn [email protected]
Geri Day [email protected]
UM-CAMRC 715 E. Huron St. Suite 1W Ann Arbor MI
48104 734-998-7715 or 877-800-9887
[email protected] www.med.umich.edu/camrc/