The introduction of a midwife-led obstetric triage system into a regional referral hospital in Ghana.

OBJECTIVE: to introduce and embed a midwife-led obstetric triage system in a busy labour ward in Accra, Ghana to improve the quality of care and to reduce delay. DESIGN: the study utilized a participatory action research design. Local staff participated in baseline data collection, the triage training course design and delivery, and post-training monitoring and evaluation. SETTING: a regional referral hospital in Accra, Ghana undertaking 11,032 deliveries in 2012. PARTICIPANTS: all midwives and medical staff. MEASUREMENTS: measurements included maternal health outcomes, observations of labour ward activity, structured assessments of midwife actions during admission, waiting times, focus group discussions, and learning needs assessments which informed the course content. During training, two quality improvement tools were developed; coloured risk acuity wristbands and a one page triage assessment form. Participants measured compliance and accuracy in the use of these tools following course completion. FINDINGS: initially, no formal triage system was in place. The environment was chaotic with poor compliance to existing protocols. Sixty-two midwives received triage training between 2013 and 2014. Two Triage Champions became responsible for triage implementation, monitoring and further training. Following training, the 'in-charge' midwives recorded a cumulative average of 83.4% of women wearing coloured wristbands. A separate audit by the Triage Champions found that 495/535 (93%) of the wristbands were correctly applied based on the diagnosis. Quarterly monitoring of the triage assessment forms by Kybele trainers, showed that 92% recorded the risk acuity colour, 85% a 'working diagnosis' and 82% a 'plan.' Median (interquartile range) waiting times were reduced from 40 (15-100) to 29 (11-60) minutes (p = 007). Twenty of 25 of the staff reported that the wristbands were helpful. CONCLUSIONS: an interactive triage training course led to the development of a triage assessment form and the use of coloured patient wristbands which resulted in delay reduction and improved quality of maternity care.

The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview.

The authors provide a historical context and overview of the experience of education projects at 14 health professions schools in the United States and the American Medical Students Association that were funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health in cohorts of five per year in 2000, 2001, and 2002-2003. These 15 projects were designed to incorporate CAM information into the curricula of conventional health professions schools. A longer-term goal was to accelerate the integration of CAM and conventional medicine. The overall program started in 2000 at a time when discussions about the definition, goals, and value of integrative medicine were already well underway. The efforts specific to each project, as well as the shared challenges, accomplishments, and collaborative efforts of all 15 projects, can provide guidance for the education of conventional health care providers about CAM in an integrative medicine environment. Challenging issues that must be faced include (1) the need to develop successful strategies to incorporate information about CAM into already dense health professions school curricula, (2) the need for conventional health professionals to have authoritative resources to provide their patients information about risks and benefits of CAM practices, and (3) the need to identify appropriate roles for CAM practitioners in educating conventional health professionals about CAM therapies. The authors discuss these issues and others and present some recommendations.

Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data.

BACKGROUND: Insomnia and other disorders that result in trouble sleeping are common in the United States and are often associated with chronic health conditions. Some individuals with insomnia or trouble sleeping use complementary and alternative medicine (CAM) therapies to treat their condition, but the prevalence of such use and the most common types of CAM therapies selected are not known. METHODS: Prevalence of insomnia or trouble sleeping and of CAM use for treating such conditions was examined using the 2002 National Health Interview Survey. Logistic regression was used to examine associations between insomnia or trouble sleeping, comorbid conditions, and use of CAM treatments. RESULTS: The 12-month prevalence rate of insomnia or trouble sleeping was 17.4%. There was a strong positive association between adults who reported having insomnia or trouble sleeping and adults who reported 4 of 5 common conditions: obesity (adjusted odds ratio [OR], 1.15; 99% confidence interval [CI], 1.01-1.31), hypertension (OR, 1.32; 99% CI, 1.16-1.51), congestive heart failure (OR, 2.24; 99% CI, 1.60-3.14), and anxiety or depression (OR, 5.64; 99% CI, 5.07-6.29). Of those with insomnia or trouble sleeping, 4.5% used some form of CAM therapy to treat their condition. CONCLUSIONS: According to the National Health Interview Survey analysis, over 1.6 million civilian, noninstitutionalized adult US citizens use CAM to treat insomnia or trouble sleeping. The details of this analysis will serve as a guide for future research on CAM therapies for sleep disorders.

Financial support for research training and career development in complementary and alternative medicine from the National Institutes of Health.

Research careers are a relatively new reality for complementary and alternative medicine (CAM) practitioners (eg, chiropractors, naturopaths, doctors of oriental medicine, etc). Before the establishment in 1998 of the National Center for Complementary and Alternative Medicine (NCCAM) as part of the National Institutes of Health (NIH), there were few funding resources available for those interested in a CAM research career and fewer still feasible paths. Now, however, NCCAM provides a broad array of research training and career development awards for those seeking a long-term career in CAM research. These awards include predoctoral and postdoctoral fellowships, individual career development awards, and institutional training awards. The goal of this article is to provide information about current research training funding opportunities from NCCAM and NIH as a whole that are available to CAM practitioners in the context of the historical challenges of transitioning from a clinical career in CAM practice to a CAM research career.

Neurobiological correlates of acupuncture: November 17-18, 2005.

The "Neurobiological Correlates of Acupuncture" Conference was convened November 17-18, 2005 in Bethesda, Maryland. The conference was sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). Its goals were to encourage exchange of ideas regarding the direction of neuroimaging in acupuncture research as well as to discuss some of the challenges in this field. The use of neuroimaging, a relatively recent advance in the study of acupuncture, holds the promise of localizing and characterizing brain activity associated with acupuncture interventions in real time and in a minimally invasive way. Among the main challenges to research into the biological mechanisms of acupuncture are the multiple treatment variables and the difficulties of selecting appropriate experimental controls. Despite these challenges, numerous findings from acupuncture neuroimaging experiments were presented and discussed at the conference on topics related to possible signaling networks, sham acupuncture controls, acupoint specificity, acupuncture analgesia, acupuncture-associated brain response, and the potential for using neuroimaging in conjunction with translational and clinical acupuncture research. Future directions in acupuncture neuroimaging research, as recommended by conference participants, should focus on (1) continuing exploration of acupuncture signaling networks; (2) establishing standards and recommendations for performing and reporting acupuncture neuroimaging results; (3) enabling data sharing in the acupuncture neuroimaging community; (4) gaining a better understanding of placebo and control groups in acupuncture neuroimaging experiments; and (5) developing biomarkers that relate to physiologically and/or clinically relevant acupuncture responses to neuroimaging results.