Six Empirically-Supported Premises About Energy Psychology: Mounting Evidence for a Controversial Therapy.

A database of peer-reviewed journal articles exploring the emerging sub-specialty known as "energy psychology" was assessed. This paper focuses on the 245 clinical trials, meta-analyses, systematic evaluations, and theory pieces examining energy psychology protocols that include tapping on acupuncture points (acupoints), the most frequently used and investigated intervention in energy psychology. The review derives 6 premises about the method's efficacy, speed, durability, and physiologic effects that have enough empirical support (at least 6 clinical trials each) to serve in delineating and making claims about the approach. These include that acupoint tapping protocols (a) are effective in treating a range of clinical conditions, (b) are rapid compared to conventional treatments, (c) lead to durable benefits, (d) produce changes in biologic markers that corroborate the subjective assessments of clients, (e) are a critical ingredient for the demonstrated clinical effects and (f) send signals that can increase or decrease arousal in specific areas of the brain. Further consideration of the mechanisms that lead to the reported rapid, durable outcomes suggest that the approach has an unusual capacity for revising outdated mental models. Specifically, a hypothesis is developed proposing that acupoint tapping protocols are facile for producing vivid and emotionally intense experiences that contradict outdated mental models. Such mismatches between what is expected and what actually occurs, called "prediction errors," have been shown to be an essential requirement for substantially altering a maladaptive mental model and reconsolidating a revised mental model into existing neural networks.

Development of a Healthcare Approach Focusing on Subtle Energies: The Case of Eden Energy Medicine.

Eden Energy Medicine (EEM) is a hands-on healthcare approach providing assessments and interventions that focus on the body's electromagnetic and more subtle energy systems. More than 1600 certified practitioners have completed an intensive 2-year training program in the method, and these practitioners have brought the approach to hundreds of thousands of people in individual sessions and self-care classes. In this article, the method's founders briefly trace its development and present illustrative case histories. They then address a number of questions that are pertinent for any approach to energy medicine from the perspective of their experiences advancing EEM. Broader acceptance of energy medicine has been impeded by the field's emphasis on energies with purported properties not known in the energies that fall along the electromagnetic spectrum. Such assertions challenge conventional concepts within Western medicine. The anomalies can, however, be explained by a framework that is informed by an understanding of subtle energies as conceived in healing systems from myriad cultures dating back thousands of years. The authors present empirical evidence that supports the validity of the subtle energy concept, propose health-related implications of such energies, and present 9 discrete energy systems emphasized by EEM. They also review the clinical efficacy of energy medicine treatments. Finally, they describe 6 advantages of an energy-informed approach to healthcare. Among these are an ability to address biological activities at their energetic foundations; the regulation of physiological processes with speed and precision; and the promotion of healing and prevention of illness with interventions that can be economically and noninvasively applied.

Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes.

BACKGROUND: Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment. METHODS: Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail. RESULTS: Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room. CONCLUSIONS: Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.

Osseous sarcoidosis: a case series.

Sarcoidosis is an inflammatory disorder characterized by noncaseating granulomas infiltrating affected organs. Any organ system can be involved, and more than 90 % of patients have a primary pulmonary manifestation. The incidence of radiographically evident bone involvement has been reported over a wide range: from 3 to 39 % depending on the population studied and imaging modalities used. Any bone may be affected in osseous sarcoidosis. Bilateral involvement of the phalanges of the hand and feet is most common. However, reports of long bone, skull, rib and vertebral involvement have appeared. To date, there are no specific tools for the assessment of skeletal disease activity in sarcoidosis. Plain radiograph picks lesions in the small bones of hands and feet greater than does in other bones. Bone scan is useful for defining the extent of the skeletal disease and bone marrow involvement. Magnetic resonance imaging usually demonstrates multifocal lesions within the vertebrae that are hypointense on T1-weighted images and hyperintense on T2-weighted images. In cases of multifocal bone lesions and an established diagnosis of sarcoidosis, a diagnosis of bone sarcoidosis should be considered in the differential diagnosis. Optimal treatment of osseous sarcoidosis remains controversial. We present five cases of multisystem sarcoidosis with skeletal involvement including long bones and vertebrae and a description of immunosuppressive therapies used in our patients. A literature review highlighting the diagnostic approach using radiographic imaging, as well as treatment strategies, is provided.

Empirically supported psychological treatments: the challenge of evaluating clinical innovations.

Clear and transparent standards are required to establish whether a therapeutic method is "evidence based." Even when research demonstrates a method to be efficacious, it may not become available to patients who could benefit from it, a phenomenon known as the "translational gap." Only 30% of therapies cross the gap, and the lag between empirical validation and clinical implementation averages 17 years. To address these problems, Division 12 of the American Psychological Association published a set of standards for "empirically supported treatments" in the mid-1990s that allows the assessment of clinical modalities. This article reviews these criteria, identifies their strengths, and discusses their impact on the translational gap, using the development of a clinical innovation called Emotional Freedom Techniques (EFT) as a case study. Twelve specific recommendations for updates of the Division 12 criteria are made based on lessons garnered from the adoption of EFT within the clinical community. These recommendations would shorten the cycle from the research setting to clinical practice, increase transparency, incorporate recent scientific advances, and enhance the capacity for succinct comparisons among treatments.

Using energy psychology to remediate emotional wounds rooted in childhood trauma: preliminary clinical guidelines.

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood, such as violence, abuse, severe neglect, or mental health problems in caregivers. The negative physical and mental health consequences of severe or multiple ACEs provide a major challenge for the health care community. Psychotherapies that utilize a mind-body approach in treating ACE-related conditions are seen by their proponents as having advantages for bringing healing and restoration compared with talk, introspective, interpersonal, and exposure therapies that do not intervene at the body level, as famously encapsulated by Bessel van der Kolk's observation that "the body keeps the score." A mind-body approach whose use has been rapidly increasing in clinical settings as well as on a self-help basis is called "energy psychology." Energy psychology combines conventional therapeutic techniques such as cognitive restructuring and psychological exposure with the stimulation of acupuncture points (acupoints) by tapping on them. A review of the development, efficacy, and plausible mechanisms of energy psychology is presented, and several strengths are enumerated, such as how integrating acupoint tapping into conventional exposure methods enhances the speed and power of outcomes. The impact of energy psychology protocols on the three brain networks most centrally involved with ACEs is also examined. Finally, recommendations are offered for using an energy psychology approach at each stage of therapy with individuals who have endured severe or multiple ACES, from establishing a therapeutic alliance to assessment to treatment to follow-up.

Uses of Energy Psychology Following Catastrophic Events.

Energy psychology, as most widely practiced, integrates the manual stimulation of acupuncture points with imaginal exposure, cognitive restructuring, and other evidence-based psychotherapeutic procedures. Efficacy for energy psychology protocols has been established in more than 120 clinical trials, with meta-analyses showing strong effect sizes for PTSD, anxiety, and depression. The approach has been applied in the wake of natural and human-made disasters in more than 30 countries. Four tiers of energy psychology interventions following the establishment of safety, trust, and rapport are described, including (1) immediate relief/stabilization, (2) reducing limbic arousal to trauma-based triggers, (3) overcoming complex psychological difficulties, and (4) promoting optimal functioning. The first tier is most pertinent in psychological first aid immediately following a disaster, with the subsequent tiers progressively being introduced over time with complex stress reactions and chronic disorders. Advantages of adding the stimulation of acupuncture points to a conventional exposure approach are identified, and challenges around cultural sensitivities and unintended effects are discussed. After establishing a framework for introducing energy psychology in disaster relief efforts, reports from a sampling of settings are presented, based on interviews with this paper's author. These include accounts of relief work with survivors of mass shootings, genocide, ethnic warfare, earthquakes, hurricanes, tornadoes, floods, wildfires, and the COVID-19 pandemic. Hundreds of other reports from the field show a pattern of strong outcomes following the use of energy psychology in the days or weeks after a disaster and in the subsequent treatment of trauma-based psychological problems. Many of these accounts corroborate one another in terms of rapid relief and long-term benefits. Finally, examples of more efficient delivery methods utilizing large groups, lay counselors, digital technology, and cultivating community resilience are presented.

Association of Simulation Participation With Diagnostic Reasoning Scores in Preclinical Students.

PURPOSE: The aim of the study was to evaluate for an association between the number of voluntary mannequin simulation sessions completed during the school year with scores on a year-end diagnostic reasoning assessment among second-year medical students. METHOD: This is retrospective analysis of participation in 0 to 8 extracurricular mannequin simulation sessions on diagnostic reasoning assessed among 129 second-year medical students in an end-of-year evaluation. For the final skills assessment, 2 physicians measured students' ability to reason through a standardized case encounter using the Diagnostic Justification (DXJ) instrument (4 categories each scored 0-3 by raters reviewing students' postencounter written summaries). Rater scores were averaged for a total DXJ score (0-12). To provide additional baseline comparison, zero participation students were divided into 2 groups based on intent to participate: those who signed up for extracurricular sessions but never attended versus those who never expressed interest. Scores across the attendance groups were compared with an analysis of variance and trend analysis. RESULTS: The class DXJ mean equaled 7.56, with a standard deviation of 2.78 and range of 0 to 12. Post hoc analysis after a significant analysis of variance (F = 4.91, df = 8, 128, P < 0.001) showed those participating in 1 or more extracurricular sessions had significantly higher DXJ scores than those not participating. Students doing 7 extracurricular sessions had significantly higher DXJ scores than those doing 0 and 2 (P < 0.05). Zero attendance groups were not different. A significant linear trend (R = 0.48, F = 38.0, df = 1, 127, P < 0.001) was found with 9 groups. A significant quadratic effect, like a dose-response pattern, was found (F = 18.1, df = 2, 125, P < 0.001) in an analysis including both zero attendance groups, a low (1-4 extracurricular sessions) group and a high (5-8) group. CONCLUSIONS: Higher year-end diagnostic reasoning scores were associated with increased voluntary participation in extracurricular mannequin-based simulation exercises in an approximate dose-response pattern.

An Elderly Gentleman with Acute Lupus Pneumonitis as the Initial Manifestation of Systemic Lupus Erythematosus.

Systemic lupus erythematosus is a systemic autoimmune disease, with presentations that vary within a population and across the lifespan of an individual. The disease afflicts childbearing women more than men and uncommonly presents in the geriatric population. Lupus pneumonitis is rare, with a reported incidence of 1-4%. Herein, we discuss the case report of an elderly gentleman with biopsy-proven acute lupus pneumonitis (ALP) as an initial presentation of lupus. After starting high-dose steroids, the patient initially improved, though unfortunately endured a non-ST elevation myocardial infarction and recurrent gastrointestinal bleeding. Despite multiple interventions and a prolonged hospital course, his gastrointestinal bleeding persisted. He elected to go on home hospice and ultimately passed away due to ongoing gastrointestinal bleeding. As with our patient, elderly patients can pose a diagnostic dilemma with regard to late-onset lupus; multiple comorbidities and growing evidence that late-onset lupus may manifest with distinct clinical patterns from younger cohorts complicate diagnosis in these patients. It is critical to maintain a broad differential, which includes unusual rheumatic manifestations when management of common comorbidities fails to alleviate symptoms for an elderly patient. Failure to do so may result in delayed diagnosis of rheumatic disease and increased side effects related to treatment. Additionally, this case serves as a reminder that due to the complexity of rheumatic disease and the additional challenge of older patients with baseline comorbidities, sometimes palliative care options may be appropriate.

The emerging role of clinical informatics fellows in service learning during the COVID-19 pandemic.

OBJECTIVE: The study sought to describe the contributions of clinical informatics (CI) fellows to their institutions' coronavirus disease 2019 (COVID-19) response. MATERIALS AND METHODS: We designed a survey to capture key domains of health informatics and perceptions regarding fellows' application of their CI skills. We also conducted detailed interviews with select fellows and described their specific projects in a brief case series. RESULTS: Forty-one of the 99 CI fellows responded to our survey. Seventy-five percent agreed that they were "able to apply clinical informatics training and interest to the COVID-19 response." The most common project types were telemedicine (63%), reporting and analytics (49%), and electronic health record builds and governance (32%). Telehealth projects included training providers on existing telehealth tools, building entirely new virtual clinics for video triage of COVID-19 patients, and pioneering workflows and implementation of brand-new emergency department and inpatient video visit types. Analytics projects included reports and dashboards for institutional leadership, as well as developing digital contact tracing tools. For electronic health record builds, fellows directly contributed to note templates with embedded screening and testing guidance, adding COVID-19 tests to order sets, and validating clinical triage workflows. DISCUSSION: Fellows were engaged in projects that span the breadth of the CI specialty and were able to make system-wide contributions in line with their educational milestones. CONCLUSIONS: CI fellows contributed meaningfully and rapidly to their institutions' response to the COVID-19 pandemic.

Optimization of the Order Menu in the Electronic Health Record Facilitates Test Patterns Consistent With Recommendations in the Choosing Wisely Initiative.

OBJECTIVES: Thyroid and rheumatologic autoimmune testing are areas where evidence-based guidance from specialty organizations and Choosing Wisely support utilizing screening tests for autoimmune and thyroid disorders prior to more specialized testing. Adjustment of the orderable options in the electronic health record (EHR) can influence ordering patterns without requiring manual review or additional effort by the clinician. METHODS: The menu was adjusted to reflect recommendations from Choosing Wisely to favor screening tests that automatically reflex to specialized testing on primary care providers' preference lists. Effectiveness was evaluated by reviewing total orders for individual tests. RESULTS: Shifts in ordering from individual screening tests (antinuclear antibody and thyrotropin) to ones that reflexed to specialized testing were observed in parallel with significant reductions in the corresponding specialized testing. CONCLUSIONS: Optimization of the EHR laboratory ordering menu can be used to shift ordering patterns toward Choosing Wisely recommendations.

Facts, paradigms, and anomalies in the acceptance of energy psychology: A rejoinder to McCaslin's (2009) and Pignotti and Thyer's (2009) comments on Feinstein (2008a).

Allegations of selection bias and other departures from critical thinking in Feinstein (see record 2008-07317-008) found in the Pignotti and Thyer (see record 2009-08897-011), and the McCaslin (see record 2009-08897-010) commentaries, are addressed. Inaccuracies and bias in the reviewers' comments are also examined. The exchange is shown to reflect a paradigmatic clash within the professional community, with energy psychology having become a lightning rod for this controversy. While postulated "subtle energies" and "energy fields" are entangled in this debate, the most salient paradigm problem for energy psychology may simply be that accumulating reports of its speed and power have not been explained using established clinical models. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Energy psychology: Efficacy, speed, mechanisms.

The most well known forms of "energy psychology" combine cognitive and exposure techniques with the stimulation of selected acupuncture points (acupoints) by tapping on them. Most clinicians who learn and utilize an acupoint tapping protocol integrate the approach within their existing clinical frameworks rather than using it as a stand-alone therapy. The method has been highly controversial, with its efficacy, purported speed, and explanatory models all questioned. Nonetheless, its utilization within clinical settings and as a self-help method has continued to expand since it was introduced more than three decades ago. This paper reviews the most salient criticisms of the method and presents research and empirically based theoretical constructs that address them. More than 100 peer-reviewed outcome studies-51 of which are randomized controlled trials-provide an evidential base for evaluating the claims and criticisms surrounding the approach. This review concludes that a growing body of evidence indicates that acupoint-based energy psychology protocols are rapid and effective in producing beneficial outcomes in the treatment of anxiety, depression, PTSD, and possibly other conditions. Mechanisms by which acupoint tapping might bring about these treatment outcomes are also proposed.

Differences in safety climate among hospital anesthesia departments and the effect of a realistic simulation-based training program.

BACKGROUND: Safety climate is often measured via surveys to identify appropriate patient safety interventions. The introduction of an insurance premium incentive for simulation-based anesthesia crisis resource management (CRM) training motivated our naturalistic experiment to compare the safety climates of several departments and to assess the impact of the training. METHODS: We administered a 59-item survey to anesthesia providers in six academic anesthesia programs (Phase 1). Faculty in four of the programs subsequently participated in a CRM program using simulation. The survey was readministered 3 yr later (Phase 2). Factor analysis was used to create scales regarding common safety themes. Positive safety climate (% of respondents with positive safety attitudes) was computed for the scales to indicate the safety climate levels. RESULTS: The usable response rate was 44% (309/708) and 38% (293/772) in Phases 1 and 2 respectively. There was wide variation in response rates among hospitals and providers. Eight scales were identified. There were significantly different climate scores among hospitals but no difference between the trained and untrained cohorts. The positive safety climate scores varied from 6% to 94% on specific survey questions. Faculty and residents had significantly different perceptions of the degree to which residents are debriefed about their difficult clinical situations. CONCLUSIONS: Safety climate indicators can vary substantially among anesthesia practice groups. Scale scores and responses to specific questions can suggest practices for improvement. Overall safety climate is probably not a good criterion for assessing the impact of simulation-based CRM training. Training alone was insufficient to alter engrained behaviors in the absence of further reinforcing actions.

Six pillars of energy medicine: clinical strengths of a complementary paradigm.

The current status of energy medicine and its increasing challenge to the biochemical paradigm that has dominated conventional medicine are reviewed. Although energy medicine represents only a small fraction of 1% of the $2.2 trillion healthcare industry, 6 properties of energy medicine give it strengths that could augment conventional health care models. These include the ways energy medicine (1) can address biological processes at their energetic foundations (reach), (2) regulates biological processes with precision, speed, and flexibility (efficiency), (3) fosters health and prevents illness with interventions that can be readily, economically, and noninvasively applied (practicality), (4) includes methods that can be used on an at-home, self-help basis, fostering a stronger patient-practitioner partnership in the healing process (patient empowerment), (5) adopts non-linear concepts consistent with distant healing, the healing impact of prayer, and the role of intention in healing (quantum compatibility), and (6) strengthens the integration of body, mind, and spirit, leading not only to a focus on healing, but to achieving greater well-being, peace, and passion for life (holistic orientation).

Energy psychology: A review of the preliminary evidence.

Energy psychology utilizes imaginal and narrative-generated exposure, paired with interventions that reduce hyperarousal through acupressure and related techniques. According to practitioners, this leads to treatment outcomes that are more rapid, powerful, and precise than the strategies used in other exposure-based treatments such as relaxation or diaphragmatic breathing. The method has been exceedingly controversial. It relies on unfamiliar procedures adapted from non-Western cultures, posits unverified mechanisms of action, and early claims of unusual speed and therapeutic power ran far ahead of initial empirical support. This paper reviews a hierarchy of evidence regarding the efficacy of energy psychology, from anecdotal reports to randomized clinical trials. Although the evidence is still preliminary, energy psychology has reached the minimum threshold for being designated as an evidence-based treatment, with one form having met the APA Division 12 criteria as a "probably efficacious treatment" for specific phobias; another for maintaining weight loss. The limited scientific evidence, combined with extensive clinical reports, suggests that energy psychology holds promise as a rapid and potent treatment for a range of psychological conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Subcutaneous oedema of upper limbs heralding an aggressive form of dermatomyositis.

Subcutaneous oedema is a rare presenting clinical manifestation of dermatomyositis. In this case, we report a 44-year-old man presenting with bilateral upper extremity predominant swelling and weakness. The proximal muscle weakness, dysphagia and presence of Gottron's papules as well poikiloderma like skin changes led to the clinical diagnosis of dermatomyositis. He received aggressive treatment with high-dose glucocorticoids and required intravenous immunoglobulin with improvement in his symptoms.

Developments in the Transition From Animal Use to Simulation-Based Biomedical Education.

STATEMENT: There has been a significant shift from the use of animals in biomedical training exercises toward simulation-based education methods. The transition has been driven by technological advances, empirical evidence of improved student outcomes, cost-effectiveness, and a growing concern for the welfare of animals. These factors have spurred policy changes worldwide in how medical and science curricula are delivered. We detail how some of these policy changes evolved and comment on the future direction of simulation-based education and its implications for healthcare providers, instructors, and the general public.

Guidelines for the Treatment of PTSD Using Clinical EFT (Emotional Freedom Techniques).

Clinical EFT (Emotional Freedom Techniques) is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The approach has been validated in more than 100 clinical trials. Its efficacy for post-traumatic stress disorder (PTSD) has been investigated in a variety of demographic groups including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters. Meta-analyses of EFT for anxiety, depression, and PTSD indicate treatment effects that exceed those of both psychopharmacology and conventional psychotherapy. Studies of EFT in the treatment of PTSD show that (a) time frames for successful treatment generally range from four to 10 sessions; (b) group therapy sessions are effective; (c) comorbid conditions such as anxiety and depression improve simultaneously; (d) the risk of adverse events is low; (e) treatment produces physiological as well as psychological improvements; (f) patient gains persist over time; (g) the approach is cost-effective; (h) biomarkers such as stress hormones and genes are regulated; and (i) the method can be adapted to online and telemedicine applications. This paper recommends guidelines for the use of EFT in treating PTSD derived from the literature and a detailed practitioner survey. It has been reviewed by the major institutions providing training or supporting research in the method. The guidelines recommend a stepped-care model, with five treatment sessions for subclinical PTSD, 10 sessions for PTSD, and escalation to intensive psychotherapy or psychopharmacology or both for nonresponsive patients and those with developmental trauma. Group therapy, social support, apps, and online and telemedicine methods also contribute to a successful treatment plan.